critical thinking
Shiatsu is a Japanese form of so-called alternative medicine (SCAM) derived from Traditional Chinese Medicine using deep pressure on the paths of the postulated acupuncture meridians. Clinical observations on this topic are said to be encouraging, especially for the treatment of sleep and conduct disorders, but there is a lack of empirical data.
The objective of this study was to examine the possible therapeutic effects of shiatsu in a clinical population of children treated in child and adolescent psychiatry. It was designed as a qualitative descriptive and non-interventional study, conducted on children treated in day-care hospital units and outpatient clinical settings. Shiatsu was administered, at least during 3 sessions, to children with an autism spectrum disorder or other disorders according to ICD-11 criteria (such as conduct disorders with impulsivity or attention deficit).
The evaluation was performed by two independent researchers (a child psychiatrist and a psychologist who were not the caregivers) based on direct observation of children during the shiatsu sessions, combined with semi-structured non-inductive interviews with their parents, and data collected from focus groups conducted with the children’s caregivers. A phenomenological interpretive analysis (IPA) approach with Nvivo coding software was used to analyze the data.
Based on semi-structured interviews with 13 parents cross-referenced with data from 2 focus groups and direct observations of 7 children during 2 full shiatsu sessions for each observation, the results show that shiatsu has positive effects on
- internal tension (a relief effect, notably on aggressive behaviors directed against others or self),
- sleep (including improvement of sleep quality),
- social interaction,
- attention,
- verbalization of affects and traumatic memories of early childhood,
- perception of bodily limits.
As these children had several other treatments as well, it cannot be proved that the positive effects observed in this study are related specifically to shiatsu practice. Shiatsu may participate and facilitate the effects of other treatments. It is noteworthy that most of the children came willingly to the shiatsu sessions, ask their parents to repeat the shiatsu sessions at home, and indicate to the practitioner, from one session to the next, their elective body points where they wish to receive the application of shiatsu.
The authors concluded that the findings suggest therapeutic benefits of shiatsu, especially on externalize violence with a relief of aggressive behavior directed against others or self (knowing, moreover, that internal tension, sleep disorders and non-verbalization of affects or traumatic memories, all improved by shiatsu, are also all risk factors for externalize violence). These results highlight, therefore, the need to develop a daily practice of shiatsu in child and adolescent psychiatry. Further research is required to clarify the effects of shiatsu and ascertain better its underlying mechanisms based on this exploratory pilot study.
I do appreciate that, with a treatment that has not been submitted to many controlled clinical trials, researchers feel that they have to start from scratch, e.g. simple observations. However, they also must realize that their observations do not lend themselves to firm conclusions about the effects of the treatment. In the present case, the researchers do seem to be aware of this caveat but nevertheless make statements that go way beyond of what is warranted:
- the results show that shiatsu has positive effects on …
- Shiatsu may participate and facilitate the effects of other treatments
- the findings suggest therapeutic benefits of shiatsu, especially on externalize violence
- These results highlight, therefore, the need to develop a daily practice of shiatsu in child and adolescent psychiatry
I fear that these statements are not merely exaggerated but suspect they are also untrue. Testing them in properly controlled clinical trials would show whether my suspicion is correct. Meanwhile, I would like to remind
- researchers,
- reviewers,
- and journal editors
of their duty to be truthful and not mislead the public.
I was fascinated to find a chiropractor who proudly listed ‘the most common conditions chiropractors help kids with‘:
- Vision problems
- Skin conditions
- Bedwetting
- Sinus problems
- ADD/ADHD
- Stomachaches
- Asthma
- Allergies
- Loss of hearing
- Ear Infections
- Hip, leg, or foot pain
- Constipation
- Poor coordination
- Breastfeeding difficulties
- Arm, hand, or shoulder pain
- Anxiety and nervousness
- Colic
- Scoliosis
The birth process, even under normal conditions, is frequently the first cause of spinal stress. After the head of the child appears, the physician grabs the baby’s head and twists it around in a figure eight motion, lifting it up to receive the lower shoulder and then down to receive the upper shoulder. This creates significant stress on the spine of the baby.
