EBM
This paper explored the intersection of science and pseudoscience in online discourse about detoxification, investigating how and to what extent they coexist on the web. Drawing on previous studies of internet health scams, it examines the discursive strategies used to either validate or refute alternative detox treatments. Using a corpus-assisted discourse studies approach, the present study analyses a corpus of texts (167,177 tokens) about detoxification randomly collected from the web.
The results show that corrective messages debunking the detox myth make up less than 10% of the corpus. Furthermore, many keywords in the corpus, such as “toxin(s),” are subject to constant renegotiation. Advocates of so-called alternative medicine (SCAM) use the term “toxin(s)” to justify detox treatments, while scientists criticize it as pseudoscientific.
The authors conclude thaat their study highlights how terminological ambiguity facilitates the mixing of science and pseudoscience, confusing readers. It also highlights the role of language in health-related misinformation and calls for interdisciplinary research to develop educational tools for health professionals.
Corpus-assisted discourse studies (CADSs) are related historically and methodologically to the discipline of corpus linguistics. Their principal endeavor is the investigation and comparison of features of particular discourse types, integrating into the analysis the techniques and tools developed within corpus linguistics. These include the compilation of specialised corpora and analyses of word and word-cluster frequency lists, comparative keyword lists and, above all, concordances. A broader conceptualisation of corpus-assisted discourse studies would include any study that aims to bring together corpus linguistics and discourse analysis.
The findings of this CADS can hardly surprise anyone who has been following this blog. We have often discussed the problem of pseudo-scientific language and the confusion it creates. Likewise, we have repeatedly dealt with the ‘detox myth’ and how it is being used by advocates of SCAM.
What is new is the finding that only 10% of of the discourse seems to come from people who debunk the ‘detox myth’. This is, of course, disappointing but not really surprising considering how much virtually the entire SCAM business relies on it.
So, to make it clear yet again:
- A toxin is a substance that is poisonous to our body.
- No ‘detox’ method from the realm of SCAM has been shown to remove a toxin from the human body.
As always, I would be delighted to learn more and to correct these statements, provided someone shows me good evidence to the contrary.
Considering the incessant promotion of the integration of so-called alternative medicine (SCAM) into conventional medicine, it seems high time to evaluate and carefully consider the opportunities and challenges that such a strategy would pose. This article addresses both; it was written on the basis of information published in the books and articles available in real and virtual libraries in a descriptive-explanatory way.
Integrating SCAM with conventional medicine brings many opportunities as well as numerous challenges. The most important challenges are legal and ethical challenges, regulation, formulation and implementation of the training program and attention to research-orientedness and validity of research. Every medical field needs legislation, control and legal supervision from inside and outside the organization. In addition to guaranteeing the quality, efficiency and reducing the risk of using tools and methods, this work prevents any abuse and fraud. This issue is more important in the field of complementary medicine, where there is a great need for a relationship based on trust between the therapist and the patient.
The authors concluded that integrating of traditional and complimentary medicine into conventional medicine, despite its many advantages, faces serious challenges that require appropriate stategies in the fields of law making, regulatory and quality control, education and research. In the legal field, it is necessary to have appropriate laws for the purpose of issuing employment licenses and clarifying the quality standards of specialists, including avoiding negligence and mistakes, and compensating for damages through increasing medical liability insurance coverage and ways to avoid legal liability, including acquiring Informed consent and privacy should be included in the rules. Regulation in both product and specialist sectors should be implemented carefully in terms of quality, safety and efficiency of products and methods.
The paper was written by two authors from the “Smart University of Medical Sciences, Tehran, Iran”. We therefore have to forgive them their often unclear English. Their paper does, however, alert us to important and much-neglected issues.
The ethical problems that arise through the use of SCAM are as significant as the legal ones. On this blog, I have repeatedly tried to alert the public to them, e.g.:
- UNESCO, bioethics, and so-called alternative medicine (SCAM)
- The lack of chiropractic ethics: “valid consent was not obtained in a single case”
- The Society of Homeopaths have a Code of Ethics, but seem to ignore it. I wonder why!
- Doctor homeopaths violate fundamental rules of ethics when practising homeopathy
- This RCT of a Chinese herbal mixture makes a mockery of science and medical ethics
- Pharmacists’ responsibilities vis a vis alternative medicine: the violation of healthcare ethics continues.
- Profits before ethics: pharmacist continue to recommend and sell bogus treatments
- The (lack of) ethics in alternative medicine
- The (lack of) ethics in alternative medicine
- THE CRIMINAL OFFENSE OF QUACK MEDICINE
- Food and Drug Administration issued warning letters to manufacturers of dietary supplements
- We have an ethical, legal and moral duty to discourage chiropractic neck manipulations
- Boots the Chemist, legal complaints, and alternative medicines
- Homeopathy on the NHS: the first legal challenge
- Time for the legal profession to have a serious look at homeopathy?
