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

detox

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It has been reported that a naturopath from the US who sold fake COVID-19 immunization treatments and fraudulent vaccination cards during the height of the coronavirus pandemic has been sentenced to nearly three years in prison. Juli A. Mazi pleaded guilty last April in federal court in San Francisco to one count of wire fraud and one count of false statements related to health care matters. Now District Judge Charles R. Breyer handed down a sentence of 33 months, according to Joshua Stueve, a spokesperson for the U.S. Department of Justice. Mazi, of Napa, was ordered to surrender to the Bureau of Prisons on or before January 6, 2023.

The case is the first federal criminal fraud prosecution related to fraudulent Centers for Disease Control and Prevention vaccination cards for COVID-19, according to the U.S. Department of Justice. In August, Breyer denied Mazi’s motion to withdraw her plea agreement after she challenged the very laws that led to her prosecution. Mazi, who fired her attorneys and ended up representing herself, last week filed a letter with the court claiming sovereign immunity. Mazi said that as a Native American she is “immune to legal action.”

She provided fake CDC vaccination cards for COVID-19 to at least 200 people with instructions on how to complete the cards to make them look like they had received a Moderna vaccine, federal prosecutors said. She also sold homeopathic pellets she fraudulently claimed would provide “lifelong immunity to COVID-19.” She told customers that the pellets contained small amounts of the virus and would create an antibody response. Mazi also offered the pellets in place of childhood vaccinations required for attendance at school and sold at least 100 fake immunization cards that said the children had been vaccinated, knowing the documents would be submitted to schools, officials said. Federal officials opened an investigation against Mazi after receiving a complaint in April 2021 to the Department of Health and Human Services Office of Inspector General hotline.

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On her website, Mazi states this about herself:

Juli Mazi received her doctorate in Naturopathic Medicine from the National University of Natural Medicine in Portland, Oregon where she trained in the traditional medical sciences as well as ancient and modern modalities that rely on the restorative power of Nature to heal. Juli Mazi radiates the vibrant health she is committed to helping her patients achieve. Juli’s positive outlook inspires confidence; her deep well of calm puts people at immediate ease. The second thing they notice is that truly she listens. Dr. Mazi’s very presence is healing.

On this site, she also advocates all sorts of treatments and ideas which I would call more than a little strange, for instance, coffee enemas:

Using a coffee enema is a time-tested remedy for detoxification, but it is not without risks. If you are not careful, the process can cause internal burns. In addition, improperly brewed coffee can lead to electrolyte imbalances and dehydration, and coffee enemas are not recommended for pregnant women or young children.

To make coffee enemas safe and effective, always choose quality organic coffee. A coffee enema should be free of toxins and pesticides. Use a reusable enema kit with stainless steel or silicone hosing for safety. Moreover, do not use a soft plastic or latex enema bags. It is also essential to limit the length of time that the coffee spends in the container.

A coffee enema should be held for 12 to 15 minutes and then released in the toilet. You may repeat the process as necessary. Usually, the procedure should be done once or twice a day. However, if you are experiencing acute toxicity, you can use a coffee enema as often as needed. Make sure you have had a bowel movement before making the coffee enema. Otherwise, the process may be hindered.

Perhaps the most interesting thing on her website is her advertisement of the fact that her peers not just tolerate such eccentricities but gave Mazi an award for ‘BEST ALTERNATIVE HEALTH & BEST GENERAL PRACTITIONER’.

To me, this suggests that US ‘doctors of naturopathy’ and their professional organizations live on a different planet, a planet where evidence counts for nothing and dangerously misleading patients seems to be the norm.

Camilla spent ten days at the end of October in a sophisticated meditation and fitness center in southern India. Life has recently been hectic for the Queen Consort: at 75, she has been in a non-stop succession of various ceremonies for the funeral of Elizabeth II, always one step behind her husband, not to mention her new status as sovereign… Enough to block her chakras in no time.

She came to the resort with her bodyguards and a handful of friends and was able to take advantage of the tailor-made treatments concocted for her by the master of the house, Dr Issac Mathai, who created this high-end holistic centre on a dozen hectares of scented gardens near Bangalore. The program includes massages, herbal steam baths, yoga, naturopathy, homeopathy, meditation, and Ayurvedic treatments to “cleanse, de-stress, soothe and revitalize the mind, body and soul”, as the establishment’s website states.

