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

EBM

1 2 3 8

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.

 

Already in 2017, the Russian Academy of Sciences (RAS) had issued a statement saying that “The principles of homeopathy contradict known chemical, physical and biological laws and persuasive scientific trials proving its effectiveness are not available.”Now Russia’s ‘Commission against Pseudoscience’ called homeopathy a “pseudoscience” whose effectiveness hasn’t been proven, which is harmful to patients because they spend money and time on ineffective treatments.Since 1995, qualified doctors who are also trained in homeopathy have been licensed to practice homeopathic medicine in Russian hospitals and clinics, and their practice has been regulated. However, the Commission has now recommended that Russia’s Ministry of Health forbid doctors from prescribing homeopathic medicine and ban the homeopathic medicines themselves from state medical institutions. “Homeopathy is not harmless: patients spend a lot of money on drugs that don’t work and neglect means of treatment with proven effectiveness. This can lead to adverse outcomes, including death of the patient,” the Commission wrote.

In response to the recommendation, the health ministry announced the formation of a working group of medical experts to suggest proposals for further regulation of homeopathy. A spokesman said that medicines whose efficiency is not clinically proven should not be procured using public funds, nor prescribed to treat the sick.

Russia has proved a profitable market for foreign suppliers of homeopathic medicine such as French company Boiron, which opened its Russian subsidiary in 2005. “Today, the Russian market is our company’s fourth largest in terms of turnover, after France, the US and Italy. Russia has always been interesting for Boiron because of the large population, and a relatively high incidence of illness and lower level of medicine consumption in comparison with Europe,” general director of Boiron in Russia Irina Nikulina said.

According to figures from Russian pharmaceutical market analysts DSM Group, Boiron sold 35 percent of all the homeopathic medicine sold in Russia last year, or 2.88 billion rubles (USD 49.5 million) worth of medicine. Boiron produces Russia’s most popular homeopathic medicine, called Oscillococcinum, which is marketed to relieve flu symptoms and accounted for 18.98 percent of all homeopathic medicines sold in 2016.

__________________________

The many international initiatives aimed at minimising the harm done by homeopathy are slowly beginning to yield results. It took many years for politicians to realise that the supposedly harmless homeopathy is, in fact, not harmless at all. Homeopathy causes harm by:

  1. wasting people’s money,
  2. distracting patients from effective treatments,
  3. the ill-conceived advice homeopaths give to patients,
  4. making a mockery of evidence-based medicine,
  5. violating the principles of medical ethics,
  6. undermining rational thinking in society.

One therefore has to applaud Russia’s ‘Commission against Pseudoscience’, hope that the working group does produce robust advice, and support similar initiatives in other countries.

 

 

In 2015, the Hungarian Academy of Sciences stated that “Homeopathic remedies don’t meet the criteria of evidence based medicine”  and that homeopathic products should follow the same strict scientific standards as conventional drugs. In 2017, the Scientific Advisory Board of European Academies (EASAC) concluded that there is no substantial evidence that homeopathy works and may even be harmful to our health.

Now, Hungary is about to act. New regulation is tightening the marketing of homeopathic products in Hungary. From Wednesday this week, homeopathic remedies can only be distributed in Hungary without a therapeutic indication or claim. The reason for this move is that none of the products’ efficacy have been adequately confirmed by rigorous clinical trials.

In a statement, the Hungarian National Institute of Pharmacy and Nutrition (OGYÉI) said the changes are due to a law amendment that came into effect last year. The new regulation only allows homeopathic medicines with therapeutic indications authorized before Hungary’s accession to the EU (2004), to be marketed after July 1, 2020, if they have complied with the EU regulations on the marketing of these medicines.

Currently, Hungary has no homeopathic product with therapeutic efficacy proven in clinical trials. The product license of homeopathic products – in compliance with the legislation of the European Union – can be obtained by two different procedures in Hungary. The so-called simplified procedure can be used for “high-dilution products” marketed without a therapeutic indication, in which case the effectiveness of the product does not need to be certified.

The “normal” procedure is applicable to homeopathic medicinal products marketed for a therapeutic indication, in which case, just as any other medicinal products, therapeutic efficacy must be clinically proven. OGYÉI emphasized that from July 1st, the advertising of marketable homeopathic remedies may only contain the label text of the product, no additional information.

