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

evidence

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“I don’t take chemicals,

I prefer natural herbal remedies!”

How often have we heard such statements? They are usually pronounced with an air of smug superiority and condescending pity towards those poor consumers who swallow paracetamol, ibuprofen, or other chemicals when having a headache or other health problem.

But the air of superiority seems misplaced because these ‘herbivores’ actually consume many more chemicals than the ‘chemivores’. What those who swear by ‘non-chemical’ medicines ignore is the fact that herbal remedies are packed with many different chemicals.

Below I have listed the main active chemical compound of some very well-known herbal remedies:

  • Calendula (Calendula officinalis L.): flavonoids, triterpene alcohols, triterpene saponins, carotenoids, polysaccharides, essential oil
  • Chamomile (Matricaria recutita L.): essential oil, sesquiterpenes, dicycloethern
  • Echinacea (Echinacea purpurea): polysaccharides, caffeic acid derivatives, alkamides, polyacetylenes, essential oil.
  • Eucalyptus (Eucalyptus globulus Labill.): cineole, euglobales, macrocarpales
  • Garlic (Allium sativum L.): alliin [(+)- S-allyl-L-cystein sulfoxide],  allicin (allyl 2- thiosulphate propane)
  • Hops (Humulus lupulus L.): phloroglucinol derivates, essential oil
  • Lavender (Lavandula angustifolia Mill.): linalyl acetate and linalool, tannins
  • Liquorice (Glycyrrhiza glabra L.): triterpenoid, flavonoids, isoflavones, polysaccharides
  • Peppermint (Mentha x piperita L.): menthol, menthone, menthyl acetate, tannins, flavonoids
  • Valerian (Valeriana officinalis L.): essential oil, sesquiterpene acids, iridoids, lignans, caffeic acid derivatives, alkaloids

Whenever I explain this to a ‘herbivore’ (here defined as a person who prefers herbal to conventional medicine), she is initially taken aback but, as soon as she has recovered from the shock, she regains their superior attitude and says: “Ah yes, but these are natural chemicals; they cannot do any harm, you know.”

“No, I don’t know!” I then reply, “There are two errors in what you just said: firstly, many chemicals that plants produce are highly poisonous – in fact, some of the most potent toxins we know come from plants – and secondly there is no difference between a chemical XY produced by a plant and the same chemical produced in a factory.”

At this stage, we usually change the subject or part our ways.

You may have noticed that my patience with homeopathy, homeopaths, and other providers of so-called alternative medicine (SCAM) has diminished. In fact, I do not think much of quacks of all shades and no longer muster much understanding. It is better, so I mean after approximately 30 years of discussions with snake oil salesmen and other charlatans, to offer such people Parole. Facts are facts, and no one should be allowed to ignore that without contradiction.

That was not always the case.

When I began as Chair of Complementary Medicine at Exeter in 1993, I was optimistic. It was clear to me that my task of scrutinizing this field would not be easy and could occasionally bring me into conflict with enthusiasts. But I was determined to build bridges, to remain polite, and to muster as much understanding as necessary.

And so I began to build a multidisciplinary team, conduct research, and publish it. My goal was to do as rigorous science as possible and, if avoidable, not to step on anyone’s toes in the process. Especially with regard to homeopathy, my general attitude was quite positive. Accordingly, my articles were as favorable as the evidence allowed. My goal was to emphasize the good aspects of homeopathy wherever possible.

What, you find that hard to believe?

Then you are in good company!

Homeopaths like to claim that I was out to malign not only homeopathy but all of SCAM from the beginning. That this assumption is not true, I tried to demonstrate in an article entitled ‘Homeopathy and I’. In this paper, I merely extracted typical passages from my publications. From them, you can probably see how my attitude slowly changed over the years. See for yourself (sorry for the length of the list):