Guests are required to follow an individualized, meat-free diet, with organic food from the resort’s vegetable gardens, based on lots of salads or soups – Camilla is said to be a fan of sweet corn soup with spinach. Cigarettes and mobile phones are not allowed, although it is assumed that Camilla must have some privileges due to her status… and the basic rate for the suites, which starts at $950 a night – the price of the rooms varies between $260 and $760, the rate including a consultation with the doctors.

Charles and Camilla have been fans of the Soukya Centre in India for a decade. The place corresponds in every way to their deep-rooted convictions about health. Like her husband, Camilla is a follower of organic food, she also practices yoga and treats her face with creams made from nettle and bee venom. For his part, Charles has long been an advocate of alternative medicine, homeopathy, acupuncture, aromatherapy, and also hypnosis… He even set up a foundation to support complementary medicine by lobbying the British health service to include it in complementary therapies for certain patients, which caused an uproar among the pundits of traditional medicine.

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If you suspected I was (yet again) sarcastic about the royal couple, you are mistaken. The text above is only my (slightly shortened) translation of an article published in the French magazine LE POINT (even the title is theirs). I found the article amusing and interesting; so, I looked up the Indian health center. Here are some of the things I found:

The 1st impression is that they are not shy about promotion calling themselves THE WORLD’S BEST AYURVEDA TREATMENT CENTER. The doctor in charge was once a ‘Consultant Physician’ at the Hale Clinic in London, where he treated a number of high-profile people. As his professional background, he offers this:

M.D. (Homeopathy); Hahnemann Post-Graduate Institute of Homeopathy, London M.R.C.H, London; Chinese Pulse Diagnosis and Acupuncture, WHO Institute of Traditional Chinese Medicine, Nanjing, China; Trained (Mind-Body Medicine Programme) at Harvard Medical School, USA

The approach of the center is described as follows:

The fundamental principle underlying Holistic Treatment is that the natural defense and immune system of an individual when strengthened, has the potential to heal and prevent diseases. In the age of super-specialisation where human beings are often viewed as a conglomeration of organs, it is crucial to understand ourselves as multi-dimensional beings with a body, mind and spirit. These interconnected dimensions need to be in perfect harmony to ensure real well-being.

And about homeopathy, they claim this:

Homeopathy originated in 1796 in Germany, and was discovered by Dr. Samuel Hahnemann, a German scientist. Homeopathy is popular today as a non-intrusive, holistic system of medicine. Instead of different medicines for different parts of the body, one single constitutional remedy is prescribed. As a system of medicine, Homeopathy is highly scientific, safe, logical and an extremely effective method of healing. For over 200 years people have used Homeopathy to maintain their good health, and also to treat and cure a wide range of illnesses like allergies, metabolic disorders, atopic dermatitis, Rheumatoid arthritis, Auto-immune disorders.

At this stage, I felt I had seen enough. Yes, you are right, we did not learn a lot from this little exploration. No, hold on! We did learn that homeopathy is highly scientific, safe, logical, and extremely effective!

 

The question, however, is should we believe it?

The global interest in dieting has increased, and many people have become obsessed with certain fad diets, assuming they are magic bullets for their problems. A fad diet is a popular dietary pattern known to be a quick fix. This review article explores the current evidence related to the health impacts of (amongst others) detox diets (DDs). DDs are interventional diets specifically designed for toxins elimination, health promotion, and weight management. They involve multiple approaches, including total calorie restriction, dietary modification, or juice fasts, and often the use of additional minerals, vitamins, diuretics, laxatives, or ‘cleansing foods’. Some of the many DDs used today are listed below:

Diet type Duration Foods allowed Proposed claims
Liver cleansing diet 8 weeks Plant-based, dairy-free, low-fat, high-fiber, unprocessed foods are allowed. Epsom salt and liver tonics are also consumed. Improved energy levels and liver function Toxins removal Improved immune response Efficient metabolism of fats and better weight control
Lemon detox diet/Master cleanser 10 days A liquid-only diet based on purified water, lemon juice, tree syrup, and cayenne pepper. A mild laxative herbal tea and sea salt water is also incorporated. Toxins removal Shiny hair, glowing skin, and strong nails Weight loss
The clean cleanse 21 days Breakfast and dinner comprise probiotic capsules, cleanse supplements and cleanse shakes. A solid meal in lunch while avoiding gluten, dairy, corn, soy, pork, beef, refined sugars, some fruits, and vegetables. Toxins removal Improved energy, digestion, sleep, and mental health Reduction in joint pains, headaches, constipation, and bloating
Martha’s vineyard detox diet 21 days Herbal teas, vegetable soups and juices, specially formulated tablets, powders and digestive enzymes are on the menu. Weight loss Toxins removal Improved energy levels
Weekend wonder detox 48 h Protein-rich meals salads, detox-promoting superfoods, and beverages. Healthy lifestyle, spa treatments, and herbal remedies. Toxins removal Improved organ function Strengthen body Enhance beauty
Fat flush 2 weeks Large meals are replaced with dilute cranberries, hot water with lemon, pre-prepared cocktails, supplements, and small meals Toxins removal Reduced stress Weight loss Improved liver function
Blueprint cleanse 3 days Consumption of six pre-prepared vegetable and fruit juices is allowed per day. Toxins removal
The Hubbard purification rundown Several weeks Niacin doses along with sustained consumption of vitamin-A, B, C, D, and E. Daily exercise with balanced meals. Restriction of alcohol and drugs. Sitting in a sauna for ≤ 5 h each day. Toxins removal from fat stores Improved memory and intelligence quotient Better blood pressure and cholesterol levels

Currently, there is no good clinical evidence for the effectiveness of DDs and some evidence to suggest they might do harm. Many of the DD are liquid-based, low-calorie, and nutrient-poor. For example, a part of BluePrint Cleanse, Excavation Cleanse, provides only 19 g protein and 860 kcal/day which is far below the actual requirement. Food and Agriculture Organization (FAO) recommends a minimum of 0.83 g/kg body weight of high-quality protein and 1,680 kcal/day for an adult. DDs may also induce stress, raise cortisol levels, and increase appetite, resulting in binge eating and weight gain.

As no convincing positive evidence exists for DDs and detox products, their use needs to be discouraged by health professionals. Moreover, regulatory review and adequate safety monitoring should be considered.

Yesterday, L’EXPRESS published an interview with me. It was introduced with these words (my translation):

Professor emeritus at the University of Exeter in the United Kingdom, Edzard Ernst is certainly the best connoisseur of unconventional healing practices. For 25 years, he has been sifting through the scientific evaluation of these so-called “alternative” medicines. With a single goal: to provide an objective view, based on solid evidence, of the reality of the benefits and risks of these therapies. While this former homeopathic doctor initially thought he was bringing them a certain legitimacy, he has become one of their most enlightened critics. It is notable as a result of his work that the British health system, the NHS, gave up covering homeopathy. Since then, he has never ceased to alert us to the abuses and lies associated with these practices. For L’Express, he looks back at the challenges of regulating this vast sector and deciphers the main concepts put forward by “wellness” professionals – holism, detox, prevention, strengthening the immune system, etc.

The interview itself is quite extraordinary, in my view. While UK, US, and German journalists usually are at pains to tone down my often outspoken answers, the French journalists (there were two doing the interview with me) did nothing of the sort. This starts with the title of the piece: “Homeopathy is implausible but energy healing takes the biscuit”.

The overall result is one of the most outspoken interviews of my entire career. Let me offer you a few examples (again my translation):

Why are you so critical of celebrities like Gwyneth Paltrow who promote these wellness methods?

Sadly, we have gone from evidence-based medicine to celebrity-based medicine. A celebrity without any medical background becomes infatuated with a certain method. They popularize this form of treatment, very often making money from it. The best example of this is Prince Charles, sorry Charles III, who spent forty years of his life promoting very strange things under the guise of defending alternative medicine. He even tried to market a “detox” tincture, based on artichoke and dandelion, which was quickly withdrawn from the market.

How to regulate this sector of wellness and alternative medicines? Today, anyone can present himself as a naturopath or yoga teacher…

Each country has its own regulation, or rather its own lack of regulation. In Germany, for instance, we have the “Heilpraktikter”. Anyone can get this paramedical status, you just have to pass an exam showing that you are not a danger to the public. You can retake this exam as often as you want. Even the dumbest will eventually pass. But these practitioners have an incredible amount of freedom, they even may give infusions and injections. So there is a two-tier health care system, with university-trained doctors and these practitioners.

In France, you have non-medical practitioners who are fighting for recognition. Osteopaths are a good example. They are not officially recognized as a health profession. Many schools have popped up to train them, promising a good income to their students, but today there are too many osteopaths compared to the demand of the patients (knowing that nobody really needs an osteopath to begin with…). Naturopaths are in the same situation.