The move by the Hungarian authorities is, of course, most welcome. It brings Hungary finally in line with the rest of the EU. The many enthusiasts of homeopathy will no doubt suspect a worldwide conspiracy against homeopathy. If so, they merely disclose how far they have put their heads into the sand. Such measures are nothing but the long overdue actions towards abolishing double standards that have existed far too long and have helped nobody except the homeopathic industry.

Michael Dixon LVOOBEMAFRCGP has been a regular feature of this blog (and elsewhere). He used to be a friend and colleague until … well, that’s a long story. Recently, I came across his (rather impressive) Wikipedia page. To my surprise, it mentions that Dixon

See the source image“has been criticised by professor of complementary medicine and alternative medicine campaigner Edzard Ernst for advocating the use of complementary medicine. Ernst said that the stance of the NHS Alliance on complementary medicine was “misleading to the degree of being irresponsible.”[31] Ernst had previously been sympathetic to building a bridge between complementary and mainstream medicine, co-writing an article with Michael Dixon in 1997 on the benefits of such an approach.[32] Ernst and Dixon write “missed diagnoses by complementary therapists giving patients long term treatments are often cited but in the experience of one of the authors (MD) are extremely rare. It can also cut both ways. A patient was recently referred back to her general practitioner by an osteopath, who was questioning, as it turned out quite correctly, whether her pain was caused by metastates. Good communication between general practitioner and complementary therapist can reduce conflicts and contradictions, which otherwise have the potential to put orthodox medicine and complementary therapy in an either/or situation.”

REFERENCES

31) February 2009, 24. “Academics and NHS Alliance clash over complementary medicine”. Pulse Today.

32) ^ Update – the journal of continuing education for General Practitioners, 7th May 1997

I have little recollection of the paper that I seem to have published with my then friend Michael, and it is not listed in Medline, nor can I find it in my (usually well-kept) files; the journal ‘Update’ does not exist anymore and was obviously not a journal good enough for keeping a copy. But I do not doubt that Wiki is correct.

In fact, it is true that, in 1997, I was still hopeful that bridges could be built between conventional medicine and so-called alternative medicine (SCAM). But I had always insisted that they must be bridges built on solid ground and with robust materials.

Put simply, my strategy was to test SCAM as rigorously as I could and to review the totality of the evidence for and against it. Subsequently, one could consider introducing those SCAMs into routine care that had passed the tests of science.

Dixon’s strategy differed significantly from mine. He had no real interest in science and wanted to use SCAM regardless of the evidence. Since the publication of our paper in 1997, he has pursued this aim tirelessly. On this blog, we find several examples of his activity.

And what happened to the bridges?

I’m glad you ask!

As it turns out, very few SCAMs have so far passed the test of science and hardly any SCAM has been demonstrated to generate more good than harm. The material to build bridges is therefore quite scarce, hardly enough for solid constructions. Dixon does still not seem to be worried about this indisputable fact. He thinks that INTEGRATED MEDICINE is sound enough for providing a way to the future. I disagree and still think it is ‘misleading to the degree of being irresponsible’.

Who is right?

Dixon or Ernst?

Opinions about this differ hugely.

Time will tell, I suppose.

The objective of this survey was to assess the prevalence and types of so-called alternative medicine (SCAM) usage as well as the participants’ spirituality/religiousness in an outpatient department for endocrinology and metabolic diseases. All individuals visiting the outpatient department at a German university hospital from April to June 2009 were offered a standardized questionnaire on the use of dietary supplements and other SCAMs as well as their religiousness/spirituality. Demographic and clinical data of 428 respondents were taken from the electronic health record.

Of the respondents, 16.4% (n = 66) classified themselves to be religious/spiritual and 67.9% (n = 273) as not religious/spiritual. The results show that:

  • 41.4% of the respondents used supplements and 27.4% additional therapies;
  • the use of supplements and other SCAMs was more frequent in people with higher religiousness/spirituality (p = 0.005 and p = 0.01,resp.);
  • there were no associations between religiousness/spirituality and the number of consultations, costs for drugs, appraisal of the physicians treatment methods, the perceived effectiveness of prescribed drugs, fear of late complications or of side effects.

