EBM
It has just been reported that the Düsseldorf Regional Court has dismissed several lawsuits against vaccine manufacturers for alleged coronavirus vaccine damage as unfounded.
Three women and one man had filed a lawsuit against manufacturers of mRNA vaccines. They claimed to have suffered significant impairment and damage to their health as a result of the coronavirus vaccines. They claimed to have suffered from states of exhaustion, concentration disorders, damage to the immune system, respiratory and lung problems, autoimmune reactions and symptoms of myocarditis. The plaintiffs demanded compensation for pain and suffering of up to 250,000 euros and damages.
The court rejected the claims. The requirements for a claim under the German Medicinal Products Act were not met, the court stated. The plaintiffs had not sufficiently proven a “negative risk-benefit balance” of the vaccine. On the contrary, the European Medicines Agency (EMA) had determined a positive balance for the vaccine during the authorisation process.
Furthermore, the plaintiffs had not provided sufficient evidence that the manufacturer had provided incorrect information regarding the vaccine, the court continued. On the contrary, it follows from the official authorisation by the EMA that the manufacturer’s statements “are not objectionable in terms of content”. The judgements are not yet legally binding.
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I have little doubt that antivazers will now claim that the court is in the pocket of the pharmaceutical industry. To give you a flavour of their mindset, here are examples of recent tweets (Xs) that I picked up on the subject (my translations):
- You stupid arseholes and stupid rabble-rousers, and who is liable for the coronavirus vaccination damage and for the German arms factories in Ukraine?
- More and more vaccines, no long-term studies…not with me!
I make decisions about my body and you can see from the coronavirus vaccine damage that I have done everything right. Even if our government wants us to believe that there are none and pays the lawyers for Biontech. - Corona vaccination damage, disinformation, corona vaccination no protection, disinformation, that’s how it works with the anti-democrats.
- The Corona vaccine damage is also still being covered up. This political cesspit also stinks and needs to be emptied as quickly as possible.
- When the force-financed government TV reports on “vaccine damage”, more and more of the people’s traitors must be getting sick to their stomachs.
- For the “fact checkers”, facts are opinions – often even contradicting government statistics, e.g. in the case of coronavirus vaccinations – that are considered correct by the establishment. Necessary open discussions are not wanted by them.
According to Healthcare.gov, a primary care provider in the US is “a physician (MD or DO), nurse practitioner, clinical nurse specialist or physician assistant, as allowed under state law, who provides, coordinates or helps a patient access a range of healthcare services.” A growing movement exists to expand who can act as a primary care privider (PCP). Chiropractors have been a part of this expansion, but is that wise? This is the question recently asked by Katie Suleta of THE AMERICAN COUNCIL ON SCIENCE AND HEALTH In it, she explains that:
- chiropractors would like to act as PCPs,
- chiropractors are not trained in pharmacology,
- chiropractors receive some training in supplements,
- chiropractors wish to avoid pumping the body full of “synthetic” hormones and substances.
Subsequently, she adresses the chiropractic profession’s stance on vaccines.
First, look at similar professional organizations to establish a reasonable expectation. The American Medical Association has firmly taken a stance on vaccines and provides resources for physicians to help communicate with patients. There is no question about where they stand on the topic, whether it be vaccines in general or COVID-19 vaccines specifically. Ditto the American Osteopathic Association and American Association of Colleges of Osteopathic Medicine. There is a contingent of vaccine-hesitant MDs and DOs. There is also an anti-vax contingent of MDs and DOs. The vaccine hesitant can be considered misguided and cautious, while anti-vaxxers often have more misinformation and an underlying political agenda. The two groups pose a threat but are, thankfully, the minority. They’re also clearly acting against the recommendations of their professional organizations.
Let’s now turn to the American Chiropractic Association (ACA). Unlike the American Medical Association or American Osteopathic Association, they seem to take no stance on vaccines. None. Zip. Zilch. As of this writing, if you go to the ACA website and search for “vaccines,” zero results are returned. Venturing over to the ACA-CDID, there is a category under their “News and Articles” section for ‘Vaccines.’ This seems promising! However, when you click on it, it returns one article on influenza vaccines from Fox News from 2017. It’s not an original article. It’s not a perspective piece. No recommendations are to be found—nothing even on the COVID-19 vaccines. Basically, there is effectively nothing on ACA-CDID’s website either. We’re oh for two.
