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

critical thinking

Sorry, but something I stated in my last post was not entirely correct!

I wrote that “I could not find a single study on Schuessler Salts“.

Yet, I do know of a ‘study’ of Schuessler Salts after all; I hesitate to write about it because it is an exceedingly ugly story that goes back to the ‘Third Reich’, and some people do not seem to appreciate me reporting about my research on this period.

The truth, however, is that I already did mention the Schuessler salts before on this blog: “…in 1941 a research unit was established in ‘block 5’ [of the Dachau Concetration Camp] which, according to Rascher’s biographer, Sigfried Baer, contained his department and a homeopathic research unit led by Hanno von Weyherns and Rudolf Brachtel (1909-1988). I found the following relevant comment about von Weyherns: “Zu Jahresbeginn 1941 wurde in der Krankenabteilung eine Versuchsstation eingerichtet, in der 114 registrierte Tuberkulosekranke homöopathisch behandelt wurden. Leitender Arzt war von Weyherns. Er erprobte im Februar biochemische Mittel an Häftlingen.” My translation: At the beginning of 1941, an experimental unit was established in the sick-quarters in which 114 patients with TB were treated homeopathically. The chief physician was von Weyherns. In February, he tested Schuessler Salts [a derivative of homeopathy still popular in Germany today] on prisoners.”

Wikipedia provides further details: [Im Dritten Reich] konnten erstmals mit staatlicher Billigung und Förderung Untersuchungen durchgeführt werden, in denen die behauptete Wirksamkeit „biochemischer“ Arzneimittel überprüft wurde. Solche Versuche fanden auch in den Konzentrationslagern Dachau und Auschwitz statt, unter Leitung des Reichsarztes SS Ernst-Robert Grawitz. Dabei wurden unter anderem künstlich herbeigeführte Fälle von Blutvergiftung und Malaria weitgehend erfolglos behandelt. Für die Häftlinge nahmen diese Experimente in den meisten Fällen einen tödlichen Ausgang.

My translation: During the Third Reich, it became possible for the first time possible to conduct with governmental support investigations into the alleged effectiveness of ‘biochemical’ Schuessler Salts. Such tests were carried out in the concentration camps of Dachau and Auschwitz under the leadership of Reichsarzt SS Ernst-Robert Grawitz. They involved infecting prisoners with sepsis and malaria and treating them – largely without success. Most of the prisoners used for these experiments died.

I also found several further sources on the Internet. They confirm what was stated above and also mention the treatment of TB with Schuessler Salts. Furthermore, they state that the victims were mostly Polish priests:

The last source claims that at least 28 prisoners died as a result of these unspeakably cruel experiments.

The most detailed account (and even there, it is just 2 or 3 pages) about these experiments that I could find is in the superb and extremely well-researched book ‘AUSCHWITZ, DIE NS MEDIZIN UND IHRE OPFER’ by Ernst Klee. In it (p 146), Klee cites Grawitz’s correspondence with Himmler where Grawitz discloses that, prior to the Dachau ‘Schuessler experiments’, there were also some in Auschwitz where all three victims had died. Apparently Grawitz tried to persuade Himmler to stop these futile and (even for his standards) exceedingly cruel tests; the prisoners suffered unimaginable pain before their deaths. However, Himmler reprimanded him sharply and instructed him to continue. Dr Kiesswetter was subsequently recruited to the team because he was considered to be an expert on the clinical use of Schuessler Salts.

[Another book entitled Der Deutsche Zentralverein homöopathischer Ärzte im Nationalsozialismus‘ also mentions these experiments. Its author claims that Weyherns was not a doctor but a Heilpraktiker (all other sources agree that he was a medic). In general, the book seems to down-play this deplorable story and reads like an attempt to white-wash German homeopathy during the Third Reich] .

Klee concludes his chapter by reporting the post-war fate of all the doctors involved in the ‘Schuessler experiments’:

Dr Waldemar Wolter was sentenced to death and executed.