  • 1. homeopathic remedies are believed by doctors and patients to be almost totally safe (Ernst E, White A. Br J Gen Pract 1995; 45: 629-30)
  • 2. it might be argued that arnica … is ineffective but homeopathy may still work (Ernst E. BMJ 1995; 311: 510-1)
  • 3. homeopathy, I fear, has soon to come up with … more convincing evidence (Ernst E. Forsch Komplementarmed 1995; 2: 32)
  • 4. future evaluations of homeopathy should be performed to a high scientific standard (Ernst E. Br Homeopath J 1995; 84: 229)
  • 5. the best way forward is clearly to do rigorous research (Ernst E, Kaptchuk TJ. Arch Intern Med 1996; 156: 2162-4)
  • 6. the most pressing question, ‘Is homeopathy clinically more effective than placebo’, needs to be answered conclusively (Ernst E. Br J Clin Pharmacol 1997; 44: 435-7)
  • 7. there is evidence that homeopathic treatment can reduce the duration of ileus (Barnes J, Resch KL, Ernst E. J Clin Gastroenterol 1997; 25: 628-33)
  • 8. the published evidence to date does not support the hypothesis that homeopathic remedies … are more efficacious than placebo (Ernst E, Barnes J. Perfusion 1998; 11: 4-8)
  • 9. the claim that homeopathic arnica is efficacious beyond a placebo effect is not supported by rigorous clinical trials (Ernst E, Pittler MH. Arch Surg 1998; 133: 1187-90)
  • 10. … the trial data … do not suggest that homeopathy is effective (Ernst E. J Pain Sympt Manage 1999; 18: 353-7)
  • 11. … the re-analysis of Linde et al. can be seen as the ultimate epidemiological proof that homeopathic remedies are, in fact, placebos (Ernst E, Pittler MH.J Clin Epidemiol 2000; 53: 1188)
  • 12. … homeopathy is not different from placebo (Ernst E, Pittler MH. J Clin Epidemiol 2002; 55: 103-4)
  • 13. … the best clinical evidence … does not warrant positive recommendations (Ernst E. Br J Clin Pharmacol 2002; 54: 577-82)
  • 14. the results of this trial do not suggest that homeopathic arnica has an advantage over placebo (Stevinson C, Devaraj VS, Fountain-Barber A, Hawkins S, Ernst E. J R Soc Med 2003; 96: 60-5)
  • 15. this study provides no evidence that adjunctive homeopathic remedies … are superior to placebo (White A, Slade P, Hunt C, Hart A, Ernst E. Thorax 2003; 58: 317-21)
  • 16. … this systematic review does not provide clear evidence that the phenomenon of homeopathic aggravations exists (Grabia S, Ernst E. Homeopathy 2003; 92: 92-8)
  • 17. … the proven benefits of highly dilute homeopathic remedies … do not outweigh the potential for harm (Ernst E.Trends Pharmacol Sci 2005; 26: 547-8)
  • 18 Our analysis … found insufficient evidence to support clinical efficacy of homeopathic therapy (Milazzo S, Russell N, Ernst E. Eur J Cancer 2006; 42: 282-9)
  • 19. … promotion can be regrettably misleading, or their effectiveness? (Ernst E. J Soc Integr Oncol 2006; 4: 113-5)
  • 20. … homeopathy is not based on solid evidence and, over time, this evidence seems to get more negative (Ernst E, Pittler MH, Wider B, Boddy K. Perfusion 2006; 19: 380-2)
  • 21. the evidence from rigorous clinical trials … testing homeopathy for childhood and adolescence ailments is not convincing enough for recommendations in any condition (Altunc U, Pittler MH, Ernst E. Mayo Clin Proc 2007; 82: 69-75)
  • 22. … context effects of homeopathy … are entirely sufficient to explain the benefit many patients experience (Ernst E. Curr Oncol 2007; 14: 128-30)
  • 23. among all the placebos that exist, homeopathy has the potential to be an exceptionally powerful one (Ernst E. Br J Clin Pharmacol 2008; 65: 163-4)
  • 24. … recommendations by professional homeopathic associations are not based on the evidence (Ernst E. Br J Gen Pract 2009; 59: 142-3)

These quotes speak for themselves, I think. But what was the reason for the change? As far as I can judge in retrospect, there were three main reasons.

1. The data became clearer and clearer

When I started researching homeopathy, at least the clinical evidence was not clearly negative. In 1991, Jos Kleinjen had published his much-noted systematic review in the BMJ. Here is its conclusion:

At the moment the evidence of clinical trials is positive but not sufficient to draw definitive conclusions because most trials are of low methodological quality and because of the unknown role of publication bias. This indicates that there is a legitimate case for further evaluation of homoeopathy, but only by means of well performed trials.

Subsequently, more and better clinical trials were published, and the overall picture became increasingly negative. Kleinjen, who had become somewhat of a hero in the realm of homeopathy, re-reviewed the evidence in 2000 and concluded that there are currently insufficient data to either recommend homoeopathy as a treatment for any specific condition or to warrant significant changes in the provision of homoeopathy.

The 24 citations above reflect this development quite nicely. Today, there is no longer much doubt that highly-diluted homeopathic remedies are pure placebos. This is perhaps most clearly expressed in the now numerous statements of high-ranking international bodies.

2. The lack of understanding on the part of homeopaths

So the evidence is now clear. But it may not fully explain why my patience with homeopaths diminished. To understand this better, one must consider the utter lack of insight of today’s homeopaths (think, for example, of the incredible Ebola story).
It is of course understandable that a homeopath would be less than enthusiastic about the increasingly negative evidence. But homeopaths are also physicians or at least medically untrained practitioners (lay homeopaths). As such, they have an obligation to acknowledge the overwhelming evidence and act accordingly. That they quite obviously do not do so, is not only regrettable but also highly unethical and shameful. In any case, I find it difficult to have much patience for such people.

3. Personal attacks

In the many years that I have now been scrutinizing SCAM, I have become used to being attacked. The attacks and insults I have received, especially from homeopaths, are legion. For example, when we published our arnica study, we were threatened with letter bombs. However, one should keep one thing in mind: ad hominem attacks are a victory of reason over unreason. If one is personally attacked by one’s opponent, it only shows that he has run out of rational arguments.

Perhaps the most impressive example of an attack was not directed against me personally, but across the board against all who dare to doubt homeopathy. Christian Boiron is the boss of the world’s largest homeopathic manufacturer, Boiron. In an interview he was once asked what he thought of homeopathy critics; his answer: “Il y a un Ku Klux Klan contre l’homéopathie” (There is a Ku Klux Klan against homeopathy).