The authors concluded that a higher religiousness/spirituality is associated with a more frequent use of supplements or additional therapies in individuals with endocrinopathies or metabolic diseases. As SCAM has been shown to be associated with worse outcome, addressing religiousness/spirituality which stresses the responsibility of the person for his life might offer an additional resource and should be further studied.

This survey has a dismal sample size and even worse response rate and must therefore be taken with more than a pinch of salt. Yet vaguely similar associations have been shown before. For instance, analysing data from the 1995-1996 National Survey of Midlife Development in the United States (n=3032), researchers examined the correlations between four aspects of spirituality/religiousness-i.e., spiritual only, religious only, both spiritual and religious, and neither spiritual nor religious-and six measures of SCAM. Compared with spiritual only persons, the odds of using energy therapies were 86% lower for spiritual and religious persons, 65% lower for religious only persons, and 52% lower for neither spiritual nor religious persons. Compared to spiritual only persons, spiritual and religious individuals were 43% more likely to use body-mind therapies in general; however, when this category did not contain prayer, meditation, or spiritual healing, they were 44% less likely. Religious only individuals were disinclined toward SCAM use.

There might be considerable cultural and national differences, of course, but if it is true that religiousness/spirituality is associated with a more frequent use of SCAM, we ought to ask what the nature of the link between the two might be. There are, as far as I can see, three possibilities:

  1. religiousness/spirituality causes SCAM use;
  2. SCAM use causes religiousness/spirituality;
  3. the two are related via one or several other factors.

I see no reason why 1 or 2 should be true. More likely there is a common denominator. The obvious one might be that both religiousness/spirituality and SCAM use are somewhat irrational, more a matter of belief than evidence, and revealing a lack of scepticism or critical thinking. In this case, religiousness/spirituality and SCAM use would simply be two different expressions of the same frame of mind.

What do you think?

 

 

In the wake of both the NEJM and the LANCET withdrawing two potentially influential papers due unanswered questions about the source and reliability of the data, one has to ask how good or bad the process of peer review is.

Peer review is the evaluation of work by one or more people with similar competences as the producers of the work (peers). It functions as a form of self-regulation by qualified members of a profession within the relevant field. It normally involves multiple steps:

  1. Authors send their manuscript to a journal of their choice for publication.
  2. The journal editor has a look at it and decides whether to reject it straight away (for instance, because the subject area is not of interest) or whether to send it out to referees for examination (often to experts suggested by the authors of the submission).
  3. The referees (usually 2 or 3) have the opportunity to reject or accept the invitation to review the submission.
  4. If they accept, they review the paper and send their report to the editor (usually following a deadline).
  5. The editor tries to come to a decision about publication; often the referees are not in agreement, and a further referee has to be recruited.
  6. Even if the submission is potentially publishable, the referees will have raised several points that need addressing. In such cases, the editor sends the submission back to the original authors asking them to revise the article.
  7. The authors do their revision (often following a deadline) and re-submit their paper.
  8. Now the editor can decide to either publish it or send it back to the referees asking them whether they feel their criticisms have been adequately addressed.
  9. Depending on the referees’ verdicts, the editor makes the final decision and informs all the involved parties accordingly.
  10. If the paper was accepted, it then goes into production.
  11. When this process is finished, the authors receive the proofs for final a check.
  12. Eventually, the paper is published and the readers of the journal may scrutinise it.
  13. Often this prompts comment which may get published.
  14. In this case, the authors of the original paper may get invited to write a reply.
  15. Finally the comments and the reply are published in the journal side by side.

The whole process takes time, sometimes lots of time. I have had papers that took almost two years from submissions to publications. This delay seems tedious and, if the paper is important, unacceptable (if it is not important, it should arguably not be published at all). Equally unacceptable is the fact that referees are expected to do their reviewing for free. The consequence is that many referees do their reviewing less than well.

