Several previously published clinical trials have suggested that both acupuncture and sham acupuncture exert significant, non-specific effects on treatment outcomes when compared to no-treatment controls. A recently developed framework (mechanisms in orthodox and complementary and alternative medicine-MOCAM) suggests that the non-specific effects of acupuncture originate from multiple domains (e.g. patient characteristics, acupuncturist skill/technique, the patient-acupuncturist relationship, and the acupuncture environment). However, it remains to be determined precisely how these domains influence the non-specific effects of treatment among patients receiving acupuncture and sham acupuncture in clinical trials.
To address this issue, researchers conducted a systematic review to synthesize existing qualitative evidence on how trial participants randomized to acupuncture and sham acupuncture groups experience non-specific effects, regardless of the types of medical conditions investigated.
This systematic review included primary qualitative studies embedded in randomized controlled trials designed to investigate acupuncture or sham acupuncture interventions. Eligible studies published in English were derived from a search of five international databases. The methodological quality of included studies was evaluated using the Critical Appraisal Skills Programme (CASP) tool. Using a framework synthesis approach, the identified MOCAM framework was adapted based on the synthesis of the available qualitative evidence.
A total of 20 studies of high methodological quality were included. The proposed model indicated that the effects of acupuncture may be increased by:
- maintaining a professional status,
- applying a holistic treatment approach,
- practicing empathy,
- providing patients with an appropriate explanation of the theory behind acupuncture and sham acupuncture.
From the patient’s perspective, the efficacy of treatment can be increased by:
- following the lifestyle modification advice provided by acupuncturists,
- maintaining a positive attitude toward treatment efficacy,
- actively engaging with acupuncturists during the consultation,
- making behavioral changes based on experience gained during the trial.
The authors concluded that the results of this study may provide a basis for improving and standardizing key components of non-specific effects in acupuncture treatment, and for improving the isolation of specific effects in future clinical trials involving acupuncture and sham acupuncture.
The authors also state that having a positive attitude and high expectations regarding treatment efficacy can lead to positive health outcomes, along with a sense of curiosity and altruistic desire to join clinical trials. Indeed, previous clinical trials have reported that higher expectations regarding treatment effects may help to reduce fatigue and alleviate osteoarthritis in both acupuncture and sham acupuncture groups. Similar benefits of positive expectations have also been observed among patients with irritable bowel syndrome in sham acupuncture trials.
SO CLOSE AND YET SO FAR!
So close to admitting that these findings indicate quite strongly that acupuncture is but a theatrical placebo.
Osteopathy is hugely popular in France. Despite the fact that osteopathy has never been conclusively shown to generate more good than harm, French osteopaths have somehow managed to get a reputation as trustworthy, evidence-based healthcare practitioners. They tend to treat musculoskeletal and many other issues. Visceral manipulation is oddly popular amongst French osteopaths. Now the trust of the French in osteopathy seems to have received a serious setback.
‘LE PARISIEN‘ has just published an article about the alleged sexual misconduct of one of the most prominent French osteopaths and director of one of the foremost schools of osteopathy in France. Here are some excerpts from the article that I translated for readers who don’t speak French:
The public prosecutor’s office of Grasse (Alpes-Maritimes) has opened a judicial investigation against Marc Bozzetto, the director and founder of the school of osteopathy in Valbonne, accused of rape and sexual assault.
In total, “four victims are targeted by the introductory indictment,” said the prosecutor’s office, stating that Marc Bozzetto had already been placed in police custody since the beginning of the proceedings. The daily paper ‘Nice-Matin’ has listed six complaints and published the testimony of a seventh alleged victim.
This victim claims to have been sexually assaulted in 2013, alleging that, during a professional appointment, Bozzetto had massaged her breasts and her intimate area. “He told me that everything went through my vagina and clitoris, that I had to spread my legs and let the energy flow through my clitoris. That I had to learn how to give myself pleasure on my own,” she told Nice-Matin. The newspaper also recorded the testimonies of a former employee, a top-level sportswoman, an employee from the world of culture, and a former student.
“I take note that a judicial inquiry is open. To date, he has neither been summoned nor indicted,” said Karine Benadava, the Parisian lawyer of the 80-year-old Bozzetto. Her client had already responded following initial accusations from students: “This is a normal feeling for women, but if all the women who work on the pelvis complain, you can’t get away with it and you have to stop working as a pelvic osteopath,” replied Bozzetto. In another interview, he had declared himself “furious” and unable to understand the reaction of these two students.
The school of osteopathy trains about 300 students each five years and presents itself as the first holistic osteopathy campus in France.
