economic evaluation
This review updated and extended a previous one on the economic impact of homeopathy. A systematic literature search of the terms ‘cost’ and ‘homeopathy’ from January 2012 to July 2022 was performed in electronic databases. Two independent reviewers checked records, extracted data, and assessed study quality using the Consensus on Health Economic Criteria (CHEC) list.
Six studies were added to 15 from the previous review. Synthesizing both health outcomes and costs showed homeopathic treatment being at least equally effective for less or similar costs than control in 14 of 21 studies. Three studies found improved outcomes at higher costs, two of which showed cost-effectiveness for homeopathy by incremental analysis. One found similar results and three similar outcomes at higher costs for homeopathy. CHEC values ranged between two and 16, with studies before 2009 having lower values (Mean ± SD: 6.7 ± 3.4) than newer studies (9.4 ± 4.3).
The authors concluded that, although results of the CHEC assessment show a positive chronological development, the favorable cost-effectiveness of homeopathic treatments seen in a small number of high-quality studies is undercut by too many examples of methodologically poor research.
I am always impressed by the fantastic and innovative phraseology that some authors are able to publish in order to avaid calling a spade a spade. The findings of the above analysis clearly fail to be positive. So why not say so? Why not honestly conclude something like this:
Our analysis failed to show conclusive evidence that homeopathy is cost effective.
To find an answer to this question, we need not look all that far. The authors’ affiliations give the game away:
- 1Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany.
- 2Medical Scientific Services/Medical Affairs, Deutsche Homöopathie-Union DHU-Arzneimittel GmbH & Co. KG, Karlsruhe, Germany.
- 3Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany.
- 4Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
Another rather funny give-away is the title of the paper: the “…evaluation for…”comes form the authors’ original title (Overview and quality assessment of health economic evaluations for homeopathic therapy: an updated systematic review) and it implies an evaluation in favour of. The correct wording would be “evaluation of”, I think.
I rest my case.
An alarming story of research fraud in the area of so-called alternative medicine (SCAM) is unfolding: Bharat B. Aggarwal, the Indian-American biochemist who worked at MD Anderson Cancer Center, focused his research on curcumin, a compound found in turmeric, and authored more than 125 Medline-listed articles about it. They reported that curcumin had therapeutic potential for a variety of diseases, including various cancers, Alzheimer’s disease and, more recently, COVID-19.
The last of these papers, entitled “Curcumin, inflammation, and neurological disorders: How are they linked?”, was publiched only a few months ago. Here is its abstract:
Background: Despite the extensive research in recent years, the current treatment modalities for neurological disorders are suboptimal. Curcumin, a polyphenol found in Curcuma genus, has been shown to mitigate the pathophysiology and clinical sequalae involved in neuroinflammation and neurodegenerative diseases.
Methods: We searched PubMed database for relevant publications on curcumin and its uses in treating neurological diseases. We also reviewed relevant clinical trials which appeared on searching PubMed database using ‘Curcumin and clinical trials’.
Results: This review details the pleiotropic immunomodulatory functions and neuroprotective properties of curcumin, its derivatives and formulations in various preclinical and clinical investigations. The effects of curcumin on neurodegenerative diseases such as Alzheimer’s disease (AD), amyotrophic lateral sclerosis (ALS), brain tumors, epilepsy, Huntington’s disorder (HD), ischemia, Parkinson’s disease (PD), multiple sclerosis (MS), and traumatic brain injury (TBI) with a major focus on associated signalling pathways have been thoroughly discussed.
Conclusion: This review demonstrates curcumin can suppress spinal neuroinflammation by modulating diverse astroglia mediated cascades, ensuring the treatment of neurological disorders.
The Anderson Cancer Center initially appeared to approve of Aggarwal’s work. However, in 2012, following concerns about image manipulation raised by pseudonymous sleuth Juuichi Jigen, MD Anderson Cancer Center launched a research fraud probe against Aggarwal which eventually led to 30 of Aggarwal’s articles being retracted. Moreover, PubPeer commenters have noted irregularities in many publications beyond the 30 that have already been retracted. Aggarwal thus retired from M.D. Anderson in 2015.
