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

critical thinking

It would be easy to continue this series on ‘tricks of the trade’ for quite a while. But this might get boring, and I have therefore decided to call it a day. So here is the last instalment (feel free to post further tricks that you may know of [in the comments section below]):

CRITICS DON’T UNDERSTAND

It is almost inevitable that, sooner or later, someone will object to some aspect of alternative medicine. In all likelihood, his or her arguments are rational and based on evidence. If that happens, the practitioner has several options to save his bacon (and income). One of the easiest and most popular is to claim that “of course, you cannot agree with me because you do not understand!”

The practitioner now needs to explain that, in order to achieve the level of expertise he has acquired, one has to do much more than to rationalise or know about science. In fact, one has to understand the subject on a much deeper level. One has to immerse oneself into it, open one’s mind completely and become a different human being altogether. This cannot be achieved by scientific study alone; it requires years of meditative work. And not everyone has the ability to go down this difficult path. It takes a lot of energy, insight and vision to become a true healer. A true Deepak Chopra is not born but trained through hard work, dedication and concentration.

Critics who disagree are really to be pitied. They fail to exist on quite the same level as those who ‘are in the know’. Therefore one must not get annoyed with those who disagree, they cannot understand because they have not seen the light.

My advice is to start thinking critically and read up about the NO TRUE SCOTSMAN FALLACY; this will quickly enable you to look beyond the charisma of these gurus and expose their charlatanry to the full.

RESEARCH IS BEING SUPRESSED

Some critics stubbornly insist on evidence for the therapeutic claims made by quacks. That attitude can be awkward for the alternative practitioner – because usually there is no good evidence.

Cornered in this way, quacks often come up with a simple but effective conspiracy theory: the research has been done and it has produced fabulous results, but it has been supressed by… well, by whoever comes to mind. Usually BIG PHARMA or ‘the scientific establishment’ have to be dragged out into the frame again.

According to this theory, the pharmaceutical industry (or whoever comes in handy) was so shaken by the findings of the research that they decided to make it disappear. They had no choice, really; the alternative therapy in question was so very effective that it would have put BIG PHARMA straight out of business for ever. As we all know BIG PHARMA to be evil to the core, they had no ethical or moral qualms about committing such a crime to humanity. Profits must come before charity!

My advice is to explain to such charlatans that such conspiracy theories do, in fact, merely prove is that the quack’s treatment is not effective against their prosecution complex.

CRITICS ARE BOUGHT AND CORRUPT

If  critics of alternative medicine become threatening to the quackery trade, an easy and much-used method is to discredit them by spreading lies about them. If the above-mentioned ploy “they cannot understand” fails to silence the nasty critics, the next step must be to claim they are corrupt. Why else would they spend their time exposing quackery?

Many people – alternative practitioners included – can only think of financial motivations; the possibility that someone might do a job for altruistic reasons does not occur to them. Therefore, it sounds most plausible that the critics of alternative medicine are doing it for money – after all, the quacks also quack for money.

My advice to potential users of alternative medicine who are confused by such allegations: do your own research and find out for yourself who is bought by whom and who has a financial interest in quackery selling well.

EVEN NOBEL PRIZE WINNERS AGREE WITH US

It is true, there are some Nobel Prize winners who defend homeopathy or other bogus treatments. Whenever this happens, the apologists of alternative medicine have a field day. They then cite the Nobel laureate ad nauseam and imply that his or her views prove their quackery to be correct.

Little do they know that they are merely milking yet another classical fallacy and that such regrettable events merely demonstrate that even bright people can make mistakes.

My advice is to check what the Nobel laureate actually said – more often than not, it turns out that a much-publicised quote is, in fact, a misquote – and what his or her qualifications are for making such a statement; a Nobel Prize in literature, for instance, is not a sufficient qualification for commenting on healthcare issues.

AS I ALRADY SAID: IF YOU KNOW OF MORE ‘TRICKS OF THE QUACKARY TRADE’, PLEASE POST THEM BELOW.

This series of post is quite good fun – at least for me who is writing it.  But I also hope that it is useful to those readers who are tempted to consult alternative practitioners. My intention is to stimulate people’s ability to think critically and to provide some sort of guide for patients which might help them in deciding which practitioners to avoid.

In this spirit, I now offer you the next instalment of three ‘tricks of the trade’:

 

NATURAL IS GOOD

Everyone working in advertising will confirm: the ‘natural label’ is a great asset for boosting sales of all sorts of things. Practitioners of alternative medicine have long appreciated this fact and exploited it to the best of their abilities. They stress the ‘naturalness’ of their treatments ad nauseam, and more often than not they use the term misleadingly.