When I was still at Exeter, I had plenty of opportunity to see the problems of peer review from the reviewers perspective. At a time, I accepted about 5 reviews per week, and in total I surely have reviewed over 1000 papers. I often recommended inviting a statistician to do a specialist review of the stats. Only rarely were such suggestions accepted by the journal editors. Very often I recommended rejecting a submission because it was rubbish, and occasionally, I told the editor that there was a strong suspicion of the paper being fraudulent. The editors very often (I estimate in about 50% of cases) ignored my suggestions and comments and published the papers nonetheless. If the editor did follow my advice to reject a paper, I regularly saw it published elsewhere later (usually in a less well-respected journal). Several times, an author of a submission contacted me directly after seeing my criticism of his paper. Occasionally this resulted in unpleasantness, once or twice even in threats. Eventually I realised that improving the publications in the realm of SCAM was a Sisyphean task, became quite disenchanted with all this and accepted less and less reviews. Today, I do only very few.

I had even more opportunity to see the peer review process from the author’s perspective. All authors must have suffered from unfair or incompetent reviews and most will have experienced the frustrations of the endless delays. Once (before my time in alternative medicine) a reviewer rejected my paper and soon after published results that were uncannily similar to mine. In alternative medicine, researchers tend to be rather emotional about their subject. Imagine, for instance, the review you might get from Dana Ullmann of a trial of homeopathy that fails to show what he believes in.

Finally, since 40 years, I have also had the displeasure of experiencing peer review as an editor. This often seemed like trying to sail between the devil and the deep blue sea. Editors want to fill their journals with the best science they can find. But all too often, they receive the worst science they can imagine. They are constantly torn by tensions pulling them in opposite directions. And they have to cope not just with poor quality submissions but also with reviewers who miss deadlines and do their work badly.

So, peer review is fraught with problems! The trouble is that there are few solutions that would keep a better check on the reliability of science. Peer review, it often seemed to me, is the worst idea, except for all others. If peer review is to survive (and I think it probably will), there are a few things that could, from my point of view, be done to improve it:

  1. Make it much more attractive for the referees. Payment would be the obvious thing – and by Jove, the big journals like the LANCET and NEJM could afford it. But recognising refereeing academically would be even more important. At present, academic careers depend largely of publications; if they also depended on reviewing, experts would queue up to do it.
  2. The reports of the referees should get independently evaluated according to sensible criteria. These data could be conflated an published as a criterion of academic standing. Referees who fail to to a good job would spoil their chances to get re-invited for this task.
  3. Speed up the entire process. Waiting months on months is hugely counter-productive for all concerned.
  4. Today many journals ask authors for the details of experts who are potential reviewers of their submission and then send the paper in question to them for review. I find this ridiculous! No author I know of has ever resisted the temptation to name people who are friends or owe a favour. Journals should afford the extra work to find who the best independent experts on any particular subject are.

None of this is simple or fool-proof or even sure to work well, of course. But surely it is worth trying to get peer-review right. The quality of future science depends on it.

By guest blogger Loretta Marron

Although assumed to be traditional, what we know today as ‘Traditional Chinese Medicine’ (TCM) was invented in the 1950s for political reasons by then Chairman Mao. It has since been proclaimed by Xi Jinping, now life-President of the People’s Republic of China, as the “jewel” in the millennia of Chinese civilization.

In May this year, Xi “announced plans to criminalise criticism of traditional Chinese medicine”. Speaking out against TCM could land you years in prison, prosecuted for “picking fights to disturb public order” and “defaming” the practice.

With the industry expected to earn $420 billion by the end of 2020, covid-19 has provided Xi with a platform to promote unproven, potentially harmful TCM. To keep these profits filling Chinese coffers, the World Health Organization (WHO) remains silent and those challenging TCM are silenced.

In January, the late Dr Li Wenliang was arrested and gaoled for warning China about covid-19. Li was one of up to nine people who were disciplined for spreading rumours about it. As the virus silently spread around the world, Beijing told the WHO that there was ‘no clear evidence’ of spread between humans.

As their death toll passed 1,000, Beijing’s response was to remove senior officials and to sack hundreds over their handling of the outbreak. With the support of the WHO, claims continue to be made that TCM “has been proved effective in improving the cure rate”, denying the simple fact that “patients would have recovered even if they hadn’t taken the Chinese medicine”.

With cases now heading for 8 million, and over four hundred thousand people confirmed dead world-wide and with economies in free-fall, Beijing continues, “to protect its interests and people overseas; to gain leadership of international governance”,for financial gain, to aggressively use its national power. Under the guise of ‘International Aid’, during the pandemic, Beijing promoted treatments based on unproven traditional medicine, sending TCM practitioners to countries including Italy, France and Iran.

