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

death

1 2 3 10

On this blog, I have discussed the adverse events (AEs) of spinal manipulative therapy (SMT) with some regularity, and we have seen that ~ 50% of patients who receive SMT from a chiropractor experience some kind of AE. In addition there are many serious complications. In my book, I discuss, apart from the better-known vascular accidents followed by a stroke or death, the following:

  • atlantoaxial dislocation,
  • cauda equina syndrome,
  • cervical radiculopathy,
  • diaphragmatic paralysis,
  • disrupted fracture healing,
  • dural sleeve injury,
  • haematoma,
  • haematothorax,
  • haemorrhagic cysts,
  • muscle abscess,
  • muscle abscess,
  • myelopathy,
  • neurologic compromise,
  • oesophageal rupture
  • pneumothorax,
  • pseudoaneurysm,
  • soft tissue trauma,
  • spinal cord injury,
  • vertebral disc herniation,
  • vertebral fracture,
  • central retinal artery occlusion,
  • nystagmus,
  • Wallenberg syndrome,
  • ptosis,
  • loss of vision,
  • ophthalmoplegia,
  • diplopia,
  • Horner’s syndrome.

Considering this long list, we currently have far too little reliable information. A recent publication offers further information on this important topic.

The aim of this study was to identify beliefs, perceptions and practices of chiropractors and patients regarding benign AEs post-SMT and potential strategies to mitigate them. Clinicians and patients from two chiropractic teaching clinics were invited to respond to an 11-question survey exploring their beliefs, perceptions and practices regarding benign AEs post-SMT and strategies to mitigate them.

A total of 39 clinicians (67% response rate) and 203 patients (82.9% response rate) completed the survey. The results show that:

  • 97% of the chiropractors believed benign AEs occur.
  • 82% reported their own patients have experienced an AE.
  • 55% of the patients reported experiencing benign AEs post-SMT, with the most common symptoms being pain/soreness, headache and stiffness.
  • 61.5% of the chiropractors reported trying a mitigation strategy with their patients.
  • Yet only 21.2% of patients perceived their clinicians had tried any mitigation strategy.
  • Chiropractors perceived that patient education is most likely to mitigate benign AEs, followed by soft tissue therapy and/or icing after SMT.
  • Patients perceived stretching was most likely to mitigate benign AEs, followed by education and/or massage

 

The authors concluded that this is the first study comparing beliefs, perceptions and practices from clinicians and patients regarding benign AEs post-SMT and strategies to mitigate them. This study provides an important step towards identifying the best strategies to improve patient safety and improve quality of care.

The question that I have often asked before, and I am bound to ask again after seeing such results, is this:

If there were a drug that causes temporary pain/soreness, headache and stiffness in 55% of all patients (plus an unknown frequency of a long list of serious complications), while being of uncertain benefit, do you think it would still be on the market?

 

My new book has just been published. Allow me to try and whet your appetite by showing you the book’s introduction:

“There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking.” These words of Fontanarosa and Lundberg were published 22 years ago.[1] Today, they are as relevant as ever, particularly to the type of healthcare I often call ‘so-called alternative medicine’ (SCAM)[2], and they certainly are relevant to chiropractic.

Invented more than 120 years ago by the magnetic healer DD Palmer, chiropractic has had a colourful history. It has now grown into one of the most popular of all SCAMs. Its general acceptance might give the impression that chiropractic, the art of adjusting by hand all subluxations of the three hundred articulations of the human skeletal frame[3], is solidly based on evidence. It is therefore easy to forget that a plethora of fundamental questions about chiropractic remain unanswered.

I wrote this book because I feel that the amount of misinformation on chiropractic is scandalous and demands a critical evaluation of the evidence. The book deals with many questions that consumers often ask:

  • How well-established is chiropractic?
  • What treatments do chiropractors use?
  • What conditions do they treat?
  • What claims do they make?
  • Are their assumptions reasonable?
  • Are chiropractic spinal manipulations effective?
  • Are these manipulations safe?
  • Do chiropractors behave professionally and ethically?

Am I up to this task, and can you trust my assessments? These are justified questions; let me try to answer them by giving you a brief summary of my professional background.