Curcumin doesn’t work well as a therapeutic agent for any disease – see, for instance, the summary from Nelson et al. 2017:
“[No] form of curcumin, or its closely related analogues, appears to possess the properties required for a good drug candidate (chemical stability, high water solubility, potent and selective target activity, high bioavailability, broad tissue distribution, stable metabolism, and low toxicity). The in vitro interference properties of curcumin do, however, offer many traps that can trick unprepared researchers into misinterpreting the results of their investigations.”
Despite curcumin’s apparent lack of therapeutic promise, the volume of research produced on curcumin grows each year. More than 2,000 studies involving the compound are now published annually. Many of these studies bear signs of fraud and involvement of paper mills. As of 2020, the United States National Institutes of Health (NIH) has spent more than 150 million USD funding projects related to curcumin.
This proliferation of research has fueled curcumin’s popularity as a dietary supplement. It is estimated that the global market for curcumin as a supplement is around 30 million USD in 2020.
The damage done by this epic fraud is huge and far-reaching. Hundreds of millions of taxpayer dollars, countless hours spent toiling by junior scientists, thousands of laboratory animals sacrificed, thousands of cancer patients enrolled in clinical trials for ineffective treatments, and countless people who have eschewed effective cancer treatment in favor of curcumin, were encouraged by research steeped in lies.
A ‘pragmatic, superiority, open-label, randomised controlled trial’ of sleep restriction therapy versus sleep hygiene has just been published in THE LANCET. Adults with insomnia disorder were recruited from 35 general practices across England and randomly assigned (1:1) using a web-based randomisation programme to either four sessions of nurse-delivered sleep restriction therapy plus a sleep hygiene booklet or a sleep hygiene booklet only. There was no restriction on usual care for either group. Outcomes were assessed at 3 months, 6 months, and 12 months. The primary endpoint was self-reported insomnia severity at 6 months measured with the insomnia severity index (ISI). The primary analysis included participants according to their allocated group and who contributed at least one outcome measurement. Cost-effectiveness was evaluated from the UK National Health Service and personal social services perspective and expressed in terms of incremental cost per quality-adjusted life year (QALY) gained. The trial was prospectively registered (ISRCTN42499563).
Between Aug 29, 2018, and March 23, 2020 the researchers randomly assigned 642 participants to sleep restriction therapy (n=321) or sleep hygiene (n=321). Mean age was 55·4 years (range 19–88), with 489 (76·2%) participants being female and 153 (23·8%) being male. 580 (90·3%) participants provided data for at least one outcome measurement. At 6 months, mean ISI score was 10·9 (SD 5·5) for sleep restriction therapy and 13·9 (5·2) for sleep hygiene (adjusted mean difference –3·05, 95% CI –3·83 to –2·28; p<0·0001; Cohen’s d –0·74), indicating that participants in the sleep restriction therapy group reported lower insomnia severity than the sleep hygiene group. The incremental cost per QALY gained was £2076, giving a 95·3% probability that treatment was cost-effective at a cost-effectiveness threshold of £20 000. Eight participants in each group had serious adverse events, none of which were judged to be related to intervention.
The authors concluded that brief nurse-delivered sleep restriction therapy in primary care reduces insomnia symptoms, is likely to be cost-effective, and has the potential to be widely implemented as a first-line treatment for insomnia disorder.
I am frankly amazed that this paper was published in a top journal, like THE LANCET. Let me explain why:
The verum treatment was delivered over four consecutive weeks, involving one brief session per week (two in-person sessions and two sessions over the phone). Session 1 introduced the rationale for sleep restriction therapy alongside a review of sleep diaries, helped participants to select bed and rise times, advised on management of daytime sleepiness (including implications for driving), and discussed barriers to and facilitators of implementation. Session 2, session 3, and session 4 involved reviewing progress, discussion of difficulties with implementation, and titration of the sleep schedule according to a sleep efficiency algorithm.