- A scale of misdemeanors by SCAM practitioners towards patients and the public
In my view, the ethical issues in and around SCAM are central to most of the problems we discuss on this blog. They are nonetheless strangely neglected by SCAM professionals, SCAM users, SCAM researchers and almost everyone else.
Why?
I have come to the conclusion that this is because addressing them adequately would more or less prevent the practice of SCAM – just think of the thorny issue of informed consent. Arguably, fully informed consent for a SCAM therapy is impossible or would chase away even the most enthusiastic parient.
In case you are looking for a book where the entire spectrum of ethical issues are concisely addressed, let me recomment our own work (it even received an award from the British Medical Association).
Robert F Kennedy Jr. (RFKJr.)recently said that he’s aiming to know the cause of the “autism epidemic” by September, and will be able to “eliminate those exposures” that he says are behind the condition. This and other statements lay bare the embarrassing ignorance of RFKJr. as it contains a surprising number of errors:
- There is no epidemic of autism. The figures he likes to quote are hugely inflated. According to a meta-analysis, 0.77% of children globally are diagnosed with ASD, with boys comprising 1.14% of this group. Notably, Australia showed the highest prevalence rate, with an effect size of 2.18, highlighting it as a critical area for public health focus. The increase observed by many is largely due to a widening of diagnostic criteria.
- He presupposes that autism is due to some type of exposure (he claimed: “We know it’s an environmental exposure.”). However, this is far from proven and several other possibilities exist; most experts think that a genetic predisposition is the most important factor.
- Even if he can identify an exposure, it is unclear that and how he might eliminate it.
- To do the necessary research by September is not realistic.
RFKJr. has hired another pseudo-scientist, David Geier, to conduct the research. If they approached the subject rationally, they would start by looking what research has already been done. Few areas of inquiry are more active that research into autism (Medline currently lists ~ 84 ooo papers on the subject).
Here are some examples of conclusions from recent meta-analyses showing subject areas where research might yield relevant findings and those that are likely to be dead ends:
Probable dead ends
- For children, strength of evidence was high for no increased risk of autism following measles, mumps, and rubella (MMR) vaccine.
- Our study provides evidence that in utero exposure to ADHD medications does not increase the risk of long-term neurodevelopmental disorders in offspring. This study replicates safety data for methylphenidate and extends it with new safety data on amphetamines and atomoxetine. These findings are crucial for informing clinical guidelines and helping healthcare providers and expectant mothers make informed decisions.
- This study indicates that individuals with Kawasaki disease have a higher risk for ADHD but not for Autism Spectrum Disorder (ASD).
- Results found no evidence to support a link between genetically predicted Human Herpesviruses infection and the risk of NDDs based on existing datasets.
- These findings indicate that prenatal painkiller exposure is unlikely to be a major determinant of the severity of neurodevelopmental outcomes in autistic children.
Possibly relevant
- Our study summarized research evidence on the genetic variants of ASD and provides a broad and detailed overview of ASD risk genes.
- Maternal diabetes is associated with an increased risk of neurodevelopmental disorders and impaired neurodevelopmental performance in children. Further high-quality research is needed to establish causality and clarify the associations between specific types of diabetes and the full spectrum of neurodevelopmental disorders.
- Suggestive evidence included the associations between pregnancy O3 exposure and autism spectrum disorder.
- Gestational exposure to valproate was associated with an increased risk of autism spectrum disorder.
- This study indicated that Bisphenol A (BPA) exposure was associated with an increased risk of neurodevelopmental disorders and problems (NDPs) in children, particularly in boys, underscoring the importance of considering BPA exposure as a potential risk factor for children’s brain health.
- Our study found a significant difference in dental caries severity between children and adolescents with Autism Spectrum Disorder (ASD) and those without ASD.
- The development of childhood ASD may be associated with screen exposure.
- The total number of cannabis exposed pregnancies (with ASD and ADHD as the outcomes) in world literature is small. However, cannabis use during pregnancy is, at the very least, a clear marker for adverse neurodevelopmental outcomes
- In this meta-analysis, the relationships between air pollutants and ASD risk revealed significant associations, particularly for PM2.5 and NO2. Exposure during preconception exhibited a protective trend, while postnatal exposure, particularly during the second year of life uncovered substantially higher ASD risk.
- While there was weak evidence for associations between antibiotic use in early-life and later neurodevelopmental outcomes, these were attenuated in sibling-controlled subgroup analyses. Thus, associations may be explained by genetic and familial confounding, and studies failing to utilise sibling-control groups must be interpreted with caution.
- The current findings suggest that Anorexia Nervosa (AN) frequently overlaps with both autistic traits and autistic symptomatology. Therefore, it is essential to evaluate autism and autistic traits in individuals with AN to tailor individualized treatment plans.