The last one we’ll try is DABCI University. No, it’s not a professional organization, but it does train DCs. The words ‘university’ and ‘internist’ are involved, so they must talk about vaccines…right? Wrong again. While there is a lot of content available only to paying members and students, the sections of their website that are publicly available are noticeably short on vaccine information. There is a section dedicated to articles, currently including five whole articles, and not a single one talked about vaccines. One report addresses the pharmacokinetics of coffee enemas, but none talks about one of the most fundamental tools PCPs have to help prevent illness.
Why It’s Important
Chiropractic was defined by DD. Palmer, its founder, as “a science of healing without drugs.” It relies on spinal manipulation. In traditional chiropractic, there is no room for medications at all. A rift has developed within the profession, and some chiropractors, those seeking that internal medicine certification, “try to avoid pumping the body with synthetic hormones and other prescriptions.”
During the COVID-19 pandemic, several prominent chiropractors publicly pushed anti-vaccine views. To highlight just a few prominent examples: Vax Con ’21, Mile Hi Chiro, and Ben Tapper. Vax Con ’21 was organized and orchestrated by the Chiropractic Society of Wisconsin. It featured Judy Mikovits, of Plandemic fame, as a speaker and touted her book with a forward written by Robert F. Kennedy Jr. It offered continuing education units (CEUs) to DCs to attend this anti-vaccine conference that peddled misinformation about COVID-19 vaccines and other prevention measures. Healthcare providers are often required to complete a certain number of continuing education units to maintain licensure, ensuring that they stay current and sharp as healthcare evolves or, in this case, devolves.
This conference was not unique in this either. Mile Hi Chiro was just held in Denver in September of this year, had several questionable speakers (including RFK and Ben Tapper of Disinformation Dozen fame), and offered continuing education. If professional conferences offer continuing education units for attendees and push vaccine misinformation, that should concern everyone. Especially if the profession in question wants to act as PCPs.
Despite training in a system that believes “the body has an innate intelligence, and the power to heal itself if it is functioning properly, and that chiropractic care can help it do that,” without medications, but frequently with supplements, roughly 58% of Oregon’s chiropractors were vaccinated against COVID-19. That said, their training and inclination, along with the silence of their professional organizations and the chiropractic conferences featuring anti-vaccine sentiment, make them a profession that, at the very least, doesn’t consider vaccinations or medications viable health alternatives. We’re now talking about an entire profession that wants to be PCPs.
Irrespective of your belief about the efficacy of COVID-19 vaccination, the germ theory of disease remains unchallenged. Anyone unwilling to work to treat and prevent infectious diseases within their community with the most effective means at our disposal should not be allowed to dispense medical advice. Chiropractors lack the basic training that a PCP should have. I’ve said it before and I’ll say it again: I want healthcare accessible for everyone. But, if you’re looking for a PCP, consider going to an MD, DO, NP, or PA – they come fully equipped for your primary care needs.
Regular readers of this blog will be aware that I have discussed the thorny issue of chiros and vaccinations many times before, e.g.:
- Chiropractic and Public Health
- The International Chiropractors Association’s Statement on Vaccination
- The General Chiropractic Council’s ‘Registrant Survey 2020’ has just been published
- Far too many chiropractors believe that vaccinations do not have a positive effect on public health
- Vaccination: chiropractors “espouse views which aren’t evidence based”
- Patients consulting chiropractors, homeopaths, or naturopaths are less likely to agree to the flu jab
- “The uncensored truth” about COVID-19 vaccines” … as told by some chiro loons
- Beliefs and behaviors of US chiropractors
- Media attention forces (some) chiropractors to get their act together
- Ever wondered why so many chiropractors are profoundly anti-vax?
I agree with Katie Suleta that the issue is important and thank her for raising it. I also agree with her conclusion that, if you’re looking for a PCP, consider going to an MD, DO, NP, or PA – they come fully equipped for your primary care needs.
Do not consult chiropractors.
The concept that the outcomes of spinal manipulation therapy (SMT) – the hallmark intervention of chiropractors which they use on practically every patient – are optimized when the treatment is aimed at a clinically relevant joint is commonly assumed and central to teaching and clinical use of chiropractic. But is the assumption true?