In Great Britain, osteopaths and chiropractors are regulated by statute. There is even a Royal College dedicated to chiropractic. It’s a bit like having a Royal College for hairdressers! It’s stupid, but we have that. We also have professionals like naturopaths, acupuncturists, or herbalists who have an intermediate status. So it’s a very complex area, depending on the state. It is high time to have more uniform regulations in Europe.

But what would adequate regulation look like?

From my point of view, if you really regulate a profession like homeopaths, it means that these professionals may only practice according to the best scientific evidence available. Which, in practice, means that a homeopath cannot practice homeopathy. This is why these practitioners have a schizophrenic attitude toward regulation. On the one hand, they would like to be recognized to gain credibility. But on the other hand, they know very well that a real regulation would mean that they would have to close shop…

What about the side effects of these practices?

If you ask an alternative practitioner about the risks involved, he or she will take exception. The problem is that there is no system in alternative medicine to monitor side effects and risks. However, there have been cases where chiropractors or acupuncturists have killed people. These cases end up in court, but not in the medical literature. The acupuncturists have no problem saying that a hundred deaths due to acupuncture – a figure that can be found in the scientific literature – is negligible compared to the millions of treatments performed every day in this discipline. But this is only the tip of the iceberg. There are many cases that are not published and therefore not included in the data, because there is no real surveillance system for these disciplines.

Do you see a connection between the wellness sector and conspiracy theories? In the US, we saw that Qanon was thriving in the yoga sector, for example…

Several studies have confirmed these links: people who adhere to conspiracy theories also tend to turn to alternative medicine. If you think about it, alternative medicine is itself a conspiracy theory. It is the idea that conventional medicine, in the name of pharmaceutical interests, in particular, wants to suppress certain treatments, which can therefore only exist in an alternative world. But in reality, the pharmaceutical industry is only too eager to take advantage of this craze for alternative products and well-being. Similarly, universities, hospitals, and other health organizations are all too willing to open their doors to these disciplines, despite the lack of evidence of their effectiveness.

 

We have repeatedly discussed the issue of detox as used in so-called alternative medicine (SCAM) and seen that, for a whole range of reasons, it is utter nonsense, e.g.:

But would it not be better to keep toxins from entering the body in the first place?

Yes, you suspected correctly: there are products that claim to do exactly this. Here is a particularly ‘impressive’ one:

ION* Gut Support seals cells in the gut lining, helping to keep toxins out of your body and strengthening the terrain upon which your microbiome can diversify. it uses Humic Extract (from Ancient Soil) and Purified Water.

Humic extract is sourced from ancient soil (roughly 60 million years old), and contains a blend of bacterial metabolites (aka, fulvate) as well as less than 1% of a variety of trace minerals and amino acids including chloride, sodium, lithium, calcium, phosphorus, sulfur, bromide, potassium, iron, antimony, zinc, copper, gold, magnesium, alanine, glycine, histidine, isoleucine, methionine, threonine, and valine.

… the trace minerals in our humic extract are naturally occurring, well below the RDI, and not meant to be used as supplementary to any deficiencies. The truly active compound in humic extract is the fulvate, a unique family of carbon molecules with oxygen-binding sites that are produced by bacteria when they digest nutrients. These molecules are the backbone of the ION* blend, helping with critical functions like cellular and microbial communication and chelation of nutrients.

The science behind ION* lies in strengthening the cellular integrity of your body’s barriers, including not just your gut, but your sinuses and skin as well. Keeping your cells connected keeps these barriers intact, which sets the stage (or “terrain” as we like to call it) for seamless interaction between you and your microbiome.

At ION*, we’re all about connection – starting with the very foundation of our science: tight junction integrity. Tight junctions are the seals between your cells which help to create defensive barriers at the gut, skin, and sinuses. They act intelligently to keep toxins and foreign particles out of the blood stream while also allowing nutrients to enter. These seals are protected by the carbon and mineral metabolites of bacterial digestion.

Unfortunately, tight junction barriers can be degraded with exposure to gluten, glyphosate (the main chemical in commercial herbicides like Roundup), and other environmental insults. ION* has been scientifically shown to promote the strengthening of this barrier through redox signaling, even in the face of those environmental insults.