Yes, many of these attacks even have something comical about them; nevertheless, they are not likely to increase my patience with homeopaths. This does not mean, however, that I will soon hang my opponents from the nearest tree in the old KKK tradition. I’ll gladly leave such tasteless ideas to Christian Boiron.

 

 

A few months ago, I started contributing to a German blog. This has been fun but only moderately successful in terms of readership. This week, I posted something about a homeopath and his strange attitude towards COVID vaccinations. This post was so far read by around 20 000 people!

As it was so unusually successful (and because there is a big conference today on the subject), I decided to translate it for my non-German readers.

Here we go:

A lot of downright silly stuff is currently being written about vaccine side effects at the moment, not least on Twitter where I recently found the following comment from a medical colleague:

I’ve been a doctor for 25 years now. I have never experienced such an amount of vaccine side effects. I can’t imagine that other colleagues feel differently.

This kind of remark naturally makes you think. So let’s think a little bit about these two sentences. In particular, I would like to ask and briefly answer the following questions:

  1. How reliable is this physician’s impression?
  2. What does the reliable evidence say?
  3.  Is it conceivable that this doctor is mistaken?
  4. What might be the causes of his error?
  5. Who is the author?
  6. Why is the tweet questionable?

1. How reliable is this doctor’s impression?

A whole 25 years of professional experience! So we are dealing with a thoroughly experienced doctor. His statement about the current unusually large amount of vaccination side effects should therefore be correct. Nevertheless, one should perhaps bear in mind that the incidence of side effects cannot be determined by rough estimations, but must be precisely quantified. In addition, we also need data on the severity and duration of symptoms. For example, is it only mild pain at the injection site or venous thrombosis? Are the symptoms only temporary, long-lasting, or even permanent? In general, it must be said that the experience of a physician, while not completely insignificant, does not constitute evidence. Oscar Wilde once said, “experience is the name we give to our mistakes.”

2. What does the reliable evidence tell us?

Even if the good doctor had 100 years of professional experience and even if he could accurately characterize the side effects, his experience would be trivial compared to the hard data we have on this subject. Nearly 2 billion vaccinations have now been performed worldwide, and we are therefore in the fortunate position of having reliable statistics to guide us. And they show that side effects such as pain at the injection site, fatigue, and headaches are quite common, while serious problems are very rare.[1] A recent summary comes to the following conclusion (my translation)[2]:

The current data suggests that the currently approved mRNA-based COVID-19 vaccines are safe and effective for the vast majority of the population. Furthermore, broad-based vaccine uptake is critical for achieving herd immunity; an essential factor in decreasing future surges of COVID-19 infections. Ensuring sufficient COVID-19 vaccination adoption by the public will involve attending to the rising vaccine hesitancy among a pandemic-weary population. Evidence-based approaches at the federal, state, city, and organizational levels are necessary to improve vaccination efforts and to decrease hesitancy. Educating the general public about the safety of the current and forthcoming vaccines is of vital consequence to public health and ongoing and future large-scale vaccination initiatives.

3. Is it conceivable that this doctor is mistaken?

In answering this question, I agree with Oscar Wilde. The evidence very clearly contradicts the physician’s impression. So the doctor seems to be mistaken — at least about the incidence of side effects that are not completely normal and thus to be expected. Even if indeed ‘other colleagues feel no differently’, such a cumulative experience would still mislead us. The plural of ‘anecdote’ is ‘anecdotes’ and not ‘evidence’.

4. What might be the causes of his error?

I wonder whether our doctor perhaps did not see or did not want to see the following circumstance: It is inevitable that a physician, at a time when soon 50% of all Germans were vaccinated, also sees a lot of patients complaining about side effects. He has never seen anything like that in his 25-year career! That’s because we haven’t been hit by a pandemic in the last 25 years. For a similar reason, the colleague will treat far fewer frostbites in midsummer than during a severe winter. The only surprising thing would be not to see more patients reporting vaccine side effects during the biggest vaccination campaign ever.

5. Who is the author?

At this point, we should ask, who is actually the author and author of the above tweet? Perhaps the answer to this question will provide insight into his motivation for spreading nonsense? Dr. Thomas Quak (no, I did not invent the name) is a practicing homeopath in Fürstenfeldbruck, Germany. Like many homeopaths, this Quak probably has a somewhat disturbed relationship to vaccination. In his case, this goes as far as recommending several vaccine-critical machinations on his website and even offering ‘critical vaccination advice’ as a special service.[3]

Now we can immediately put the Quak tweet in a better perspective. Dr. Quak is a vaccination opponent or critic and wants to warn the public: for heaven’s sake, don’t get vaccinated folks; side effects are more common than ever!!!! Therefore, he also conceals the fact that the side-effects are completely normal, short-term vaccination reactions, which are ultimately of no significance.

6. Why is the tweet concerning?

Perhaps you feel that the Quak and his Quack tweet are irrelevant? What harm can a single tweet do, and who cares about a homeopath from Fürstenfeldbruck? As good as none and nobody! However, the importance does not lie in a single homeopath unsettling the population; it consists in the fact that such things currently happen every day thousandfold.

