evidence
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.”
Neuropathic pain is difficult to treat. Luckily, we have acupuncture! Acupuncturists leave us in no doubt that their needles are the solution. But are they correct or perhaps victims of wishful thinking?
This review was aimed at determining the proportion of patients with neuropathic pain who achieve a clinically meaningful improvement in their pain with the use of different pharmacologic and nonpharmacologic treatments.
Randomized controlled trials were included that reported a responder analysis of adults with neuropathic pain-specifically diabetic neuropathy, postherpetic neuralgia, or trigeminal neuralgia-treated with any of the following 8 treatments: exercise, acupuncture, serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), topical rubefacients, opioids, anticonvulsant medications, and topical lidocaine.
A total of 67 randomized controlled trials were included. There was moderate certainty of evidence that anticonvulsant medications (risk ratio of 1.54; 95% CI 1.45 to 1.63; number needed to treat [NNT] of 7) and SNRIs (risk ratio of 1.45; 95% CI 1.33 to 1.59; NNT = 7) might provide a clinically meaningful benefit to patients with neuropathic pain. There was low certainty of evidence for a clinically meaningful benefit for rubefacients (ie, capsaicin; NNT = 7) and opioids (NNT = 8), and very low certainty of evidence for TCAs. Very low-quality evidence demonstrated that acupuncture was ineffective. All drug classes, except TCAs, had a greater likelihood of deriving a clinically meaningful benefit than having withdrawals due to adverse events (number needed to harm between 12 and 15). No trials met the inclusion criteria for exercise or lidocaine, nor were any trials identified for trigeminal neuralgia.
The authors concluded that there is moderate certainty of evidence that anticonvulsant medications and SNRIs provide a clinically meaningful reduction in pain in those with neuropathic pain, with lower certainty of evidence for rubefacients and opioids, and very low certainty of evidence for TCAs. Owing to low-quality evidence for many interventions, future high-quality trials that report responder analyses will be important to strengthen understanding of the relative benefits and harms of treatments in patients with neuropathic pain.
This review was published in a respected mainstream journal and conducted by a multidisciplinary team with the following titles and affiliations:
- Associate Professor in the College of Pharmacy at the University of Manitoba in Winnipeg.
- Pharmacist in Edmonton, Alta, and Clinical Evidence Expert for the College of Family Physicians of Canada.
- Family physician and Assistant Professor at the University of Alberta.
- Family physician and Associate Professor in the Department of Family Medicine at the University of Alberta.
- Pharmacist, Clinical Evidence Expert Lead for the College of Family Physicians of Canada, and Associate Clinical Professor in the Department of Family Medicine at the University of Alberta.
- Pharmacist in Edmonton and Clinical Evidence Expert for the College of Family Physicians of Canada.
- Pharmacist and Clinical Evidence Expert at the College of Family Physicians of Canada.
- Family physician, Director of Programs and Practice Support at the College of Family Physicians of Canada, and Adjunct Professor in the Department of Family Medicine at the University of Alberta.
- Professor in the Faculty of Pharmaceutical Sciences at the University of British Columbia in Vancouver.
- Pharmacist at the CIUSSS du Nord-de-l’lle-de-Montréal and Clinical Associate Professor in the Faculty of Pharmacy at the University of Montreal in Quebec.
- Care of the elderly physician and Assistant Professor in the Department of Family Medicine at the University of Alberta.
- Family physician and Professor in the Department of Family Medicine at the University of Alberta.
- Assistant Professor in the Department of Family Medicine at Queen’s University in Kingston, Ont.
- Research assistant at the University of Alberta.
- Medical student at the University of Alberta.
- Nurse in Edmonton and Clinical Evidence Expert for the College of Family Physicians of Canada.
As far as I can see, the review is of sound methodology, it minimizes bias, and its conclusions are therefore trustworthy. They suggest that acupuncture is not effective for neuropathic pain.
But how can this be? Do the authors not know about all the positive evidence on acupuncture? A quick search found positive recent reviews of acupuncture for all of the three indications in question:
- Diabetic neuropathy: Acupuncture alone and vitamin B combined with acupuncture are more effective in treating DPN compared to vitamin B.
- Herpes zoster: Acupuncture may be effective for patients with HZ.
- Trigeminal neuralgia: Acupuncture appears more effective than pharmacotherapy or surgery.
How can we explain this obvious contradiction?
Which result should we trust?
Do we believe pro-acupuncture researchers who published their papers in pro-acupuncture journals, or do we believe the findings of researchers who could not care less whether their work proves or disproves the effectiveness of acupuncture?
I think that these papers offer an exemplary opportunity for us to study how powerful the biases of researchers can be. They also remind us that, in the realm of so-called alternative medicine (SCAM), we should always be very cautious and not accept every conclusion that has been published in supposedly peer-reviewed medical journals.