For instance, there is nothing natural to thrust a patients spine beyond the physiological range of motion [chiropractic]; there is nothing natural in endlessly diluting and shaking remedies which may or may not have their origin in a natural substance [homeopathy]; there is nothing natural in sticking needles into the skin of patients [acupuncture].

Moreover, the notion of a benign ‘mother nature’ is naïvely misleading. Ask those who have been at sea during a storm or who have been struck by lightning.

My advice is to see through transparent marketing slogans and to tell the anyone who goes on about the ‘naturalness’ of his therapy to buzz off.

ENERGY

When one goes to a meeting of alternative practitioners, the term ‘energy’ is mentioned more often than at a board meeting of EDF. The difference is that the alternative brigade does not mean really energy when they speak of energy; they mean ‘vital force’ or one of the many related terms from other traditions.

Practitioners do prefer to use ‘energy’ because this sounds modern and impressive to many consumers. Crucially, it avoids disclosing how deeply steeped the therapists are in vitalism and vitalistic ideas. Whereas rational thinkers have discarded such concepts more than a century ago, alternative medicine advocates find it hard to do the same – if they did, there would be little else to underpin their various ‘philosophies’.

My advice is to avoid clinicians who are ‘vitalists’ because adhering to long obsolete concepts is a sure sign of dangerous backward thinking.

STIMULATING THE IMMUNE SYSTEM

‘Your immune system need stimulating!’ – how often have we heard that from practitioners of alternative medicine? By contrast, conventional clinicians are most reserved about such aims; they might try to stimulate the immune system in certain, rare circumstances. Quite often they need to achieve the opposite effect and use powerful drugs to suppress the immune system. But even when they aim at stimulating the immune system of a patient, they would not use any of the treatments alternative practitioners swear by.

How come? There are several reasons:

  1. The alternative ‘immune stimulants’ do not really stimulate the immune system.
  2. Stimulating the immune system is rarely a desirable therapeutic aim.
  3. Stimulating a normal immune system is hardly possible.
  4. For many of us, stimulating the immune system might even be a very risky business (if it were at all achievable).

My advice is to ask your practitioner precisely why he wants to stimulate your immune system. If he can give you a good reason, ask him to try stimulating his own immune system first and to show you the proof that his therapy can do such a thing.

In part one and part two of this series of posts, we have discussed altogether six ‘tricks of the trade’:

TREAT A NON-EXISTING CONDITION

MAINTENANCE TREATMENT

IT MUST GET WORSE BEFORE IT GETS BETTER

THINK HOLISTICALLY

IT’S DUE TO THE POISONS YOUR DOCTOR GAVE YOU

A CURE TAKES A LONG TIME

Now it is time to disclose three more.

DETOX

Alternative therapies are hugely diverse, but they nevertheless have a few characteristics in common. One is that many of their practitioners try to persuade their patients that they are being poisoned. This sounds odd, however, it is true.

Most alternative therapists tell their patients sooner or later that they need to ‘detox’ and, as it happens, their type of treatment is ideally suited to achieve this aim. Detox is short for detoxification which, in real medicine, is the term used for weaning addicts off their drugs. In alternative medicine, it is used as a marketing slogan.

Yes, detox, as used in alternative medicine, is nothing but a marketing slogan. I have several reasons for this statement:

  • The poisons in question are never accurately defined. Instead, we hear only vague terminologies such as metabolic waste products or environmental toxins. The reason for that lack of precision is simple: once the poison is named, we could be able to measure it and test the efficacy of the treatment in  question in eliminating it from the body. But this is the last thing these ‘detoxers’ want because we would soon establish how bogus their claims are.
  • None of the alternative therapies claimed to detox our body take any toxin from us; all they do take from us is our cash.
  • Our body has powerful organs and mechanisms to detoxify (skin, lungs, kidneys, liver). These take care of all the toxins we undoubtedly are exposed to. If any of these organs fail, we do not need homeopathic globoli or detoxifying diets, or electric foot baths or any other charlatanry; in this case, we are more likely to need an A&E department’s intensive care.

My advice is, as soon as you hear the word ‘detox’ from a quack, ask for your money back and go home.

THE TEST OF TIME

Another thing that many alternative therapies have in common is their age. They have almost all been around for hundreds, if not thousands of years. To the enthusiasts of alternative medicine, this means that these interventions have ‘stood the test of time’; they argue that acupuncture, for instance, would not be around any more, if it were not effective. They tell their patients, write in books and argue in debates that the age of their therapy is like a badge of approval from millions of people before us, a badge that surely weighs more that modern scientific studies (which tend to cast doubt on the effectiveness of the treatments in question).