- Increased risk of autism in children is significantly associated with greater parents’ ages.
- Parental PMADs are significantly associated with an increased risk of NDDs in children.
Above, I wrote that rational scientists would approach the subject by evaluating the research that has already been done. So, why will Kennedy, Geier et al not do that?
Simple!
The very first meta-analysis cited above (confirmed by multiple further reviews) firmly establishes that the pursuit of RFKJr.’s obsession (vaccines cause autism) is a dead end! The issue has been researched, re-researched ad nauseam and laid to bed.
So, in order to confirm his belief, RFKJr. needs to spend all this money in order to find (or manipulate) some evidence that questions a rock-solid consensus. Once he has succeeded in this task, he will to do what all pseudo-scientists do best: he will pretend that correlations are prove of causation.
In the end, this will amount to a spectecular waste of money. Because some people will nevertheless believe RFKJr., it will also strengthen the anti-vax movement and thus further endanger public health.
WATCH THIS SPACE!
Yes, this was the (rather sensationalist) headline of a recent article in the Daily Mail that I allegedly wrote. Its unusual genesis might interest some of you.
I was contacted by a journalist who asked for a telephone interview on the subject of chiropractic as well as my recent book. I agreed under the condition that we do this not over the phone but in writing via email. So, he sent me his questions and I supplied the responses; here they are:
· What’s the absolute worst case scenario of seeing a chiropractor?
The worst that can happen is that you die. Certain manipulations that chiropractors regularly do can injure an artery that supplies part of the brain. This would then result in a stroke; and a stroke can of course be fatal. This is what happened, for example, to the American model Katie May. She had pinched a nerve in her neck on a photoshoot and consulted a chiropractor who manipulated her neck. This caused a tear to an artery in her upper spine. The result was a massive stroke of which she died a few days later.
· How did you first become interested in the topic?
I learned hands on spinal manipulation as a junior doctor. Later, as the head of the department of Physical Medicine and Rehabilitation at the University of Vienna, we used such techniques routinely. In 1993, I became chair of Complementary Medicine in Exeter, and my task was to scientifically investigate alternative therapies such as chiropractic. Recently, I decided to summarize all our research in a book.
· What did you learn from your research?
In essence, our investigations found that almost all the claims that chiropractors make are unsubstantiated. Their manipulations are not nearly as effective as they claim. More worryingly, they are also not free of risks. About 50% of patients who see a chiropractor suffer from side effects after spinal manipulation. These are usually not severe and disappear after 2 or 3 days. But, in addition, very serious complications like stroke, death, bone fractures, paralysis can also occur. Chiropractors say that these are rare, and I hope they are right, but the truth is that nobody knows because there is no system of monitoring such events. We once asked British neurologists to report cases of neurological complications occurring within 24 hours of cervical spine manipulation over a 12-month period. This unearthed a total of 35 cases. Particularly striking was the fact that none of these cases had previously been reported anywhere. So, the underreporting was exactly 100%. This tells me that, when chiropractors claim there are just a few such incidents, in truth there might be a few hundred or even thousand.
· Is there an especially shocking finding?
What I find particularly unnerving is the way chiropractors regularly disregard medical ethics. Take the issue of informed consent, for example. It means that we all have to fully inform patients about the treatment we plan to give. In the case of chiropractic spinal manipulation, it would need to include that the therapy is of doubtful effectiveness, that other options are more likely to help, and that the treatment carries very frequent minor as well as probably rare major risks. I do understand why chiropractors do often not provide this information – it would chase away most patients and thus impact of their income. At the same time, I feel that chiropractors should not be allowed to violate fundamental principles of medical ethics. This is not in the interest of patients!!!
· Why do you think patients are so keen on chiropractors?
I am not sure that they really are so keen; some are but the vast majority are not. Our own research suggests that, depending on the country, between 7 and 33% of the population see chiropractors. This means that between 93 and 67% have enough sense to avoid chiropractors.
· But what does the evidence actually show about the efficacy of chiropractic?
As it happens our most recent summary has just been published. It concluded that “it is uncertain if chiropractic spinal manipulation is more effective than sham, control, or deep friction massage interventions for patients with headaches” [Is chiropractic spinal manipulation effective for the treatment of cervicogenic, tension-type, or migraine headaches? A systematic review – ScienceDirect]. For other conditions the evidence tends to be even less convincing. The only exception might be chronic low back pain, according to another recent summary [Analgesic effects of non-surgical and non-interventional treatments for low back pain: a systematic review and meta-analysis of placebo-controlled randomised trials | BMJ Evidence-Based Medicine]. But here too, I would argue that other treatments are safer and cheaper.
· Are some chiropractors worse than others?