This systematic review investigated whether clinical effects are superior when this is the case compared to SMT applied elsewhere. Eligible study designs were randomized controlled trials that investigated the effect of SMT applied to candidate versus non-candidate sites for spinal pain.
The authors obtained studies from four different databases. Risk of bias was assessed using an adjusted Cochrane risk of bias tool, adding four items for study quality. Between-group differences were extracted for any reported outcome or, when not reported, calculated from the within-group changes. Outcomes were compared for SMT applied at a ‘relevant’ site to SMT applied elsewhere. The authors prioritized methodologically robust studies when interpreting results.
Ten studies were included. They reported 33 between-group differences; five compared treatments within the same spinal region and five at different spinal regions.
None of the nine studies with low or moderate risk of bias reported statistically significant between-group differences for any outcome. The tenth study reported a small effect on pain (1.2/10, 95%CI – 1.9 to – 0.5) but had a high risk of bias. None of the nine articles of low or moderate risk of bias and acceptable quality reported that “clinically-relevant” SMT has a superior outcome on any outcome compared to “not clinically-relevant” SMT. This finding contrasts with ideas held in educational programs and clinical practice that emphasize the importance of joint-specific application of SMT.
The authors concluded that the current evidence does not support that SMT applied at a supposedly “clinically relevant” candidate site is superior to SMT applied at a supposedly “not clinically relevant” site for individuals with spinal pain.
I came across this study when I searched for the published work of Prof Stephen Perle, a chiropractor and professor at the School of Chiropractic, College of Health Sciences, University of Bridgeport, US, who recently started trolling me on this blog. Against my expectation, I find his study interesting and worthwhile.
His data quite clearly show that the effects of SMT are non-specific and mainly due to a placebo response. That in itself is not hugely remarkable and has been suspected to some time, e.g.:
- Chiropractic manipulation for migraine is a placebo therapy
- Chiropractic treatments are placebos
- Chiropractic spinal manipulation = placebo!
- Manual therapy (mainly chiropractic and osteopathy) does not have clinically relevant effects on back pain compared with sham treatment
- Manual therapies for back pain: not better than a placebo
- Is spinal manipulation a placebo therapy?
What is remarkable, however, is the fact that Perle and his co-authors offer all sorts of other explanation for their findings without even seriously considering what is stareing in their faces:
SPINAL MANIPULATIONS ARE PLACEBOS
CHIROPRACTIC IS A PLACEBO THERAPY
This might be almost acceptable, if chiropractic would not also be burdened with significant risks (as we have discussed ad nauseam on this blog) – another fact of which chiros like Perle are in denial.
What does all that mean for patients?
The practical implication is fairly straight forward: the risk/benefit balance of chiropractic is negative. And this surely means the only responsible advice to patients is this:
NEVER CONSULT A CHIRO!
We have often discussed cupping on this blog, e.g.:
- The ‘WORST PAPER OF 2022 COMPETITION’ entry No 6: “The efficacy and safety of dry cupping in cervical spondylosis with optimization of cup application time – A randomized clinical trial”
- Cupping therapy for non-specific chronic low back pain
- Cupping for Olympic swimmers. Or: why breaking your shoulder is not necessarily good for writing a successful book
- Infant receiving cupping treatment prompts outrage
Yes, generally speaking I have been critical about cupping – not because I don’t like it (I even used the treatment as a young clinician many years ago) but because the evidence tells me to. I was glad to see that the authors of a recent article entitled “Utility of Cupping Therapy in Substance Use Disorder: A Novel Approach or a Bizarre Treatment?” offer even more outspoken words about the therapy. Here are their conclusions:
Established treatment modalities for substance use disorder and its withdrawal symptoms include pharmacotherapy and psychotherapy, but their utilization by the general population remains unsatisfactory. Taboos regarding mental health services and concerns about confidentiality are massive obstacles for patients seeking psychiatric help, and alternative forms of medicine may seem more approachable, even with the associated risks. As displayed in this case, cupping therapy is a traditional therapy with no role in treating polyaddiction and withdrawal symptoms, but it unnecessarily exposes individuals to really uncomfortable and often concealed complications such as bruising, and skin and blood infections, especially when carried out by untrained, incompetent individuals. While one can explore these options in addition to seeking professional mental health care, it is imperative to spread awareness about the roles, scientific soundness, and adverse effects of these alternative health practices. The health promotion and education sectors need reforms to educate the general population, especially the rural population in India, about the dangers of iatrogenesis caused by non-evidence-backed treatments. There needs to be an extensive advertisement of only the most effective and scientific treatment options provided by medical professionals, and the risks of overlooking them in favor of traditional cures propagated by unqualified individuals. With all the scientific advancements in the 21st century ranging from artificial intelligence in healthcare, and robotic surgeries, to extensive clinical trials for novel anti-cancer drugs, we cannot allow the propagation of ancient, scientifically unsound techniques that may cause more harm than benefit to patients.