I grew up in Germany where SCAM is hugely popular. I studied medicine and, as a young doctor, was enthusiastic about SCAM. After several years in basic research, I returned to clinical medicine, became professor of rehabilitation medicine first in Hanover, Germany, and then in Vienna, Austria. In 1993, I was appointed as Chair in Complementary Medicine at the University of Exeter. In this capacity, I built up a multidisciplinary team of scientists conducting research into all sorts of SCAM with one focus on chiropractic. I retired in 2012 and am now an emeritus professor. I have published many peer-reviewed articles on the subject, and I have no conflicts of interest. If my long career has taught me anything, it is this: in the best interest of consumers and patients, we must insist on sound evidence; not opinion, not wishful thinking; evidence.

In critically assessing the issues related to chiropractic, I am guided by the most reliable and up-to-date scientific evidence. The conclusions I reach often suggest that chiropractic is not what it is often cracked up to be. Hundreds of books have been published that disagree. If you are in doubt who to trust, the promoter or the critic of chiropractic, I suggest you ask yourself a simple question: who is more likely to provide impartial information, the chiropractor who makes a living by his trade, or the academic who has researched the subject for the last 30 years?

This book offers an easy to understand, concise and dependable evaluation of chiropractic. It enables you to make up your own mind. I want you to take therapeutic decisions that are reasonable and based on solid evidence. My book should empower you to do just that.

[1] https://pubmed.ncbi.nlm.nih.gov/9820267

[2] https://www.amazon.co.uk/SCAM-So-Called-Alternative-Medicine-Societas/dp/1845409701/ref=pd_rhf_dp_p_img_2?_encoding=UTF8&psc=1&refRID=449PJJDXNTY60Y418S5J

[3] https://www.amazon.co.uk/Text-Book-Philosophy-Chiropractic-Chiropractors-Adjuster/dp/1635617243/ref=sr_1_1?keywords=DD+Palmer&qid=1581002156&sr=8-1

When chiropractors try to play medical doctors, their patients are in danger. When they try to play epidemiologists, we might all be in danger. Already in April 2020, the Australian ‘Patrons of Chiropractic Science’ issued a press release on COVID 19 stating:

Good function of the body’s joints, particularly within the spine, may improve neurological function, which is important for an effective natural immune system. Treatment by a qualified and experienced chiropractor offers one of the most effective methods to improve and maintain good spinal joint function. The chiropractic profession attends to many patients, and like all other health workers, the profession truly cares for the welfare of every individual.

Now they have gone further. Their press release of 18/8/2020 states amongst other things:

  • Approximately 1.5% of those infected with SARS-CoV-2 may die; all people with a compromised immune system, that being the aged or those suffering a co-morbidity;
  • 98.5% of those infected with the COVID-19 virus suffer either no symptoms, mild symptoms or treatable symptoms no worse than seasonal influenza;
  • COVID-19 positive test numbers are largely irrelevant, as 98.5% of those testing positive will simply develop natural immunity and recover as the virus moves through the population. Recent studies by the UK based Centre for Evidence Based Medicine confirms increased COVID testing is the primary reason for increased case numbers, which have little relationship to mortality. The focus on case numbers is again designed to engender public fear and compliance;

Patrons of Chiropractic Science demands that the Victorian Government and its senior health officials cease distorting facts, stop blaming Victorian non-compliance for the increased positive testing numbers, and assume full responsibility for the aged care deaths and the current economic damage.

Simple facts: it is critical and more effective to isolate and protect the high-risk groups, effectively quarantine return travellers, but cease the illogical isolation of the vast majority of the population who are not at risk as the virus naturally circulates, and allow them to recommence working to save many businesses and initiate economic recovery.

________________________________

Implying that regular chiropractic manipulations improve immunity or protect people from the corona virus is bad enough. But the new press release is worse:

  1. It is not true that only people with impaired immune systems, of old age, or affected by other diseases die of COVID 19.
  2. It is not true that all of the 98.5% who do not die have treatable symptoms not worse than a flu; an undefined percentage of the survivors suffer from very severe and sometimes long-lasting conditions.
  3. It is not true that 98.5% of those testing positive will simply develop natural immunity and recover; many will not recover completely, and the question whether mildly affected individuals develop immunity and for how long is as yet unanswered.
  4. It is not true that COVID testing results are unrelated to mortality; the figures need, of course, careful interpretation; the percentage of positive tests per number of tests done, for instance, should be independent of the frequency of testing.
  5. It is not true that the vast majority of the population are not at risk, if the virus were to circulate naturally.