Such stories of sexual misconduct of practitioners of so-called alternative medicine (SCAM) are sadly no rarety, particularly those working in the area of manual therapy. They remind me of a case against a Devon SCAM practitioner in which I served as an expert witness many years ago. Numerous women gave witness that he ended up having his fingers in their vagina during therapy. He did not deny the fact but tried to defend himself by claiming that he was merely massaging lymph-nodes in this area. It was my task to elaborate on the plausibility of this claim. The SCAM practitioner in question was eventually sentenced to two years in prison.
It stands to reason that SCAM practitioners working in the pelvic area are at particularly high risk of going atray. The above case might be a good occasion to have a public debate in France and ask: IS VISCERAL OSTEOPATHY EVIDENCE-BASED? The answer is very clearly NO! Surely, this is a message worth noting in view of the current popularity of this ridiculous, costly, and dangerous charlatanry.
And how does one minimize the risk of sexual misconduct of SCAM professionals? The most obvious answer would be, by proper education during their training. In the case mentioned above, this might have been a problem: if the director is into sexual misconduct, what can you expect of the rest of the school? In many other cases, the problem is even greater: many SCAM practitioners have had no training at all, or no training in healthcare ethics to speak of.
The fact that the NHS England has stopped reimbursing homeopathy in 2018 is probably quite well known. France followed more recently, and then Germany too reported trouble for homeopaths on various levels. About two years ago, the manufacturer of homeopathic products, Hevert (Germany), threatened legal action against several German critics of homeopathy for expressing the fact that highly diluted homeopathic remedies do not work beyond placebo. Crucially, the medical associations of many regions in Germany have – one after the next – discontinued their training in and recognition of homeopathy.
Now similar difficulties are being felt also by Austrian homeopaths. In 2019, the Vienna medical school closed its course on homeopathy because students had filed a complaint about its unethical content. And recently, it was reported by the Austrian ‘Initiative für Wissenschaftliche Medizin‘ that at a secret webinar run by lobbyists in Vienna things were reported to no longer going well for homeopathy. Faced with such problems, the lobbyist, Dr. Jens Behnke, recommended in the above-mentioned secret webinar an alliance of all so-called alternative medicine (SCAM):
“…..and if we do not form this broad alliance now, in order to make appropriate professional PR and lobbying … then everything will fall apart….”
Now a union of pseudomedicine and politics is being forged with the aim of stopping the decline of quackery and paving the way for pseudomedicine in Austria. A resolution has been tabled in the Austrian parliament with the following demands:
- Institutionalising of the field of “Complementary Medicine” as “Integrative Medicine” in the academic education at all medical schools.
- Appropriate support for and funding of complementary medicine research, especially in the university sector.
- Establishment of a broad range of complementary medicine in the hospital sector, in outpatient but also inpatient healthcare.
- Promotion of active knowledge transfer in the area of integrative and complementary medicine within the Austrian medical profession.
- Securing of complementary diplomas by the Austrian Medical Association.
The motion was introduced by the Freedom Party (FPÖ, the Austrian far-right party) on 21.12.2020, forwarded to the Health Committee for consultation, and is now scheduled for consultation there. The application was introduced by the FPÖ-Nationalratsabgeordnete Mag. Gerhard Kaniak (Chairman of the Health Committee of Parliament, pharmacist), Peter Wurm (entrepreneur), Dr. Dagmar Belakowitsch (physician), and “other deputies”. It is supported by members of the “Initiative Complementary Medicine at Austrian Universities” of the Austrian Society for Homeopathic Medicine. The list of signatories of the motion reads like the “Who’s Who” of pseudo-medicine procedures in Austria – foremost homeopathy, but also anthroposophic medicine, ozone therapy, functional myo-diagnostics (= kinesiology), Ayurvedic medicine, orthomolecular medicine, TCM, etc. It almost goes without saying that it also includes Prof Michael Frass (a prominent member of THE ALTERNATIVE MEDICINE HALL OF FAME), who regular readers of my blog would have met several times before.
Instead of a comment (other than I sincerely wish that reason prevails in Austria and the motion is going to be defeated), I think I will quote the concluding phrases from my memoir (which incidentally also covers my most turbulent time in Vienna):
When science is abused, hijacked, or distorted in order to serve political or ideological belief systems, ethical standards will inevitably slip. The resulting pseudoscience is a deceit perpetrated on the weak and the vulnerable. We owe it to ourselves, and to those who come after us, to stand up for the truth, no matter how much trouble this might bring.
I am pleased to report that our ‘resident homeopathic doctor’ from Germany, Dr. Heinrich Huemmer, posted a review of my new book on Amazon. As his comments are in German, I translated them which was not easy because they are confusing and confused. Now that it’s done, I cannot resist the temptation to show them to you (the references were inserted by me, and refer to my comments below):
First of all, the author, who as a scientist  once had a thoroughly positive attitude towards homeopathy [and in a meta-analysis even attested to it significantly positive results in a certain clinical picture ], explains the principles and procedures in homeopathy in a clear and objective manner.