“Time to say good-bye? Homeopathy, skeptics and thoughts on how to proceed” is the title of an article by two Swiss homeopaths which is almost touchingly naive. Here is its abstract:
Although homeopathy is frequently used by many health professionals, there are ongoing debates concerning its effectiveness. Currently no unifying explanation how homeopathy works exists. Homeopaths are frequently challenged by skeptics, and in public opinion, the swan song for homeopathy is frequently sung.
Content: Regarding the efficacy of homeopathy, several well-designed RCTs, observational studies, case studies, and case reports, have been published, demonstrating its clinical efficacy. Regarding its mode of action, the discovery of the working principle of homeopathy would be a major advance towards a thorough scientific recognition of homeopathy. Basic research has already discovered some milestones, e.g., significant and reproducible effects of homeopathic preparations in plants.
Summary: To overcome the distrust of skeptics and public opinion, the support of basic research is indispensable. Second, homeopaths should continue to design prospective randomized clinical studies in order to create robust clinical evidence for the efficacy of homeopathy. Third, they should continue to publish their treatment outcomes, as these publications document clinical effectiveness beyond doubts about its mode of action.
Outlook: These measures will not only support homeopaths in continuing their clinical work, but may lead to a better recognition of this treatment in both the scientific world and the public.
To this, I might add the following comments:
- “ongoing debates concerning its effectiveness”: this debate has been ongoing for 200 years but it has now come to a conclusion, namely that homeopathy is a placebo therapy.
- “no unifying explanation how homeopathy works exists”: we do know, however, that the laws of nature, as we understand them today, must be wrong if homeopathy did work.
- “Homeopaths are frequently challenged by skeptics”: the main challenges currently come not from skeptics but from health experts who rightly insist on sound evidence.
- “several well-designed RCTs, observational studies, case studies, and case reports, have been published, demonstrating its clinical efficacy”: arguably, this might be correct but misses the crucial point that the totality of the reliable evidence fails to show that homeopathy is efficacious for any condition of humans or animals.
- “the discovery of the working principle of homeopathy would be a major advance”: yes, so much so that it would require rewriting whole sections of the textbooks of physics and chemistry.
- “Basic research has already discovered some milestones”: these ‘milestones’ are so imposing that nobody outside the realm of homeopathy has ever recognized them.
- “the support of basic research is indispensable”: not so much indispensable as non-existent, I would say.
- “design prospective randomized clinical studies in order to create robust clinical evidence for the efficacy of homeopathy”: homeopaths believe research to be a tool for creating evidence that supports their creed; I have often tried to remind them that it is a tool for testing hypotheses – to no avail, it seems.
- “publish their treatment outcomes, as these publications document clinical effectiveness”: I have also often tried to explain to them that treatment outcomes can be due to many factors other than the specific effect of the applied therapy – again to no avail.
- “These measures will not only support homeopaths in continuing their clinical work, but may lead to a better recognition of this treatment in both the scientific world and the public”: these measures, if applied rigorously, will merely confirm what we already know, namely that homeopathy does not work beyond placebo.
The UK ‘Advertising Standards Authority‘ (ASA) received a complaint about an advertisement that stated:
“Homeopathy is used throughout the world to keep healthy … People in the UK have been using it to successfully help with migraine, anxiety, chronic pain, woman’s [sic] health issues, depression, eczema, chronic fatigue, asthma, IBS, rheumatoid arthritis, and many other conditions”.
The ‘Good Thinking Society‘ had challenged whether:
- the ad discouraged essential treatment for conditions for which medical supervision should be sought, namely migraines, chronic pain, women’s health issues, depression, asthma, rheumatoid arthritis; and
- the claim “People in the UK have been using [homeopathy] to successfully help with anxiety, chronic pain … eczema, chronic fatigue syndrome … IBS” was misleading and could be substantiated.
The response of the ASA has just been published. Here are the key excerpts from the ASA’s assessment:
1. Upheld
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. Among other conditions, the ad referred to “migraines”, “chronic pain”, “woman’s [sic] health issues”, “depression”, “asthma”, and “rheumatoid arthritis”, which we considered were conditions for which medical supervision should be sought, and therefore advice, diagnosis or treatment must be conducted under the supervision of a suitably qualified medical professional. We noted that the practice was run by a GMC-registered GP, who we considered was a suitably qualified health professional. However, the individual homeopaths were not registered and did not hold the same qualifications. Therefore, Homeopathy UK had not shown that all treatment and diagnoses conducted at the practice would be conducted under the supervision of a suitably qualified medical professional. Because Homeopathy UK had not supplied evidence that treatment would always be carried out by a suitably qualified health professional, and because reference to the conditions listed in the ad 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).
2. Upheld
We considered that consumers would understand the claim “People in the UK have been using [homeopathy] to successfully help with anxiety, chronic pain … eczema, chronic fatigue syndrome … IBS” to mean that homeopathy could be used to successfully treat those conditions … when we reviewed the evidence provided by Homeopathy UK, we considered that the studies provided did not meet the standard of evidence we required for the types of claims being made, both in terms of adequacy and relevance…
On that point the ad breached CAP Code (Edition) rules 3.1 (Misleading advertising), 3.7 (Substantiation) and 12.1 (Medicines, medical devices, health-related products and beauty products).