“Spinal cord and brain stem traumas often occur during the process of birth but frequently escape diagnosis. Infants often experience lasting neurological defects. Spinal trauma at birth is essentially attributed to longitudinal traction, especially when this force is combined with flexion and torsion of the spinal axis during delivery.” ~Abraham Towbin, MD
Growth patterns suggest the potential for neurological disorders is most critical from birth to two years of age, as this time is the most dynamic and important phase of postnatal brain development. Over sixty percent of all neurological development occurs after birth in the child’s first year of life. This is why it is so important to bring your child to a local pediatric chiropractor to have them checked and for your child to get a chiropractic adjustment during the first year of their life. Lee Hadley MD states “Subluxation alone is a rational reason for Pediatric Chiropractic care throughout a lifetime from birth.”
As our children continue to grow, the daily stresses can have a negative impact on an ever growing body. During the first few years of life, an infant often falls while learning to walk or can fall while tumbling off a bed or other piece of furniture. Even the seemingly innocent act of playfully tossing babies up in the air and catching them often results in a whiplash-like trauma to the spine, making it essential to get your baby checked by a pediatric chiropractor every stage of his/her development as minor injuries can present as major health concerns down the road if gone uncorrected.
______________________________
On the Internet, similar texts can be found by the hundreds. I am sure that many new parents are sufficiently impressed by them to take their kids to a chiropractor. I have yet to hear of a single case where the chiropractor then checked out the child and concluded: “there is nothing wrong; your baby does not need any therapy.” Chiropractors always find something – not something truly pathological, but something to mislead the parent and to earn some money.
Often the treatment that follows turns out to be a prolonged and thus expensive series of sessions that almost invariably involve manipulating the infant’s fragile and developing spine. There is no compelling evidence that this approach is effective for anything. In addition, there is evidence that it can do harm, sometimes even serious harm.
And that’s the reason why I have mentioned this topic before and intend to continue doing so in the future:
- There is hardly a good reason for adults to consult a chiropractor.
- There is no reason to take a child to a chiropractor.
- There are good reasons for chiropractors to stop treating children.
But let’s be a bit more specific. Let’s deal with the above list of indications on the basis of the reliable evidence:
- Vision problems – no sound evidence that chiropractic manipulations are effective.
- Skin conditions – no sound evidence that chiropractic manipulations are effective.
- Bedwetting – some evidence that chiropractic manipulations are ineffective.
- Sinus problems – no sound evidence that chiropractic manipulations are effective.
- ADD/ADHD – some evidence that chiropractic manipulations are ineffective.
- Stomachaches – no sound evidence that chiropractic manipulations are effective.
- Asthma – some evidence that chiropractic manipulations are ineffective.
- Allergies – no sound evidence that chiropractic manipulations are effective.
- Loss of hearing – no sound evidence that chiropractic manipulations are effective.
- Ear Infections – some evidence that chiropractic manipulations are ineffective.
- Hip, leg, or foot pain – no sound evidence that chiropractic manipulations are effective.
- Constipation – no sound evidence that chiropractic manipulations are effective.
- Poor coordination – no sound evidence that chiropractic manipulations are effective.
- Breastfeeding difficulties – no good evidence that chiropractic manipulations are effective.
- Arm, hand, or shoulder pain – no sound evidence that chiropractic manipulations are effective.
- Anxiety and nervousness – no sound evidence that chiropractic manipulations are effective.
- Colic – some evidence that chiropractic manipulations are ineffective.
- Scoliosis – no sound evidence that chiropractic manipulations are effective.
I rest my case.
This study aimed to evaluate the number of craniosacral therapy sessions that can be helpful to obtain a resolution of the symptoms of infantile colic and to observe if there are any differences in the evolution obtained by the groups that received a different number of Craniosacral Therapy sessions at 24 days of treatment, compared with the control group which did not received any treatment.
Fifty-eight infants with colic were randomized into two groups:
- 29 babies in the control group received no treatment;
- babies in the experimental group received 1-3 sessions of craniosacral therapy (CST) until symptoms were resolved.
Evaluations were performed until day 24 of the study. Crying hours served as the primary outcome measure. The secondary outcome measures were the hours of sleep and the severity, measured by an Infantile Colic Severity Questionnaire (ICSQ).