This means that the verum group received fairly extensive attention, while the control group did not. In other words, a host of non-specific effects are likely to have significantly influenced or even entirely determined the outcome. Despite this rather obvious limitation, the authors fail to discuss any of it. On the contrary, that claim that “we did a definitive test of whether brief sleep restriction therapy delivered in primary care is clinically effective and cost-effective.” This is, in my view, highly misleading and unworthy of THE LANCET. I suggest the conclusions of this trial should be re-formulated as follows:
The brief nurse-delivered sleep restriction, or the additional attention provided exclusively to the patients in the verum group, or a placebo-effect or some other non-specific effect reduced insomnia symptoms.
Alternatively, one could just conclude from this study that poor science can make it even into the best medical journals – a problem only too well known in the realm of so-called alternative medicine (SCAM).
The U.S. Department of Health and Human Services alleges that Jason James of the James Healthcare & Associates clinic in Iowa, USA — along with his wife, Deanna James, the clinic’s co-owner and office manager — filed dozens of claims with Medicare for a disposable acupuncture device, which is not covered by Medicare, as if it were a surgically implanted device for which Medicare can be billed. According to the lawsuit, more than 180 such claims were filed. Beginning in 2016, the lawsuit alleges, the clinic began offering an electro-acupuncture device referred to as a “P-Stim.” When used as designed, the P-Stim device is affixed behind a patient’s ear using an adhesive. The device delivers intermittent electrical pulses through a single-use, battery-powered attachment for several days until the battery runs out and the device is thrown away.
Because Medicare does not reimburse medical providers for the use of such devices, DHHS alleges that some doctors and clinics have billed Medicare for the P-Stim device using a code number that only applies to a surgically implanted neurostimulator. The use of an actual neurostimulator is reimbursed by Medicare at approximately $6,000 per claim, while P-Stim devices were purchased by the Keokuk clinic for just $667, DHHS alleges. The department alleges James knew his billings were fraudulent as the P-Stim device is “nowhere close to even resembling genuine implantable neurostimulators” and does not require surgery.
The lawsuit alleges that on June 15, 2016, when Jason James was contemplating the use of P-Stim devices at the Keokuk clinic, he sent a text message to P-Stim sales representative Mark Kaiser, asking, “Is there a limit on how many Neurostims can be done on one day? Don’t wanna do so many that gives Medicare a red flag on first day. Thanks.” After realizing the “large profit windfall” that could result from the billing practice, DHHS’s lawsuit alleges, James “told Mark Kaiser not to mention the Medicare reimbursement rate to his nurse practitioner or staff – only his office manager and biller needed that information.” James then pressured clinic employees to heavily market the P-Stim devices to patients, even if those patients were not agreeable or, after trying it, were reluctant to continue the treatment, the lawsuit claims.
In October 2016, the clinic’s supplier of P-Stim devices sent the clinic an email stating the company had “no position on what the proper coding might be for this device if billed to a third-party payer” such as an insurer or Medicare, according to the lawsuit. The company advised the clinic to “consult a certified biller/coder and/or attorney to ensure compliance.” According to the lawsuit, James then sent Kaiser a text message asking, “Should we be concerned?”
DHHS alleges the clinic’s initial reimbursement claims were submitted to Medicare through a nurse practitioner and were denied for payment due to the lack of a trained physician’s involvement. In response, the clinic hired Dr. Robert Schneider, an Iowa-licensed physician, to work at the clinic for the sole purpose of enabling James Healthcare & Associates to bill Medicare for the P-Stim devices, the lawsuit claims. James then informed Kaiser he had a goal of billing Medicare for 20 devices per month, which would generate roughly $125,573 of monthly income, the lawsuit alleges. The lawsuit also alleges Dr. Schneider rarely saw clinic patients in person, consulting with them instead through Facebook Live.
In April 2017, Medicare allegedly initiated a review of the clinic’s medical records, triggering additional communications between James and Kaiser. At one point, James allegedly wrote to Kaiser and said he had figured out why Medicare was auditing the clinic. “Anything over $7,500 is automatically audited for my area,” he wrote, according to the lawsuit. “We are now charging $7,450 to remove the audit.”
The clinic ultimately submitted 188 false claims to Medicare seeking reimbursement for the P-Stim devices, DHHS alleges, with Medicare paying out $4,100 and $6,300 per claim, for a total loss of $1,028,800. DHHS is suing the clinic under the federal False Claims Act and is seeking trebled damages of more than $3 million, plus a civil penalty of up to $4.2 million.