This line of thinking has always puzzled me. We are talking of TECHNOLOGIES, health technologies, in fact. Would we argue that a hot air balloon is an older technology that an aeroplane and therefore better suited for transporting people from A to B? The fact that acupuncture was developed thousands of years ago might just mean that it was invented by relatively ignorant people who understood too little about the human body to create a truly effective intervention. And the fact that blood-letting was used for centuries (and thus killed millions), might teach us a lesson about the true value of ‘the test of time’ in medicine.

My advice is to offer leeches, blood-letting and mercury cures to those who try to persuade you that the test of time has meaningful therapeutic implications.

TREATING THE ROOT CAUSE OF THE DISEASE

Alternative practitioners often claim that, in conventional medicine, doctors only treat the symptoms of their patients, whereas they treat the root causes of the illness. I have often wondered where this assumption and the fierce conviction with which it is so often expressed come from. I have to conclude that the explanations are quite simple.

  • This notion is the mantra that is being taught over and over again during the practitioners’ training. It even constitutes a central message of most ‘textbooks’ for the aspiring alternative practitioner.
  • More importantly in the context of this post, the notion is a clever sales-trick. It sounds profound and logical to many consumers who lean towards alternative medicine. Crucially, it kills two flies with one stroke: it denigrates conventional healthcare and, at the same time, elevates alternative medicine.

The idea that alternative practitioners treat the root causes is  based on the practitioners’ understanding of aetiology. If a traditional acupuncturist, for instance, is convinced that all disease is the expression of an imbalance of life-forces, and that needling acupuncture points will re-balance these forces thus restoring health, he must automatically assume that he is treating the root causes of any condition. If a chiropractor believes that all diseases  are due to ‘subluxations’ of the spine, it must seem logical to him that spinal ‘adjustment’ is synonymous with treating the root cause of whatever complaint his patient is suffering from.

These are concepts that are deeply engrained into the minds of alternative practitioners. And they have one embarrassing feature in common: they are false! Some practitioners surely must know that; yet I have so far not met one who therefore would have stopped using it. The reason must be that, as a trick of the trade to increase his cash flow, it is invaluable.

My advice is to use your abilities for critical thinking, explain to the practitioner who tells you that he is going to treat the root causes of your condition that he is a quack, and look for a proper physician.

 

In part one, we have dealt with three common tricks used by quacks to convince the public to consult them and to keep coming back for more. It has been pointed out to me that some of these tricks are used not just by alternative practitioners but also by real physicians. This is, of course, absolutely true. A quack can be defined as “a person who dishonestly claims to have special knowledge and skill in some field, typically medicine.” Therefore real doctors can be real quacks, of course. I happen to have an interest mainly in alternative medicine; that’s why I write about these type of quacks (if it helps keeping you blood pressure within the limits of normal, I can tell you that I occasionally also published about quackery in mainstream medicine, for instance here).

Anyway, now it is time to continue this series of posts by discussing three further common deceptions used by quacks.

A CURE TAKES A LONG TIME

Imagine a scenario where, even after, several therapy sessions, a patient’s condition has not improved. Let’s assume the problem is back pain, and that it has not improved a  bit despite the treatments and the money spent on it. Surely, many patients in such a situation are sooner or later going to give up. They will have had enough! And this is, of course, a serious threat to the practitioner’s cash flow.

Luckily, there is a popular ploy to minimize the risk: the practitioner merely has to explain that the patient’s condition has been going on for a very long time (if, in the above scenario, this were not the case, the practitioner would explain that the pain might be relatively recent but the underlying condition is chronic). This means that a cure will also have to take a very long time – after all, Rome was not built in one day!

This plea to carry on with the ineffective treatments despite any improvement of symptoms is usually not justifiable on medical grounds. It is, however, entirely justifiable on the basis of financial considerations of the practitioners. They rely on their patients’ regular payments and will therefore think of all sorts of means to achieve this aim.

Take my advice and see a clinician who can help you within a reasonable and predictable amount of time.

IT’S DUE TO THE POISONS YOUR DOCTOR GAVE YOU

In the pursuit of a healthy cash-flow, almost all means seem to be allowed – even the fabrication of the bogus notion that the reasons for the patient’s problem were the poisonous drugs prescribed by her doctor who, of course, is in cahoots with BIG PHARMA. Alternative medicine thrives on conspiracy theories, and the one of the evil ‘medical mafia’ is one of the all-time favourites. It enables scrupulous practitioners to instil a good dose of fear into the minds of their patients, a fear that minimises the risk of them returning to real medicine.