Statistically significant differences were observed in favor of the experimental group compared to the control group on day 24 in all outcome measures:
- crying hours (mean difference = 2.94, at 95 %CI = 2.30-3.58; p < 0.001);
- hours of sleep (mean difference = 2.80; at 95 %CI = – 3.85 to – 1.73; p < 0.001);
- colic severity (mean difference = 17.24; at 95 %CI = 14.42-20.05; p < 0.001).
Also, the differences between the groups ≤ 2 CST sessions (n = 19), 3 CST sessions (n = 10), and control (n = 25) were statistically significant on day 24 of the treatment for crying, sleep and colic severity outcomes (p < 0.001).
The authors concluded that babies with infantile colic may obtain a complete resolution of symptoms on day 24 by receiving 2 or 3 CST sessions compared to the control group, which did not receive any treatment.
Why do SCAM researchers so often have no problem leaving the control group of patients in clinical trials without any treatment at all, while shying away from administering a placebo? Is it because they enjoy being the laughingstock of the science community? Probably not.
I suspect the reason might be that often they know that their treatments are placebos and that their trials would otherwise generate negative findings. Whatever the reasons, this new study demonstrates three things many of us already knew:
- Colic in babies always resolves on its own but can be helped by a placebo response (e.g. via the non-blinded parents), by holding the infant, and by paying attention to the child.
- Flawed trials lend themselves to drawing the wrong conclusions.
- Craniosacral therapy is not biologically plausible and most likely not effective beyond placebo.
One of the numerous conditions chiropractors, osteopaths, and other manual therapists claim to treat effectively is tension-type headache (TTH). For this purpose, they (in particular, chiropractors) often use high-velocity, low-amplitude manipulations of the neck. They do so despite the fact that the evidence for these techniques is less than convincing.
This systematic review evaluated the evidence about the effectiveness of manual therapy (MT) on pain intensity, frequency, and impact of pain in individuals with tension-type headache (TTH).
Medline, Embase, Scopus, Web of Science, CENTRAL, and PEDro were searched in June 2020. Randomized clinical trials that applied MT not associated with other interventions for TTH were selected. The level of evidence was synthesized using GRADE, and Standardized Mean Differences (SMD) were calculated for meta-analysis.
Fifteen studies were included with a total sample of 1131 individuals. The analyses show that high-velocity, low-amplitude techniques were not superior to no treatment in reducing pain intensity (SMD = 0.01, low evidence) and frequency (SMD = -0.27, moderate evidence). Soft tissue interventions were superior to no treatment in reducing pain intensity (SMD = -0.86, low evidence) and frequency of pain (SMD = -1.45, low evidence). Dry needling was superior to no treatment in reducing pain intensity (SMD = -5.16, moderate evidence) and frequency (SMD = -2.14, moderate evidence). Soft tissue interventions were not superior to no treatment and other treatments on the impact of headache.
The authors concluded that manual therapy may have positive effects on pain intensity and frequency, but more studies are necessary to strengthen the evidence of the effects of manual therapy on subjects with tension-type headache. Implications for rehabilitation soft tissue interventions and dry needling can be used to improve pain intensity and frequency in patients with tension type headache. High velocity and low amplitude thrust manipulations were not effective for improving pain intensity and frequency in patients with tension type headache. Manual therapy was not effective for improving the impact of headache in patients with tension type headache.
So, this review shows that:
- soft tissue interventions are better than no treatment,
- dry needling is better than no treatment.
These two results fail to impress me. Due to a placebo effect, almost any treatment should be better than no therapy at all.
ALMOST, because high-velocity, low-amplitude techniques were not superior to no treatment in reducing the intensity and frequency of pain. This, I feel, is an important finding that needs an explanation.
As it is only logical that high-velocity, low-amplitude techniques must also produce a positive placebo effect, the finding can only mean that these manipulations also generate a negative effect that is strong enough to cancel the positive response to placebo. (In addition, they can also cause severe complications via arterial dissections, as discussed often on this blog.)
Too complicated?
Perhaps; let me, therefore, put it simply and use the blunt words of a neurologist who once was quoted saying this:
DON’T LET THE BUGGARS TOUCH YOUR NECK!