An attorney for the clinic, Michael Khouri, said Wednesday he believe the federal government’s lawsuit was filed in error because a settlement in the case had already been reached. However, the assistant U.S. attorney handling the case said no settlement in the case had been finalized and the lawsuit was not filed in error.
Previous legal cases
In 2015, the Iowa Board of Chiropractic charged Jason James with knowingly making fraudulent or untrue representations in connection with his practice, engaging in conduct that was harmful or detrimental to the public, and making untruthful statements in advertising. The board alleged James told patients they would be able to stop taking diabetes medication through the use of a diet and nutrition program, and that he had claimed to be providing extensive laboratory tests when not all of the tests for which he billed were ever conducted. The board also claimed James referred patients to a medical professional who was not licensed to practice in Iowa. The case was resolved with a settlement agreement in which James agreed to pay a $500 penalty and complete 10 hours of education in marketing and ethics.
In 2019, Schneider sued the clinic for failing to comply with the terms of his employment agreement. Court exhibits indicate the agreement stipulated that Schneider was to work no more than two days per month and would collect $2,000 for each day worked, plus $250 per month for consulting, plus “$250 per device over six per calendar month.” In March 2020, a jury ruled in favor of the clinic and found that it had not breached its employment agreement with Schneider.
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Before some chiropractors now claim that such cases represent just a few rotten apples in a big basket of essentially honest chiropractors, let me remind them of a few previous posts:
- A $2.6M Insurance Fraud by Chiropractors and Doctors?
- Fraud and sex offences by chiropractors
- Chiropractic therapy for gastrointestinal diseases. Evidence of scientific misconduct?
- Twenty Things Most Chiropractors Won’t Tell You
- The Dark Side of Chiropractic Care
- Chiropractic subluxation: the myth must be kept alive
- CHIROPRACTIC: an early and delightful critique
- Students of chiropractic condemn the ‘unacceptable behaviour’ of some chiropractors and their professional organisations
- Far too many chiropractors believe that vaccinations do not have a positive effect on public health
- Chiropractor is in the dock for not wearing a mask
- “The uncensored truth” about COVID-19 vaccines” … as told by some chiro loons
To put it bluntly: chiropractic was founded by a crook on a bunch of lies and unethical behavior, so it is hardly surprising that today the profession has a problem with ethics and honesty.
In the UK – this post is mainly for UK readers – journalists and opinion leaders are currently falling over themselves reporting about a major breakthrough: an Alzheimer’s drug has been shown to slow the disease by around 36%. “After 20 years with no new Alzheimer’s disease drugs in the UK, we now have two potential new drugs in 12 just months,” wrote Dr Richard Oakley, associate director at the Alzheimer’s Society. And the Daily Mail headlined: “New drug which claims to slow mental decline caused by Alzheimer’s by 36% could spell ‘the beginning of the end’ for the degenerative brain disease”.
That’s excellent news!
Many people will have made a sigh of relief!
So, why does it make me angry?
Once we listen to the news more closely we learn that:
- the drug only works for patients who are diagnosed early;
- for an early diagnosis, we need a PET scan;
- the UK hardly has any PET scanners, in fact, we have the lowest number among developed countries;
- these scanners are very expensive;
- the costs for the new drug are as yet unknown but will also be high.
Collectively these facts mean that we have a major advance in healthcare that could help many patients. At the same time, we all know that this is mere theory and that the practice will be very different.
Why?
- Because the NHS has been run down and is on its knees.
- Because our government will again say that they have invested xy millions into this area.
- The statement might be true or not, but in any case, the funds will be far too little.
- The UK has become a country where some patients suffering from severe toothache currently resort to pulling out their own teeth at home with pairs of pliers.
- In the foreseeable future, the NHS will not be allocated the money to invest in sufficient numbers of PET scans (not to mention the funds to buy the new and expensive drug).
In other words, the UK celebrates yet another medical advance raising many people’s expectations, while everyone in the know is well aware of the fact that the UK public will not benefit from it.
Does that not make you angry too?