In explaining the principle of potentization, however, Ernst’s one-dimensional and completely unscientific matter-bound, quasi-medieval understanding of science shines through for the first time. With the assertion, “both the dilution and the similarity rule contradict the laws of nature” he clearly reveals his unscientific thinking, whereby he could have easily relativized this by an inserted differentiation “presently, known laws of nature”.  And not even the following sentence “…we understand very well that it can function only if the known laws of nature would be invalid” is agreed by critically thinking natural scientists.  Also the assertion: “The totality of this evidence does not show that homeopathic remedies would be no more than placebo”, is countered by a well-known – belonging to the skeptic movement – expert of the homeopathic study situation with the remark: “Furthermore, you should read my statements and those of the INH more carefully again: Our statement is that there is no robust/reliable/convincing evidence for efficacy beyond placebo. ALSO NOT “NONE” but “none conclusive”, which yes makes a difference in absolute numbers. Just like “no beer” is different than “not a good beer”. ”  Since patients usually turn to homeopathy only when so-called scientific medicine negates their illnesses and accordingly has nothing to offer them , Ernst’s reference to the fact that patients could “endanger their health” is to be seen as a cheap attempt at discrediting.  The reference that this assessment comes from the Australian National Health and Medical Research Council is not without a particularly piquant note, since this NHMRC may have to be held responsible for a particularly infamous attempt at scientific fraud to the disadvantage of homeopathy.  Also, the alleged “fact” that “[positive] experiences […] are the result of a long, empathetic, sympathetic encounter with a homoeopath…” can be disproved by immediate – also diagnostically verified – cures, which occurred immediately without a long admission or which failed to appear even after several intensive anamneses under most sympathetic admission against all expectations….. Finally Ernst’s argument “the benefit-cost-argument of homeopathy is not positive” is an absolute air number, because the saving of 1 €/patient and year (in case of abolition of the homeopathy-reimbursement) would not even allow a free new glasses-nose-pad…. 
- I am not sure where Homeopathy Heinrich Huemmer (HHH) got the claim from that I, as a scientist, once had a thoroughly positive attitude towards homeopathy. This is not even remotely true! As a very young clinician (40 years ago), I once was quite impressed by homeopathy, never as a scientist (for full details, see my memoir). What HHH seems to display here is his very own misunderstanding about science and scientists: if they are for real (i.e. not pseudoscientists like many of those who research homeopathy), scientists try not to let their personal attitudes get in the way of good science.
- I presume that HHH refers here to this meta-analysis: Homeopathy for postoperative ileus? A meta-analysis. I fear that HHH has yet to learn how to read a scientific paper. Our conclusions were: There is evidence that homeopathic treatment can reduce the duration of ileus after abdominal or gynecologic surgery. However, several caveats preclude a definitive judgment. These results should form the basis of a randomized controlled trial to resolve the issue.
- This made me laugh! Does HHH think that only the handful of homeopathic loons who claim that homeopathy has a scientific basis in the unknown laws of nature are truly scientific? And all the rest are unscientific?
- I doubt that anyone can understand this passage, perhaps not even HHH. My conclusion that “the totality of this evidence does not show that homeopathic remedies are more than placebo” merely expresses what even most homeopaths would admit and is unquestionably correct.
- This statement is untrue in more than one way. Firstly, responsible clinicians never tell a patient that they have nothing more to offer, simply because this is never the case – there is always something a good clinician can do for his/her patient, even if it is just in terms of palliation or moral support. Secondly, we know that German patients opt to use homeopathy for all sorts of reasons, including as first-line therapy and not as a last resort.
- In the book, I refer (and reference the source) to the phenomenon that many homeopaths discourage their patients from vaccination. Unfortunately, this is no ‘cheap attempt’, it is the sad reality. HHH does not even try to dispute it.
- HHH does not like the NHMRC report. Fair enough! But he omits to mention that, in the book, I list a total of 4 further official verdicts. Does HHH assume they are all fraudulent? Is there perhaps a worldwide conspiracy against homeopathy?
- We all know that HHH is enormously proud of his only publication to which he refers here (on this blog, he must have mentioned it a dozen times). However, in the book, I refer to an RCT for making my point. Which is more convincing, a case report or an RCT?
- Here HHH simply demonstrates that he has not understood the concept of cost-effectiveness.
So, what we have here is a near-perfect depiction of a homeopath’s way of thinking. But there is worse in HHH’s comment< I fear.