Action
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. We also told them to ensure they did not make claims for homeopathy unless they were supported with robust evidence.
_____________________________
Am I reading this correctly?
The ASA seems to be saying that homeopaths are not suitably qualified health professionals and, as no therapeutic claims are supported by robust evidence, that claims for homeopathy are improper.
You may not like it, but we do seem to live in the age of the ‘alternative truth’. It might necessitate reconsidering some of our definitions. A lie, for instance, was formerly defined as making an untrue statement with intent to deceive. Does that definition need to be revised in the age of the ‘alternative truth’?
Laura Kuenssberg, the political editor of the BBC, seems to think so. She recently published an interesting new definition of a lie: “… outright lying … is relatively rare. It is too easily found out. Only one senior politician still in the game has ever privately told me something that was utterly, entirely, and completely untrue.” She wrote this in an article about our PM, Boris Johnson who, by old standards, would probably qualify as a habitual liar. And as the BBC political editor cannot easily call him that, she conveniently moved the goal post and defined a lie to be something “utterly, entirely, and completely untrue”.
So, here we have it, the age of alternative truths has redefined the lie!
But I am not starting to write political rants – tempting though it often is – there is enough to rant about in so-called alternative medicine (SCAM). The questions I asked myself are these: how does SCAM measure up to the new Kuenssberg definition, and how gullible have we become?
Let’s play a little game to find out, shall we?
I provide 10 statements commonly used by the SCAM fraternity, and I ask you to consider which of them is “utterly, entirely, and completely untrue”.
- Chiropractic manipulations have been proven to do more good than harm.
- Acupuncture is effective for chronic pain.
- Homeopathy is supported by sound evidence.
- Homeopathic remedies act as nano-particles.
- Natural means safe.
- Integrative medicine is in the best interest of patients.
- Chiropractic subluxations do exist.
- Detox is a concept that makes sense.
- SCAM practitioners treat the root causes of disease.
- SCAM is cost-effective.
Next, please count the number of statements that are “utterly, entirely, and completely untrue”. This will give you a figure between 0 and 10. I propose that it can be used as a measure of gullibility.
I suggest the following grading:
- 10 – 8 = not gullible
- 7 – 5 = gullible
- 4 – 2 = very gullible
- 1 – 0 = dangerously gullible.
And here you have the ‘Edzard Ernst measure of gullibility’!
Many people believe that homeopathy is essentially plant-based – but they are mistaken! Homeopathic remedies can be made from anything: Berlin wall, X-ray, pus, excrement, dental plaque, mobile phone rays, poisons … anything you can possibly think of. So, why not from vaccines?
This is exactly what a pharmacist specialized in homeopathy thought.
It has been reported that the ‘Schloss-Apotheke’ in Koblenz, Germany offered for sale a homeopathic remedy made from the
Pfizer vaccine. This has since prompted not only the Chamber of Pharmacists but also the Paul Ehrlich Institute and Pfizer to issue statements. On Friday (30/4/2021) morning, the pharmacy had advertised homeopathic remedies based on the Pfizer/Biontech vaccine. The Westphalia-Lippe Chamber of Pharmacists then issued an explicit warning against it. “We are stunned by this,” said a spokesman. The offer has since disappeared from the pharmacy’s website.
On Friday afternoon, the manufacturer of the original vaccine also intervened. The Paul Ehrlich Institute released a statement making it clear that a vaccine is only safe “if it is administered in accordance with the marketing authorization.”
The Schloss-Apotheke had advertised the product in question with the following words:
“We have Pfizer/BioNTech Covid-19-Vaccine in potentized form up to D30 as globules or dilution (for discharge) in stock.”
The chamber of pharmacists countered with a warming under the heading “Facts instead of Fake News” on Facebook and Instagram:
“Whatever they might contain: These remedies are no effective protection against Covid-19.”
Pharmacy manager, Annette Eichele, of the Schloss-Apotheke claimed she had not sold homeopathic Corona vaccines and stressed that effective vaccines of this kind do not exist. According to Eichele, only an additional “mini drop” of the original Biontech vaccine had been used and “highly potentized” and prepared homeopathically. According to Eichele, Corona vaccinations that had already been administered were thus to have a “better and more correct effect with this supplementary product, possibly without causing side effects … but this is not scientifically proven”. The homeopathic product had been produced only on customer request and had been sold less than a dozen times in the past weeks. Ten grams of the remedy were sold for about 15 Euros. On Twitter, Eichele stated: „Wir haben nichts Böses getan, wir wollten nur Menschen helfen!“ (We have done nothing evil, we only wanted to help people). I am reminded yet again of Bert Brecht who observed:
“The opposite of good is not evil but good intentions”.