Why, I am sure you ask yourself, are they so critical? The reason lies in the case they report in the same paper:
A 30-year-old man presented to the psychiatric outpatient department with complaints of nervousness, anxiety, a sense of impending doom, irritability, anger outbursts, headache, and reduced sleep and appetite for the last five days. The patient had a history of daily consumption of 5-10 mg of alprazolam tablets, 200-250 mg of codeine syrup, and about five packets of chewable tobacco over the last seven years; this was a pattern of polyaddiction to a benzodiazepine, opiate, and nicotine. The patient had no history of fever, confusion, or hallucinations. On eliciting the past history, the patient revealed that he went to an alternative medicine practitioner after his family persuaded him to seek help for his substance use disorder. After ceasing the consumption of all three substances for three days, he started developing the symptoms with which he presented to our hospital. He was hesitant to talk about his substance use disorder to medical professionals and concerned about confidentiality, and, hence, went to an alternative medicine practitioner whom he deemed approachable. There he was given wet cupping therapy on the head for four days, which involved the use of rubber pumps to create a suction inside the cups placed on his head. After three to five minutes, the cups were removed and small incisions were made on the cupping sites, following which a second suction caused the oozing out of blood from the incision sites on the scalp (Figure 1). But, this did not improve his symptoms, and hence, he stopped going there two days before coming to our tertiary care hospital.
Figure 1: Wet cupping therapy on the head with blood oozing from incision sites<
On examination, the patient had a pulse rate of 76 beats per minute, blood pressure of 128/78 mm Hg, and respiratory rate of 22 per minute. He was well-oriented to time, place, and person. Systemic examination of the cardiovascular system was unremarkable. He denied any other substance use. The skin over his head had distinct cupping marks but no signs of infection or active bleeding, which are some common complications after cupping therapy (Figure 2). On assessment, the patient had a Clinical Opiate Withdrawal Scale (COWS) score of 13 and a Clinical Institute Withdrawal Assessment (CIWA) scale score of 26.
Figure 2: Cupping marks on the head
Later, the patient was admitted to the psychiatric ward to manage the withdrawal symptoms, where we initiated pharmacotherapy. Tablet diazepam (20 mg/day), sodium valproate (800 mg/day), tramadol (200 mg/day), thiamine (300 mg/day), paracetamol (500 mg/day) and intravenous fluids were given to the patient. We counseled the patient regarding substance abuse, its harmful effects, and de-addiction. The patient’s symptoms started to improve, and we continued the treatment for four days and discharged him with a COWS score of 4 and a CIWA score of 2. We intended to reassess him after 14 days, but we lost him to follow-up.
The BBC has a popular program entitled JUST ONE THING presented by Dr, Michael Mosely. In each of these short broadcasts, Mosely presents JUST ONE THING that will make your life more healthy. Whenever I listen to them, I get slightly irritated. Mosely is clearly a very skilled presenter and makes complicated things easy to understand; but for my taste his approach is totally devoid of critical thinking. This is obviously the point of the series and probably one reason for its success. So, maybe it needs to be tolerated – perhaps, but surely not if it seriously misleads the public on important health issues.
The most recent broadcast was entitled EMBRACE THE RAIN and, in my view, it did cross this crucial line. Mosely explained that after it has rained, the air is full of negative ions and these ions are effective against depression. The center piece was his interview with Prof Michael Terman who explained some of his research on the subject, in particular a clinical trial which showed that intensely ionized air was effective against depression. Terman explained that this was more than a placebo effect, that it worked even for serious chronic depressed patients, and that the effect was better than standard treatments.