My book (of 224 pages) scrutinizes – as even its title states – not one but 40 types of so-called alternative medicine (SCAM); 20 of the most effective and 20 of the most dangerous SCAMs. In addition, it covers (in ~ 50 pages) many general topics (like ‘WHAT IS EVIDENCE? or WHY IS SCAM SO POPULAR?). It includes over 200 references to published papers. Yet, HHH reviews and judges the book by commenting exclusively on the meager 5 pages dedicated to homeopathy!
If that does not exemplify the limitations of the homeopathic mind, please tell me what does.
THANK YOU, HHH, FOR MAKING THIS SO CLEAR TO US!
Physicians who include so-called alternative medicine (SCAM) in their practice are thought to have an understanding of health and disease different from that of colleagues practicing conventional medicine. The aim of this study was to identify and compare the thoughts and concepts concerning infectious childhood diseases (measles, mumps, rubella, chickenpox, pertussis, and scarlet fever) of physicians practicing homeopathic, anthroposophic and conventional medicine.
This qualitative study used semistructured interviews. Participating physicians were either general practitioners or pediatricians. Data collection and analysis were guided by a grounded theory approach.
Eighteen physicians were interviewed (6 homeopathic, 6 anthroposophic, and 6 conventional). All physicians agreed that while many classic infectious childhood diseases such as measles, mumps, and rubella are rarely observed today, other diseases, such as chickenpox and scarlet fever, are still commonly diagnosed. All interviewed physicians vaccinated against childhood diseases.
- A core concern for physicians practicing conventional medicine was the risk of complications of the diseases. Therefore, it was considered essential for them to advise their patients to strictly follow the vaccination schedule.
- Homeopathic-oriented physicians viewed acute disease as a biological process necessary to strengthen health, fortify the immune system and increase resistance to chronic disease. They tended to treat infectious childhood diseases with homeopathic remedies and administered available vaccines as part of individual decision-making approaches with parents.
- For anthroposophic-oriented physicians, infectious childhood diseases were considered a crucial factor in the psychosocial growth of children. They tended to treat these diseases with anthroposophic medicine and underlined the importance of the family’s resources. Informing parents about the potential benefits and risks of vaccination was considered important.
All physicians agreed that parent-delivered loving care of a sick child could benefit the parent-child relationship. Additionally, all recognized that existing working conditions hindered parents from providing such care for longer durations of time.
The authors concluded that the interviewed physicians agreed that vaccines are an important aspect of modern pediatrics. They differed in their approach regarding when and what to vaccinate against. The different conceptual understandings of infectious childhood diseases influenced this decision-making. A survey with a larger sample would be needed to verify these observations.
The authors (members of a pro-SCAM research group) stress that the conventional physicians saw many risks in the natural course of classic childhood illnesses and appreciated vaccinations as providing relief for the child and family. By contrast, the physicians trained in homeopathy or anthroposophic medicine expected more prominent unknown risks because of vaccinations, due to suppression of the natural course of the disease. Different concepts of disease lead to differences in the perceptions of risk and the benefit of prevention measures. While prevention in medicine aims to eliminate classic childhood diseases, anthroposophic and homeopathic literature also describes positive aspects of undergoing these diseases for childhood development.
This paper thus provides intriguing insights into the bizarre thinking of doctors who practice homeopathy and anthroposophical medicine. The authors of the paper seem content with explaining and sometimes even justifying these beliefs, creeds, concepts, etc. They make no attempt to discuss the objective truths in these matters or to disclose the errors in the thought processes that underly homeopathy and anthroposophical medicine. They also tell us that ALL the interviewed physicians vaccinated children. They, however, fail to provide us with information on whether these doctors all recommend vaccinations for all patients against all the named infectious diseases. From much of previous research, we have good reasons to fear that their weird convictions often keep them from adhering strictly to the current immunization guidelines.
“My father invented a therapy for which there was no disease, my mother caught it and died.”
This type of scurrility makes me laugh. And it reminds me of the missing link in so-called alternative medicine (SCAM). We have heard about alternative therapies, alternative diagnostic methods, but what about alternative diseases and conditions? Here are some that SCAM practitioners seem to be oddly fond of:
- – adrenal fatigue
- – chi deficiency
- – yeast overgrowth
- – leaky gut syndrome
- – leaky brain syndrome
- – chronic Lyme disease
- – various food ‘sensitivities’
- – methylation dysfunction
- – spinal subluxation
- – vaccine-induced ‘toxicity’
- – toxin-overload
But surely, these cannot be enough! For the field of SCAM to make progress, we definitely need many more. So, I had a brainstorm and came up with the following suggestions:
- Ataxia: the condition (of many SCAM practitioners, but also others) where patients fail to declare their income to the taxman; usually cured by a short stay in the nick.
- Cardioversion: an insurmountable dislike of conventional clinicians like cardiologists; a self-limiting condition that usually improves after receiving proper medical attention during a serious illness.