Yesterday, the NHS turned 75, and virtually all the newspapers have joined in the chorus singing its praise.
RIGHTLY SO!
The idea of nationalized healthcare free for all at the point of delivery is undoubtedly a good one. I’d even say that, for a civilized country, it is an essential concept. The notion that an individual who had the misfortune to fall ill might have to ruin his/her livelihood to get treated is absurd and obscene to me.
The NHS was created the same year that I was born. Even though I did not grow up in the UK, I cannot imagine a healthcare system where people have to pay to get or stay healthy. To me, ‘free’ – it is, of course not free at all but merely free at the point of delivery – is a human right just as freedom of speech or the right to a good education.
While reading some of what has been written about the NHS’s 75th birthday, I came across more platitudes than I care to remember. Yes, we are all ever so proud of the NHS but we would be even more proud if our NHS did work adequately. I find it somewhat hypocritical to sing the praise of a system that is clearly not functioning nearly as well as that of comparable European countries (where patients also don’t have to pay out of their own pocket for healthcare). I also find it sickening to listen to politicians paying lip service, while doing little to fundamentally change things. And I find it enraging to see how the conservatives have systematically under-funded the NHS, while pretending to support it adequately.
How can we be truly proud of the NHS when it seems to be dying a slow and agonizing death due to political neglect? In the UK, politicians like to be ‘world beating’ with everything, and I am sure some Tories want you to believe that, under their leadership, a world-beating healthcare system has been established in the UK.
Let me tell you: it’s not true. I have personal experience with the healthcare systems of 5 different nations and worked as a doctor in 3 of them. In Austria, France, and Germany for instance, the system is significantly better and no patient’s finances are ruined through illness.
Now there is talk about reform – yet again! Let us please not look towards the US when thinking of reforming the NHS. I have lived for a while in America and can tell you one thing: when it comes to healthcare, the US is not a civilized country. If reform of the NHS is again on the cards, let us please look towards the more civilized parts of the world!
Exceptionally, this post is unrelated to so-called alternative medicine (SCAM). It addresses a new and worrisome development in UK healthcare. The UK has fewer doctors per population than most other developed countries. This shortage has now reached a level where it puts patients in danger. Recently, the government has unveiled a new NHS plan aimed to fix the problem.
The apprenticeship scheme could allow one in 10 doctors to start work without a traditional medical degree, straight after their A-levels. A third of nurses are also expected to be trained under the “radical new approach”. It is the centerpiece of a long-delayed NHS workforce strategy, following warnings that staff shortages in England could reach half a million without action to find new ways to train and recruit health workers. Amanda Pritchard, the head of NHS England, said: “This radical new approach could see tens of thousands of school-leavers becoming doctors and nurses or other key healthcare roles, after being trained on the job over the next 25 years.” She added that the plan offered a “once-in-a-generation opportunity to put the NHS on a sustainable footing”.
The “medical doctor degree apprenticeship” involves the same training and standards as traditional education routes, including a medical degree and all the requirements of the General Medical Council. Candidates will be expected to have similar A-levels as those for medical school, with qualifications in sciences, as well as options for graduates with non-medical degrees. The key difference behind such models is that apprentice medics would be available on the wards almost immediately, working under supervision, while being paid.
The medical degree apprenticeship is due to launch this autumn.
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I am impressed!
Sadly, not in a positive way.
In fact, I cannot remember having ever heard of a more stupid idea for dealing with doctor shortages.
As incompetent amateurs, do the Tories really think that a similar level of incompetence might work also in healthcare?
Such shortages have happened before.
They are regrettable and need swift and firm action.
The only countermeasure that works is to train more doctors.
REAL DOCTORS!
Low back pain is the leading cause of years lived with disability globally, but most interventions have only short-lasting, small to moderate effects. Cognitive functional therapy (CFT) is an individualized approach that targets unhelpful pain-related cognitions, emotions, and behaviors that contribute to pain and disability. Movement sensor biofeedback might enhance treatment effects.
This study aimed to compare the effectiveness and economic efficiency of CFT, delivered with or without movement sensor biofeedback, with usual care for patients with chronic, disabling low back pain.