Your body’s barriers know what to let in (nutrients) and what to ward off (toxins). But the barriers must be strong. ION* works to strengthen your gut, sinus, and skin barriers at a cellular level by fostering tight junction integrity, helping to promote this intelligent defense system at a foundational level.

So much scientific-sounding language can make your head spin.

Which toxins are we talking about?

Are there any clinical studies of the product?

Why is the product so expensive?

What exactly are Humic substances?

I found an answer to only the last question. Humic substances are organic compounds that are important components of humus, the major organic fraction of soil, peat, and coal, and also a constituent of many upland streams, dystrophic lakes, and ocean water.

I imagine that tightening the named junctions – if this is truly a realistic mechanism of action – might interfere with the absorption of all sorts of substances that the body needs for survival. I am, of course, speculating, but one should ask about the risks of using this product (other than the one to the consumer’s bank account).

What we need are clinical studies. And there seem to be none (if anyone knows one, please let me know).

So, what do we call again a health product that makes unsubstantiated claims?

Was it perhaps ‘snake oil’?

 

The last few days, I spent much of my time answering questions from journalists on the subject of Charles lll. [interestingly, almost exclusively journalists NOT writing for UK newspapers]. Unsurprisingly, they all wanted to know about the way Charles managed to close down my research department at Exeter University some 10 years ago.

The story is old and I am a bit tired of repeating it. So, nowadays I often refer people to Wikipedia where a short paragraph sums it up:

Ernst was accused by Prince Charles’ private secretary of having breached a confidentiality agreement regarding the 2005 Smallwood report. After being subjected to a “very unpleasant” investigation by the University of Exeter, the university “accepted his innocence but continued, in his view, to treat him as ‘persona non grata’. All fundraising for his unit ceased, forcing him to use up its core funding and allow its 15 staff to drift away.”[15] He retired in 2011, two years ahead of his official retirement.[10][25] In July 2011, a Reuters article described his “long-running dispute with the Prince about the merits of alternative therapies” and stated that he “accused Britain’s heir-to-the-throne Prince Charles and other backers of alternative therapies on Monday of being ‘snake-oil salesmen’ who promote products with no scientific basis”, and that the dispute “had cost him his job – a claim Prince Charles’s office denied”.[14][26] Ernst is a republican, and has supported Republic, an organisation which campaigns for the abolition of the British monarchy.[27]

Re-reading it yesterday, I noticed that the text is not entirely correct (a full account can be found here). Let me explain:

  • There never was a formal confidentiality agreement with signature etc. But I did feel bound to keep the contents of the Smallwood report confidential.
  • The investigation by my University was not just ‘very unpleasant’, it was also far too long. It lasted 13 months! I had to take lawyers against my own University!
  • In addition, it was unnecessary, not least because a University should simply establish the facts and, if reasonable, defend its professor from outside attacks. The facts could have been established over a cup of tea with the Vice Chancellor in less than half an hour.
  • When my department had been destroyed in the process, I retired voluntarily and was subsequently re-employed for half a year to help find a successor. In retrospect, I see this move as a smart ploy by the University to keep me sweet and prevent me from going to the press.
  • A successor was never hired; one good candidate was found but he was told that he had to find 100% of the funds to do the job. Nobody of high repute would have found this acceptable, and thus the only good candidate was not even tempted to accept the position.
  • The snake oil salesman story is an entirely separate issue (see here) that happened years later.
  • It is true that Charles’s office denied that Charles knew about his 1st private secretary writing to my Vice Chancellor asking him to investigate my alleged breach of confidence. However, as Sir Michael Peat started his letter with the words “I AM WRITING … AS THE PRINCE OF WALES’ PRIVATE SECRETARY…, I find this exceedingly hard to believe.
  • Even though Charles did a sterling job in trying, I did not become a republican. I do have considerable doubts that Charles will be a good King (his reign might even be the end of the monarchy), and I did help the republican cause on several occasions but I never formally joined any such group (in general, I am not a joiner of parties, clubs or interest groups).

To one of the journalists who recently interviewed me, I explained that I do not in the slightest feel sore, bitter, or angry on a personal level. Going into early retirement suited me perfectly fine, and thanks to that decision I enjoy life to the full. The significance of this story lies elsewhere: Charles’ intervention managed to permanently close the then worldwide-only department that systematically and critically investigated so-called alternative medicine. If you know another, please let me know.