Dr Hermann Pape disappeared.

Dr Rudolf Kiesswetter disappeared.

Dr Babor fled to Addis Abeba.

Dr Laue died.

Dr Heinrich Schuetz managed to become a successful consultant in Essen. Only in 1972, he was charged and tried by a German court to 10 years of jail. Several of his colleagues, however, certify that he was too ill to be imprisoned, and Schuetz thus escaped his sentence.

Why do I dwell on this most unpleasant subject?

Surely, this has nothing to do with today’s use of Schuessler Salts!

Do I do it to “smear homeopathy and other forms of complementary medicine with a ‘guilt by association’ argument, associating them with the Nazis“, as Peter Fisher once so stupidly put it?

No!

I have other, more important reasons:

  • I do not think that the evidence regarding Schuessler Salts is complete without these details.
  • I believe that these are important historical facts.
  • I feel that the history of alternative medicine during the Third Reich is under-researched and almost unknown (contrary to that of conventional medicine for which a very large body of published evidence is now available).
  • I feel it should be known and ought to be much better documented than it is today.
  • I fear that we live in times where the memory of such atrocities might serve as a preventative for a resurgence of fascism in all its forms.

A new acupuncture study puzzles me a great deal. It is a “randomized, double-blind, placebo-controlled pilot trial” evaluating acupuncture for cancer-related fatigue (CRF) in lung cancer patients. Twenty-eight patients presenting with CRF were randomly assigned to active acupuncture or placebo acupuncture groups to receive acupoint stimulation at LI-4, Ren-6, St-36, KI-3, and Sp-6 twice weekly for 4 weeks, followed by 2 weeks of follow-up. The primary outcome measure was the change in intensity of CFR based on the Chinese version of the Brief Fatigue Inventory (BFI-C). The secondary endpoint was the Functional Assessment of Cancer Therapy-Lung Cancer Subscale (FACT-LCS). Adverse events were monitored throughout the trial.

A significant reduction in the BFI-C score was observed at 2 weeks in the 14 participants who received active acupuncture compared with those receiving the placebo. At week 6, symptoms further improved. There were no significant differences in the incidence of adverse events of the two group.

The authors, researchers from Shanghai, concluded that fatigue is a common symptom experienced by lung cancer patients. Acupuncture may be a safe and feasible optional method for adjunctive treatment in cancer palliative care, and appropriately powered trials are warranted to evaluate the effects of acupuncture.

And why would this be puzzling?

There are several minor oddities here, I think:

  • The first sentence of the conclusion is not based on the data presented.
  • The notion that acupuncture ‘may be safe’ is not warranted from the study of 14 patients.
  • The authors call their trial a ‘pilot study’ in the abstract, but refer to it as an ‘efficacy study’ in the text of the article.

But let’s not be nit-picking; these are minor concerns compared to the fact that, even in the title of the paper, the authors call their trial ‘double-blind’.

How can an acupuncture-trial be double-blind?

The authors used the non-penetrating Park needle, developed by my team, as a placebo. We have shown that, indeed, patients can be properly blinded, i. e. they don’t know whether they receive real or placebo acupuncture. But the acupuncturist clearly cannot be blinded. So, the study is clearly NOT double-blind!

As though this were not puzzling enough, there is something even more odd here. In the methods section of the paper the authors explain that they used our placebo-needle (without referencing our research on the needle development) which is depicted below.

Park Sham Device Set

Then they state that “the device is placed on the skin. The needle is then gently tapped to insert approximately 5 mm, and the guide tube is then removed to allow sufficient exposure of the handle for needle manipulation.” No further explanations are offered thereafter as to the procedure used.

Removing the guide tube while using our device is only possible in the real acupuncture arm. In the placebo arm, the needle telescopes thus giving the impression it has penetrated the skin; but in fact it does not penetrate at all. If one would remove the guide tube, the non-penetrating placebo needle would simply fall off. This means that, by removing the guide tube for ease of manipulation, the researchers disclose to their patients that they are in the real acupuncture group. And this, in turn, means that the trial was not even single-blind. Patients would have seen whether they received real or placebo acupuncture.