All this looks to me as though the ‘Patrons of Chiropractic Science’ are in urgent need of learning some science. Meanwhile, it would be most helpful, if they could keep quiet.

At present, we see a wave of promotion of Traditional Chinese Medicine (TCM) as a treatment of corona-virus infections. In this context, we should perhaps bear in mind that much of the Chinese data seem to be less than reliable. Moreover, I find it important to alert people to a stern warning recently published by two Australian experts. Here is the crucial passage from their paper:

We wish to highlight significant concerns regarding the association between traditional herbal medicines and severe, non-infective interstitial pneumonitis and other aggressive pulmonary syndromes, such as diffuse alveolar haemorrhage and ARDS which have emerged from Chinese and Japanese studies particularly during the period 2017−2019. Initially the association between traditional herbal therapies and pneumonitis was based on isolated case reports. These included hypersensitivity pneumonitis associated with the use of traditional Chinese or Japanese medicines such as Sai-rei-to, Oren-gedoku-to, Seisin-renshi-in and Otsu-ji-to (9 references in supplemental file). Larger cohorts and greater numbers now support this crucial relationship. In a Japanese cohort of 73 patients, pneumonitis development occurred within 3 months of commencing traditional medicine in the majority of patients [], while a large report from the Japanese Ministry of Health, Labor and Welfare, described more than 1000 cases of lung injury secondary to traditional medications, the overwhelming majority of which (852 reports) were described as ‘interstitial lung disease [].

Currently the constituent of traditional herbal medicines which is considered most likely to underlie causation of lung disease is Scutellariae Radix also known as Skullcap or ou-gon, which has been implicated through immunological evidence of hypersensitivity as well as circumstantial evidence, being present in all of those medicines outlined above []. Notably, skullcap is a constituent of QPD as used and described in the paper by Ren et al. relating to COVID-19 []. Scutellariae Radix-induced ARDS and COVID-19 disease share the same characteristic chest CT changes such as ground-glass opacities and airspace consolidation, therefore distinguishing between lung injury due to SARS-CoV-2 and that secondary to TCM may be very challenging. The potential for iatrogenic lung injury with TCM needs to be acknowledged []…

Morbidity and mortality from COVID-19 are almost entirely related to lung pathology []. Factors which impose a burden on lung function such as chronic lung disease and smoking are associated with increased risk for a poor outcome. Severe COVID-19 may be associated with a hypersensitivity pneumonitis component responsive to corticosteroid therapy []. Against this background the use of agents with little or no evidence of clinical efficacy and which have been significantly implicated in causing interstitial pneumonitis that could complicate SARS-CoV-2 infection, should be considered with extreme caution.

In conclusion, the benefits of TCM in the treatment of COVID-19 remain unproven and may be potentially deleterious. We recognise that there is currently insufficient evidence to prove the role of TCM in the causation of interstitial pneumonitis, however the circumstantial data is powerful and it would seem prudent to avoid these therapies in patients with known or suspected SARS-CoV-2 infection, until the evidence supports their use.

Declaration of Competing Interest: There are no conflicts to declare.

Frank Odds passed away on 7 July at the age of 75. He was well-known to regular readers of this blog. Having started to submit his views in 2014, he has contributed well over 1 500 insightful and helpful comments.

Prof Odds was a world leading expert in medical mycology, recognized internationally for his studies of fungal pathogens.  He was recognized as an authority by academics, clinicians and those in the pharmaceutical industry. The European Confederation of Mycology wrote:

He wrote the defining text on Candida and was a major authority on fungal pathogenesis and antifungal drugs (having led Janssen’s antifungal drug discovery programme for 10 years). In no small measure he helped establish the reputation of the Aberdeen Fungal Group as a pre-eminent presence in medical mycology and was an integral part of the foundations upon which the current University of Exeter MRC-CMM was formed. He was a concert level pianist and he played the piano for the singsong at the BSMM annual meeting that was an integral part of the traditions of this society. During his career he acted as President of the BSMM, as well as of ISHAM and the ECMM.

Prof Odds has published about 300 original research and review articles on the pathogenesis, diagnosis, epidemiology and treatment of fungal infections.  He acted as co-editor of the standard textbook ‘Clinical Mycology’ and was listed in the ISI Most Highly Cited Scientists (Microbiology) database in 2007 and he made many seminal contributions to his field.