I had totally forgotten this amusing little episode: According to THE GUARDIAN, Jacob Rees-Mogg (JRM) once tweeted that I should be locked up in the Tower of London!

If you are not from the UK, you may not know this Member of Parliament. So, let me explain.

JRM is the MP for North East Somerset and currently the ‘Minister for Brexit Opportunities and Government Efficiency’. His personal net worth is estimated to be well over £100 million. I probably don’t need to add much more about JRM; there is plenty about him on the Internet and on social media, for instance, this little gem:

Some of JRM’s medically relevant voting records are revealing:

  • He voted against raising welfare benefits five times in 2013.
  • He voted against higher benefits over long periods for those unable to work as a result of an illness or disability: 14 votes over 5 years.
  • Between 2012-2016, he voted 52 times to reduce the spending on welfare benefits.
  • He voted to exempt pubs and clubs where food is not served from the smoking ban in October 2010.
  • He voted against a law to make private vehicles smoke-free if a child is present.
  • He voted against allowing terminally ill people to be given assistance in ending their lives.

Wikipedia mentions that Rees-Mogg is against abortion in all circumstances, stating: “life begins at the point of conception. With same-sex marriage, that is something that people are doing for themselves. With abortion, that is what people are doing to the unborn child.” In September 2017, he expressed “a great sadness” on hearing about how online retailers had reduced pricing of emergency contraception. 

In October 2017, it was reported that Somerset Capital Management, of which Rees-Mogg was a partner, had invested £5m in Kalbe Farma, a company that produces and markets misoprostol pills designed to treat stomach ulcers but widely used in illegal abortions in Indonesia. Rees-Mogg defended the investment by arguing that the company in question “obeys Indonesian law so it’s a legitimate investment and there’s no hypocrisy. The law in Indonesia would satisfy the Vatican”. Several days later, it was reported that the same company also held shares in FDC, a company that sold drugs used as part of legal abortions in India. Somerset Capital Management subsequently sold the shares it had held in FDC. Rees-Mogg said: “I am glad to say it’s a stock that we no longer hold. I would not try to defend investing in companies that did things I believe are morally wrong”.

In a nutshell, JRM seems to stand for pretty much everything that I am against. But that is no reason to send me to the Tower of London. So, what exactly was JRM referring to when he wanted me locked up?

The Guardian article explains: At a press conference to mark his retirement [Ernst] agreed with a Daily Mail reporter’s suggestion that the Prince of Wales is a “snake-oil salesman”. In the living room of his house in Suffolk he unpacks the label with the precision on which he prides himself. “He’s a man, he owns a firm that sells this stuff, and I have no qualms at all defending the notion that a tincture of dandelion and artichoke [Duchy Herbals detox remedy] doesn’t do anything to detoxify your body and therefore it is a snake oil.” Far from regretting the choice of words and the controversy it has generated, he appears to relish it.

Looking back at all this bizarre story, I am surprised that JRM did not advocate chopping my head off in the Tower of London. He must have been in a benevolent mood that day!

The US Food and Drug Administration (FDA) state that dietary supplements can help people improve or maintain their overall health. But they may also come with health risks. Whether you’re a consumer of dietary supplements or it’s your job to inform and educate, it’s important to know the facts before deciding to take any dietary supplement.

Therefore, they launched the initiative, “Supplement Your Knowledge”. It aims to help inform health care professionals, consumers, and educators about dietary supplements.

“Dietary supplements can be valuable to your health but taking some supplements can also involve health risks,” Douglas Stearn, JD, deputy director for regulatory affairs in the FDA’s Center for Food Safety and Applied Nutrition, said in a statement. “These Supplement Your Knowledge resources will help provide consumers and health care professionals with facts to make informed decisions when determining if they want to use or recommend dietary supplements.”

In collaboration with the American Medical Association, publisher of JAMA, the FDA has developed a free continuing medical education program for physicians and other health care professionals about the regulation of dietary supplements, informing patients about their use, and reporting adverse events to the agency. The program includes 3 videos and accompanying educational materials. It is available on the FDA website and the AMA Ed Hub.

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The objectives of the program are:
1. Define dietary supplements
2. Describe how dietary supplements are regulated
3. Describe how dietary supplements are labelled and the types of claims permitted
4. Review potential interactions of dietary supplements with other supplements, medications, and laboratory tests
5. Identify adverse events and how to report them to FDA

Even though some parts of the program are quite specific to the US, I think that the initiative is most laudable and an excellent resource for physicians, SCAM practitioners, consumers, and decision-makers to learn more about this important subject.