It follows that all the outcomes noted in this trial are most likely due to patient and therapist expectations, i. e. they were caused by a placebo effect.

Now that we have solved this question, here is the next one: IS THIS A MISUNDERSTANDING, CLUMSINESS, STUPIDITY, SCIENTIFIC MISCONDUCT OR FRAUD?

This is a fascinating new review of upper neck manipulation. It raises many concerns that we, on this blog, have been struggling with for years. I take the liberty of quoting a few passages which I feel are important and encourage everyone to study the report in full:

The Minister of Health, Seniors and Active Living gave direction to the Health Professions Advisory Council (“the Council”) to undertake a review related to high neck manipulation.

Specifically, the Minister directed the Council to undertake:

1) A review of the status of the reserved act in other Canadian jurisdictions,

2) A literature review related to the benefits to patients and risks to patient safety associated with the procedure, and

3) A jurisprudence review or a review into the legal issues that have arisen in Canada with respect to the performance of the procedure that touch upon the risk of harm to a patient.

In addition, the Minister requested the Council to seek written input on the issue from:

  • Manitoba Chiropractic Stroke Survivors
  • Manitoba Chiropractic Association
  • College of Physiotherapists of Manitoba
  • Manitoba Naturopathic Association
  • College of Physicians and Surgeons of Manitoba
  • other relevant interested parties as determined by the Council

… The review indicated that further research is required to:

  • strengthen evidence for the efficacy of cervical spinal manipulations (CSM) as a treatment for neck pain and headache, “as well as for other indications where evidence currently does not exist (i.e., upper back and should/arm pain, high blood pressure, etc.)”
  • establish safety and efficacy of CSM in infants and children
  • assess the risk versus benefit in consideration of using HVLA cervical spine manipulation, which also involve cost-benefit analyses that compare CSM to other standard treatments.

… the performance of “high neck manipulation” or cervical spine manipulation does present a risk of harm to patients. This risk of harm must be understood by both the patient and the practitioner.

Both the jurisprudence review and the research literature review point to the need for the following actions to mitigate the risk of harm associated with the performance of cervical spine manipulation:

  • Action One: Ensure that the patient provides written informed consent prior to initiating treatment which includes a discussion about the risk associated with cervical spine manipulation.
  • Action Two: Provide patients with information to assist in the early recognition of a serious adverse event.

Chiropractic is hugely popular, we are often told. The fallacious implication is, of course, that popularity can serve as a surrogate measure for effectiveness. In the United States, chiropractors provided 18.6 million clinical services under Medicare in 2015, and overall spending for chiropractic services was estimated at USD $12.5 billion. Elsewhere, chiropractic seems to be less commonly used, and the global situation has not recently been outlined. The authors of this ‘global overview‘ might fill this gap by summarizing the current literature on the utilization of chiropractic services, reasons for seeking care, patient profiles, and assessment and treatment provided.

Systematic searches were conducted in MEDLINE, CINAHL, and Index to Chiropractic Literature from database inception to January 2016. Eligible articles

1) were published in English or French (not all that global then!);

2) were case series, descriptive, cross-sectional, or cohort studies;

3) described patients receiving chiropractic services;

4) reported on the following theme(s): utilization rates of chiropractic services; reasons for attending chiropractic care; profiles of chiropractic patients; or, types of chiropractic services provided.

The literature searches retrieved 328 studies (reported in 337 articles) that reported on chiropractic utilization (245 studies), reason for attending chiropractic care (85 studies), patient demographics (130 studies), and assessment and treatment provided (34 studies).

Globally, the median 12-month utilization of chiropractic services was 9.1% (interquartile range (IQR): 6.7%-13.1%) and remained stable between 1980 and 2015. Most patients consulting chiropractors were female (57.0%, IQR: 53.2%-60.0%) with a median age of 43.4 years (IQR: 39.6-48.0), and were employed.