RESTORE was a randomized, three-arm, parallel-group, phase 3 trial, done in 20 primary care physiotherapy clinics in Australia. The researchers recruited adults (aged ≥18 years) with low back pain lasting more than 3 months with at least moderate pain-related physical activity limitation. Exclusion criteria were serious spinal pathology (eg, fracture, infection, or cancer), any medical condition that prevented being physically active, being pregnant or having given birth within the previous 3 months, inadequate English literacy for the study’s questionnaires and instructions, a skin allergy to hypoallergenic tape adhesives, surgery scheduled within 3 months, or an unwillingness to travel to trial sites. Participants were randomly assigned (1:1:1) via a centralized adaptive schedule to
- usual care,
- CFT only,
- CFT plus biofeedback.
The primary clinical outcome was activity limitation at 13 weeks, self-reported by participants using the 24-point Roland Morris Disability Questionnaire. The primary economic outcome was quality-adjusted life-years (QALYs). Participants in both interventions received up to seven treatment sessions over 12 weeks plus a booster session at 26 weeks. Physiotherapists and patients were not masked.
Between Oct 23, 2018, and Aug 3, 2020, the researchers assessed 1011 patients for eligibility. After excluding 519 (51·3%) ineligible patients, they randomly assigned 492 (48·7%) participants; 164 (33%) to CFT only, 163 (33%) to CFT plus biofeedback, and 165 (34%) to usual care. Both interventions were more effective than usual care (CFT only mean difference –4·6 [95% CI –5·9 to –3·4] and CFT plus biofeedback mean difference –4·6 [–5·8 to –3·3]) for activity limitation at 13 weeks (primary endpoint). Effect sizes were similar at 52 weeks. Both interventions were also more effective than usual care for QALYs, and much less costly in terms of societal costs (direct and indirect costs and productivity losses; –AU$5276 [–10 529 to –24) and –8211 (–12 923 to –3500).
The authors concluded that CFT can produce large and sustained improvements for people with chronic disabling low back pain at considerably lower societal cost than that of usual care.
This is a well-designed and well-reported study. It shows that CFT is better than usual care. The effect sizes are not huge and seem similar to many other treatments for chronic LBP, including the numerous so-called alternative medicine (SCAM) options that are available.
Faced with a situation where we have virtually dozens of therapies of similar effectiveness, what should we recommend to patients? I think this question is best and most ethically answered by accounting for two other important determinants of usefulness:
- risk
- cost.
CFT is both low in risk and cost. So is therapeutic exercise. We would therefore need a direct comparison of the two to decide which is the optimal approach.
Until we have such a study, patients might just opt for one or both of them. What seems clear, meanwhile, is this: SCAM does not offer the best solution to chronic LBP. In particular, chiropractic, osteopathy, or acupuncture – which are neither low-cost nor risk-free – are, contrary to what some try so very hard to convince us of, sensible options.
Here in the UK, we are looking yet again for a new Prime Minister (PM). Did I say ‘we’? That’s not quite true; the Tory party is hunting for one, and it seems a difficult task for the talent-depleted conservatives. Eventually, the geriatric group of Tory members might again have the say. Amazingly, some senior Tories are already suggesting Boris Johnson (BJ).
To me, this demonstrates how common cognitive decline and memory loss seem to be among the elderly. They evidently have already forgotten that, only a few months ago, BJ has already been our PM.
Yes, it is often the short-term memory that suffers first!
It might, therefore, help to remind the Tory membership thus affected that BJ:
- was elected as PM in 2019,
- he then created scandal after scandal,
- he was even found guilty of breaking the law,
- he is still under investigation for misleading the Parliament,
- eventually, in 2022, he was removed from office after mishandling a sexual abuse scandal.