The profession is divided into 2 groups, the ‘straights’ and the ‘mixers’. The former believe in all the nonsense their founding father, DD Palmer, proclaimed 120 years ago, including that spinal manipulation is the only treatment for virtually all our ailments, and that vaccinations must be avoided at all cost. The mixers have realized that Palmer was a charlatan of the worst kind, focus on musculoskeletal conditions and use treatments borrowed from physiotherapy. Needless to say that the mixers might be bad, but the straights are even worse.
· What can patients do to keep safe?
Avoid chiropractors, go to a library and read my book.
· If you have backpain or joint pain what can you do instead?
There is lots people can do but advice has to be individualized. By far the best is to prevent back pain from happening. Here advice might include more exercise, loosing weight, changing your mattress, avoiding certain things like heavy lifting, etc. If you are acutely suffering, see a physio or a doctor, keep moving and be aware that over 90% of back pain disappears within a few days regardless of what you do.
________________________
I had insisted that I see his edits before this gets published, and a little while later I received the edited version. To my big surprise, the journalist had transformed the interview into an article allegedly authored by me. I told him that I was uncomfortable with this solution, and we agreed that he would make it clear that the article was merely based on an interview with me. I then revised the article in question and the result was the mentioned article published still naming me as its author but with a footnote: “As told in an interview with Ethan Ennals”
Never a dull day when you research so-called alternative medicine!
King Charles is, as we all know, one of the world’s most subborn (i.e. despite convincing evidence) supporter of homeopathy:
- After managing to get osteopathy and chiropractic regulated by statute, Charles had planned to do the same with homeopathy. Jonathan Dimbleby wrote in 1995: “It is now hoped that a Homeopathy Bill will be laid before the House in 1995 or 1996”
- Charles advocates homeopathy not just for humans but also for animals. Farmers in the UK, for instance, are being taught how to treat their livestock with homeopathy “by kind permission of His Royal Highness, The Prince Of Wales”
- Ainsworth, the UK homeopathic pharmacy, carries Charles’ royal warrant.
- Charles often supports homeopathic events with his presence and speeches. For instance, he opened the Glasgow Homeopathic hospital.
- The Smallwood report commissioned by Charles concluded that millions of pounds could be saved, if only the NHS used more homeopathy.
- The College of Medicine and Integrated Medicine of which Charles is a patron regularly promotes homeopathy.
- Charles regularly lobbied politicians urging them to make more homeopathy available via the NHS.
- In 2019, the Faculty of Homeopathy announced that His Royal Highness The Prince of Wales had accepted to become Patron of the Faculty of Homeopathy.
About a year ago, it was announced that the King is suffering from cancer. Since then, his illness is almost a daily subject of news and speculation. From what we hear, Charles is coping famously and well on the way to recovery (at least that is what I sincerely hope). Many who discuss the subject of Charles’ cancer are convinced that his relatively good health can only have one reason:
HOMEOPATHY
They are convinced that his treatment plan is prominently or even exclusively based on homeopathy. Here are some statements that I recently picked up on ‘X’:
- King Charles cured his cancer with herbal remedies & homeopathy & didn’t shed a hair like his DIL, if true they had cancer
- King Charles uses homeopathy. Is for his cancer in Bangalore.
- He hasn’t been sick at all ,he uses homeopathy and nobody that uses homeopathy will die of cancer .Was all to push a cancer so called vax ,like the other so called vaccines !!William unfortunately is more of the same ,and also Charles isn’t king !!
- Homeopathy . It is the only guaranteed cure for Cancer and majority of chronic illnesses worldwide proved. Although sneared at by our guilty House of Lords Health Committee. HRH King Charles was the patron of Homeopathic council for many many years, why is that ?
- King Charles has cancer diagnosis and elects to use natural remedy and Kate Middleton has cancer and opts for chemotherapy. I think that is weird. I understand the monarchy has always sought homeopathy as a first route for treatment and pharmaceutical as a last resort.
- Told my mom i think I have bone cancer and now shes making me eat onions is this the homeopathy stuff that king charles guy is doing
- As an Avid Homeopathy Enthusiast King Charles now has the superpower to cure cancer.
Similar hints can be found in articles about Charles’ cancer, e.g.: King Charles is likely using an “oxygen tent” and his proclivity for homeopathic remedies to help him battle cancer. Some also argue that Dr. Michael Dixon, who two years ago has been appointed as the HEAD OF THE ROYAL MEDICAL HOUSEHOLD, would have seen to Charles’ treatment being homeopathic in nature.
But all of this is pure speculation!
The question clearly is whether there is any reliable evidence.
I have done my best to find some … and I failed (if a reader knows more, please let me know). To the best of my knowledge, there is no evidence that Charles’ cancer is being treated with homeopathy. Contrary to the many who assume that he is being cured by a homeopath, I have always felt this to be most unlikely. I am sure that Charles receives the very best conventional treatments that scientific medicine has to offer.