Countries challenging Beijing can expect claims of racism and financial retaliation.

Back in 2016, the Chinese State Council released a “Strategic Development Plan for Chinese Medicine (2016-2030)”, seeking to spread ‘knowledge’ into campuses, homes and abroad.

In July 2017, a law promising equal status for TCM and western medicine came into effect. Provisions included encouragement to China’s hospitals to set up TCM centres. “The new law on traditional Chinese medicine will improve global TCM influence, and give a boost to China’s soft power”.

In 2019, after strong lobbying by the Chinese Communist Party (CCP), WHO added a chapter on TCM to their official International Classification of Diseases (ICD-11).  In China, doctors are now instructed to prescribe traditional medicine to most patients.

While Chinese herbs might have exotic names, they are, once translated, often the same as western herbs, many of which might have significant interactions. WHO fails to acknowledge any drug interactions.

In 1967, Mao launched Project 523 to find a cure for chloroquine-resistant malaria. Over 240,000 compounds had already been tested and none had worked. Trained in pharmacology and modern western methods, Tu Youyou used the scientific method to test sweet wormwood, a herb traditionally used in China for fever, where she developed a useful artemisinin derivative for resistant malaria. The drug has saved millions of lives. In 2015 she won the Nobel Prize for her work. However, Tu’s work is not a blanket endorsement of TCM: without the years of research, she would not have been successful.

TCM is commercially driven. Criticism of remedies is often blocked on the Internet in China, and critics have been jailed.  The majority of TCM’s are not tested for efficacy in randomized clinical trials. Clinical trials are usually of poor quality and serious side effects are underreported.   China has even rolled back regulations as Beijing forcefully promotes TCM’s as an alternative to proven western medicine. An increasing number of prestigious research hospitals now prescribe and dispense herbs that may cause drug interactions alongside western medicine for major illness patients.

TCM’s are not safe. Most systematic reviews suggest that there is no good or consistent evidence for effectiveness, negative results aren’t published, research data are fabricated and TCM-exports are of dubious quality.

If the benefits of herbal remedies are to be realised, good clinical studies must be encouraged.

TCM is not medicine. It’s little more than a philosophy or a set of traditional beliefs, about various concoctions and interventions and their alleged effect on health and diseases.

To stop misleading the world with what Mao himself saw as nonsense, and to mitigate future pandemics, WHO can and should remove all mention of TCM other than to state that it is unproven and could be dangerous.

As mentioned before, the US ‘Agency for Healthcare Research and Quality (AHRQ) have published a most comprehensive review update entitled ‘Noninvasive Nonpharmacological Treatment for Chronic Pain‘. It followed the AHRQ Methods Guide for Effectiveness and Comparative Effectiveness. The conditions included were:

  • Chronic low back pain
  • Chronic neck pain
  • Osteoarthritis (knee, hip, hand)
  • Fibromyalgia
  • Chronic tension headache

 

Here are the main findings related to spinal manipulation:

LOW BACK PAIN

  • Spinal manipulation was associated with small improvements compared with sham manipulation, usual care, an attention control, or a placebo intervention in short-term (3 trials) and intermediate-term (3 trials) function (strength of evidence : low). There was no difference between spinal manipulation versus sham manipulation, usual care, an attention control, or a placebo intervention in short-term pain (3 trials), but manipulation was associated with a small improvement compared with controls on intermediate-term pain (3 trials) (SOE: low for short term, moderate for intermediate term).

CHRONIC TENSION HEADACHE

  • Spinal manipulation therapy was associated with small improvements in function and moderate improvements in pain compared with usual care over the short term in one trial (: low). Approximately a quarter of the patients had comorbid migraine.

HARMS

It was noted that many trails failed to report on adverse effects (AEs). Non- serious AEs reported included mild to moderate increase in pain, local discomfort and tiredness (2 RCTs).

___________________

Hardly impressive, is it?

Yet, some chiropractors treating chronic pain claim they practice Evidence-based medicine. This review seems to disclose this claim as bogus. What chiropractors do practice on virtually all patients is spinal manipulation which generates more harm than it produces benefit.