The most common reported reasons for people attending chiropractic care were (median) low back pain (49.7%, IQR: 43.0%-60.2%), neck pain (22.5%, IQR: 16.3%-24.5%), and extremity problems (10.0%, IQR: 4.3%-22.0%). The most common treatment provided by chiropractors included (median) spinal manipulation (79.3%, IQR: 55.4%-91.3%), soft-tissue therapy (35.1%, IQR: 16.5%-52.0%), and formal patient education (31.3%, IQR: 22.6%-65.0%).

The authors concluded that this comprehensive overview on the world-wide state of the chiropractic profession documented trends in the literature over the last four decades. The findings support the diverse nature of chiropractic practice, although common trends emerged.

My interpretation of the data presented is somewhat different from that of the authors. For instance, I fail to share the notion that utilization remained stable over time.

The figure might not be totally conclusive, but I seem to detect a peak in 2005, followed by a decline. Also, as the vast majority of studies originate from the US, I find it difficult to conclude anything about global trends in utilization.

Some of the more remarkable findings of this paper include the fact that 3.1% (IQR: 1.6%-6.1%) of the general population sought chiropractic care for visceral/non-musculoskeletal conditions. Some of the reasons for attending chiropractic care reported by the paediatric population are equally noteworthy: 7% for infections, 5% for asthma, and 5% for stomach problems. Globally, 5% of all consultations were for wellness/maintenance. None of these indications is even remotely evidence-based, of course.

Remarkably, 35% of chiropractors used X-ray diagnostics, and only 31% did a full history of their patients. Spinal manipulation was used by 79%, 31% sold nutritional supplements to their patients, and 10% used applied kinesiology.

In general, this is an informative paper. However, it suffers from a distinct lack of critical input. It seems to skip over almost all areas that might be less than favourable for chiropractors. The reason for this becomes clear, I think, when we read the source of funding for the research: PJHB, AEB, SAM and SDF have received research funding from the Canadian national and provincial chiropractic organizations, either as salary support or for research project funding. JJW received research project funding from the Ontario Chiropractic Association, outside the submitted work. SDF is Deputy Editor-in-Chief for Chiropractic and Manual Therapies; however, he did not have any involvement in the editorial process for this manuscript and was blinded from the editorial system for this paper from submission to decision.

 

The fact that many dentists practice dubious alternative therapies receives relatively little attention. In 2016, for instance, Medline listed just 31 papers on the subject of ‘complementary alternative medicine, dentistry’, while there were more than 1800 on ‘complementary alternative medicine’. Similarly, I have discussed this topic just once before on this blog. Clearly, the practice of alternative medicine by dentists begs many questions – perhaps a new paper can answer some of them?

The aims of this study were to “analyse whether dentists offer or recommend complementary and alternative medicine (CAM) remedies in their clinical routine, and how effective these are rated by proponents and opponents. A second aim of this study was to give a profile of the dentists endorsing CAM.

A prospective, explorative, anonymised cross-sectional survey was spread among practicing dentists in Germany via congresses, dental periodicals and online (n=250, 55% male, 45% female; mean age 49.1±11.4years).

Of a set of 31 predefined CAM modalities, the dentists integrated plant extracts from Arnica montana (64%), chamomile (64%), clove (63%), Salvia officinalis (54%), relaxation therapies (62%), homeopathy (57%), osteopathic medicine (50%) and dietetics (50%). The effectiveness of specific treatments was rated significantly higher by CAM proponents than opponents. However, also CAM opponents classified some CAM remedies as highly effective, namely ear acupuncture, osteopathic medicine and clove.