My advice is that alternative practitioners who habitually use this or any other conspiracy theory should be avoided at all costs.

THINK HOLISTICALLY

The notion that alternative medicine takes care of the whole person is a most attractive and powerful ploy. Never mind that nothing could be further from being holistic than, for instance, diagnosing conditions by looking at a patient’s iris (iridology), or focussing on her spine (chiropractic, osteopathy), or massaging the soles of her feet (reflexology). And never mind that any type of good conventional medicine is by definition holistic. What counts is the label, and ‘holistic’ is a most desirable one, indeed. Nothing sells quackery better than holism.

Most alternative practitioners call themselves holistic and they rub the holism into the minds of their patients whenever and however they can. This insistence on holism has the added advantage that they have seemingly plausible excuses for their therapeutic failures.

Imagine a patient consulting a practitioner with depression and, even after prolonged treatment, her condition is unchanged. Even in such a situation, the holistic practitioner does not need to despair: he will point out that he never treats diagnostic labels but always the whole person. Therefore, the patient’s depression might not have changed, but surely other issues have improved… and, if the patient introspects a little, she might find that her appetite has improved, that her indigestion is better, or that her tennis elbow is less painful (some things always change given enough time). The holism of quacks may be a false pretence, but its benefits for the practitioner are obvious.

My advice: take holism from quacks with a pinch of salt.

“When orthodox medicine has nothing more to offer” is the title of an article by Dr Elizabeth Thompson, a UK medical homeopath. The article was written years ago, but it is still an excellent example for disclosing the dangerously false and deeply unethical reasoning used by many alternative practitioners. The notion that all sorts of disproven treatments like homeopathy are justified when orthodox medicine has nothing more to offer is so very prevalent that I decided to do this post analysing it.

In the following, you see the most relevant sections of Dr Thompson’s original article (in normal print) and my brief comments (in brackets and in bold):

…Some people come when conventional treatments can no longer offer them anything to save their lives. This is a frightening time for them and although the homeopathic approach may not offer a cure at this late stage of their illness (Is she implying that, in some cases, homeopathy can cure cancer?), it can often offer hope of a different kind. (Surely, one does not need homeopathy for giving patients hope). Sometimes it helps people to outlive the prognosis given to them by months or even years. (A prognosis is not a precise time of death; it is based on statistics and therefore depicts a likelihood, not a certainty. Thus patients outlive their prognosis all the time regardless of treatments.) Sometimes it helps them need less (less than what? there is no control group and therefore the statement seems nonsensical) in the way of conventional medicine including pain killers and offers them continuing support despite progressive disease (is she trying to say that in conventional medicine patients with progressive disease do not get continuing support?).

As a doctor working in both conventional and complementary cancer care I have learned the importance of integrating these two perspectives (the integration of unproven therapies into EBM can only render the latter less effective). Ideally the doctor practising homeopathy would work as an integral part of a much wider team which would include family members, nurses, general practitioners, oncologists, surgeons, palliative physicians and other complementary therapists (the concept of a multi-disciplinary team for cancer is one from conventional medicine where it has long been routine). It is disappointing sometimes to see that other healthcare professionals can be unsupportive of a person’s desire to use complementary therapies and for some people the knowledge that the team is not working together can cause doubt and insecurity (for the majority of patients, however, it might be reassuring to know that their oncology-team is evidence-based).

Some patients come at the beginning of their diagnosis wanting to support their bodies with gentler (homeopathic remedies are not gentler, they are ineffective) approaches and help themselves recover from some difficult and powerful treatments such as chemotherapy and radiotherapy (Why are they being told that alternative therapies are effective in achieving these aims when there is no good evidence to show that this is true? Isn’t that unethical?). As well as using homeopathic medicines (no good evidence of effectiveness!!!), the GHH also has experience in using Mistletoe which is given by injection and has been shown to stimulate the group of white cells whose numbers can be depleted during chemotherapy and radiotherapy (also no good evidence that it works clinically!!!).

Other patients come when they have finished most of their treatments but may still not be feeling well despite being given the all clear by their doctors (same again: no good evidence!!!)…

One wonderful aspect of the homeopathic approach is that it can be a very important opportunity to help someone re-evaluate their life and their health (We don’t need to prescribe placebos for that, this aim is better reached by employing a clinical psychologist).