- Collagen: a genetic disorder that shows itself through a strong dislike of experts who have been to college; incurable.
- Deepak Chopra Syndrome: a serious neurosis where the patient cannot stop uttering BS; incurable.
- Digitoxin: the unfortunate condition where a spiritual healer sends toxic spirits into the patient via his/her fingers; needs urgent detox.
- Donovan bodies: a psychiatric affliction where patients are compelled to look and sing like Donavan; requires a sound-proof cell.
- Duodenal ulcer: an unfortunate condition where the patient has two denal ulcers at the same time; emergency Reiki is advised.
- Dyspepsia: the pathological preference of Coke over Pepsi; incurable.
- Familial diseases: an umbrella term for all the few conditions that SCAM practitioners actually know about; can improve with reading a few textbooks.
- Free radicals: terrorists on the run; call the police!
- Fungal infection: a rare form of food poisoning where the magic mushrooms were off; needs detox.
- Iridocyclitis: an obsession that afflicts iridologists who cannot stop riding bicycles; incurable.
- Keratosis: the dangerous situation where a patient develops an aversion to his/her carer; change of carer is often needed.
- Murial dyslexia: the inability to be able to read the writing on the wall; incurable.
- Myositis: is always worse than your ositis.
- Osteoblast: an event where, after chiropractic manipulation, a bone breaks with an audible noise; see an orthopedic surgeon.
- Semi-colon: the embarrassing situation where a colonic irrigationist managed to clean out only half of the colon; manageable by changing your therapist.
If you, the reader, can think of more ways to expand the repertoire of SCAM terminology, please feel free to let us all know by posting your ideas below.
Yes, I have just published a new book! Its title is ‘Alternativmedizin – was hilft, was schadet: Die 20 besten, die 20 bedenklichsten Methoden’ (Alternative medicine – treatments that help and treatments that harm: The 20 best and the 20 most worrying methods). Yes, it is in German, and somehow I doubt that there will be an English version of it. Therefore I take the liberty of translating a short section for those who do not read German.
But first, let me tell you about the book’s concept.
Some people who read this blog seem to have the impression that I am dead against so-called alternative medicine (SCAM) – my friend Dana Ullman, for instance, is convinced of it. This, however, is not quite correct (Dana rarely is). The truth is that I am
- FOR evidence-based medicine,
- FOR a level playing field in all areas of healthcare,
- FOR critically evaluating all options.
This also means, of course, that I am against misleading consumers about the value of SCAM. And therefore I am FOR any SCAM that demonstrably does more good than harm.
This attitude should have been clear from all my books. However, it seems to be difficult to understand for those who are on the more fanatical end of the SCAM spectrum. And because it is not that obvious, I decided to write a book that analyses (understandably yet analytically [including ~300 references of the original science]) the evidence for 20 SCAMs that are supported by reasonably sound evidence together with 20 for which this is not the case. My hope is that, with this approach, I might reach more consumers who are in favour of SCAM.
There is a risk, of course. Chances are that, instead of reaching more people from the pro-camp, I will merely offend both the sceptics as well as the enthusiasts.
We shall see.
Anyway, here is the promised bit that I translated for you. It is the postscript of the book, and I hope it gives you a flavour of what it is all about. Here we go:
In the first chapter of the book, I promised that I would neither uncritically hype alternative medicine nor unfairly condemn it. I have taken great pains to keep this promise.
Have I succeeded?
I fear there will be many who answer this question in the negative. And I can’t even blame my critics! Who likes to be criticized for something in which he deeply believes? Who likes to hear that his prejudices against everything called alternative medicine are wrong and counter-productive? Who doesn’t mind an ugly fact that destroys his beautiful theory? Both the dogmatic naysayers and the naive believers will be dissatisfied with my book (or at least parts of).
That’s a shame, but ultimately it is irrelevant. My point was not to take the word of one camp or another in the endless trench warfare that is alternative medicine. My main concern was to present the evidence as up-to-date, understandable, and objective as possible, and to serve those who are seriously interested in facts.
The book is thus not for dogged trench warriors; rather, it is aimed at ordinary consumers with an interest in their health. After all, the vast majority of the population is not among the unteachables of one camp or the other. Most people don’t want ideology, they want effective medicine. And most of them are baffled by the unmanageable variety of alternative medicine on offer, the grandiose promises of healing, and the vehement emotions that it all triggers.
In the area of alternative medicine, there is undoubtedly a lot of nonsense, charlatanry, and danger. But there are also some things that demonstrably do more good than harm. In order to separate the wheat from the chaff, consumers don’t need creeds. What they need above all is reliable evidence!
You can read about this evidence in my book. How you then deal with it is solely your decision. I do not want to tell anyone what to do with my presentation of the facts. But I know that the abundance of misinformation in the field of alternative medicine causes great damage and that the consumer and reader of my book, deserve better than to be led up the garden path.