The authors of this article searched 37 online sources, as well as print libraries, for homeopathy (HOM) and related terms in eight languages (1980 to March 2021). They included studies that compared a homeopathic medicine or intervention with a control regarding the therapeutic or preventive outcome of a disease (classified according to International Classification of Diseases-10). Subsequently, the data were extracted independently by two reviewers and analyzed descriptively.
A total of 636 investigations met the inclusion criteria, of which 541 had a therapeutic and 95 a preventive purpose. Seventy-three percent were randomized controlled trials (n = 463), whereas the rest were non-randomized studies (n = 173). The most frequently employed comparator was placebo (n = 400).
The type of homeopathic intervention was classified as:
- multi-constituent or complex (n = 272),
- classical or individualized (n = 176),
- routine or clinical (n = 161),
- isopathic (n = 19),
- various (n = 8).
The potencies ranged from 1X (dilution of -10,000) to 10 M (100–10.000). The included studies explored the effect of HOM in 223 different medical indications. The authors also present the evidence in an online database.
The authors concluded that this bibliography maps the status quo of clinical research in HOM. The data will serve for future targeted reviews, which may focus on the most studied conditions and/or homeopathic medicines, clinical impact, and the risk of bias of the included studies.
There are still skeptics who claim that no evidence exists for homeopathy. This paper proves them wrong. The number of studies may seem sizable to homeopaths, but compared to most other so-called alternative medicines (SCAMs), it is low. And compared to any conventional field of healthcare, it is truly tiny.
There are also those who claim that no rigorous trials of homeopathy with a positive results have ever emerged. This assumption is also erroneous. There are several such studies, but this paper was not aimed at identifying them. Obviously, the more important question is this: what does the totality of the methodologically sound evidence show? It fails to convincingly demonstrate that homeopathy has effects beyond placebo.
The present review was unquestionably a lot of tedious work, but it does not address these latter questions. It was published by known believers in homeopathy and sponsored by the Tiedemann Foundation for Classical Homeopathy, the Homeopathy Foundation of the Association of Homeopathic Doctors (DZVhÄ), both in Germany, and the Foundation of Homeopathy Pierre Schmidt and the Förderverein komplementärmedizinische Forschung, both in Switzerland.
The dataset established by this article will now almost certainly be used for numerous further analyses. I hope that this work will not be left to enthusiasts of homeopathy who have often demonstrated to be blinded by their own biases and are thus no longer taken seriously outside the realm of homeopathy. It would be much more productive, I feel, if independent scientists could tackle this task.
The global interest in dieting has increased, and many people have become obsessed with certain fad diets, assuming they are magic bullets for their problems. A fad diet is a popular dietary pattern known to be a quick fix. This review article explores the current evidence related to the health impacts of (amongst others) detox diets (DDs). DDs are interventional diets specifically designed for toxins elimination, health promotion, and weight management. They involve multiple approaches, including total calorie restriction, dietary modification, or juice fasts, and often the use of additional minerals, vitamins, diuretics, laxatives, or ‘cleansing foods’. Some of the many DDs used today are listed below:
| Diet type | Duration | Foods allowed | Proposed claims |
| Liver cleansing diet | 8 weeks | Plant-based, dairy-free, low-fat, high-fiber, unprocessed foods are allowed. Epsom salt and liver tonics are also consumed. | Improved energy levels and liver function Toxins removal Improved immune response Efficient metabolism of fats and better weight control |
| Lemon detox diet/Master cleanser | 10 days | A liquid-only diet based on purified water, lemon juice, tree syrup, and cayenne pepper. A mild laxative herbal tea and sea salt water is also incorporated. | Toxins removal Shiny hair, glowing skin, and strong nails Weight loss |
| The clean cleanse | 21 days | Breakfast and dinner comprise probiotic capsules, cleanse supplements and cleanse shakes. A solid meal in lunch while avoiding gluten, dairy, corn, soy, pork, beef, refined sugars, some fruits, and vegetables. | Toxins removal Improved energy, digestion, sleep, and mental health Reduction in joint pains, headaches, constipation, and bloating |