In their narrow-mindedness, vaccination opponents of all shades want to make us believe that they are concerned about our well-being because they know more than we and all the experts (who are of course bought by the pharmaceutical industry). But if you scratch just a little at the surface of their superficiality, it turns out that the exact opposite is true. They are ill-informed and only interested in spreading their hare-brained, misanthropic ideology.

And why do homeopaths do this? There are certainly several reasons. Although Hahnemann himself was impressed by the success of vaccination, which was invented in his time and hailed as a breakthrough, most of his successors soon sided with vaccination critics. Many do so by warning (like our Quak) of side effects, thinking that they are thus protecting their patients. However, they ignore two very important points:

  1. Even if the dangers of vaccinations were much greater than they actually are (no one is claiming that they are completely harmless), the benefits would still far outweigh the potential harms.
  2. If the Quaks (and all the quacks) of this world succeeded in dissuading a sizable percentage of the population from vaccinating and thus save them from the ‘oh-so-dangerous side effects’, they would still be doing a real disservice to public health. With regard to COVID-19, this would mean that the pandemic would remain with us in the long term and cost many more lives.

Whatever the motives of the homeopathic anti-vax brigade, it is certain that their attitude is a threat to our health. This has repeatedly made me state:

The homeopathic pills may be harmless, but unfortunately, the homeopaths are not!

REFERENCES

  1. COVID-19 vaccine availability: what are the side effects? | British Journal of General Practice (bjgp.org) ︎
  2. Review the safety of Covid-19 mRNA vaccines: a review – PubMed (nih.gov) ︎
  3. Vaccination Information (doktor-quak.de) ︎

 

 

The integration of so-called alternative medicine (SCAM) into cancer care may reduce the adverse effects of anti-neoplastic treatment but also cause new problems and non-adherence to conventional treatment. Therefore, its net benefit is questionable.

The aim of this randomized controlled study was to investigate the impact of integrative open dialogue about SCAM  on cancer patients’ health and quality of life (QoL).

Patients undergoing curative or palliative anti-neoplastic treatment were randomly assigned to standard care (SC) plus SCAM or SC alone. A nurse specialist facilitated SCAM in one or two sessions. The primary endpoint was the
frequency of grade 3–4 adverse events (AE) eight weeks after enrollment. Secondary endpoints were the frequency of grade 1–4 AE and patient-reported QoL, psychological distress, perceived information, attitude towards and use of SCAM 12 and 24 weeks after enrollment. Survival was analyzed post-hoc.

Fifty-seven patients were randomized to SCAM and 55 to SC.  No significant differences were found in terms of AEs of cancer patients. A trend towards better QoL, improved survival, and a lower level of anxiety was found in the SCAM group.

The authors concluded that integration of SCAM into daily oncology care is feasible. IOD-CAM was not superior to SC in reducing the frequency of grade 3-4 AEs, but it did not compromise patient safety.  Implementation of  SCAM
may improve the QoL, anxiety, and emotional well-being of the patients by reducing the level of nausea, vomiting and diarrhea. Finally, SCAM potentially improves the patients’ self-care, which contributes to
increased treatment adherence and improved survival.

This is an interesting paper with a very odd conclusion. The positive trends found failed to be statistically significant. Why employ statistics only to ignore them in our interpretation of the findings?

I can well imagine that the integration of effective treatments into cancer care improves the outcome. I have no problem with this at all – except it is not called INTEGRATIVE MEDICINE but EVIDENCE-BASED MEDICINE!!! If we integrate dubious treatments into cancer care, it’s called INTEGRATIVE MEDICINE, and it’s unlikely to do any good.

In my view, this small study showed just one thing:

Integrative medicine does not reduce adverse effects in cancer patients.

 

Prince Charles has claimed that people struggling to return to full health after having the coronavirus should practice yoga. This is what the GUARDIAN reported about it on Friday:

In a video statement on Friday to the virtual yoga and healthcare symposium Wellness After Covid, the heir apparent said doctors should work together with “complementary healthcare specialists” to “build a roadmap to hope and healing” after Covid. “This pandemic has emphasised the importance of preparedness, resilience and the need for an approach which addresses the health and welfare of the whole person as part of society, and which does not merely focus on the symptoms alone,” Charles said. “As part of that approach, therapeutic, evidenced-informed yoga can contribute to health and healing. By its very nature, yoga is an accessible practice which provides practitioners with ways to manage stress, build resilience and promote healing…”

… Charles, who has previously espoused the benefits of yoga, is not the only fan in the royal family. His wife, the Duchess of Cornwall, has said “it makes you less stiff” and “more supple”, while Prince William has also been pictured doing yogic poses. In 2019, the Prince of Wales said yoga had “proven beneficial effects on both body and mind”, and delivered “tremendous social benefits” that help build “discipline, self-reliance and self-care”.