At no stage was there an even mildly critical question from Mosely. Consequently many depressed patients might now abandon their standard treatments and opt for air ionizers in their homes or walks in the rain which was deemed to be just as effective. In view of the fact that chronic depression, through its suicide risk, can be a life-threatening condition, I find this rather concerning.
My concerns were not exactly alleviated when I did a quick search for the evidence. The most recent review on the subject states that there has been considerable interest in the potential effects of negative air ions (NAIs) on human health and well-being, but the conclusions have been inconsistent and the mechanisms remain unclear. So, why does Terman promote NAIs as though they are the best thing since sliced bread? It took me less than a minute to find a possible answer: he holds a patent for a NEGATIVE ION GENERATOR!
It is laudable of the BBC and Michael Mosely to present aspects of healthcare in a simple, understandable way. Yet, it would be even more laudable, if they did their homework a bit better and, crucially, tried to also educate the public in critical thinking. After all ’embracing the rain’ will not change lives but critical thinking most certainly does!
If you assumed that the best management of a child by chiropractors is not to treat this patient and refer to a proper doctor, think again. This paper was aimed at building upon existing recommendations on best practices for chiropractic management of children by conducting a formal consensus process and best evidence synthesis. Its authors composed a best practice guide based on recommendations from current best available evidence and formal consensus of a panel of experienced practitioners, consumers, and experts for chiropractic management of pediatric patients. They thus syntheized results of a literature search to inform the development of recommendations from a multidisciplinary steering committee, including experts in pediatrics, followed by a formal Delphi panel consensus process.
The consensus process was conducted June to August 2022. All 60 panelists completed the process and reached at least 80% consensus on all recommendations after three Delphi rounds. Recommendations for best practices for chiropractic care for children addressed the following aspects of the clinical encounter:
- patient communication, including informed consent;
- appropriate clinical history, including health habits;
- appropriate physical examination procedures;
- red flags/contraindications to chiropractic care and/or spinal manipulation;
- aspects of chiropractic management of pediatric patients, including infants;
- modifications of spinal manipulation and other manual procedures for pediatric patients;
- appropriate referral and comanagement;
- appropriate health promotion and disease prevention practices.
The authors concluded that this set of recommendations represents a general framework for an evidence-informed and reasonable approach to the management of pediatric patients by chiropractors.
Whenever I read the term ‘evidence-informed’ I need to giggle. Why not evidence-based? Evidence-informed might mean that chiros are informed that their treatments are useless or even dangerous for children … but, on reflection and taking their own need for earning a living, they subsequently ignore these facts. And sure enough, the authors of the present paper do mention that a Cochrane review concluded that spinal manipulation is not recommended for children under 12, for a number of conditions, or for general wellness … only to then go on and ignore the very fact.
In doing so, the authors issue a string of self-evident platitudes which occasionally border on the irresponsible. For instance, under the heading of ‘primary prevention’, vaccinations are mentioned as the very last item with the following words:
If parents ask for advice or information about childhood vaccinations, explain that they have the right to make their own health decisions. They should be adequately informed about the benefits and risks to both their child and the broader community associated with these decisions. Consider referral to a health professional whose scope of practice includes vaccinations to address patient questions or concerns.
What that really means in practice, I fear, might be summarized like this: If parents ask for advice or information about childhood vaccinations, explain that they are dangerous, and that even D. D. Palmer recognized as early as 1894 that vaccination is ‘…the monstrous delusion … fastened on us by the medical profession, enforced by the state boards, and supported by the mass of unthinking people …’
Altogether, the ‘Clinical Practice Guideline for Best Practice Management of Pediatric Patients by Chiropractors’ is a thoroughly disreputable document. It was constructed in the way all charlatans tend to construct their consensus documents:
- convene a few people who are all in favour of a certain motion,
- discuss the motion,
- agree with it,
- write up the process
- publish your paper in a third class journal,
- boast that there is a consensus,
- stress that the motion must thereefore be ethical, correct and valuable.
Do chiropractors know that, using this methodology, the ‘flat earth society’ can easily pass a consensus that the earth is indeed flat?
I am sure they do!
Mistletoe, an anthroposophical medicine, is often recommended as a so-callled alternative medicine (SCAM) for cancer patients. But what type of cancer, what type of mistletoe preparation, what dosage regimen, what form of application?