Prof Odds led the antifungal drug discovery programme as Director of Bacteriology and Mycology at the Janssen Research Foundation (Johnson & Johnson) in Belgium for 10 years.  He played a major role in the development of anti-fungal medicines azole and triazole.  Eighteen patents bear Prof. Odds’ name as co-inventor and he served as a consultant and/or experimental contractor for more than 20 pharmaceutical companies.

Born on 29th August 1945 in Devon and educated in the South West of England.  He undertook undergraduate and PhD degrees at the University of Leeds and became a visiting Fellow at the Center for Disease Control, in Atlanta USA (1970–72) before returning to the UK to undertake a postdoctoral fellowship at the University of Leeds (1972–75).  He became a lecturer and then senior lecturer in Medical Microbiology at the University of Leicester (1975–89).  In 1992 he accepted the post of Director of Bacteriology & Mycology at the Janssen Research Foundation, Beerse, Belgium (1992–99), and in 1999 he became Professor of Medical Mycology in the Aberdeen Fungal Group of the University of Aberdeen.  He retired in 2009.

Prof Odds served as President of the International Society for Human and Animal Mycology, President of the European Confederation of Medical Mycology, Honorary Secretary and President of the British Society for Medical Mycology, and Chair of the Medical Mycology Division F of the American Society for Microbiology.  He was co-chair and chair of the Wellcome Trust Immunology and Infectious Disease grant panel and on numerous editorial boards of international journals including acting as Chief Editor of Current Topics in Medical Mycology.

Prof Odd’s honours included Fellowship of the Royal Society of Edinburgh, Fellowship of the American Academy of Microbiology, and Honorary Membership of the British and International Medical Mycology societies.  He received many prestigious prizes including an ISHAM award and medal, the Maxwell L. Littman Award from the New York Medical Mycology Society, and a Pfizer Award in Biology.  He was also awarded an MRCPath and FRCPath in recognition of his clinical expertise.

On 9 July, Frank’s wife sent me an email:

The sad news has arrived: Frank died on Tuesday night, peacefully at home as he had wished.

During the final few days, his health deteriorated rapidly, but he was extremely well cared for by the NHS District Nurses, who could not have been kinder or more solicitous…

I feel honoured by the indefatigable attention he devoted to my blog (particularly since I had never met him in person) and am sure that we all will all miss his critical and constructive comments.

This analysis was aimed at assessing the associations of acupuncture use with mortality, readmission and reoperation rates in hip fracture patients using a longitudinal population-based database. A retrospective matched cohort study was conducted using data for the years 1996-2012 from Taiwan’s National Health Insurance Research Database. Hip fracture patients were divided into:

  • an acupuncture group consisting of 292 subjects who received at least 6 acupuncture treatments within 183 days of hip fracture,
  • and a propensity score matched “no acupuncture” group of 876 subjects who did not receive any acupuncture treatment and who functioned as controls.

The two groups were compared using survival analysis and competing risk analysis.

Compared to non-treated subjects, subjects treated with acupuncture had

  • a lower risk of overall death (hazard ratio (HR): 0.41, 95% confidence interval (CI): 0.24-0.73, p = 0.002),
  • a lower risk of readmission due to medical complications (subdistribution HR (sHR): 0.64, 95% CI: 0.44-0.93, p = 0.019)
  • and a lower risk of reoperation due to surgical complications (sHR: 0.62, 95% CI: 0.40-0.96, p = 0.034).

The authors concluded that postoperative acupuncture in hip fracture patients is associated with significantly lower mortality, readmission and reoperation rates compared with those of matched controls.

That’s a clear and neat finding; the question is, what does it mean?

Here are a few possibilities for consideration:

  1. As a result of having at least 6 acupuncture sessions, patients had lower rates of mortality, readmission and reoperation.
  2. As a result of having lower rates of mortality, readmission and reoperation, patients used acupuncture.
  3. As a result of some other factor, patients had both lower rates of mortality, readmission and reoperation and at least 6 sessions of acupuncture.

Which of the three possibilities is the most likely?