__________________

END OF QUOTE

Yoga is a complex subject because it entails a host of different techniques, attitudes, and life-styles. There have been numerous clinical trials of various yoga techniques. They tend to suffer from poor study design as well as incomplete reporting and are thus no always reliable. Several systematic reviews have summarised the findings of these studies. A 2010 overview included 21 systematic reviews relating to a wide range of conditions. Nine systematic reviews arrived at positive conclusions, but many were associated with a high risk of bias. Unanimously positive evidence emerged only for depression and cardiovascular risk reduction.[1] There is no evidence that yoga speeds the recovery after COVID-19 or any other severe infectious disease, as Charles suggested.

Yoga is generally considered to be safe. However, a large-scale survey found that approximately 30% of yoga class attendees had experienced some type of adverse event. Although the majority had mild symptoms, the survey results indicated that patients with chronic diseases were more likely to experience adverse events.[2]  It, therefore, seems unlikely that yoga is suited for many patients recovering from a COVID-19 infection.

The warning by the Vatican’s chief exorcist that yoga leads to ‘demonic possession’[3] might not be taken seriously by rational thinkers. Yet, experts have long warned that many yoga teachers try to recruit their clients into the more cult-like aspects of yoga.[4]

Perhaps the most remarkable expression in Charles’ quotes is the term ‘EVIDENCE-INFORMED‘. It crops up regularly when Charles (or his advisor Dr. Michael Dixon) speaks or writes about so-called alternative medicine (SCAM). It is a clever term that sounds almost like ‘evidence-based’ but means something entirely different. If a SCAM is not evidence-based, it can still be legitimately put under the umbrella of ‘evidence-informed’: we know the evidence is not positive, we were well-informed of this fact, we nevertheless conclude that yoga (or any other SCAM) might be a good idea!

In my view, the regular use of the term ‘evidence-informed’ in the realm of SCAM discloses a lack of clarity that suits all snake-oil salesmen very well.

 

[1] Ernst E, Lee MS: Focus on Alternative and Complementary Therapies Volume 15(4) December 2010 274–27

[2] Matsushita T, Oka T. A large-scale survey of adverse events experienced in yoga classes. Biopsychosoc Med. 2015 Mar 18;9:9. doi: 10.1186/s13030-015-0037-1. PMID: 25844090; PMCID: PMC4384376.

[3] https://www.social-consciousness.com/2017/06/vaticans-chief-exorcist-warns-that-yoga-causes-demonic-possession.html

[4] https://www.theguardian.com/lifeandstyle/2020/jun/26/experience-my-yoga-class-turned-out-to-be-a-cult

 

Post-traumatic stress disorder (PTSD), previously known as battle fatigue syndrome or shell shock, is a condition that can be triggered by the experience of some frightening event. PTSD can be debilitating leading to the production of feelings of helplessness, intense fear, and horror. Numerous treatments of PTSD exist but few have been shown to be truly effective. A team of Canadian researchers explored the effects of cannabis on PTSD symptoms, quality of life (QOL), and return to work (RTW). Their systematic review also investigated harms such as adverse effects and dropouts due to adverse effects, inefficacy, and all-cause dropout rates.

Their electronic searches located one RCT and 10 observational studies (n = 4672). Risk of bias (RoB) was assessed with the Cochrane risk of bias tool and ROBINS-I. Evidence from the included studies was mainly based on studies with no comparators. Results from unpooled, high RoB studies suggested that cannabis was associated with a reduction in overall PTSD symptoms and improved QOL. Dry mouth, headaches, and psychoactive effects such as agitation and euphoria were the most commonly reported adverse effects. In most studies, cannabis was well tolerated. A small proportion of patients experienced a worsening of PTSD symptoms.

The authors concluded that the evidence in the current study primarily stems from low quality and high RoB observational studies. Further RCTs investigating cannabis effects on PTSD treatment should be conducted with larger sample sizes and explore a broader range of patient-important outcomes.

Various drugs are currently used for the treatment of PTSD including selective serotonin reuptake inhibitors; tricyclic antidepressants (amitriptyline and isocarboxazid); mood stabilizers (Divalproex and lamotrigine); atypical antipsychotics (aripiprazole and quetiapine) but their effectiveness has not been proven. A recent systematic review included 30 RCTs of a range of heterogeneous non-psychological and non-pharmacological interventions. There was emerging evidence for 6 different approaches:

  • acupuncture,
  • neurofeedback,
  • saikokeishikankyoto (a herbal preparation),
  • somatic experiencing,
  • transcranial magnetic stimulation,
  • yoga.

This list makes me wonder: are these treatments, including cannabis, truly promising, or is PTSD one of those conditions for which nearly every treatment works a little because of its placebo effect?

By guest blogger João Júlio Cerqueira

A word of caution to all the skeptics out there defending Reason, Science, and the Truth. This is a summary of a long story and only about one of many battles. It is not a very beautiful story but it is what it is. I’m a medical doctor, influenced by some of the great minds of our time, all of them familiar to you, Edzard Ernst, Steven Novella, David Gorski, Harriet Hall, Kimball Atwood and so much more (thank you all, for everything that you do).