The aim of this systematic analysis was to assess the concept of mistletoe treatment in published clinical studies with respect to indication, type of mistletoe preparation, treatment schedule, aim of treatment, and assessment of treatment results. The following databases were systematically searched: Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, CINAHL, and “Science Citation Index Expanded” (Web of Science). The researchers assessed all studies for study types, methods, endpoints and mistletoe preparations including their ways of application, host trees and dosage schedules.
The searches revealed 3296 hits. Of these, 102 publications with a total of 19.441 patients were included. The researchers included several study types investigating the application of mistletoe in different groups of participants: cancer patients with any type of cancer were included as well as studies conducted with healthy volunteers and pediatric patients. The most common types of cancer were:
- breast cancer,
- pancreatic cancer,
- colorectal cancer,
- malignant melanoma.
Randomized controlled studies, cohort studies and case reports make up most of the included studies. A huge variety was observed concerning the type and composition of mistletoe extracts (differing pharmaceutical companies and host trees), ways of applications and dosage schedules. Administration varied widely, e. g. between using mistletoe extract as sole treatment and as concomitant therapy to cancer treatment. The researchers found no relationship between the mistletoe preparation used, host tree, dosage, and cancer type.
A variety of different mistletoe preparations was used to treat cancer patients. Due to the heterogeneity of the mistletoe preparations used, no comparability between different studies or within single studies using different types of mistletoe preparations or host trees is possible. Moreover, no relationship between mistletoe preparation and type of cancer can be observed. This results in a severely limited comparability of studies with regard to the different cancer entities and mistletoe therapy in oncology in general. Analyzing the methods sections of all articles, there are no information on how the selection of the respective mistletoe preparation took place. None of the articles provided any argument which type of preparation (homeopathic, anthroposophic, standardized) or which host tree was chosen due to which selection criteria. Considering preparations from different companies, funding may have been the reason of the selection.
Dosage or dosage regimens varied strongly in the studies. Due to the heterogeneity of dosage and dosage regimens within studies and between studies of the endpoints the comparability of the different studies is severely limited. Duration of mistletoe treatment varied strongly in the studies ranging from a single dose given on one day to the application of mistletoe preparations for several years. Moreover, the duration of treatment frequently varied within the studies. Mistletoe preparations were administered by different ways of application. Most frequently, the patients received mistletoe preparations subcutaneously. The second most common way was intravenous administration of mistletoe preparations. According to the respective manufacturers, this type of application is only recommended for Lektinol® and Eurixor®. Other preparations were given as off-label intravenous applications. No dosage recommendations from the respective manufacturers were available. Only in two studies the dose schedules were mentioned: according to the classical phase I 3 + 3 dose escalation schedule or in ratio to the body surface area.
The authors concluded that despite a large number of clinical studies and reports, there is a complete lack of transparently reported, structured procedures considering all fields of mistletoe therapy. This applies to type of mistletoe extract, host tree, preparation, treatment schedules as well as indication with respect of type of cancer and the respective treatment aim. All in all, despite several decades of clinical mistletoe research, no clear concept of usage is discernible and, from an evidence-based point of view, there are serious concerns on the scientific base of this part of anthroposophical treatment.
A long time ago, I worked as a junior doctor in a hospital where we used subcutaneous misteloe injections regularly to treat cancer. I remember being utterly confused: none of my peers was able to explain to me what preparation to use and how to does it. There simply were no rules and the manufacurer’s instructions made little sense. I suspected then that mistletoe therapy was a danerous nonsense. Today, after much research has been published on mistletoe, I do no longer suspect it, I know it.
I would urge every cancer patient to stay well clear of mistletoe and those practitioners who recommend it.
Autogenic training (AT) is a relaxation technique that has garnered attention for its potential to reduce anxiety and improve psychological well-being. This review aimed to synthesize the findings from a diverse range of studies investigating the relationship between AT and anxiety disorder across different populations and settings.
A comprehensive review of 162 studies, including randomised controlled trials (RCTs), non-randomized controlled trials (N-RCTs), surveys, and meta-analysis, was conducted and 29 studies were selected. Participants in the studies were patients with:
- cancer,
- bulimia nervosa,
- stroke,
- coronary angioplasty,
Others were nursing students, healthy volunteers, athletes, etc.