Dr. Stephan Baumgartner, Deputy Director of the “Institute of Complementary and Integrative Medicine” in Bern, Switzerland, and Dr. Alexander Tournier, Research Associate at the same institution are well known defenders of homeopathy. They just published a paper entitled SCIENTIFIC EVIDENCE ON HOMEOPATHY. Needless to say that such an article is relevant for my blog and attracted my interest.
In their abstract, they claim that “the most recent meta-analyses of RCTs across all indications concluded that there is evidence for specific effects of homeopathic remedies superior to placebo when prescribed by a qualified homeopath. Furthermore, there are several meta-analyses on specific indications (e.g. allergic complaints, childhood diarrhoea) which provide evidence for specific effects of homeopathic preparations superior to placebo.”
As I have published several such papers, I had a look at which of them – if any – they quoted. It turns out they only cited the one entitled “Homeopathy for postoperative ileus? A meta-analysis“. Here is its abstract:
Homeopathic remedies are advocated for the treatment of postoperative ileus, yet data from clinical trials are inconclusive. We therefore performed meta-analyses of existing clinical trials to determine whether homeopathic treatment has any greater effect than placebo administration on the restoration of intestinal peristalsis in patients after abdominal or gynecologic surgery. We conducted systematic literature searches to identify relevant clinical trials. Meta-analyses were conducted using RevMan software. Separate meta-analyses were conducted for any homeopathic treatment versus placebo; homeopathic remedies of < 12C potency versus placebo; homeopathic remedies of > or = 12C potency versus placebo. A “sensitivity analysis” was performed to test the effect of excluding studies of low methodologic quality. Our endpoint was time to first flatus. Meta-analyses indicated a statistically significant (p < 0.05) weighted mean difference (WMD) in favor of homeopathy (compared with placebo) on the time to first flatus. Meta-analyses of the three studies that compared homeopathic remedies > or = 12C versus placebo showed no significant difference (p > 0.05). Meta-analyses of studies comparing homeopathic remedies < 12C with placebo indicated a statistically significant (p < 0.05) WMD in favor of homeopathy on the time to first flatus. Excluding methodologically weak trials did not substantially change any of the results. There is evidence that homeopathic treatment can reduce the duration of ileus after abdominal or gynecologic surgery. However, several caveats preclude a definitive judgment. These results should form the basis of a randomized controlled trial to resolve the issue.
And here is the paragraph from the article by Baumgartner and Tournier citing our paper:
Barnes et al. (1997) performed a systematic review and meta-analysis of controlled clinical
trials investigating the effects of a homeopathic treatment of postoperative ileus. Meta
analysis yielded a statistically significant (p < 0.05) weighted mean difference (WMD) in favour
of homeopathy (compared with placebo) on the time to first flatus. The exclusion of
methodologically weak trials did not substantially alter the results. The authors concluded
that “our analyses suggest that homeopathic treatment administered immediately after
abdominal surgery may reduce the time to first flatus when compared with placebo
administration”.
(The bits that I have put in bold print are the ones that appear in this paragraph.)
Are you puzzled?
Me too!
What they also forgot to mention is the fact that, in our paper, we explained that the partly positive outcome was produced by several small and flawed trials. They were the reason why eventulally a large and rigorous study was conducted. Its results showed homeopathy to be no better than placebo. Yet, in the meta-analysis this study was not large enough to out-weigh the rigorous trial (this is a well-known weakness of meta-analyses and requires carefull attention when interpreting the findings).
It seems important to note that after the rigorous trial, no further studies of homeopathy for post-operative ileus have emerged. The reason, it seems, is that this trial was conclusive and thus put the notion to rest that homeopathy might work for this highly prevalent condition.
Finally, as I merely looked at one single aspect, I wonder whether there are further misrepresentations in the Baumgartner/Tournier paper.
Here is my question to my readers: does the behavior of Baumgartner and Tournier amount to
- honest error,
- sloppiness,
- wishful thinking,
- dishonesty,
- fraud,
- scientific misconduct?
PLEASE, DO LET ME KNOW WHAT YOU THINK
Homeopathy is harmless – except when it kills you!
Death by homeopathy has been a theme that occurred with depressing regularity on my blog, e.g.:
- Death by homeopathy
- Another death by homeopathy
- Death by homeopathy?
- The case of a boy tortured to death with homeopathy
- Homeopathy is the death of the patient suffering from gangrene
Now, there is yet another sad fatality that must be added to the list. This case report presents a 61-year-old woman with metastatic breast cancer who opted for homeopathic treatments instead of standard oncological care. She presented to the Emergency Department with bilateral necrotic breasts, lymphedema, and widespread metastatic disease. Imaging revealed extensive lytic and sclerotic lesions, as well as pulmonary emboli. Laboratory results showed leukocytosis, lactic acidosis, and hypercalcemia of malignancy.