With respect to the characteristic of the proponents, the majority of CAM-endorsing dentists were women. The mean age (50.4±0.9 vs 47.0±0.9years) and number of years of professional experience (24.2±1.0 vs 20.0±1.0years) were significantly higher for CAM proponents than the means for opponents. CAM proponents worked significantly less and their perceived workload was significantly lower. Their self-efficacy expectation (SEE) and work engagement (Utrecht work engagement, UWE) were significantly higher compared to dentists who abandoned these treatment options. The logistic regression model showed an increased association from CAM proponents with the UWES subscale dedication, with years of experience, and that men are less likely to be CAM proponents than women.

The authors concluded that various CAM treatments are recommended by German dentists and requested by their patients, but the scientific evidence for these treatments are often low or at least unclear. CAM proponents are often female, have higher SE and work engagement.

GIVE ME A BREAK!!!

These conclusion are mostly not based on the data provided.

The researchers seemed to insist on addressing utterly trivial questions.

They failed to engage in even a minimum amount of critical thinking.

If, for instance, dentists are convinced that ear-acupuncture is effective, they are in urgent need of some rigorous education in EBM, I would argue. And if they use a lot of unproven therapies, researchers should ask whether this phenomenon is not to a large extend motivated by their ambition to improve their income.

Holistic dentistry, as it is ironically often called (there is nothing ‘holistic’ about ripping off patients), is largely a con, and dentists who engage in such practices are mostly charlatans … but why does hardly anyone say so?

 

 

There has been a flurry of legal actions against manufacturers of homeopathic products (mostly) in the US. Many of these cases seem to settle out of court which means that we hardly hear about them. Of those that go to court, most are being won by the plaintiffs, but unfortunately some are also lost.

The recent case of Allen v. Hyland’s, Inc. is such an incidence. The US lawyer Robert G Knaier has analysed this case in detail and recently published a paper about it. The article is fascinating and well worth reading in full.

Here I take the liberty to show you a (shorted) section of Knaier’s paper where he asks what went wrong:

… How did a jury decide that Hyland’s did not misrepresent the efficacy of its products? Surely, the court’s instruction that Hyland’s would be liable only if the plaintiffs proved homeopathy “cannot work” contributed to the result. So long as defense experts were able to propose ways that homeopathy might work, the jury was left with the difficult decision—for laypersons, in any event—of rejecting that testimony.

But should the jury ever have been put in the position of having to make that choice? Should the defense experts ever have been allowed to testify? Had the court in Allen granted the plaintiffs’ motions to exclude those experts, the case likely would have ended with a settlement. Without the ability to put on evidence supporting its products, Hyland’s may very well have recognized that it had no realistic chance of prevailing at trial. But the court denied those motions.

In this respect, the court erred. There can be little doubt that expert testimony in support of the efficacy of homeopathy fails tests of admissibility. Consider the Federal Rules of Evidence and the factors that courts should evaluate under Daubert and its progeny. Is testimony that homeopathy is effective “the product of reliable principles and methods”?

In other words, does it have a “reliable foundation”? Is “the reasoning or methodology underlying [it] . . . scientifically valid”?  As explained above, homeopathy’s core principles—provings, like cures like, and the law of minimum dose—are based on little more than Samuel Hahnemann’s late eighteenth-century speculations. They were not developed through, nor have they been validated by, controlled scientific studies… the principles and efficacy of homeopathy have been “tested” and “subjected to peer review and publication” — but they have consistently failed those tests and the scrutiny of that review process… Indeed, the FDA has stated that it simply is “not aware of scientific evidence to support homeopathy as effective.”

Thus, homeopathy’s “rate of error” is known, and far from gaining “general acceptance” in the scientific and medical community, it has gained near-universal condemnation. The defense of homeopathy, in some respects, presents a classic example of “unjustifiably extrapolat[ing] from an accepted premise to an unfounded conclusion.”  Advocates extrapolate from the efficacy of vaccines that similia similibus currentur has a sound scientific basis, and from the concept of hormesis that providing ultralow doses is well-founded methodology. But as one contemporary skeptic has explained, unlike homeopathic remedies, vaccines actually “contain measurable numbers of antigen molecules,” and “act by well-understood scientific mechanisms”; and hormesis, even in the limited circumstances in which it appears to operate, “describes a response to a low dose, not to no dose.”  As Martin Gardner noted many decades ago, the defense of homeopathy thus begins with plausible-sounding principles, and then “exaggerate[s] them to the point of absurdity.”  In other words, it impermissibly extrapolates to “unfounded conclusion[s].”