The US Food and Drug Administration created the Tainted Dietary Supplement Database in 2007 to identify dietary supplements adulterated with active pharmaceutical ingredients (APIs). This article compared API adulterations in dietary supplements from the 10-year time period of 2007 through 2016 to the most recent 5-year period of 2017 through 2021. Its findings are alarming:

  • From 2007 through 2021, 1068 unique products were found to be adulterated with APIs.
  • Sexual enhancement and weight-loss dietary supplements are the most common products adulterated with APIs.
  • Phosphodiesterase-5 inhibitors are commonly included in sexual enhancement dietary supplements.
  • A single product can include up to 5 APIs.
  • Sibutramine, a drug removed from the market due to cardiovascular adverse events, is the most included adulterant API in weight loss products.
  • Sibutramine analogues, phenolphthalein (which was removed from the US market because of cancer risk), and fluoxetine were also included.
  • Muscle-building dietary supplements were commonly adulterated before 2016, but since 2017 no additional adulterated products have been identified.

The authors concluded that the lack of disclosure of APIs in dietary supplements, circumventing the normal procedure with clinician oversight of prescription drug use, and the use of APIs that are banned by the Food and Drug Administration or used in combinations that were never studied are important health risks for consumers.

The problem of adulterated supplements is by no means new. A similar review published 4 years ago already warned that “active pharmaceuticals continue to be identified in dietary supplements, especially those marketed for sexual enhancement or weight loss, even after FDA warnings. The drug ingredients in these dietary supplements have the potential to cause serious adverse health effects owing to accidental misuse, overuse, or interaction with other medications, underlying health conditions, or other pharmaceuticals within the supplement.”

These papers relate to the US where supplement use is highly prevalent. The harm done by adulterated products is thus huge. If we focus on Chinese or Ayurvedic supplements, the problem might even be more serious. In 2002, my own review concluded that adulteration of Chinese herbal medicines with synthetic drugs is a potentially serious problem which needs to be addressed by adequate regulatory measures. Twenty years later, we seem to be still waiting for effective regulations that protect the consumer.

Progress in medicine, they say, is made funeral by funeral!

 

Recently, I came across a remarkable paper about the German ‘Association of Catholic Doctors’ and homeopathic conversion therapy. Its author is Yannick Borkens from the College of Public Health, Medical and Veterinary Science, James Cook University, Townsville, QLD, Australia. I think, it is worth reading in full, but here I have just a few excerpts for you:

Even in modern Germany of the 21st century there is still homophobia and other intolerances towards different sexualities and genders. These are also evident in the presence of so-called conversion therapies, which are still offered although there are already legal efforts. Among those groups, the Bund katholischer Ärzte (Association of Catholic Doctors) is a unique curiosity. Although this group is no longer really active, it is currently moving into the German focus again due to criminal charges and reporting in the tabloid press. The aim of this paper is to bring the Bund katholischer Ärzte not only into a more scientific but also into a more international focus. Furthermore, it is an ideal example to show what strange effects homophobia can produce…

The Bund katholischer Ärzte was founded in the year 2004 as the katholische Ärztevereinigung (catholic medical association). In 2010, the name was changed to BkÄ—Bund katholischer Ärzte. The BkÄ was founded by Dr. (I) Gero Winkelmann, a general practitioner and homeopath based in Unterhaching (the second largest municipality in the district of Munich—Bavaria) ()…

Nowadays, the BkÄ is best known for its conversion therapies and its general homophobic attitude. On its website, the BkÄ describes these topics as special forms of therapy from a Catholic medical point of view (“allgemeine wie auch besondere Therapieformen aus katholischer-ärztlicher Sicht”) and to the extent to which certain forms of therapy are harmful or even acceptable to Christians (“[…] inwiefern gewisse Therapieformen schädlich oder für Christen überhaupt annehmbar sind”). The term therapies (“Therapieformen”) does not actually describe medical therapies, but rather actions, measures, character traits and sexualities like homosexuality. Other topics addressed by the BkÄ are abortions, the prohibition of contraceptives (condoms and birth control pills), but also medical and biologically ethical topics such as stem cell research (). However, The BkÄ is primarily concerned with homosexuality and conversion therapies. But these differ from the classic and well-known therapies, which are mostly psychotherapies. On his online presences, Gero Winkelmann describes not only his therapeutic approaches but also scientific backgrounds, which however do not stand up to modern scientific knowledge and can (and should) be called pseudoscientific.