During hospitalization, patient was managed with anticoagulation and broad-spectrum antibiotics. Despite disease progression, patient declined systemic oncological treatments, leading to a complicated disease trajectory marked by frailty, sarcopenia, and functional quadriplegia, ultimately, a palliative care approach was initiated, and she was discharged to hospice and died.
This case highlights the complex challenges in managing advanced cancer when patients choose alternative therapies over evidence-based treatments. The role of homeopathy in cancer care is controversial, as it lacks robust clinical evidence for managing malignancies, especially metastatic disease.
Although respecting patient autonomy is essential, this case underscores the need for healthcare providers to ensure patients are fully informed about the limitations of alternative therapies. While homeopathy may offer emotional comfort, it is not a substitute for effective cancer treatments. Earlier intervention with conventional oncology might have altered the disease course and improved outcomes. The eventual transition to hospice care focused on maintaining the quality of life and dignity at the end-of-life, emphasizing the importance of integrating palliative care early in the management of advanced cancer to enhance patient and family satisfaction.
Even though such awful stories are far from rare, reports of this nature rarely get published. Clinicians are simply too busy to write up case histories that show merely what sadly must be expected, if a patient refuses effective therapy for a serious condition and prefers to use homeopathy as an “alternative”. Yet, the rather obvious truth is that homeopathy is no alternative. I have pointed it out many times before: if a treatment does not work, it is dangerously misleading to call it alternative medicine – one of the reasons why I nowadays prefer the term so-called alternative medicine (SCAM).
But what about homeopathy as an adjunctive cancer therapy?
In 2011, Walach et al published a prospective observational study with cancer patients in two differently treated cohorts: one cohort with patients under complementary homeopathic treatment (HG; n = 259), and one cohort with conventionally treated cancer patients (CG; n = 380). The authors observed an improvement of quality of life as well as a tendency of fatigue symptoms to decrease in cancer patients under complementary homeopathic treatment.
Walach and other equally deluded defenders of homeopathy (such as Wurster or Frass) tend to interpret these findings as being caused by homeopathy. Yet, this does not seem to be the case, as they regularly forget about the possibility of other, more plausible explanations for their results (e.g. placebo or selection bias). I am not aware of a rigorous trial showing that adjunctive homeopathy has specific effects when used by cancer patients (if a reader knows more, please let me know; I am always keen to learn).
So, is there a role for homeopathy in the fight against cancer?
My short answer:
No!
Robert F. Kennedy Jr. is coming out with so much stupidity, ignorance and quackery that it is getting difficult to keep up. A recent article reported that he touted two particular medications that have not been shown to work as first-line treatments for measles:
- the steroid budesonide,
- the antibiotic clarithromycin.
Kennedy claimed on X that the medications had been instrumental in treating around 300 children in Texas, and told Fox News that doctors prescribing them had seen “very, very good results.”
Consequently, families in Texas have turned to questionable remedies — in some cases, also prompted by the recommendation of two Texas doctors, Dr. Ben Edwards and Dr. Richard Bartlett. Kennedy called Edwards and Bartlett “extraordinary healers” who have “treated and healed” hundreds of children with budesonide and clarithromycin, sharing a photo of himself and the doctors with three Mennonite families whose children had become ill. Two of the families had each recently lost a daughter to measles: 6-year-old Kayley Fehr died in February and 8-year-old Daisy Hildebrand died last week. Neither child was vaccinated.
Edwards, a conventionally trained doctor who has shifted to promoting natural remedies and prayer, has been operating a makeshift clinic in Seminole, offering children these unproven treatments — including, according to a video posted by an anti-vaccine group, while he said he was sick with measles. Edwards has allied himself with the anti-vaccine movement in recent months, hosting influencers and activists on his podcast, including Andrew Wakefield.
“There is no evidence to support the use of either aerosolized budesonide or clarithromycin for treatment of children with measles,” said Dr. Adam Ratner, a spokesman for the American Academy of Pediatrics. Prescribing treatments that have not been vetted in clinical trials amounts to experimenting on patients, added Dr. Susan McLellan, a professor in the infectious diseases division at the University of Texas Medical Branch.
During the measles outbreak, both Edwards and Bartlett have each warned of risks associated with the MMR vaccine: Edwards claimed, falsely, that it causes “potentially” hundreds of deaths a year and Bartlett has said that the complications caused by measles, including brain swelling and pneumonia, can also be caused by the vaccine. In reality, the MMR vaccine, which is only given to children with healthy immune systems, has been overwhelmingly safe since its approval more than five decades ago, and has saved an estimated 94 million lives worldwide.