| Martha’s vineyard detox diet | 21 days | Herbal teas, vegetable soups and juices, specially formulated tablets, powders and digestive enzymes are on the menu. | Weight loss Toxins removal Improved energy levels |
| Weekend wonder detox | 48 h | Protein-rich meals salads, detox-promoting superfoods, and beverages. Healthy lifestyle, spa treatments, and herbal remedies. | Toxins removal Improved organ function Strengthen body Enhance beauty |
| Fat flush | 2 weeks | Large meals are replaced with dilute cranberries, hot water with lemon, pre-prepared cocktails, supplements, and small meals | Toxins removal Reduced stress Weight loss Improved liver function |
| Blueprint cleanse | 3 days | Consumption of six pre-prepared vegetable and fruit juices is allowed per day. | Toxins removal |
| The Hubbard purification rundown | Several weeks | Niacin doses along with sustained consumption of vitamin-A, B, C, D, and E. Daily exercise with balanced meals. Restriction of alcohol and drugs. Sitting in a sauna for ≤ 5 h each day. | Toxins removal from fat stores Improved memory and intelligence quotient Better blood pressure and cholesterol levels |
Currently, there is no good clinical evidence for the effectiveness of DDs and some evidence to suggest they might do harm. Many of the DD are liquid-based, low-calorie, and nutrient-poor. For example, a part of BluePrint Cleanse, Excavation Cleanse, provides only 19 g protein and 860 kcal/day which is far below the actual requirement. Food and Agriculture Organization (FAO) recommends a minimum of 0.83 g/kg body weight of high-quality protein and 1,680 kcal/day for an adult. DDs may also induce stress, raise cortisol levels, and increase appetite, resulting in binge eating and weight gain.
As no convincing positive evidence exists for DDs and detox products, their use needs to be discouraged by health professionals. Moreover, regulatory review and adequate safety monitoring should be considered.
Guest post by Norbert Aust and Viktor Weisshäupl
Readers of this blog may remember the recent study of Frass et al. about the adjunct homeopathic treatment of patients suffering from non-small cell lung cancer (here). It was published in 2020 by the ‘Oncologist’, a respectable journal, and came to stunning results about to the effectiveness of homeopathy.
In our analysis, however, we found strong indications for duplicity: important study parameters like exclusion criteria or observation time were modified post hoc, and data showed characteristics that occur when unwanted data sets get removed.
We, that is the German Informationsnetzwerk Homöopathie and the Austrian ‘Initiative für wissenschaftliche Medizin’, had informed the Medical University Vienna about our findings – and the research director then asked the Austrian Agency for Scientific Integrity (OeAWI) to review the paper. The analysis took some time and included not only the paper and publicly available information but also the original data. In the end, OeAWI corroborated our findings: The results are not based on sound research but on modified or falsified data.
Here is their conclusion in full:
The committee concludes that there are numerous breaches of scientific integrity in the Study, as reported in the Publication. Several of the results can only be explained by data manipulation or falsification. The Publication is not a fair representation of the Study. The committee cannot for all the findings attribute the wrongdoings and incorrect representation to a single individual. However following our experience it is highly unlikely that the principal investigator and lead author, but also the co-authors were unaware of the discrepancies between the protocols and the Publication, for which they bear responsibility. (original English wording)
Profil, the leading news magazine of Austria reported in its issue of October 24, 2022, pp 58-61 (in German). There the lead author, Prof. M. Frass, a member of Edzard’s alternative medicine hall of fame, was asked for his comments. Here is his concluding statement:
All the allegations are known to us and completely incomprehensible, we can refute all of them. Our work was performed observing all scientific standards. The allegation of breaching scientific integrity is completely unwarranted. To us, it is evident that not all documents were included in the analysis of our study. Therefore we requested insight into the records to learn about the basis for the final statement.
(Die Vorwürfe sind uns alle bekannt und absolut unverständlich, alle können wir entkräften. Unsere Arbeit wurde unter Einhaltung aller wissenschaftlichen Standards durchgeführt. Der Vorhalt von Verstößen gegen die wissenschaftliche Intergrität enbehrt jeder Grundlage. Für uns zeigt sich offenkundig, dass bei der Begutachtung unserer Studie nicht alle Unterlagen miteinbezogen wurden. Aus diesem Grunde haben wir um Akteneinsicht gebeten, um die Grundlagen für das Final Statment kennenzulernen.)