  1. Some enthusiasts might think that acupuncture makes you live longer. But does anyone truly believe it reduces the likelihood of needing a reoperation? Seriously? Well, I don’t see even a hint of a mechanism by which acupuncture might achieve this. Therefore, I would categorise this possibility as highly unlikely.
  2. It stands to reason that patients who are alive and well use more acupuncture than those who are dead or in need of surgery. So, this possibility is not entirely inconceivable.
  3. It seems very likely that people who are more health conscious might use acupuncture and live longer, need less readmissions or surgery. No doubt, this possibility is by far the best explanation of the findings of this retrospective matched cohort study.

If that is so, does this paper tell us anything useful at all?

Not really (that’s why it was published in an acupuncture journal which few people would read)

On second thought, perhaps it does tell us something valuable: retrospective matched cohort studies are hopeless when it comes to establishing cause and effect!

New German Medicine?

German New Medicine?

What on earth is that?

German New Medicine (GNM) is the creation of Ryke Geerd Hamer (1935-2017), a German doctor. The name is reminiscent of the ‘Neue Deutsche Heilkunde’ created by the Nazis during the Third Reich. Hamer received his medical licence in 1963 but was later struck off because of malpractice. He then continued his practice as a ‘Heilpraktiker’. According to proponents, GNM Therapy is a spoken therapy based on the findings and research of the Germanic New Medicine of Dr.Hamer. On the understanding that every disease is triggered by an isolating and shocking event, GNM Therapy assists in finding the DHS (shocking moment) in our lives that preceded the dis-ease and in turn allowing our bodies to complete its natural healing cycle back to full health. Hamer believed to have discovered the ‘5 laws of nature’:

  • The Iron Rule of Cancer
  • The two-phased development of disease
  • Ontogenetic system of tumours and cancer equivalent diseases
  • Ontogenetic system of microbes
  • Natures biological meaning of a disease

Hamer also postulated that:

  • All diseases are caused by psychological conflicts.
  • Conventional medicine is a conspiracy of Jews to decimate the non-Jewish population.
  • Microbes do not cause diseases.
  • AIDS is just an allergy.
  • Cancer is the result of a mental shock.

None of Hamer’s ‘discoveries’ and assumptions are plausible or based on facts, and none of his therapeutic approaches have been shown to be effective.

 These days, I do not easily get surprised by what I read about so-called alternative medicine (SCAM), but this article entitled ‘Homoeopathy And New German Medicine: Two German Siblings‘ baffled me greatly. Here are a few short excerpts:

… German New Medicine (GNM) like Homoeopathy is one of the gentle healing methods. As siblings, they have some common features as well as their own unique features. So, let’s explore a unique relationship between these two siblings.

1) Holistic aspect:
Both therapeutic methods are believed in holistic concept of body. The disease condition in Homoeopathy and conflict in GNM are very similar in expression as they are reflecting on mental as well as physical level also. In Homoeopathy, Mind, Body and Soul are one of the important trios to understand the Homoeopathic philosophy. While in GNM, Psyche, Brain, Body are important aspect in learning the GNM. Let’s see these trio in their founder’s language,

• Homoeopathy:
Dr. Hahnemann in his oragnon of medicine, 6th edition mentioned about a unity of materialistic body and vital force. Last lines of aphorism 15 are as follows, “…although in thought our mind separates these two unities into distinct conceptions for the sake of easy comprehension.

• German New Medicine:
Dr. Ryke Geerd Hamer, founder of GNM said that, “The differentiation between psyche, brain and the body is purely academic. In reality, they are one.”

2) Disease origin concept:

• Homoeopathy:
In Homoeopathy, disease originates from the dynamic disturbances and followed by functional and pathological changes.

• German New Medicine:
In GNM, morbid condition starts from conflict in the psyche level and later it reflects on body. The common feature is the disturbance is at the all levels of man.

3) Cause of disease:

• Homoeopathy:
In Homoeopathy, among the web of causations, psyche (mind) is also considers as a cause of disease.

• German New Medicine:
So, in GNM, psyche is playing important role in cause of disease. When Conflict starts, its dynamic effect perceived first at mind level.

4) Individuality:

• Homoeopathy:
In Homoeopathy, diathesis is a predisposition for disease condition. i.e. According to the diathesis every individual suffers with their own individual morbid dispositions. Rheumatic diathesis, gouty diathesis, etc. are the examples of diathesis.