Public health experts said touting these medications as first-line treatments sends the wrong message. “By mentioning such treatments without that context, RFK Jr. continues to distract away from the prevention measure that incontrovertibly works — the vaccine,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security
A national public health organization is calling for RFK Jr. to resign citing “implicit and explicit bias and complete disregard for science.” Georges Benjamin, executive director of the American Public Health Association, said in a statement that concerns raised during Kennedy’s confirmation hearing last month have been realized, followed by massive reductions in staff at key health agencies.
What’s next? I aslk myself.
Perhaps homeopathy as a savior of the US healthcare system?
Watch this space.
This systematic review/network meta-analysis assessed whether relaxation and stress management techniques are useful in reducing blood pressure in individuals with hypertension and prehypertension. The authors retrieved all studies published in English of adults with hypertension (blood pressure ≥140/90 mm Hg) or prehypertension (blood pressure ≥120/80 mm Hg but <140/90 mm Hg). Studies were considered that compared non- pharmacological interventions used to promote relaxation or reduce stress with each other, or with a control group (eg, no intervention, waiting list, or standard care). Studies were assessed with the risk of bias 2 tool (RoB2), and those at high risk of bias were excluded from the primary analysis. The certainty of the evidence was assessed with CINeMA (Confidence in Network Meta- Analysis).
A total of 182 studies were included (166 for hypertension and 16 for prehypertension). Results from a random effects network meta-analysis showed that, at short term follow- up (≤3 months), most relaxation interventions appeared to have a beneficial effect on systolic and diastolic blood pressure for individuals with hypertension. Between study heterogeneity was moderate (τ=2.62- 4.73). Compared with a passive comparator (ie, no intervention, waiting list, or usual care), moderate reductions in systolic blood pressure were found for breathing control (mean difference −6.65 mm Hg, 95% credible interval −10.39 to −2.93), meditation (mean difference −7.71 mm Hg, −14.07 to −1.29), meditative movement (including tai chi and yoga, mean difference −9.58 mm Hg, −12.95 to −6.17), mindfulness (mean difference −9.90 mm Hg, −16.44 to −3.53), music (mean difference −6.61 mm Hg, −11.62 to −1.56), progressive muscle relaxation (mean difference −7.46 mm Hg, −12.15 to −2.96), psychotherapy (mean difference −9.83 mm Hg, −16.24 to −3.43), and multicomponent interventions (mean difference −6.78 mm Hg, −11.59 to −1.99). Reductions were also seen in diastolic blood pressure. Few studies conducted follow-up for more than three months, but effects on blood pressure seemed to lessen over time. Limited data were available for prehypertension; only two studies compared short term follow- up of relaxation therapies with a passive comparator, and the effects on systolic blood pressure were small (mean difference −3.84 mm Hg, 95% credible interval −6.25 to −1.43 for meditative movement; mean difference −0.53 mm Hg, −2.03 to 0.97 for multicomponent intervention). The certainty of the evidence was considered to be very low based on the CINeMA framework, owing to the risk of bias in the primary studies, potential publication bias, and imprecision in the effect estimates.
The authors concluded that the results of our study indicated that many relaxation interventions show promise for reducing blood pressure in the short term but the longer term effects are unclear. Future studies in this area should include adequate follow-up to establish whether the effects on blood pressure persist over time, both while the relaxation interventions are ongoing and after they have been completed. Researchers should also use rigorous study methods and reporting to minimise the risk of bias in the results. Finally, we encourage researchers to assess all relevant outcomes, including cardiovascular events and adverse events, as well as blood pressure itself.
I was asked to provide a comment on this paper for a ‘Science Media Centre Roundup’ – here is what I wrote:
“This is a rigorous and important review. Its findings are eminently plausible: just like stress would increase blood pressure, so does relaxation decrease it. The problem, as I see it, might be compliance. Stressed people tend to be chronically pressed for time, and relaxation techniques take considerably more time than simply swallowing an antihypertensive pill.”