Anxiety levels were measured before and after the AT intervention using a variety of anxiety assessment scales, including the State Trait Anxiety Inventory (STAI) and the Hospital Anxiety and Depression Scale (HADS). The formats, duration, and delivery of the interventions varied, with some studies utilising guided sessions by professionals and other self-administered practises.
The combined findings of these studies revealed consistent trends in the beneficial effects of AT on anxiety reduction. AT was found to be effective in reducing anxiety symptoms across a wide range of populations and settings. Following AT interventions, participants reported reduced anxiety, improved mood states, and improved coping mechanisms. AT was found to be superior to no treatment or a comparable intervention in a number of cases.
The authors conclused that the body of evidence supports autogenic training as a non-pharmacological approach to reducing anxiety and improving psychological well-being. Despite differences in methodology and participant profiles, the studies show that AT has a positive impact on a wide range of populations. The findings merit further investigation and highlight AT’s potential contribution to anxiety management strategies.
I was taught AT many years ago and have practised it occasionally ever since. I have also co-authored several papers of AT that showed encouraging results, e.g.:
- Autogenic training for tension type headaches: a systematic review of controlled trials. Complement Ther Med. 2006 Jun;14(2):144-50.
- Autogenic training for stress and anxiety: a systematic review. Complement Ther Med. 2000 Jun;8(2):106-10.
- Autogenic training to reduce anxiety in nursing students: randomized controlled trial. Kanji N, White A, Ernst E.J Adv Nurs. 2006 Mar;53(6):729-35.
- Autogenic training to manage symptomology in women with chest pain and normal coronary arteries. Menopause. 2009 Jan-Feb;16(1):60-5.
- Autogenic training reduces anxiety after coronary angioplasty: a randomized clinical trial. Am Heart J. 2004 Mar;147(3)
Thus, I feel that the conclusions of this review might be correct.
Several further recent papers seem to support the notion that AT is a treatment worth trying, e.g.:
- A review concluded that as an add-on intervention psychotherapy technique with beneficial outcome on psychophysiological functioning, AT represents a promising avenue towards expanding research findings of brain-body links beyond the current limits of the prevention and clinical management of number of mental disorders.
- A clinical trial showed that AT seems to improve sleep quality and could improve some dimensions of quality of life and other symptoms among people living with HIV. Further studies are needed to confirm these results.
Why then AT is not better studied and more popular? A short paragraph of my next book (to be published in about 6 months) on the inventors of so-called alternative medicines (SCAMs), including the German psychiatry professor Johannes Schulz (1884-1970), inventor of AT, might give you a clue:
Schultz supported the euthanasia program of the Nazis, i.e. the extermination of disabled and other people considered ‘unworthy of living’ during the Third Reich. He passed death sentences on “hysterical women” through his diagnoses. In 1933, Schultz began research on a guide-book on sexual education in which he focused on homosexuality and explored the topics of sterilization and euthanasia. In 1935, he published an essay about the psychological consequences of sterilization and castration among men; in it he supported compulsory sterilization of men in order to eliminate hereditary illnesses. With a diagnostic scheme developed by him in 1940, Schulz advocated the execution of mentally ill patients by stating: “I personally have to align myself with Mr. Hoche […], by recalling the ‘annihilation of life unworthy of life’ and by raising the hope that the madhouses will soon become emptied and remodelled according to this principle.” Schultz was fully aware of the consequences of his diagnostic assessment and even used the term “death sentence in the form of a diagnosis”.
I came across this evidence only years after having published my papers on AT. Would I have developed an interest in AT, if I had known about Schulz’s Nazi past? Probably not.
Robert Jütte, a German medical historian, has long been a defender of homeopathy and other forms of so-called alternative medicine (SCAM). His latest paper refers to the situation in Switzerland where the public was given the chance to vote for or against the reimbursement of several SCAMs, including homeopathy. I reported previously about this unusual situation, e.g.:
- More about homeopathy in Switzerland: “Globuli only cause unnecessary healthcare costs”
- More on the situation of homeopathy in Switzerland
- SCAM in Switzerland: paediatricians couldn’t care less
- It’s official: Switzerland is going holistically round the bend
Unsurprisingly, Prof Jütte’s views are quite different from mine. Here is the abstract of his recent paper:
Behind the principle of involving users and voters directly in decision-making about the health care system are ideas relating to empowerment. This implies a challenge to the traditional view that scientific knowledge is generally believed to be of higher value than tried and tested experience, as it is the case with CAM. The aim of this review is to show how a perspective of the history of medicine and science as well as direct democracy mechanisms such as stipulated in the Swiss constitution can be used to achieve the acceptance of CAM in a modern medical health care system. A public health care system financed by levies from the population should also reflect the widely documented desire in the population for medical pluralism (provided that therapeutical alternatives are not risky). Otherwise, the problem of social inequality arises because only people with a good financial background can afford this medicine.