I started reading skeptic blogs in 2013 and was amazed by the lack of critical thinking about science production and the lack of knowledge about pseudoscience in the medical community. And if this was bad in the medical community, in the general population it should be close to apocalyptic…

In 2017, I was confronted by a medical doctor that imported the great pitches of international charlatans. From alkaline diet, bioidentical hormones, colonic cleansings all through the “health benefits” of drinking diluted saltwater…yes, this is a real thing. He was transformed into a television celebrity, wrote one of the bestselling books in my country, and only a few people were horrified by what was happening. How? How can someone that says that kind of stuff could have this kind of reach in the media? He even sold foot detox!

So, frustrated by the lack of action of the regulatory institutions and the lack of critical approach by the media, I decided to create a blog that I called SCIMED. Using what I had learned through the years with “the masters of skepticism”, I tried to teach and convince people why pseudoscience is useless and dangerous. Why those selling pseudoscience are a danger to society and are only after the wallet of scientifically illiterate people.

Thanks to hard work and a lot of luck, the blog started to have a decent public projection. Started to get invitations to interviews in the media, invited to speak at conferences, started to write in the opinion section of mainstream journals, appearing on television, invited to do a TEDx talk, was invited to be one of the subscribers to the first world manifesto against pseudoscience and even had the pleasure to be a speaker in a conference side by side with Edzard Ernst, one of my heroes!

It was like something was changing. Well, it was not.

With public projection, came the problems…people calling my employers to get me fired, physical and death threats, constant harassment by email or in social media, doxing, and false accusations about my personal and professional life. You name it. And I endured…I considered it the dark side of defending Science and Truth.

In April of 2019, I was invited to represent my country´s Medical College in a debate about pseudoscience on television, prime time. I was very excited and emotion clouded my reason. I didn´t think about the consequences. And well, it was a shitshow.

The audience was dominated by alternative health practitioners. The moderator was sympathetic with alternative health practices. And of course, the people representing the alternative health practitioners didn’t play by the same rules. They used deception, lying, testimonials, and all the logical fallacies you can think of.

But what really took me over the hedge was a Traditional Chinese Medicine Practitioner with connections to the Chinese Government, a constant presence in the mainstream media, that started to sell “acupuncture anesthesia” as something valid. Talking about how he, more than 20 years ago, used this practice to help perform surgical procedures. For me, that was a disrespect for all the people that suffered at the hands of Mao´s Chinese dictatorship. All the people that suffered excruciating pain, being operated on without general anesthesia only to sell East Snake Oil to the West. The “miracle” of acupuncture and Eastern medicine. The propaganda.

We exchanged words in the debate and that continued into social media. In the days after, I was called everything you can imagine by the defenders of alternative therapies. And this man took the opportunity to write that I was “short, ugly and bald” and that I have an “inferiority complex” because of that. That I´m a lousy doctor that cannot compete with his clinics. That only a masochist woman would want something with me.

But I endured. I could not stop feeling disgusted by the lack of shame of these people. I could not let go. Like Gaad Sad, I feel physical pain when someone is bullshitting. It makes me physically sick that people can say outrageous things with a serious face.

So, I wrote a blog post to explain the myth and the horror of acupuncture anesthesia and to dismantle other claims said by that man, like “all babies born with fire in the

liver…if you treat that problem, you can prevent infertility and cancer metastasis in the future!”. Preventing metastasis of a non-existing cancer… And I used a lot of adjectives: dumb, ignorant, charlatan, and snake oil salesman.

In November of 2019, this man goes to a wannabe Joe Rogan show and tells all sort of outrageous things like “Chinese people are so many because Traditional Chinese Medicine was very advanced for those days” or “until recently Traditional Chinese Medicine was more effective treating cancer than Conventional Medicine” or “Homeopathy works but they don´t want you to know…see this Documentary”. Again, I used sarcasm, irony, and a lot of adjectives.

And then, legal problems…

Soon after I wrote this last blog post, I received a letter from the court saying that I was being sued by this man. I hired a lawyer and made a lengthy response to all the accusations, more than 100 pages. Nevertheless, I have been charged with seventeen defamation crimes, awaiting trial, for defending the truth. For defending the people that Institutions refused to defend.

My country, Portugal, legally recognizes “Non-Conventional Therapies” like Homeopathy, Acupuncture, Traditional Chinese Medicine, Osteopathy, Chiropractic, and Naturopathy. My country, instead of defending the consumer, took the option to give these people the legal right of robbing people. I thought that the COVID-19 pandemic would change that a little bit since pseudoscience contributed zero for solving the problem, alternative practitioners embraced negationism about COVID-19, and Traditional Chinese Medicine was put in the corner. It was Science that came to the rescue with vaccines.

But now, when the pandemic is finally getting managed in my country, the snakes are starting to come out of hibernation to sell snake oil. And the media are giving them credit, again, like nothing has happened…nothing has changed, except for me.

Right now, I face four legal battles, for defamation. Besides this man, I have another lawsuit from a Nurse that promotes Reiki and Traditional Chinese Medicine, other from a Naturopath/Quantum Doctor and, lastly, from a Medical Doctor that was the head of the “Doctors For the Truth”, an organization part of an international network of Health Professionals that still denies the science about COVID-19.