Sometimes hurts in the past have never been healed and sitting with someone as they describe difficult experiences can be itself therapeutic. Combining this therapeutic listening time with substances from nature that gently stimulate the body’s own healing potential (where is the evidence for that claim?) can be an approach that through patient demand and research (what research?) we can demonstrate is really worth offering to many more people…

END OF QUOTE

 

This text shows in an exemplary fashion how desperate patients can be convinced to make dramatically wrong choices. If you read Dr Thompson’s text without my comments, it probably sounds fairly reasonable to many people. I can understand why patients and carers end up thinking that homeopathy or other disproven therapies are reasonable options WHEN ORTHODOX MEDICINE HAS NOTHING MORE TO OFFER.

But the claim of homeopaths and others that mainstream medicine has, in certain cases, nothing more to offer is demonstrably wrong. Supportive and palliative care are established and important parts of conventional medicine. To deny this fact amounts to a lie! The implied scenario where a patient is told by her oncology team: “sorry but we cannot do anything else for you”, does quite simply not exist. The argument is nothing else but a straw-man – and a vicious one at that.

Moreover, the subsequent argument of homeopaths, “as ‘they’ have given you up, we now offer you our effective homeopathic remedies”, is not supported by good evidence. In other words, one lie is added to another. To call this unethical, would be the understatement of the year, I think.

Homeopathy must be effective! It is used extensively throughout the world, not least India! If it were ineffective, as all these nasty sceptics insist, Indians would not use it in such large numbers.

How often have we heard this argument?

Take, for instance, statements from the ‘peer-reviewed’ literature such as this one: “At present, in India, homeopathy is the third most popular method of medical treatment after allopathy and Ayurveda. There are over 200,000 registered homeopathic doctors currently, with approximately 12,000 more being added every year.” Or take statements from UK homeopaths like this one: “It seems clear that homeopathy is there to stay in India. So next time you see or read some condescending and patronising rubbish about homeopathy in the media, know that in India, a country with a population of 1.2 billion people (that’s more than 20x the population of the UK) homeopathy is an integral part of the healthcare system and deeply respected by the people of that country.”

Yes, homeopaths have always loved to mislead the public with fallacies!

The appeal to popularity is, of course, a classic fallacy – but, in the case of homeopathy’s popularity in India, it is not just that; here is an intriguing aspect to the use of homeopathy in that country that shines a different light on the whole story.

Epidemiologists from Canada conducted semi-structured interviews of 175 Mumbai slum-based practitioners holding degrees in Ayurveda, homeopathy and Unani. Most providers gave multiple interviews. The researchers also observed 10 providers in clinical interactions, documenting clinical examinations, symptoms, history taking, prescriptions and diagnostic tests.

No practitioners exclusively used his or her system of training. The practice of biomedicine was frequent, with practitioners often using biomedical disease categories and diagnostics. The use of homeopathy was rare; only 4% of consultations with homeopaths resulted in the prescription of homeopathic remedies.

The authors concluded that important sources of health care in Mumbai’s slums, AYUSH physicians frequently use biomedical therapies and most refer patients with TB to chest physicians or the public sector. They are integral to TB care and control.

These data seem to suggest that the use of homeopathic remedies in India is far, far less than often claimed by apologists. Indian homeopaths seem to have much more sense than to use homeopathy for serious conditions. This is good news for Indian public health, in my view.

The story also shows how the ‘appeal to popularity’ is being misused for the promotion of homeopathy: not only is it based on poor logic but often also on false information.

John Garrow died yesterday at home.

John had suffered a stroke about 6 weeks ago but had previously been in good health.

His professional achievements were too many to list here in full. He had been Professor of Human Nutrition, University of London, Honorary consultant physician St Bartholomew’s Hospital, St Mark’s Hospital, Royal London Hospital and Northwick Park Hospital. He also was head of Nutrition Research Unit at the MRC Clinical Research Centre, Harrow, and member of Department of Health Committee on Medical Aspects of Food Policy; Chair of the Joint Advisory Committee on Nutrition Education and the Chair of Association for the Study of Obesity. For many years, he also acted as editor in chief of the European Journal of Clinical Nutrition, and as the chairman of HealthWatch.