I hope this helps to refresh your memory, Tory members suffering from cognitive decline. Considering this blog is about so-called alternative medicine (SCAM), I should perhaps also offer you some treatments for the often progressive deterioration of mental capacity. Here is a recent paper that might point you in the right direction:
Senile ages of human life is mostly associated with developmental of several neurological complicated conditions including decreased cognition and reasoning, increased memory loss and impaired language performance. Alzheimer’s disease (AD) is the most prevalent neural disorder associated with dementia, consisting of about 70% of dementia reported cases. Failure of currently approved chemical anti-AD therapeutic agents has once again brought up the idea of administering naturally occurring compounds as effective alternative and/or complementary regimens in AD treatment. Polyphenol structured neuroprotecting agents are group of biologically active compounds abundantly found in plants with significant protecting effects against neural injuries and degeneration. As a subclass of this family, Flavonoids are potent anti-oxidant, anti-inflammatory and signalling pathways modulatory agents. Phosphatidylinositol 3-kinase (PI3K)/AKT and mitogen activated protein kinase (MAPK) pathways are both affected by Flavonoids. Regulation of pro-survival transcription factors and induction of specific genes expression in hippocampus are other important anti AD therapeutic activities of Flavonoids. These agents are also capable of inhibiting specific enzymes involved in phosphorylation of tau proteins including β-secretases, cyclin dependent kinase 5 and glycogen synthase. Other significant anti AD effects of Flavonoids include neural rehabilitation and lost cognitive performance recovery. In this review, first we briefly describe the pathophysiology and important pathways involved in pathology of AD and then describe the most important mechanisms through which Flavonoids demonstrate their significant neuroprotective effects in AD therapy.
Sorry, I forgot that this might be a bit too complex for semi-senile Tories. Put simply, this means consuming plenty of:
- berries,
- apples,
- garlic,
- onion,
- green tea,
- beans (beware flatulence in Parliament!)
In addition, I might advise you to stay off the Port, get enough rest, avoid stress of any type, and do plenty of aerobic exercise. And please:
- not too much excitement,
- stimulate your brain (this means avoid reading right-wing papers),
- no major scandals,
- no further deterioration of moral standards,
- no more lies,
- no more broken promises!
In other words, no vote for BJ!!!
The problems for homeopathy in Germany do not seem to stop. Recently, the German health minister announced that he will look at the issue of reimbursement of homeopathy. Now, an article in the Deutsche Apotheker Zeitung (German Journal for Pharmacists) critically discussed the question of the place of homeopathy in German pharmacies. At present, pharmacies are the only places that are allowed to sell homeopathic preparations. This undoubtedly gives them a veneer of respectability; many consumers seem to feel that, if homeopathic preparations are only available in pharmacies, they must be well-tested and effective.
But recently, more and more German pharmacists have been pointing out that homeopathy is ineffective nonsense. A journalist who had listened to the advanced training “Homeopathy Highlights” of the Westphalia-Lippe Chamber of Pharmacists, he subsequently confronted the Chamber with the controversial contents of this advanced training event. The Chamber then declared that it would “no longer offer any refresher seminars on the subject of homeopathy with immediate effect” and that the speaker would also no longer work for it.
And now, the Berlin Chamber of Pharmacists wants the pharmacy community to distance itself from homeopathy as a scientifically recognized and evidence-based drug therapy. With its motion, the Chamber wants to achieve that the title “Naturopathic Medicine and Homeopathy” of the training regulations is replaced by the title “Phytopharmacy and Naturopathy”. The justification states: “The permission to use the title ‘pharmacist for naturopathic treatment and homeopathy’ by the state chambers of pharmacists suggests that homeopathy is a scientifically recognized and evidence-based drug therapy”.
I think it is time that German pharmacists remind themselves that they are more than shopkeepers; they are healthcare professionals who have an ethical duty. I have discussed this issue often enough. If you are interested, here are a few of my posts on this subject:
- Pharmacists must advise customers that homeopathic remedies lack evidence
- “Pharmacists should not sell or dispense homeopathic products”
- German pharmacists fail their customers when advising them on homeopathy
- Pharmacists put themselves at risk by selling homeopathic remedies
- Pro and Contra: should UK community pharmacists sell homeopathic remedies?
- Pharmacists’ responsibilities vis a vis alternative medicine: the violation of healthcare ethics continues.
- It is “disappointing that some pharmacists are still stocking homeopathy products”
- Pharmacists: to sell quackery means you are quacks – or have I got that wrong?
- Pharmacists must use their professional judgement to prevent the supply of homeopathic remedies
It is high time that German pharmacists do the right thing!