So, this is my prize for all the hours battling liars and charlatans. The regulatory institutions don´t care. The mainstream media and Social Media don´t care. They are like brokers. They always win no matter if the stock market goes up or down. They will use you just to fuel the battle between science and pseudoscience and make money out of it. Why do you think the “Disinformation Dozen” still exists, besides some gestures of goodwill by the Social Media giants?

What I learned and you should learn…

I learned that it is pointless trying to convince people to change their minds on social media… People don´t follow reason, follow emotion, and something closer to religious belief. People want to be right, don´t want to learn what is right. Facts don´t change the minds of believers.

I learned that “True Skeptics” are unicorns. Everyone is a rational, skeptical person that values truth, reason, and science until you hit some nerve, some irrational belief that they hold dear. And then the “skepticism” goes down the drain. The more topics you talk about, the lonely you will be. And then you became a unicorn or, in the words of Malcolm Gladwell in the book “Talking to Strangers”, a Holy Fool: the truth-teller that is an outcast.

The COVID-19 pandemic just made things a lot worse…People started to getting hit by the pandemic in their quality of life and you start seeing hardcore skeptics doubting the most basic science and common sense. You even see some of your personal heroes like John Ioannidis going down the rabbit hole. Making the same basic mistakes that he spent his life point out about science production!

You start to see the animal inside us taking ground, what William James argued: if something improves your chances of survival, is not that the “truth”? The pragmatic, utilitarian truth? We saw irrationality in all its splendor, people negating reality, trying to conserve their way of life, making sense of events they don´t control. Fighting for control. Reason went to sleep and a lot of skeptics ceased to be…

So, I came to ask for your help… After two years of enduring the Sword of Damocles over my head, the energy to continue is running out. The SLAPP (Strategic lawsuit against public participation) they call it, is making a dent in my will to continue to fight against irrationality and charlatans.

So, I came to ask for your help, the International Skeptic community, for covering the legal expenses. I already asked for the support of my country’s skeptical community but it was not enough…only after two years of this marathon probably will take another two, I took this decision. I´m not proud of this, I´m angry that these people, besides robbing the sick and fragile giving them false hope are now making those who fight them spend money and probably pay “compensation” for not be silent about charlatanism. You can support me through Paypal or Patreon. Thank you in advance and I will keep you up-to-date.

PS

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Vertebral artery dissections (VAD) are a rare but important cause of ischemic stroke, especially in younger patients. Many etiologies have been identified, including motor vehicle accidents, cervical fractures, falls, physical exercise, and, as I have often discussed on this blog, cervical chiropractic manipulation. The goal of this study was to investigate the subgroup of patients who suffered a chiropractor-associated injury and determine how their prognosis compared to other-cause VAD.

The researchers, neurosurgeons from Chicago, conducted a retrospective chart review of 310 patients with vertebral artery dissections who presented at their institution between January 2004 and December 2018. Variables included demographic data, event characteristics, treatment, radiographic outcomes, and clinical outcomes measured using the modified Rankin Scale.

Overall, 34 out of our 310 patients suffered a chiropractor-associated injury. These patients tended to be younger (p = 0.01), female (p = 0.003), and have fewer comorbidities (p = 0.005) compared to patients with other-cause VADs. The characteristics of the injuries were similar, but chiropractor-associated injuries appeared to be milder at discharge and at follow-up. A higher proportion of the chiropractor-associated group had injuries in the 0-2 mRS range at discharge and at 3 months (p = 0.05, p = 0.04) and no patients suffered severe long-term neurologic consequences or death (0% vs. 9.8%, p = 0.05). However, when a multivariate binomial regression was performed, these effects dissipated and the only independent predictor of a worse injury at discharge was the presence of a cervical spine fracture (p < 0.001).

The authors concluded that chiropractor-associated injuries are similar to VADs of other causes, and apparent differences in the severity of the injury are likely due to demographic differences between the two populations.

The authors of the present paper are clear: “chiropractic manipulations are a risk factor for vertebral artery dissections.” This fact is further supported by a host of other investigations. For instance, the Canadian Stroke Consortium found that 28% of strokes following cervical artery dissection were preceded by chiropractic neck manipulation. Dziewas et al. obtained a similar rate in patients with vertebral artery dissections. Many chiropractors are in denial; however, this is merely due to their overt conflicts of interest.

My conclusions from the accumulated evidence are this:

Spinal manipulations of the upper spine should not be routinely used for any condition. Patients who nevertheless insist on having them must be made aware of the risks and give informed consent.

By guest blogger Michael Scholz

For several years, the “flower essences” invented by Dr. Edward Bach had a difficult time in the European Union and especially Germany. The manufacturers were regularly taken to court for violating the EU Health Claim Regulation. This now culminates in the fact that the manufacturer, Nelsons, who sells the “Original Bach Flowers” in Germany, was forced to rename its popular “Rescue” remedies.

What happened?

The “Rescue” remedies were promoted with statements such as “calm and strong through the day” and “recommended use in emotionally exciting situations, e.g. at work” or to “face emotional challenges”. The competitor, Annoyax Nutripharm, regarded this as a health-related statement that is prohibited according to the EU Health Claim Regulation. Since the “Bach Flower Remedies” are not considered to be medicinal products in Germany, they are treated as food supplements, according to a ruling by the Oberlandesgericht (Higher Regional Court) Hamburg in 2007.