Finally, the defense of homeopathy glaringly fails to “account for obvious alternative explanations.” Do people who take homeopathic remedies sometimes feel better? Of course they do. But studies of homeopathy have overwhelmingly concluded that the reason for this is not that homeopathy is actually efficacious, but rather because it is “the ideal placebo.” It is cheap. It has no side effects (unless, as discussed below, it is adulterated). And practitioners spend substantial time with their “patients,” thus encouraging psychosomatic effects.

In the end, advocates of homeopathy may have little to stand on other than that many people—including some “experts” who would gladly be paid to testify—inexplicably seem to believe that it works. But this will not do. That homeopathy has many believers does not validate it as a scientifically sound “field of expertise,” or color it, against nearly 200 years of evidence to the contrary, as one “known to reach reliable results for the type of opinion the expert would give.”  As our Supreme Court perhaps most saliently observed, “general acceptance” of a principle cannot “help show that an expert’s testimony is reliable where the discipline itself lacks reliability.” As the Court explained, general acceptance of “principles of astrology or necromancy,” for example, would not transform those subjects into appropriately reliable subjects of expert testimony.  The Court could easily have added homeopathy to that list.

Thus, in allowing the jury to receive testimony about the principles of homeopathy—not as a matter of historic curiosity, but as a matter of scientific validity—the Allen court arguably abdicated its gatekeeping responsibility to screen out unreliable expert testimony. By permitting “experts” to testify in favor of a field the bases of which defy basic principles of biology, chemistry, and physics — indeed, in some respects “basic logical principles” — the “integrity and fairness of the trial process” was compromised.

END OF QUOTE

I fully agree with Knaier. Allowing the ‘flat earth society’ to present to a court their views about the shape of our planet, while instructing the jury that they must accept them as ‘evidence’ (unless the plaintiff can prove it to be untrue) cannot be the right way forward. In fact, it is a method of preventing progress. Following this logic, I cannot imagine the proponents of any absurdity – however ridiculous – to not be victorious in court.

Knaier’s ultimate conclusion is, I think correct: “Trial courts have robust power and clear responsibility to preclude litigants from introducing irrelevant and unreliable evidence in support of purportedly scientific claims… To the extent that courts continue abdicating their evidentiary gatekeeping role in this way, they may contribute to a waste of time and resources, financial harm to consumers, and risks to public health. But to the extent that litigants and courts strengthen their spines in this regard, take seriously the dangers of unfounded expert testimony, and make genuine efforts to seek and grant its exclusion, they might contribute to the health and well-being of both the courts and those who turn to them for help.”

Several national organisations of sceptics give annual awards to people and institutions who do outstanding work and those who do the opposite. Later this week, I will travel to Vienna, for instance, to give away one of this year’s ‘GOLDENES BRETT’, a negative prize for the most outrageous BS of 2017. Such things are good fun but also important tools in fighting nonsense. I probably will report about it when I am back.

Earlier this year, the UK sceptics awarded Gwyneth Paltrow with the well-earned RUSTY RAZOR. The ‘Bent Spoon’ is a similar type of prize. It has just been awarded by the Australian Skeptics to the proponent of the most preposterous piece of pseudoscientific or paranormal piffle of the year. Past winners have included Pete ’Paleo’ Evans, the CSIRO’s head Larry Marshall, the ABC, the Pharmacy Guild of Australia, the University of Wollongong, and a psychic dentist.