• German New Medicine:
In GNM, every individual suffers from the disease condition after the receiving conflict. It is different and depending upon the type of conflict they are receiving. E.g. lung cancer- death fright conflict, cervical cancer –female sexual conflict…

Conclusion:
Some similarities and with some own characteristics, these two healing methods are developing at a good length in medical science. The main aim of these both methods is – “to serve the suffering humanity in gentle way”…

_____________________

Could it be that the author forgot the most striking similarities between GNM and homeopathy? How about these points:

  • There is nothing truly gentle about either methods.
  • Both are based on bizarre fantasies, far removed from reality.
  • Both pretend to be a panacea.
  • Both lack proof of efficacy.
  • Both have the potential to kill patients (mostly through neglect).
  • Both mislead consumers.
  • Both are deeply anti-scientific.
  • Both dissuade patients from using evidence-based healthcare.
  • Both are in conflict with medical ethics.
  • Both have cult-like features.
  • Both are far from being recognised by proper healthcare.
  • Both have been repeatedly in conflict with the law.
  • Both were invented by deludes fanatics.

On his website, Phillip Hughes – D. Hom (Med), M.A.R.H, describes himself as follows:

In the early 1990’s my life was turned upside-down by a prolapsed disk in my back, putting me in traction in a hospital for 6 weeks! The doctor’s prognosis was poor, leaving me with little hope of full mobility, and no choice but to seek treatment elsewhere.

I decided on Homeopathy, and after treatment I experienced real change in my condition within a month, and was completely well within 3 months. I was so inspired by this I decided to study Homeopathy myself – and in 1994 I enrolled at the Hahnemann College of Homeopathy in London, qualifying in 1998.

After qualifying I set up my first clinic in Waterloo, Liverpool. I also became a senior lecturer at the Hahnemann College of Homeopathy, and founder of the Liverpool branch of the Hahnemann College.

I then moved my clinic to College Road Crosby, when I took up the role of secretary of Homeopathic Medical Association (since resigned). It was during this time that my wife Rosa found a lump in her breast, motivating us again to seek safer and alternative treatments, this time using Thermography. We now run Thermography and Homeopathic clinics side by side.

I had never heard of Mr Hughes until yesterday, when it was reported that he had treated a Sean Walsh, a young musician, for Hodgkin lymphoma that had initially been controlled with chemotherapy, but had later returned. Here is an excerpt from the sad story:

Sean was having scans at a clinic – Medical Thermal Imaging – run by a couple called Philip and Rosa Hughes. Philip Hughes, a homeopath, had previously told Sean’s parents he’d successfully treated Rosa for breast cancer. Dawn [Sean’s girlfriend] went along to Sean’s first appointment. “Phil was just talking all about how damaging chemotherapy is, you know, on the human body… saying, ‘I’ve had lots of people come to my clinic, but by the time I get them, they’re shot with all this chemotherapy, so I can’t help them … And then he was talking all about how you can change your diet, which can reverse cancer. He’d said that Rosa had developed breast cancer. She’d had a lump in her breast, and she decided not to do hospital treatment, and she was going to, you know, reverse the cancer herself. So obviously Sean’s listening to this thinking, ‘Well, if one person’s done it, and then I’m hearing other little stories off them, I can do this’. Sean’s scans did carry a disclaimer, stating that thermography does not see or diagnose cancer and recommending further clinical investigation. But the scan results seemed reassuring – and Sean was convinced his cancer had gone. ‘Medical Thermal Imaging’ describe their scans as “100% safe and radiation-free”.

To find out more about the service the Hughes were offering, a BBC reporter went to the clinic where Sean had his scans, posing as a patient who’d found a lump. They were seen by Rosa Hughes, who had provided scans for Sean. Rosa told our reporter that when she went to the breast clinic to have her lump investigated, she should have an ultrasound rather than a mammogram. This is a transcript of what she said: “Not a mammogram, because you’re going to get radiated, and it’s going to squash… and the amount of women that have had their tumours, the tumour burst, that spreads cancer.”

[The BBC] asked cancer specialist Prof Andrew Wardley, of Manchester’s Christie Hospital, to review the medical claims Rosa Hughes made to our reporter. “That’s preposterous. You don’t burst tumours, they are solid. You do squash the breast down to do a mammogram, it is unpleasant but it’s a short-term thing. You do not spread cancer by doing a mammogram, that’s a complete fallacy.” Rosa and Philip Hughes say they “utterly reject” the allegation that they gave Mr Walsh inappropriate advice. They added they had “consistently made clear” that thermography can only be used alongside other tests, such as MRIs or mammograms.