I think that Jütte’s statement that “a public health care system financed by levies from the population should also reflect the widely documented desire in the population for medical pluralism provided that therapeutical alternatives are not risky. Otherwise, the problem of social inequality arises because only people with a good financial background can afford this medicine” is untenable. Here are my reasons:
- Lay people are not normally sufficiently informed to decide which treatments are effective and which are not. If we leave these decisions to the public, we will end up with all manner of nonsense diluting the effectiveness of our health services and wasting our scarce public funds.
- Jütte seems to assume that SCAMs that are not risky do no harm. He fails to consider that ineffective treatments inevitably do harm by not adequately treating symptoms and diseases. In serious conditions this will even hasten the death of patients!
- Jütte seems concerned about inequity, yet I think this concern is misplaced. Not paying from the public purse for nonsensical therapies is hardly a disadvantage. Arguably, those who cannot affort ineffective SCAMs are even likely to benefit in terms of their health.
I do realize that there might be conflicting ethical principles at play here. I am, however, convinced that the ethical concern of doing more good than harm to as many consumers as possible is best realized by implementing the principles of evidence-based medicine. Or – to put it bluntly – a healthcare system is not a supermarket where consumers can pick and chose any rubbish they fancy.
I wonder who you think is correct, Jütte or I?
So-called alternative medicine (SCAM) interventions are growing in popularity and are even advocated as treatments for long COVID symptoms. However, comprehensive analysis of current evidence in this setting is still lacking. This study aims to review existing published studies on the use of SCAM interventions for patients experiencing long COVID through a systematic review of randomized controlled trials (RCTs).
A comprehensive electronic literature search was performed in multiple databases and clinical trial registries from September 2019 to January 2023. RCTs evaluating efficacy and safety of SCAM for long COVID were included. Methodological quality of each included trial
was appraised with the Cochrane ‘risk of bias’ tool. A qualitative analysis was conducted due to heterogeneity of included studies.
A total of 14 RCTs with 1195 participants were included in this review. Study findings demonstrated that SCAM interventions could benefit patients with long COVID, especially those suffering from
- neuropsychiatric disorders,
- olfactory dysfunction,
- cognitive impairment,
- fatigue,
- breathlessness,
- mild-to-moderate lung fibrosis.
The main interventions reported were:
- self-administered transcutaneous auricular vagus nerve stimulation,
- neuro-meditation,
- dietary supplements,
- olfactory training,
- aromatherapy,
- inspiratory muscle training,
- concurrent training,
- online breathing programs,
- online well-being programs.
The authors concluded that SCAM interventions may be effective, safe, and acceptable to patients with symptoms of long COVID. However, the findings from this systematic review should be interpreted with caution due to various methodological limitations. More rigorous trials focused on CAM for long COVID are warranted in the future.
Such wishy-washy conclusions seem to be popular in the fantasy land of SCAM. Yet, they are, in my view, most ojectionable because:
- they tell us nothing of value;
- that something “MAY BE EFFECTIVE” has been known before and cannot be the result of but is the reason for a systematic review;
- a review of 14 RCTs of almost as many interventions cannot possibly tell us anything about the SAFETY of these treatments;
- it also does not provide evidence of effectiveness and merely indicates a lack of independent replications;
- if the abstract mentions an assessment of the study rigor, one expects that it also informs us about this important aspect.
Once we do come around looking at the methodological quality of the primary studies we realize that it is mostly miserable. This means that the conclusions of the review are not just irritating but plainly misleading. Responsible researchers should have concluded along the following lines:
The quantity and the quality of the evidence are both low. Therefore, the effectiveness and safety of SCAM interventions for long COVID remains unproven.
PS
This project was financially supported by The HEAD Foundation, Singapore and in part by the grant from the NIH R61 AT01218.
Shame on the authors, journal editors, peer-reviewers, and funders of this dangerous nonsense!