If this book helps readers to make wise treatment decisions, my efforts will have been worthwhile. And if they get half as much pleasure from reading it as I did from writing it, my goal has been achieved.
(If by any chance you do read German and are in the position to publish a book review, please let me know and I will see that you get a free review copy of my book)
It’s sad but true: not everyone likes THE ALTERNATIVE MEDICINE HALL OF FAME. Take this recent comment, for instance:
It is pathetic to see that Edzard only engages in the systematic harassment of his former colleagues or people who in most cases ignore him. Perhaps because he knows that his battle against homeopathy was totally lost in Germany, Switzerland and Brazil, as could be seen in the imminent failure of the “Questao Da Ciencia Institute”… Edzard acts as a real bully against Dr. Jacobs by including her in a “hall of fame” to humiliate her before the hoolingans who applaud her, who are always the four guardian trolls who never contribute or benefit to the discussion…
But then there are others who do appreciate it and recognize that it serves an important purpose: to alert the public to the fact that there is something deeply wrong with much of the published research in so-called alternative medicine (SCAM). Incidentally, this was also the theme of my last post on acupuncture and is the topic of many of my recent articles. Thus the aim of my HALL OF FAME is not to humiliate anyone; it is merely one of many of my attempts to protect the public from misleading information that has the potential to do much harm.
And therefore, I am not likely to close the HALL OF FAME any time soon.
Someone who has been waiting for ages to get admitted is the prolific psychologist Professor Harald Walach. He has in the past changed employment frequently. After building up a research group in SCAM at the University Hospital in Freiburg he held a research professorship with the University of Northampton, UK from 2005-2009 where he directed the MSc Program of Transpersonal Psychology and Consciousness Studies. From 2010 to 2016, he worked at the European University Viadrina in Frankfurt (Oder), where he headed a postgraduate Master program training doctors in SCAM and cultural sciences. Currently, Walach is affiliated with three institutions:
- Department of Pediatric Gastroenterology, Medical University Poznan, Poznan, Poland.
- Department of Psychology, University Witten-Herdecke, Witten, Germany.
- Change Health Science Institute, Berlin, Germany
In 2012, Walach was elected pseudoscientist of the year, a fact that should almost automatically unlock the HALL’s door for him. But let’s not be hasty; let’s have a look at his publications. My Medline search for ‘Walach H, clinical trial’ generated 40 hits of which 19 related to clinical studies of so-called alternative medicine (SCAM). Here are their conclusions:
- Both physiotherapy and PPT improve subacute low back pain significantly. PPT is likely more effective and should be studied further.
- One treatment session of enhanced MMT physiotherapy or RegentK can lead to nearly full function and thus recovery of a ruptured ACL after 1 year.
- MBSR did not produce cardiac autonomic benefits or changes in daily activity in FM. Furthermore, the lack of an association between patient-experienced clinical improvement and objective physiological measures suggests that subjective changes in the wellbeing of FM patients over time are not related to alterations in the cardiorespiratory autonomic function or activity levels.
- Mindfulness therapy may prevent disability pension and it may have a potential to significantly reduce societal costs and increase the effectiveness of care. Accumulated weeks of unemployment and sickness benefit are possible risk factors for BDS.
- Mindfulness therapy is a feasible and acceptable treatment. The study showed that mindfulness therapy was comparable to enhanced treatment as usual in improving quality of life and symptoms.
- In conclusion, primary outcome analyses did not support the efficacy of MBSR in fibromyalgia, although patients in the MBSR arm appeared to benefit most.
- Homeopathic remedies produce different symptoms than placebo.
- We, therefore, conclude that homeopathic remedies produce more symptoms typical for a remedy than non-typical symptoms. The results furthermore suggest a somewhat non-classical pattern because symptoms of one remedy appear to be mimicked in the other trial arm. This might be indicative of entanglement in homeopathic systems.
- In patients with CFS, distant healing appears to have no statistically significant effect on mental and physical health but the expectation of improvement did improve outcome.
- Treatments with QUANTEC may be accompanied by beneficial health effects.
- The results showed that both remedies ‘produced’ significantly more symptoms than placebo. With regard to the specificity, the Calendula officinalis group displayed more remedy-specific symptoms than placebo. However, in the Ferrum muriaticum group more Calendula symptoms than placebo were also recorded.
- Homeopathic proving symptoms appear to be specific to the medicine and do not seem to be due to a local process.
- We conclude that in an unselected sample of headache patients some may indeed be susceptible to the low intensity type of electromagnetic radiation exemplified by sferics pulses.
- We conclude that Bach-flower remedies are an effective placebo for test anxiety and do not have a specific effect.