At first Sean believed he had cured his own cancer. But tragically Sean was wrong. Gradually his health declined, until he was rushed to hospital in Liverpool where medical staff found he had multiple tumours in his stomach and chest. He did eventually receive chemotherapy but it was too late.

Sean died in January 2019.

On Philip Hughes’ website, he advertises his services with the help of several testimonials from happy customers. Here is one of them:

In November 2000, I had an aggressive Sarcoma Tumour removed along with my left lung. Shortly after surgery I was referred to Weston Park Hospital, Sheffield for ‘follow up’ treatments where I was offered both chemotherapy and radiotherapy. At around the same time, I first visited Waterloo Homeopathic Clinic on a friends recommendation. After this initial introduction to Homeopathy I began ti educate myself about my condition and possible treatments. Consequently I considered chemotherapy to be a crude option and decided to refuse it. However, the frightening thought of this aggressive tumour returning encourages me to go ahead with a six week course of radiotherapy as a precaution alongside Homeopathic treatment. Accordingly this holistic approach resulted in my immune system being boosted by Homeopathy and my body prepared for this medical treatment. Leading up to the radiotherapy and during the six weeks of treatments, I took a rang of Homeopathic remedies. Radium Brom, in my opinion, was undoubtedly the input that enabled me to go through an intense course of treatment daily and continue my healthy recovery. I didn’t miss a days work and finished a half marathon only three weeks after completing the radiotherapy. I have since remained in good health and all checks been clear.

I have said it often, but it seems I have to say it again: the homeopathic remedy might be harmless, but the homeopath isn’t!

 

 

 

PS

The BBC documentary provides many more details about Sean and another of Mr Hughes’ patients. It also shows some rare footage from the inside of the Gerson clinic in Mexico where Sean went for a while. Very sad but well worth watching!!!

I have discovered ‘Google Scholar’!

Yes, of course, I knew about it, but I never used it much. In particular, I did not know it has a huge page just on me. So I had a good look at it (who would be able to resist?) and found many things of interest – for instance, the fact that (as of yesterday) my papers have been cited a total of 86 759 times, and that 4 of them have been cited more that a thousand times.

Here they are:

Interactions between herbal medicines and prescribed drugs AA Izzo, E Ernst

Drugs 61 (15), 2163-2175
1517* 2001
Fibrinogen as a cardiovascular risk factor: a meta-analysis and review of the literature

E Ernst, KL Resch
Annals of internal medicine 118 (12), 956-963
1491 1993
Influence of context effects on health outcomes: a systematic review

Z Di Blasi, E Harkness, E Ernst, A Georgiou, J Kleijnen
The Lancet 357 (9258), 757-762
1458 2001
The prevalence of complementary/alternative medicine in cancer: a systematic review

E Ernst
Cancer: Interdisciplinary International Journal of the American Cancer …
1124 1998

Two things are perhaps noteworthy here, I feel:

  1. Only 2 of the 4 papers are on research in so-called alternative medicine (SCAM).
  2. In the 4th paper, they forgot to add Barrie Cassileth who was its co-author.

Scanning my own articles, the real revelation was how much I owe to others, how many co-workers I have had, how many of them I had completely forgotten about, and how many have already gone forever.

So, allow me to take this opportunity to honour those who have passed away (in the order they appear on the page).

  • ARPAD MATRAI was a brilliant scientist, Olympic swimmer for Hungary, and close friend. He came to London in 1980 to work in my lab. After I had left, I attracted him to Munich where we had several hugely productive years together – until he died of leukaemia in 1988.
  • JOHN DORMANDY see here.
  • VERONIKA FIALKA was my senior registrar in Vienna and became a good friend. After I had left Vienna, she took over my position as head of the department. We then somehow lost contact and, one day, I received the sad news of her early death.
  • NASSIM KANJI was my PhD student at Exeter. She did very well, and we published several papers on autogenic training together.
  • PETER FISHER see here.
  • GEORGE LEWITH see here.
  • CHRIS SILAGY was a brilliant GP and researcher. We did not have much contact except for one paper we had together.
  • JOHN GARROW see here.
  • ANDREW HERXHEIMER see here.
  • WALLACE SAMPSON was a famous and brilliant US sceptic. We had various contacts and shared one paper.
  • P T FLUTE was head of haematology at St George’s Hospital, London while I worked there. I remember him as kind and supportive.