As it is strictly forbidden to advertise food supplements with health-related claims that are unproven, Annoyax Nutripharm filed a lawsuit against Nelsons that all the way to the Bundesgerichtshof (Federal High Court of Justice) in Karlsruhe. Since the case concerned European law, the judges in Karlsruhe referred it to the European Court of Justice in Luxemburg.

The judges wanted two questions clarified: 1. Are the “Rescue” remedies to be regarded simply as Brandy due to their alcohol content of 27%? (in which case, health-related claims would be strictly forbidden). 2. Does the product’s name “Rescue” itself constitute a violation of the Health Claims Regulation?

The Luxemburg judges ruled “No” and “Yes”. “No”, it is not Brandy, although the „essences“ consist of a considerable quantity of alcohol, the recommended dose is too small to be intoxicating. But “Yes”, the term “Rescue” does indeed violate the Health Claim Regulation. So the plaintiff won – and what is the result?

When the Health Claims Regulation was enacted in 2005, a transition period until 2022 was established. This applied to all products that were sold using the same brand name and composition before 2005. This now gave the defendant – Nelsons – the opportunity to use Edward Bach’s 135th anniversary for launching an advertising campaign that praises the court-ordered renaming as „modernization“ for the 21st century. And as you see, the new name is a paragon of creativity, innovation & modernism, indeed (//irony:off): “Rescue” becomes – drum roll – “Rescura”. Yes, I looked just like that too…

This pyrrhic victory for the plaintiffs shows how important it is to protect the European citizens against misleading advertising. And – far more important – it is now established through a ruling of the Federal High Court of Justice that “Bach Flowers” are an esoterical concept devoid of medical evidence.

‘CLAMP DOWN ON THE BOGUS SCIENCE OF HOMEOPATHY’ is the title of a comment by Oliver Klamm in The Times today. Here is the background to his article.

In September 2020, the website of Homeopathy UK, www.homeopathy-uk.org, featured a page titled “Conditions Directory” with text that stated “Please find below a list of conditions where homeopathy can help …” followed by a list of medical conditions that included depression, diabetes, infertility, psoriasis and asthma. When consumers clicked-through the links to the conditions listed on that page, they were taken to separate pages for each that contained anecdotal descriptions from doctors detailing how they had applied homeopathic methods to the relevant conditions.

The UK Advertising Standards Authority received a complainant that challenged whether the ad discouraged essential treatment for conditions for which medical supervision should be sought, namely depression, diabetes, infertility, psoriasis and asthma.

The response of ‘Homeopathy UK’ said that, as a registered charity, they sought to share information about homeopathy for the benefit of others, rather than for commercial gain, and that they would always recommend that patients seeking homeopathic care did so under the supervision of a qualified medical practitioner…

The ASA upheld the complaint and argued as follows:

The CAP Code required that marketers must not discourage essential treatment for conditions for which medical supervision should be sought. For example, they must not offer specific advice on, diagnosis or treatment for such conditions unless that advice, diagnosis or treatment was conducted under the supervision of a suitably qualified medical professional. The ad referred to “depression”, “diabetes”, “infertility”, “psoriasis” and “asthma”, which we considered were conditions for which medical supervision should be sought. Any advice, diagnosis or treatment, therefore, must be conducted under the supervision of a suitably qualified medical professional. We acknowledged that the articles had been written by GMC-registered doctors, who we considered would be suitably qualified to offer advice, diagnosis or treatment. However, we noted that the ad and the articles to which it linked referred to homeopathy in general, rather than treatment by a specific individual. We understood that there were no minimum professional qualifications required to practice homeopathy, which could result in consumers being advised, diagnosed, or treated for the conditions listed in the ad by a practitioner with no medical qualification. We therefore considered Homeopathy UK would not be able to demonstrate that all such treatment would be conducted under the supervision of a suitably qualified health professional.

Furthermore, we understood that, although elsewhere on the website there were links to specific clinics, not all treatment would be conducted under the supervision of a suitably qualified health professional across those clinics. Because Homeopathy UK had not supplied evidence that treatment would always be carried out by a suitably qualified health professional. Also, because reference to the conditions listed in the ad, and discussed in the related articles, could discourage consumers from seeking essential treatment under the supervision of a suitably qualified health professional, we concluded that the ad had breached the Code.

On that point the ad breached CAP Code (Edition 12) rule 12.2 (Medicines, medical devices, health-related products and beauty products).

The ad must not appear again in the form complained about. We told Homeopathy UK to ensure their future marketing communications did not to refer to conditions for which advice should be sought from suitably qualified health professionals.

___________________________

Depression, diabetes, and asthma have few things in common. Just two characteristics stand out, in my view:

  • they are potentially fatal;
  • homeopathy is ineffective in changing their natural history.
  • It was therefore high time that the ASA stopped this criminally dangerous nonsense of deluded homeopaths.

The article by Oliver Klamm concludes with the following wise words about homeopathy:

“For public officials and opinion formers, the time for appeasing this dangerous quackery should be long past.”

 

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