- Approximately 30% of patients in homeopathic treatment will benefit after 1 y of treatment. There is no indication of a specific, or of a delayed effect of homeopathy.
- There is no indication that belladonna 30CH produces symptoms different from placebo or from no intervention. Symptoms of a homeopathic pathogenetic trial (HPT) are most likely chance fluctuations.
- Chronically ill patients who want to be treated by distant healing and know that they are treated improve in quality of life.
- Mind machines do not have a specific effect on general well-being and physiological relaxation, although they may produce unusual psychological experiences; people with psychiatric illnesses should not use such devices.
- Group evaluation showed no clearcut differences. The claim that homoeopathic potencies can produce symptoms other than placebo in healthy subjects should be put to further scrutiny.
So, as we see, Prof Walach has published many clinical trials on numerous SCAMs . Their majority arrived at positive conclusions. His TI is therefore sky-high. But he has also published studies that were dramatically negative, even some of homeopathy!
The main criterion for admission to THE ALTERNATIVE MEDICINE HALL OF FAME is to have published SCAM research that hardly ever concludes negatively. Does Walach fulfill it? Should he be allowed to join this illustrious group of people?
- Andreas Michalsen ( various SCAMs, Germany)
- Jennifer Jacobs (homeopath, US)
- Jenise Pellow (homeopath, South Africa)
- Adrian White (acupuncturist, UK)
- Michael Frass (homeopath, Austria)
- Jens Behnke (research officer, Germany)
- John Weeks (editor of JCAM, US)
- Deepak Chopra (entrepreneur, US)
- Cheryl Hawk (US chiropractor)
- David Peters (osteopathy, homeopathy, UK)
- Nicola Robinson (TCM, UK)
- Peter Fisher (homeopathy, UK)
- Simon Mills (herbal medicine, UK)
- Gustav Dobos (various SCAMs, Germany)
- Claudia Witt (homeopathy, Germany/Switzerland)
- George Lewith (acupuncture, UK)
- John Licciardone (osteopathy, US)
I have to admit, the decision was not easy in this case. However, after considering all the evidence, I have decided in favour of admission.
WELCOME PROF WALACH!
The state of acupuncture research has long puzzled me. The first thing that would strike who looks at it is its phenomenal increase:
- Until around the year 2000, Medline listed about 200 papers per year on the subject.
- From 2005, there was a steep, near-linear increase.
- It peaked in 2020 when we had a record-breaking 20515 acupuncture papers currently listed in Medline.
Which this amount of research, one would expect to get somewhere. In particular, one would hope to slowly know whether acupuncture works and, if so, for which conditions. But this is not the case.
On the contrary, the acupuncture literature is a complete mess in which it gets more and more difficult to differentiate the reliable from the unreliable, the useful from the redundant, and the truth from the lies. Because of this profound confusion, acupuncture fans are able to claim that their pet-therapy is demonstrably effective for a wide range of conditions, while skeptics insist it is a theatrical placebo. The consumer might listen in bewilderment.
Yesterday (18/1/2021), I had a quick (actually, it was not that quick after all) look into what Medline currently lists in terms of new acupuncture research published in 2021 and found a few other things that are remarkable:
- There were already 100 papers dated 2021 (today, there were even 118); that corresponds to about 5 new articles per day and makes acupuncture one of the most research-active areas of so-called alternative medicine (SCAM).
- Of these 100 papers, only 7 were clinical trials (CTs). In my view, clinical trials would be more important than any other type of research on acupuncture. To see that they amount to just 7% of the total is therefore disappointing.
- Twelve papers were systematic reviews (SRs). It is odd, I find, to see almost twice the amount of SRs than CTs.
- Eighteen papers referred to protocols of studies of SRs. In particular protocols of SRs are useless in my view. It seems to me that the explanation for this plethora of published protocols might be the fact that Chinese researchers are extremely keen to get papers into Western journals; it is an essential boost to their careers.
- Seven papers were surveys. This multitude of survey research is typical for all types of SCAM.
- Twenty-four articles were on basic research. I find basic research into an ancient therapy of questionable clinical use more than a bit strange.
- The rest of the articles were other types of publications and a few were misclassified.
- The vast majority (n = 81) of the 100 papers were authored exclusively by Chinese researchers (and a few Korean). In view of the fact that it has been shown repeatedly that practically all acupuncture studies from China report positive results and that data fabrication seems rife in China, this dominance of China could be concerning indeed.
Yes, I find all this quite concerning. I feel that we are swamped with plenty of pseudo-research on acupuncture that is of doubtful (in many cases very doubtful) reliability. Eventually, this will create an overall picture for the public that is misleading to the extreme (to check the validity of the original research is a monster task and way beyond what even an interested layperson can do).