This year’s nominations are listed here. The winner of the 2017 Bent Spoon is the National Institute of Complementary Medicine at the University of Western Sydney. “When they were nominated last year they said they’d have a closer look at their site,” said Eran Segev, president of Australian Skeptics Inc. “But they’re still promoting unproven treatments and now also involved in a project to establish a clinic for Traditional Chinese Medicine on the campus of the University of Western Sydney. The 2017 winner’s involvement is described as ‘clinical trials’, but the University acknowledges that the TCM clinic may be opened to the public – a highly dubious pseudomedicine given the imprimatur of university ‘research’. “

On this blog, we have discussed several of the NICM’s papers. An interesting article about the NICM can also be found here. To give you an additional flavour of their research, here are the conclusions of just 5 of their recent articles:

CONCLUSION: In our study of acupuncture for menopausal hot flashes, higher expectancy after the first treatment did not predict better treatment outcomes. Future research may focus on other determinants of outcomes in acupuncture such as therapist attention. The relationship between smoking and hot flashes is poorly understood and needs further exploration.

Conclusion: There is a clear need to understand breast cancer survivors’ needs for physical and psychological support as they aim to regain control over their life through their experience of illness. More studies are needed to measure and evaluate these outcomes and to help identify breast cancer survivors’ healthcare seeking behaviours, during and after the acute treatment stage that addresses their physical, emotional, and spiritual needs. These results aim to inform future research design and evaluate and develop support services that are patient-centred and focus on whole health outcomes, shared decision-making, and quality of life.

CONCLUSION: These results are important for healthcare providers as they work with patients to identify life experiences, including ‘loss/potential loss’ and ‘the need for preservation’, that have personal significance. Some patients may realize that ‘enough is enough’; something needs to change. These intrinsic motivating factors may also be the impetus for eventual recovery for some individuals.

CONCLUSIONS: 16 weeks of Bikram yoga significantly improved perceived stress, general self-efficacy and HRQoL in sedentary, stressed adults. Future research should consider ways to optimise adherence, and should investigate effects of Bikram yoga intervention in other populations at risk for stress-related illness.

CONCLUSIONS: These findings suggest that long-term acupuncture treatment has targeted regulatory effects on multiple brain regions in rats with Alzheimer’s disease.

The ‘Bent Spoon’ was awarded mostly, I think, because of the persistently misleading claims made on the websites of the NICM. Go and have a look – I am sure you will agree: they are highly deserving winners.

In my opinion, these awards deserve our support. They are an effective means of fighting charlatans and promoting progress. They should be publicised much more widely.

 

This is too wonderful (I found it on Twitter where it was posted by ‘Doctors Leonard and Michael Valentine’, chiropractors at Valentine Chiropractic in Fountain Valley, CA.) – I have to show it to you.

This could almost pass without a comment. But for what it’s worth, here are my 7 points:

  1. platitude,
  2. platitude,
  3. no, they do not easily move out of alignment, and if they do, you are severely ill and need urgent treatment but not chiropractic,
  4. subluxations as dreamt up by chiropractors are a myth; they simply do not exist,
  5. it is vital that we don’t disclose this BS, if not chiros need to find new jobs,
  6. chiros pretend to find subluxations because this is their livelihood,
  7. pathetic platitude.

 

This randomized controlled trial was aimed to investigate the effect of aromatherapy massage on anxiety, depression, and physiologic parameters in older patients with acute coronary syndrome. It was conducted on 90 older women with acute coronary syndrome. The participants were randomly assigned into the intervention and control groups. The intervention group received reflexology with lavender essential oil plus routine care and the control group only received routine care. Physiologic parameters, the levels of anxiety and depression in the hospital were evaluated using a checklist and the Hospital’s Anxiety and Depression Scale, respectively, before and immediately after the intervention.

Significant differences in the levels of anxiety and depression were reported between the groups after the intervention. The analysis of physiological parameters revealed a statistically significant reduction in systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate. However, no significant difference was observed in the respiratory rate.

The authors concluded that aromatherapy massage can be considered by clinical nurses an efficient therapy for alleviating psychological and physiological responses among older women suffering from acute coronary syndrome.