The OeAWI together with the Medical University Vienna asked the ‘Oncologist’ for a retraction of this paper – which has not occurred as yet.
I almost missed an article that Swiss Hugo Stamm (no, I don’t know him) has written about me. It is not entirely accurate but made me giggle quite a lot. Here are some passages that I translated for you:
… [Charles] wanted to obtain scientific evidence for the efficacy of homeopathy. It was therefore no surprise that Queen Elisabeth’s homeopath also sat on the appointment committee. The choice fell in 1993 on the German physician and scientist Edzard Ernst, who until then had taught and researched at the University of Vienna. The royal expectations were clear: Ernst was to produce the desired results.
But the professor was not prepared … to fulfill the royal expectations blindly. He first wanted to conduct research according to scientific standards and examine the available studies on homeopathy. In the process, doubts soon surfaced in his mind about alternative medicine. When he then set up randomized, placebo-controlled double-blind studies, he saw himself confirmed: The results were devastating and in some cases did not even reach the values of placebo effects.
Ernst felt obliged to his scientific conscience and published his studies against the will of his “client”. Charles was appalled and instructed his personal secretary to intervene. The latter wrote to the university administration that Professor Ernst had violated the agreed confidentiality. The university buckled after the royal scolding and opened disciplinary proceedings against the rebellious professor. The commission cleared him of all charges in 2010, but his department was closed.
“I was researching alternative medicine with my team; Charles, on the other hand, did not want to question it, but to propagate it. As I found more and more evidence that many alternative medicine procedures were not effective and sometimes even dangerous, tensions between me and Charles increased.” Edzard Ernst
Ernst did not allow himself to be muzzled by the prince and current king and, in 2022, published his book “Charles, the Alternative Prince”… In an interview with the Standard, Ernst said: “For as long as homeopathy has existed, the British royal family has been among the homeopathy advocates. However, Charles has not only promoted homeopathy, but also many other alternative medical procedures. What is striking about this is that he always picks out only the most bizarre and implausible ones and leaves aside those that are rudimentarily evidence-based. This may be because he always prefers the mystical and anti-scientific. Even as a young man, he was led down this path by Laurens van der Post, a South African-born esotericist and self-proclaimed guru.”
… For better understanding, it should be added that homeopathy grossly violates four basic scientific findings. It does not take an education in chemistry or medicine to recognize this.
- Mistake number 1: Cure like with like. Example: Someone who has lead poisoning is given globules made from lead in a diluted form. So, according to homeopathy, lead cures blood contaminated with lead.
- Mistake number 2: Dilution. The tinctures are diluted to such an extent that they contain only a few to no molecules of the alleged active substance. Nevertheless, a healing effect is attributed to them.
- Error number 3: Potentiation: The stronger the dilution, the greater the effect. If a globule still contains many molecules of the active substance, it has less effect than if it contains no molecules at all.
- Misconception number 4: Water absorbs information: By shaking the diluted liquid, information of the active substance supposedly jumps over to the water. This theory also contradicts all scientific findings. If water were to absorb such information, it would be so poisoned that we would no longer be able to drink it.
What probably few consumers of homeopathic remedies know: Globuli are made from countless substances. For example, from whale droppings, stomped ants, highly poisonous black belladonna or from the poison atropine.
But back to Charles: A prince has become a king overnight. But his attitude towards complementary medicine will not change. As a king, he certainly cannot admit to having been wrong all his life. Even if the scientific facts are clear.
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In case you are interested in a full account of this story, you might try my memoir.
Turmeric is a commonly used herbal product implicated in causing liver injury. The aim of this case series
was to describe the clinical, histologic, and human leukocyte antigen (HLA) associations of turmeric-associated liver injury enrolled in the U.S. Drug Induced Liver Injury Network (DILIN).
All adjudicated cases enrolled in DILIN between 2004-2022 in which turmeric was an implicated product were reviewed. Causality was assessed using a 5-point expert opinion score. Available products were analyzed for the presence of turmeric using ultra-high-performance liquid chromatography. Genetic analyses included HLA sequencing.