Please note yet again that:

  • many chiro trials fail to mention AEs (thus violating research ethics),
  • clinical trials are always too small to give a reliable impression about safety,
  • no post-marketing surveillance exists in chiropractic,
  • we thus have to rely mostly on case reports and similar articles,
  • and the collective evidence from such reports shows quite clearly that spinal manipulations are not safe,
  • chiropractors tend to deny all of the above,
  • this is because they have a monumental conflict of interest.

The WHO have issued the following press-release:

The World Health Organization (WHO) welcomes innovations around the world including repurposing drugs, traditional medicines and developing new therapies in the search for potential treatments for COVID-19.

WHO recognizes that traditional, complementary and alternative medicine has many benefits and Africa has a long history of traditional medicine and practitioners that play an important role in providing care to populations. Medicinal plants such as Artemisia annua are being considered as possible treatments for COVID-19 and should be tested for efficacy and adverse side effects. Africans deserve to use medicines tested to the same standards as people in the rest of the world. Even if therapies are derived from traditional practice and natural, establishing their efficacy and safety through rigorous clinical trials is critical.

African governments through their Ministers of Health adopted a resolution urging Member States to produce evidence on the safety, efficacy and quality of traditional medicine at the Fiftieth Session of the WHO Regional Committee for Africa in 2000. Countries also agreed to undertake relevant research and require national medicines regulatory agencies to approve medicines in line with international standards, which include the product following a strict research protocol and undergoing tests and clinical trials. These studies normally involve hundreds of people under the monitoring of the national regulatory authorities and may take quite a few months in an expedited process.

WHO is working with research institutions to select traditional medicine products which can be investigated for clinical efficacy and safety for COVID-19 treatment. In addition, the Organization will continue to support countries as they explore the role of traditional health practitioners in prevention, control, and early detection of the virus as well as case referral to health facilities.

Over the past two decades, WHO has been working with countries to ensure safe and effective traditional medicine development in Africa by providing financial resources and technical support. WHO has supported clinical trials, leading 14 countries to issue marketing authorization for 89 traditional medicine products which have met international and national requirements for registration. Of these, 43 have been included in national essential medicines lists. These products are now part of the arsenal to treat patients with a wide range of diseases including malaria, opportunistic infections related to HIV, diabetes, sickle cell disease and hypertension. Almost all countries in the WHO African region have national traditional medicine policies, following support from WHO.

As efforts are under way to find treatment for COVID-19, caution must be taken against misinformation, especially on social media, about the effectiveness of certain remedies. Many plants and substances are being proposed without the minimum requirements and evidence of quality, safety and efficacy. The use of products to treat COVID-19, which have not been robustly investigated can put people in danger, giving a false sense of security and distracting them from hand washing and physical distancing which are cardinal in COVID-19 prevention, and may also increase self-medication and the risk to patient safety.

WHO welcomes every opportunity to collaborate with countries and researchers to develop new therapies and encourages such collaboration for the development of effective and safe therapies for Africa and the world.

________________________________

While this message – mostly directed towards Africa – seems very clear and reasonable, it is, at the same time, prone to be misunderstood. Here is an excerpt from an Ghana newspaper article commenting on the WHO initiative which demonstrates my point:

In the view of this newspaper, it stands to reason that, since the virus, was transmitted from animals, the best form of cure, is to use herbs.

We have abundance of the plant Madagascar is using to develop the cure. Medical doctors should stop seeing those practicing alternative medicine, as competitors.

The open hatred, and disdain by medical doctors, towards practitioners of alternative medicine, must be a cause for concern by all.

In the considered opinion of this newspaper, the government must bring the two together to work to avert any calamity.

The number of cases recorded so far, is a ticking time bomb. We cannot continue to treat it as business as usual, where traditional medicine practitioners, will claim to make a discovery, which will not be accepted by their counterpart who practice orthodox medicine.

If any country in Africa, should have been the first to announce a discovery of cure for coronavirus, using herbal remedy it should have been Ghana.

We can do a lot, if the two come together, instead of working at cross purpose.

This is how easily the crucial WHO message ‘the use of products to treat COVID-19, which have not been robustly investigated can put people in danger’ can be forgotten.