And what might be the solution? I am not sure I have one. But for starters, I think, that journal editors should get a lot more discerning when it comes to article submissions from (Chinese) acupuncture researchers. My advice to them and everyone else:
if it sounds too good to be true, it probably is!
I was alerted to an article in which some US doctors, including the famous Andrew Weil, promote the idea that so-called alternative medicine (SCAM) has a lot to offer for people recovering from Covid-19 infections. There would be a lot to argue about their recommendations, but today I will not go into this (I find it just too predictable how SCAM proponents try to promote SCAM on the basis of flimsy evidence; perhaps I am suffering from ‘BS for Covid fatigue’?). What did, however, strike me in their paper was a definition of INTEGRATIVE MEDICINE (IM) that I had not yet come across:
Integrative medicine is defined as healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies.
Ever since the term IM became fashionable, there have been dozens of definitions of the term (almost as though IM proponents were not quite sure themselves what they were promoting). And ever since I first heard about IM, I felt it was a thinly disguised attempt to smuggle unproven treatments into the routine of evidence-based medicine (EBM). In 2002, I published my 1st comment on the subject. In it, I warned that IM must not become an excuse for using every conceivable untested treatment under the banner of holism. Nineteen years on, this is exactly what has happened, and one definition of IM after the next is soaked in platitudes, falsehoods and misunderstandings.
So, let’s see how reasonable this new definition is. I will try to do this by briefly discussing each element of the two sentences.
- IM is healing-oriented medicine: this is a transparently daft platitude. Does anyone know a medicine that is not oriented towards healing? Healing is the process of becoming well again, especially after a cut or other injury, or of making someone well again. Healing is what medicine has always been and always be aimed at. In other words, it is not something that differentiates IM from other forms of healthcare.
- IM takes account of the whole person: This is the little holistic trick that IM proponents like to adopt. It implies that normal medicine or EBM is not holistic. This implication is wrong. Any good medicine is holistic, and if a sector of healthcare fails to account for the whole person, we need to reform it. (Here are the conclusions of an editorial I published in 2007 entitled ‘Holistic heath care?‘: good health care is likely to be holistic but holistic health care, as it is marketed at present, is not necessarily good. The term ‘holistic’ may even be a ‘red herring’ which misleads patients. What matters most is whether or not any given approach optimally benefits the patient. This goal is best achieved with effective and safe interventions administered humanely — regardless of what label we put on them.) Creating a branch of medicine that, like IM, pretends to have a monopoly on holism can only hinder this process.
- IM includes all aspects of lifestyle: really, all of them? This is nonsense! Good physicians take into account the RELEVANT lifestyles of their patients. If, for instance, my patient with intermittent claudication is a postman, his condition would affect him differently from a patient who is a secretary. But all lifestyles? No! I fear this ‘over the top’ statement merely indicates that those who have conceived it have difficulties differentiating the important from the trivial.
- IM emphasizes the therapeutic relationship: that’s nice! But so do all other physicians (except perhaps pathologists). As medical students, we were taught how to do it, some physicians wrote books about it (remember Balint?), and many of us ran courses on the subject. Some conventional clinicians might even feel insulted by the implication that they do not emphasize the therapeutic relationship. Again, the IM brigade take an essential element of good healthcare as their monopoly. It almost seems to be a nasty habit of theirs to highjack a core element of healthcare and declare it as their invention.
- IM is informed by evidence: that is brilliant, finally there emerges a real difference between IM and EBM! While proper medicine is BASED on evidence, IM is merely INFORMED by it. The difference is fundamental, because it allows IM clinicians to use any un- or disproven SCAM. The evidence for homeopathy fails to show that it is effective? Never mind, IM is not evidence-based, it is evidence-informed. IM physiciance know homeopathy is a placebo therapy (if not they would be ill-informed which would make them unethical), but they nevertheless use homeopathy (try to find an IM clinic that does not offer homeopathy!), because IM is not EBM. IM is evidence-informed!
- IM makes use of all appropriate therapies: and the last point takes the biscuit. Are the IM fanatics honestly suggesting that conventional doctors use inappropriate therapies? Does anyone know a branch of health care where clinicians systematically employ therapies that are not appropriate? Appropriate means suitable or right for a particular situation or occasion. Are IM practitioners the only ones who use therapies that are suitable for a particular situation? This last point really does count on anyone falling for IM not to have the slightest ability to think analytically.
This short analysis confirms yet again that IM is little more than a smokescreen behind which IM advocates try to smuggle nonsense into routine healthcare. The fact that, during the last two decades, the definition constantly changed, while no half decent definition emerged suggests that they themselves don’t quite know what it is. They like moving the goal post but seem unsure in which direction. And their latest attempt to define IM indicates to me that IM advocates might not be the brightest buttons in the drawer.