John was a clinician and an active researcher with a focus on nutrition and, occasionally, alternative medicine. He has published many ground-breaking articles on these and other subjects. I had the pleasure to plan, conduct and publish a study with John; it was an investigation into an area which, at the time, was entirely novel. I think it might have been the first RCT into the peer-review system ever conceived. Here is the full abstract:

A study was designed to test the hypothesis that experts who review papers for publication are prejudiced against an unconventional form of therapy. Two versions were produced (A and B) of a ‘short report’ that related to treatments of obesity, identical except for the nature of the intervention. Version A related to an orthodox treatment, version B to an unconventional treatment. 398 reviewers were randomized to receive one or the other version for peer review. The primary outcomes were the reviewers’ rating of ‘importance’ on a scale of 1-5 and their verdict regarding rejection or acceptance of the paper. Reviewers were unaware that they were taking part in a study. The overall response rate was 41.7%, and 141 assessment forms were suitable for statistical evaluation. After dichotomization of the rating scale, a significant difference in favour of the orthodox version with an odds ratio of 3.01 (95% confidence interval, 1.03 to 8.25), was found. This observation mirrored that of the visual analogue scale for which the respective medians and interquartile ranges were 67% (51% to 78.5%) for version A and 57% (29.7% to 72.6%) for version B. Reviewers showed a wide range of responses to both versions of the paper, with a significant bias in favour of the orthodox version. Authors of technically good unconventional papers may therefore be at a disadvantage in the peer review process. Yet the effect is probably too small to preclude publication of their work in peer-reviewed orthodox journals.

Years later, John also contributed a chapter entitled ‘CAM IN COURT’ to a book that I had edited. I remember very well what a pleasure it was to co-operate with John. He was quick to conceive new ideas and had an intellectual rigor and honesty that I have not often encountered elsewhere.

But it is not his professional achievements which impressed me most about John. What I found even more remarkable was his ability to understand, his kindness and warmth. He had the gift not just to grasp the issues but also to empathize with the people behind them. I am proud to have known John, worked with him, and been inspired by him.

I will sorely miss my friend.

Turmeric (Curcuma longa) is a truly fascinating plant with plenty of therapeutic potential. It belongs to the ginger family, Zingiberaceae and is native to southern Asia. Its main active ingredients are curcumin (diferuloylmethane) and the related compounds, demethoxycurcumin and bis-demethoxycurcumin (curcuminoids) which are secondary metabolites. Turmeric  has been used extensively in Ayurvedic medicine and has a variety of pharmacologic properties including antioxidant, analgesic, anti-inflammatory, and antiseptic activities.

In the often weird world of alternative medicine, turmeric is currently being heavily hyped as the new panacea. Take this website, for instance; it promotes turmeric for just about any ailment known to mankind. Here is a short excerpt to give you a flavour (pun intended, turmeric is, of course, a main ingredient in many curries):

It comes at a surprise to a lot of people that herbs can be highly effective, if not more effective, than conventional medications …

To date, turmeric is one of the top researched plants. It was involved in more than 5,600 peer-reviewed and published biomedical studies. In one research project that extended over a five year period, it was found that turmeric could potentially be used in preventive and therapeutic applications. It was also noted that it has 175 beneficial effects for psychological health…

The 14 Medications it Mimics

Or should we say the 14 medications that mimic turmeric, since turmeric has been around much longer than any chemical prescription drug. Here’s a quick look at some of them:

  • Lipitor: This is a cholesterol drug that is used to reduce inflammation and oxidative stress inside of patients suffering from type 2 diabetes. When the curcuminoid component inside of turmeric is properly prepared, it can offer the same effects (according to a study published in 2008).
  • Prozac: This is an antidepressant that has been overused throughout the past decade. In a study published back in 2011, turmeric was shown to offer beneficial effects that helped to reduce depressive behaviors (using animal models).
  • Aspirin: This is a blood thinner and pain relief drug. In a study done in 1986, it was found that turmeric has similar affects, which makes it a candidate for patients that are susceptible to vascular thrombosis and arthritis.
  • Metformin: This is a drug that treats diabetes. It is used to activate AMPK (to increase uptake of glucose) and helps to suppress the liver’s production of glucose. In a study published in 2009, it was found that curcumin was 500 to 100,000 times more effective at activating AMPK ad ACC.
  • Anti-Inflammatory Drugs: This includes medications like ibuprofen, aspirin and dexamethasone, which are designed to reduce inflammation. Again, in 2004, it was proven that curcumin was an effective alternative option to these chemical drugs.
  • Oxaliplatin: This is a chemotherapy drug. A study done in 2007 showed that curcumin is very similar to the drug, acting as an antiproliferative agent in colorectal cell lines.
  • Corticosteroids: This is a steroid medication, which is used to treat inflammatory eye diseases. In 1999, it was found that curcumin was effective at managing this chronic condition. Then in 2008, curcumin was used in an animal model that proved it could also aid in therapy used to protect patients from lung transplantation-associated injuries by “deactivating” inflammatory genes.