WRONG!

This trial does not show remotely what the authors think. It demonstrates that A+B is always more than B. We have discussed this phenomenon so often that I hesitate to mention it again. Any study with the ‘A+B versus B’ design can only produce a positive result. The danger that this result is false-positive is so high that it is best to forget about such investigations altogether.

Ethics committees should not accept such protocols.

Researchers should stop running such studies.

Reviewers should not pass them for publication.

Editors should not publish such trials.

THEY MISLEAD ALL OF US AND GIVE CLINICAL RESEARCH A BAD NAME.

It was the very first sentence of the Boiron US website on Oscillococcinum (we have discussed this amazing product before) that caught my attention: “Homeopathy is a therapeutic method that uses diluted substances to relieve symptoms.” I think this is demonstrably wrong.

  • Homeopathy is a therapeutic method that uses mostly the complete absence of an ingredient, and not ‘diluted substances’; specifically, Oscillococcinum is a  C 200 potency ( 1: 0000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000) which means the likelihood of any substance being present is zero.
  • Homeopathy is, according to Hahnemann, not ‘to relieve symptoms’ but to tackle the root cause of the condition. Hahnemann meant it to be a causal and not a symptomatic treatment (the truth is that it neither relieves symptoms or the root cause of anything).

And then the website continued to puzzle me by stating this: “The active ingredients in homeopathic medicines include diluted plants, animals or minerals that relieve the same symptoms they cause at full strength (i.e., a micro dose of coffee bean helps to relieve nervousness).” This is wrong too, I think:

  • there is no active ingredient in homeopathic medicines,
  • many of the mother tinctures used in homeopathy cause no symptoms whatsoever,
  • a zero dose is not a micro dose,
  • homeopathic coffee does not relieve nervousness better than a placebo.

Now my interest was aroused and I decided to read on. This is what I found under the heading of ‘Frequently Asked Questions’:

START OF QUOTE

Are there clinical studies on Oscillococcinum?

Yes. Two studies, published in peer-reviewed journals, show that Oscillococcinum helps to reduce the severity and shorten the duration of flu-like symptoms.1-2 The most recent study showed that 63 percent of the patients who took Oscillo at the onset of flu-like symptoms showed “clear improvement” or “complete resolution” of their symptoms after 48 hours, vs. 48% with a placebo.2

1Papp R, Schuback G, Beck E, et al. Oscillococcinum in patients with influenza-like syndromes: a placebo-controlled, double-blind evaluation. Br Homeopath J. 1998;87:69-76. 2Ferley JP, Zmirou D, D’Adhemar D, Balducci F. A controlled evaluation of a homeopathic preparation in the treatment of influenza-like syndromes. Br J Clin Pharmacol. 1989;27:329-335.

END OF QUOTE

Now, this is strange!

Why would they cite just two studies when there are several more? Surely they don’t want to be seen to be cherry picking!?!? The current Cochrane review by Mathie RT, Frye J, Fisher P., for instance, included 6 trials!

And what did this review show?

The authors concluded that “There is insufficient good evidence to enable robust conclusions to be made about Oscillococcinum® in the prevention or treatment of influenza and influenza-like illness. Our findings do not rule out the possibility that Oscillococcinum® could have a clinically useful treatment effect but, given the low quality of the eligible studies, the evidence is not compelling. There was no evidence of clinically important harms due to Oscillococcinum®.”

Even though the authors of this Cochrane review are amongst the most ardent homeopathy-promoters on the planet (if not they would not have included this odd 2nd sentence in the above quote), this conclusion does not seem to please Boiron (Christian Boiron seems to have not much time for critical thinking; in a recent, short interview he opined that “Il y a un Ku Klux Klan contre l’homéopathie” THERE IS A KU KLUX KLAN AGAINST HOMEOPATHY).

After studying all this, I ask myself whether Boiron is telling the truth.

What do you think?

 

 

 

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