I owe more gratitude to these (and all my other) co-authors than I will ever be able to express.

 

When tested rigorously, the evidence for so-called alternatives medicine (SCAM) is usually weak or even negative. This fact has prompted many SCAM enthusiasts to become utterly disenchanted with rigorous tests such as the randomised clinical trial (RCT). They seem to think that, if the RCT fails to generate the findings we want, let’s use different methodologies instead. In other words, they are in favour of observational studies which often yield positive results.

This line of thinking is prevalent in all forms of SCAM, but probably nowhere more so that in the realm of homeopathy. Homeopaths see that rigorous RCTs tend not to confirm their belief and, to avoid cognitive dissonance, they focus on observational studies which are much more likely to confirm their belief.

In this context, it is worth mentioning a recent article where well-known homeopathy enthusiasts have addressed the issue of observational studies. Here is their abstract:

Background: Randomized placebo-controlled trials are considered to be the gold standard in clinical research and have the highest importance in the hierarchical system of evidence-based medicine. However, from the viewpoint of decision makers, due to lower external validity, practical results of efficacy research are often not in line with the huge investments made over decades.

Method: We conducted a narrative review. With a special focus on homeopathy, we give an overview on cohort, comparative cohort, case-control and cross-sectional study designs and explain guidelines and tools that help to improve the quality of observational studies, such as the STROBE Statement, RECORD, GRACE and ENCePP Guide.

Results: Within the conventional medical research field, two types of arguments have been employed in favor of observational studies. First, observational studies allow for a more generalizable and robust estimation of effects in clinical practice, and if cohorts are large enough, there is no over-estimation of effect sizes, as is often feared. We argue that observational research is needed to balance the current over-emphasis on internal validity at the expense of external validity. Thus, observational research can be considered an important research tool to describe “real-world” care settings and can assist with the design and inform the results of randomised controlled trails.

Conclusions: We present recommendations for designing, conducting and reporting observational studies in homeopathy and provide recommendations to complement the STROBE Statement for homeopathic observational studies.

In their paper, the authors state this:

It is important to realize three areas where observational research can be valuable. For one, as already mentioned, it can be valuable as a preparatory type of research for designing good randomized studies. Second, it can be valuable as a stand-alone type of research, where pragmatic or ethical reasons stand against conducting a randomized study. Additionally, it can be valuable as the only adequate method where choices are involved: for instance, in any type of lifestyle research or where patients have very strong preferences, such as in homeopathy and other CAM. This might also lead to a diversification of research efforts and a broader, more realistic, picture of the effects of therapeutic interventions.

My comments to this are as follows:

  1. Observational research can be valuable as a preparatory type of research for designing good randomized studies. This purpose is better fulfilled by pilot studies (which are often abused in SCAM).
  2. Observational research can be valuable as a stand-alone type of research, where pragmatic or ethical reasons stand against conducting a randomized study. Such situations rarely arise in the realm of SCAM.
  3. Observational research can be valuable as the only adequate method where choices are involved: for instance, in any type of lifestyle research or where patients have very strong preferences, such as in homeopathy and other CAM. I fail to see that this is true.
  4. Observational research leads to a diversification of research efforts and a broader, more realistic, picture of the effects of therapeutic interventions. The main aim of research into the effectiveness of SCAM should be, in my view, to determine whether the treatment per se works or not. Observational studies are likely to obscure the truth on this issue.

Don’t get me wrong, I am not saying that observational studies are useless; quite to the contrary, they can provide very important information. But what I am trying to express is this:

  • We should not allow double standards in medical research. The standards and issues of observational research as they exist in conventional medicine must also apply to SCAM.
  • Observational studies cannot easily determine cause and effect between the therapy and the outcome.
  • Observational studies cannot be a substitute for RCTs.
  • Depending on their exact design, observational studies measure the outcome caused by a whole range of factors, including the therapy per se, the placebo-effect, the natural history of the disease, the regression towards the mean.
  • Observational studies are particularly useful in effectiveness research, AFTER the efficacy of a therapy has been established by RCTs.
  • If RCT fail to show that a therapy is effective and observational studies seem to indicate that they work, the therapy in question is probably a placebo.
  • SCAM-enthusiasts’ preference for observational studies is transparently due to motivated reasoning.
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