… Dr. (I) Gero Winkelmann is a German general practitioner with the additional title Homöopathie (homeopathy)… Nowadays he is best known for his homophobic and comparable views. He describes himself as a doctor who also practices his Catholic faith at work (). According to him, this is achieved through three pillars: Christian ethics, especially at the beginning and the end of life (“Christliche Ethik, insbesondere am Lebensanfang und Lebensende”), prayers and visits to church services (“Gebete und Besuch von Gottesdiensten”) and to participate in church services on public holidays and also on working holidays, especially as a doctor on call who works at untimely times (e.g. holidays, at night) (“Gerade als Bereitschaftsarzt, der zu “Unzeiten” tätig ist (feiertags, nachts) […] die Gottesdienste an Feiertagen und auch an Werktagen (z.B. Rorate-Amt) zu besuchen”) ().

The point of Christian ethics, in particular, requires a closer look. “Christian ethics, especially at the beginning and the end of life” results in a pro-life view. In the United States, this pro-life view, also known as pro-life movement, results not only in demonstrations and political petitions but also in violence, sometimes with death consequences. Since 1993, at least 11 people have been killed in attacks on abortion clinics, mostly doctors and physicians who perform abortions. The perpetrators can often be assigned to a radical Christian spectrum (). In Germany, Winkelmann is both an opponent of abortion and contraceptives as well as an opponent of medical euthanasia. Before he became known throughout Germany through the establishment of the BkÄ, he founded the  association, which campaigns against abortion, but also against contraceptives and research such as stem cell therapy. The foundation was in the year 2000. However, there is neither an official establishment of the EPLD as an official association nor an official entry in the German association register. This also applies to the BkÄ (European Pro-Life Doctors, no publication date; ). In addition to the rejection of abortions and euthanasia, Winkelmann uses the EPLD webpage also to spread the view that condoms do not work and also do not help against AIDS. He explains this with the fact that the latex skin of the condom is too thin and the HI-Virus could penetrate it without any problems. According to him, this made condoms reflect a pseudo-security (). Furthermore, he also defended the statement of Pope Benedict XVI, that condoms could not help against AIDS. Pope Benedict XVI stated that on his Africa trip in 2009 (). Especially for men who have sex with men (MSM), the condom is an important means of protection against AIDS infections (). This is especially true in African countries that have a high AIDS rate. In some parts, the AIDS rate is 100 times higher than in the United States (with a similar sexual activity) ().

On his website, Winkelmann not only describes the scientific background of homosexuality and his conversion therapy (which, however, does not stand up to modern scientific findings) but also defends the use of conversion therapies in general. He describes that every bad state needs a reversal (conversion). Furthermore, users of those therapies should not be afraid of a reversal, inner maturation and strengthening of self-healing powers. In addition, users should not let themselves be deterred from improving the situation. Those statements prove that Winkelmann considers homosexuality to be an evil condition that requires conversion, which in turn leads to inner maturation. According to Winkelmann, there are various causes for homosexuality. The causes include hormones, liver damages, epigenetically transmitted syphilis or abuse in childhood (). Thus, he contradicts not only biological-medical but also socio-behavioral knowledge. However, his conversion therapies differ from the classic conversion therapies, which are often psychotherapies. In contrast to these, Winkelmann uses homeopathy in his conversion therapies. He himself does not call his therapy conversion therapy but constitution therapy. This constitution therapy is a whole-body therapy that is primarily intended to stimulate physical and emotional self-healing. In that therapy, he combines homeopathy with psychotherapy and religious care. At the beginning, the body is detoxified with sulfur globules and nosodes, globules made from pathological material. Winkelmann says that the therapy has already been successfully completed for many after this detoxification. It should be noted that there is no information available on the number of people who accepted Winkelmann’s offer. If the detoxification is not enough, a lengthy homeopathic therapy begins, which also includes psychological and religious support. In this therapy, Winkelmann uses Calcium Carbonicum and Clacium Phosphoricum globules. Religious support includes prayers, sacraments, anointing of the sick and the holy communion ().

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The article left me speechless. I don’t know what to say other than thank Dr. Borkens for publishing the paper. Therefore, I will leave this here without further comment

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