FIRST TEST

MAKE SURE IT WORKS

MAKE SURE IT’S REASONABLY SAFE

THEN USE IN ROUTINE CARE

Everything else is not going to be helpful!

Dr. Dhanunjaya Lakkireddy, a cardiologist at the Kansas City Heart Rhythm Institute in the US, has started a trial of prayer for corona-virus infection. The study will involve  1000 patients with COVID-19 infections severe enough to require intensive care. The four-month study will investigate “the role of remote intercessory multi-denominational prayer on clinical outcomes in COVID-19 patients,” according to a description provided to the National Institutes of Health.

Inclusion Criteria:

  • Male or female greater than 18 years of age
  • Confirmed positive for COVID-19
  • Patient admitted to Intensive Care Unit

Exclusion Criteria:

  • Patients admitted to ICU for diagnosis that is not COVID-19 positive

(Not giving informed consent is not listed as an exclusion criterion!)

Half of the patients, randomly chosen, will receive a “universal” prayer offered in five denominational forms, via:

  • Buddhism,
  • Christianity,
  • Hinduism,
  • Islam,
  • Judaism.

The other 500 patients in the control group will not be prayed for by the prayer group. All the patients will receive the standard care prescribed by their medical providers. “We all believe in science, and we also believe in faith,” Lakkireddy claims. “If there is a supernatural power, which a lot of us believe, would that power of prayer and divine intervention change the outcomes in a concerted fashion? That was our question.”

The outcome measures in the trial are

  • the time patients remain on ventilators,
  • the number of patients who suffer from organ failure,
  • the time patients have to stay in intensive care,
  • the mortality rate.

On this blog, we have seen many other ‘corona-quacks’ come forward with their weird ideas. I ask myself why we give them not the opportunity to test their concepts as well? Why do we not spend our resources testing:

In my recent book, I included a short review of the literature on prayer as a medical intervention. This is what I wrote:

  1. Prayer can be defined as the solemn request or thanksgiving to God or other object of worship.
  2. Intercessory prayer is practised by people of all faiths and involves a person or group setting aside time for petitioning god on behalf of another person who is in need. Intercessory prayer is organised, regular, and committed. Those who practise it usually do not ask for payments because they hold a committed belief.
  3. The mechanisms by which prayer might work therapeutically are unknown, and hypotheses about its mode of action will depend to a large extent on the religious beliefs in question. People who believe in the possibility that prayers might improve their health assume that god could intervene on their behalf by blessing them with healing energy.
  4. These assumptions lack scientific plausibility.
  5. Numerous clinical trials have been conducted. Most of them fail to adequately control for bias, and their findings are not uniform.
  6. A systematic review of all these studies is available. It included 10 trials with a total of 7646 patients. The authors concluded that the findings are equivocal and, although some of the results of individual studies suggest a positive effect of intercessory prayer, the majority do not and the evidence does not support a recommendation either in favour or against the use of intercessory prayer. We are not convinced that further trials of this intervention should be undertaken and would prefer to see any resources available for such a trial used to investigate other questions in health care.[1]

[1] https://www.ncbi.nlm.nih.gov/pubmed/19370557

Lakkireddy says he has no idea what he will find. “But it’s not like we’re putting anyone at risk,” he says. “A miracle could happen. There’s always hope, right?”

Personally, I have a pretty good idea what he will find. I also find Lakkireddy not all that honest and think his assumptions are deeply mistaken:

  • Lakkireddy cites an extensive list of references; however, the Cochrane review (usually the most reliable and independent source of evidence) that arrived to the conclusions I quoted above, he somehow ‘forgot’ to mention.
  • As the review-authors tried to indicate, further trials of prayer are a waste of resources.
  • There are many much more promising interventions to be tested, and by conducting this study, he is diverting research funds that are badly needed elsewhere.
  • The study seems to have several ethical problems, e.g. informed consent.
  • Contrary to Lakkireddy’s belief, he will harm in more than one way; apart from wasting resources, his study undermines rational thought and public trust in clinical research.

PERSONALLY, I FIND THIS PROJECT DESPICABLE!

1 2 3 8
Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted but you must tick the box: “Save my name, email, and website in this browser for the next time I comment.”

The most recent comments from all posts can be seen here.

Archives
Categories