Turmeric Fights Drug-Resistant Cancers… it’s been shown that curcumin can battle against cancers that are resistant to chemotherapy and radiation…

END OF QUOTE

As I said, turmeric is fascinating and promising, but such hype is clearly counter-productive and dangerous. As so often, the reality is much more sobering than the fantasy of uncritical quacks. Research is currently very active and has produced a host of interesting findings. Here are the conclusions (+links) of a few, recent reviews:

Overall, there is early evidence that turmeric/curcumin products and supplements, both oral and topical, may provide therapeutic benefits for skin health. However, currently published studies are limited and further studies will be essential to better evaluate efficacy and the mechanisms involved.

This meta-analysis of RCTs suggested a significant effect of curcumin in lowering circulating TNF-α concentration.

While statistical significant differences in outcomes were reported in a majority of studies, the small magnitude of effect and presence of major study limitations hinder application of these results.

Overall, scientific literature shows that curcumin possesses anti-diabetic effects and mitigates diabetes complications.

The highlighted studies in the review provide evidence of the ability of curcumin to reduce the body’s natural response to cutaneous wounds such as inflammation and oxidation. The recent literature on the wound healing properties of curcumin also provides evidence for its ability to enhance granulation tissue formation, collagen deposition, tissue remodeling and wound contraction. It has become evident that optimizing the topical application of curcumin through altering its formulation is essential to ensure the maximum therapeutical effects of curcumin on skin wounds.

What emerges from a critical reading of the evidence is that turmeric has potential in several different areas. Generally speaking, clinical trials are still thin on the ground, not of sufficient rigor and therefore not conclusive. In other words, it is far too early to state or imply that we all should rush to the next health food store and buy the supplements.

On the contrary, at this stage, I would even warn people not to be seduced by the unprofessional hype and wait until we know more – much more. There might be risks associated with ingesting turmeric at high doses over long periods of time. And there are fundamental open questions about oral intake. One recent review cautioned: …its extremely low oral bioavailability hampers its application as therapeutic agent.

WATCH THIS SPACE!

Homeopaths assume lots of things; one of their main claims is, for instance, that the process of repeatedly diluting a remedy and vigorously shaking it at each step – they call this potentisation – renders it more potent. This is the famous MEMORY OF WATER’ theory of homeopathy. In Hahnemann’s own words: ‘…the power of a medicine in solution is much increased by intimate mixture with a large volume of fluid…’ And elsewhere he stated that ‘as the smallest quantity of medicine naturally disturbs the organism least, we should choose the very smallest doses, provided always that they are a match for the disease… hardly any dose of the homeopathically selected remedy can be so small as not to be stronger than the natural disease…’

Hahnemann’s explanation for this extraordinary assumption (which he claimed to have observed empirically) was that his remedies do not work through any material effects but via spirit-like energies. As this sounds a little silly in the light of modern science, homeopaths have been keen to find more rational support for their theories. Thus they have developed several ‘sciency’ concepts to explain the mode of action of their highly diluted homeopathic remedies. For instance that postulated that water can form secondary structures that hold some information of the original substance (stock), even if it has long been diluted out of the remedy. Alternatively, they claimed that the shaking of the remedy generates nano-particles or silicone-particles which, in turn, are the cause of the clinical effects.

Today, I want to assume for a minute, that one of these theories is correct – they cannot all be right, of course. Homeopaths regularly show us investigations that seem to support them, even though it only needs a real expert in the particular field of science to cast serious doubt on them. I will nevertheless assume that, after potentisation, the diluent retains information via nano-particles or some other phenomenon. For the purpose of this mind-experiment, I grant homeopaths that, in this respect, they are correct. In other words, let’s for a moment assume that the ‘memory of water’ theory is correct.

As I have been more than generous, I want homeopaths to return the favour and consider what this would really mean: information has been transferred from the stock to the diluent. Does that prove anything? Does it show that homeopathy is valid?

Could the homeopaths who make this assumption be equally generous and answer the following questions, please?

  1. How 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? The claim that information has been retained by the diluent is no where near to an explanation of a rational mode of action, isn’t it?
  2. Most homeopathic remedies are consumed not as liquids but as ‘globuli’, i. e.  tiny little pills made of lactose. They are prepared by dropping the liquid remedy on to them. The liquid subsequently evaporates. How is it that the information retained in the liquid does not evaporate with the diluent?
  3. The diluent usually is a water-alcohol mixture which inevitably contains impurities. In fact, a liquid C12 remedy most certainly contains dimensions more impurities than 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 rest remain absolutely still? How can we explain this fantastic concept?
  4. 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. I have granted you that potentisation works in the way you think. But how is information transferred from one solid material to another?
  5. 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?

Now, homeopaths, let me propose a deal.