Ten cases of turmeric-associated liver injury were found, all enrolled since 2011 and six since 2017. Of the 10 cases, 8 were women, 9 were White and the median age was 56 years (range, 35-71). Liver injury was hepatocellular in 9 patients and mixed in one. Liver biopsies in 4 patients showed acute hepatitis or mixed cholestatic-hepatitic injury with eosinophils. Five patients were hospitalized, and one patient died of acute liver failure. Chemical analysis confirmed the presence of turmeric in all 7 products tested; 3 also contained piperine (black pepper). HLA typing demonstrated that 7 patients carried HLA-B*35:01, 2 of whom were homozygous, yielding an allele frequency of 0.450 compared to population controls of 0.056-0.069.
The authors concluded that liver injury due to turmeric appears to be increasing in the United States, perhaps reflecting usage patterns or increased combination with black pepper. Turmeric causes potentially severe liver injury that is typically hepatocellular, with a latency of 1 to 4 months and strong linkage to HLA-B*35:01.
Turmeric or curcumin is said to cause multiple effects, such as inhibiting inflammation, oxidative stress, tumor cell proliferation, cell death, and infection. Yet, sound clinical trials to test whether these effects might translate into health benefits are rare. In addition, the bioavailability of oral turmeric supplements is known to be low.
Turmeric has been used in food for millennia and is thus generally considered to be safe. Known adverse effects include gastrointestinal problems such as nausea and diarrhea and allergic reactions. Clearly, the new case series casts considerable doubt on the safety of turmeric. Yet, one ought to point out that the number of cases is low (but, on the other hand under-reporting can be assumed to be high). Furthermore, we should take into account that the quality of commercially available products is often low. One must therefore ask whether the liver injuries were truly caused by turmeric itself or by contaminants.
My conclusion is that turmeric is unquestionably an interesting plant with considerable potential as a medicine. At present, there is much hype surrounding it. Yet, hype is almost always contra-productive. If we want to know the true value of turmeric, we need to solve the bioavailability problem and do much more research into its safety and efficacy for defined conditions.
Aging often contributes to a decrease in physical activity. As age advances, a decrease in muscle mass, muscle strength, and flexibility can impair physical function. One obvious way to prevent these developments might be regular physical exercise.
This open-label, randomized trial was intended to evaluate the effects of an integrated yoga module in improving the flexibility, muscle strength, and quality of life (QOL) of older adults. Participants were 96 older adults, aged 60-75 years (64.1 ± 3.95 years). The program was a three-month, yoga-based lifestyle intervention. The participants were randomly allocated to the intervention group (n = 48) or to a waitlisted control group (n = 48). The intervention group underwent three one-hour sessions of yoga weekly, with each session including loosening exercises, asanas, pranayama, and meditation spanning.
At baseline and post-intervention, the following assessments were made:
- spinal flexibility using a sit-and-reach test,
- back and leg strength using a back leg dynamometer,
- handgrip strength (HGS) and endurance (HGE) using a hand-grip dynamometer,
- Older People’s Quality of Life (OPQOL) questionnaire.
Analysis was performed employing Wilcoxon’s Sign Rank tests and Mann-Whitney Tests, using an intention-to-treat approach.
The results show that, compared to the control group, the intervention group experienced a significantly greater increase in spinal flexibility (P < .001), back leg strength (P < .001), HGE (P < .01), and QOL (P < .001) after three months of yoga.
The authors concluded that yoga can be used safely for older adults to improve flexibility, strength, and functional QOL. Larger randomized controlled trials with an active control intervention are warranted.
I agree with the authors that this trial was too small and not properly controlled. I disagree that their study shows yoga to be effective or safe. In fact, the two sentences of the conclusion do not seem to fit together at all.
Is it surprising that doing yoga exercises is better than doing nothing at all?
No!
Is it relevant to demonstrate this fact in an RCT?
No!
If anyone wants to test the value of yoga exercises, they must compare them to conventional exercises. And why don’t they do this? Could it be because they know they would be unlikely to show that yoga is superior?