In a recent post, I mentioned a new report which allegedly claimed that “employing chiropractors in the [English] health service could save £1.5 billion“. Thanks to ‘Blue Wode’, we can now read the original report, and I had a critical look at it. Here are some quotes of crucial passages from the report:
The objective of this analysis was to establish how chiropractors could help to address the unmet need of people with MSK [musculoskeletal] conditions, who are currently absent from work due to these conditions, on NHS MSK physiotherapy waiting lists …
To assess the available evidence on the relative effectiveness of chiropractors, physiotherapists and osteopaths a pragmatic literature review was undertaken. This consisted of a rapid, pragmatic search of existing literature evidence to explore the effectiveness of chiropractic interventions (in terms of productivity/return to work) compared with physiotherapists and/or osteopaths … The strategies were not designed to be ‘comprehensive’ but focused to target records for relevant studies whilst retrieving record numbers that were manageable within the project timescales and available resources…
The results of the analysis are based on the assumption that there are equivalent work-related outcomes associated with MSK physiotherapy and chiropractic care…
1,270 records were retrieved from the database searches and 41 records were sent by the BCA. 101 duplicates were removed, and the remaining 1,210 references were screened for inclusion. 18 studies met the eligibility criteria and were included in data extraction (see Appendix B for the study flow diagram). Included studies had the following study designs: five systematic reviews [29-32] (of which one was only a summary [33]), three non-systematic reviews [34, 35] with one running a meta analysis [36], five randomised controlled trials [37-41], three cohort studies [42-44], and two case series studies [26, 45]…
A pragmatic review of literature found that evidence of the effectiveness of chiropractors in helping people with MSK conditions to get back to work is sparse and poor quality. There is weak evidence to suggest that chiropractors treating MSK conditions would be able to achieve equivalent return-to-work outcomes as physiotherapists. If more robust evidence could be developed, it is feasible that chiropractors could be used to address supply shortages in treatment for MSK conditions. This would require the NHS to consider closely the clinical governance arrangements it would need to put in place to ensure patient safety. It would also need to review the type of treatment and advice that chiropractors were able to provide for people with MSK conditions.
The initial analysis carried out for this study estimated that there are almost 1.6 million people unable to work due to an MSK condition in the UK. Spare capacity in the chiropractic profession indicates that around 114,000 more people per year could be treated by chiropractors. This represents around 7% of the current waiting list. Chiropractors have an average waiting time of 1.5 weeks compared with a minimum of 11 weeks for physiotherapists.
If the spare chiropractor capacity was used to address MSK conditions preventing people from working, then this could improve workforce productivity by reducing the time people are waiting for treatment. Adopting a simple analysis, assuming that all of the spare capacity could be used in the most efficient way, the estimated value of the improvement in productivity is £612 million per year. Using the Markov model to factor in a wider range of potential outcomes provides a more conservative, more robust estimated value of £399 million per year. If minimum rather that median wages are used to value the productivity gain based on an 11 week wait then it would reduce to £258 million.
A range of factors may increase or decrease the potential productivity gains. If the 11-week waiting time for physiotherapists is an under-estimate and the waiting times are 18 or 24 weeks, then the productivity gain would increase to £713 million and £1 billion respectively.
This analysis focused on productivity costs only, but people may also potentially have better health outcomes and lower treatment costs if they are treated more quickly.
Recommendations
Key recommendations emerging from this research are:
- The NHS should consider commissioning pilot research studies to generate evidence to make the case for the use of chiropractors in providing treatment for people with MSK conditions to allow them to return to work more quickly.
- The NHS should consider how the potential use of chiropractors to provide treatment and advice for people with MSK conditions can help to address the demand, capacity and financial challenges facing the health and social care system. This would need to be within the constraints of clinical guidelines and governance, to ensure safety and effective outcomes.
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And here are a few critical points:
- What on earth is a “pragmatic literature review”; was the term invented to disguise tha fact that the review is not systematic and thus is a bonanza in cherry-picking? I had a look at the cited literature and can confirm that any critical assessment of chiropractic has been excluded.
- “The results of the analysis are based on the assumption that there are equivalent work-related outcomes associated with MSK physiotherapy and chiropractic care.” Are you kidding me? I thought the aim was to “assess the available evidence on the relative effectiveness of chiropractors, physiotherapists and osteopaths”. How can you then assume equivalent outcomes as a basis for conducting the research?
- “Included studies had the following study designs: five systematic reviews [29-32] (of which one was only a summary [33]), three non-systematic reviews [34, 35] with one running a meta analysis [36], five randomised controlled trials [37-41], three cohort studies [42-44], and two case series studies [26, 45].” So, just 5 RCTs are the basis of the evaluations? What did you do with the dozens of other RCTs in this area? Did they perhaps not fit your conclusions?
- “If more robust evidence could be developed, it is feasible that chiropractors could be used to address supply shortages in treatment for MSK conditions.” However, I predict that more robust evidence will show the opposite of what you seem to wish!
- “Ensure patient safety”. Yes, thanks for mentioning safety. The report neglects safety completely. In view of the known risks of chiropractic this seems a serious mistake!
- “The estimated value of the improvement in productivity is £612 million per year.” From my comments above, it follows that this wild and largely unsubstantiated estimate was guided by little more than wishful thinking.
- “This analysis focused on productivity costs only, but people may also potentially have better health outcomes and lower treatment costs if they are treated more quickly.” More likely people experience health outcomes that are very similar to those of doing nothing at all. In this case, it would follow that a lot of money might be saved if we scrap MSK treatments altogether.
This report is a transparent and dilettante attempt to push more chiropractic on the NHS, a move that would not improve much and could even put a few patients in wheelchairs.