If you can answer these questions satisfactorily, I will no longer doubt your memory of water theory. If you cannot do this, I think you ought to admit that all your ‘sciency’ theories about the mode of action of highly diluted homeopathic remedies are really quite silly – more silly even than Hahnemann’s idea of a ‘spirit-like’ effect.

 

The ACUPUNCTURE NOW FOUNDATION (ANF) have recently published a document that is worth drawing your attention to. But first I should perhaps explain who the ANF are. They state that “The Acupuncture Now Foundation (ANF) was founded in 2014 by a diverse group of people from around the world who were concerned about common misunderstandings regarding acupuncture and wanted to help acupuncture reach its full potential. Our goal is to become recognized as a leader in the collection and dissemination of unbiased and authoritative information about all aspects of the practice of acupuncture.”

This, I have to admit, sounds like music to my ears! So, I studied the document in some detail – and the music quickly turned into musac.

The document which they call a ‘white paper’ promises ‘a review of the research’. Reading even just the very first sentence, my initial enthusiasm turned into bewilderment: “It is now widely accepted across health care disciplines throughout the world that acupuncture can be effective in treating such painful conditions as migraine headaches, and low back, neck and knee pain, as well as a range of painful musculoskeletal conditions.” Any review of research that starts with such a deeply uncritical and overtly promotional statement, must be peculiar (quite apart from the fact that the ANF do not seem to appreciate that back and neck pain are musculoskeletal by nature).

As I read on, my amazement grew into bewilderment. Allow me to present a few further statements from this review (together with a link to the article provided by the ANF in support and a very brief comment by myself) which I found more than a little over-optimistic, far-fetched or plainly wrong:

Male fertility, especially sperm production and motility, has also been shown to improve with acupuncture. In a recent animal study, electro-acupuncture was found to enhance germ cell proliferation. This action is believed to facilitate the recovery of sperm production (spermatogenesis) and may restore normal semen parameters in subfertile patients.

The article supplied as evidence for this statement refers to an animal experiment using a model where sperm are exposed to heat. This has almost no bearing on the clinical situation in humans and does not lend itself to any clinical conclusions regarding the treatment of sub-fertile men.

In a recent meta-analysis, researchers concluded that the efficacy of acupuncture as a stand-alone therapy was comparable to antidepressants in improving clinical response and alleviating symptom severity of major depressive disorder (MDD). Also, acupuncture was superior to antidepressants and waitlist controls in improving both response and symptom severity of post-traumatic stress disorder (PTSD). The incidence of adverse events with acupuncture was significantly lower than antidepressants.

The review provided as evidence is wide open to bias; it was criticised thus: “the authors’ findings did not reflect the evidence presented and limitations in study numbers, sample sizes and study pooling, particularly in some subgroup analyses, suggested that the conclusions are not reliable”. Moreover, we need to know that by no means all reviews of the subject confirm this positive conclusion, for instance, thisthis, or this one; all of the latter reviews are more up-to-date than the one provided by ANF. Crucially, a Cochrane review concluded that “the evidence is inconclusive to allow us to make any recommendations for depression-specific acupuncture”.

“A randomized controlled trial of acupuncture and counseling for patients presenting with depression, after having consulted their general practitioner in primary care, showed that both interventions were associated with significantly reduced depression at three months when compared to usual care alone.”

We have discussed the trial in question on this blog. It follows the infamous ‘A+B versus B’ design which cannot possibly produce a negative result.

Now, please re-read the first paragraph of this post; but be careful not to fall off your chair laughing.

There would be more (much more) to criticise in the ANF report but, I think, these examples are ENOUGH!

Let me finish by quoting from the ANF’s view on the future as cited in their new ‘white paper’: “Looking ahead, it is clear that acupuncture is poised to make significant inroads into conventional medicine. It has the potential to become a part of every hospital’s standard of care and, in fact, this is already starting to take place not only in the U.S., but internationally. The treatment is a cost-effective and safe method of relieving pain in emergency rooms, during in-patient stays and after surgery. It can lessen post-operative nausea, constipation and urinary difficulties, and have a positive impact on conditions like hypertension, anxiety and insomnia…

Driven by popular demand and a growing body of scientific evidence, acupuncture is beginning to be taken seriously by mainstream conventional medicine, which is incorporating it into holistic health programs for the good of patients and the future of health care. In order for this transition to take place most effectively, misunderstandings about acupuncture need to be addressed. We hope this white paper has helped to clarify some of those misunderstandings and encourage anyone with questions to contact the Acupuncture Now Foundation.”

My question is short and simple: IGNORANCE OR FRAUD?

 

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