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

experience

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In case you have categorized Harry Windsor as an ungrateful brat, you are entirely wrong! He did thank a lot of people – Ophra and Gwyneth Paltrow, for instance. No, I did not read Harry’s bestseller ‘SPARE’. But I did, of course, read the odd report about it simply because it is almost impossible to escape the current press hoo-ha about it.

Most of what I learned is of no interest to me. Some of it, I have to admit, made me concerned about Hary’s wellbeing – after all, we know that chronic drug-taking can severely affect one’s mental health! However, one recent article in Newsweek managed to reassure me on that score:

Among the “professionals, medical experts, and coaches” thanked by the prince for “keeping me physically and mentally strong over the years,” is John Amaral, a Los Angeles-based chiropractor, energy practitioner, author and educator. Amaral is known for his self-developed “energy flow formula,” which combines body and energy work to include mindfulness, meditation and breathing.

This sounded sufficiently relevant for me to look up Amaral. This is what we learn from one website:

Dr. John Amaral is a holistic chiropractor that practices Network Spinal (NSA). This technique helps people release stored tension in their muscles and joints through gentle force adjustments, also known as entrainments. Instead of the traditional cracking or popping of bones that you’re used to seeing at chiropractic offices, John Amaral leverages different energetic intelligences to help people heal physically and emotionally.

Another source tells us the following:

John Amaral is a chiropractor, energy healer and educator who works behind the scenes helping celebrities, entrepreneurs, pro athletes and influencers elevate their energy so they feel and perform their best. John has worked with thousands of people from over 50 countries. He is the Founder of Body Centered Leadership… How much do his sessions cost? According to the Wall Street Journal, a healing session with Amaral will run you $2,500.

And a third website informs us that:

Amaral works with what he calls the “subtle energy body”, which is the energy field around the body that can extend around 3 to 8 feet from the physical body. His work is primarily focused on shifting the tension state of the body and help in freeing up bound-up energy that’s held in different parts of the body. He accesses the energy around the body to achieve this.

In case you have not yet got the drift, take a look at this video; impressive isn’t it?

Yes, Amaral is not cheap but he must be worth it! And because he is such a genial healer, I am confident that we can all relax now knowing that Harry’s health is in such good hands. Personally, I am thrilled by Harry’s hint that there might be a second book in the offing – one with the really dirty linen. I think I might actually buy that one, now that I know how badly he needs the money for keeping healthy.

It is hardly surprising that I receive plenty of complaints about the things I publish. After all, so-called alternative medicine (SCAM) is dominated by emotions and not by rationality. When I was still in post at Exeter, my peers received complaints about me all the time. Now that I write articles for several newspapers and journals (not to mention this blog), the flow of complaints to the editors is continuing nicely. Consequently, I am in a good position to offer a beginner’s guide to complaining to everyone who is fed up with me and my work.

Foremost, such a complaint must have a clear structure. Here is one that I advise considering:

  1. Introduction
  2. Self-aggrandizement
  3. Your objection
  4. Ad hominem
  5. Generalizations
  6. Threats

Allow me to take you through these headings one by one.

Introduction

The recipient of your complaint (e.g. a newspaper editor) needs to know why you are addressing him or her. This means you ought to clearly state your aim at the outset. Something like “I am writing to you to complain about an article recently published in your paper” would probably suffice. But you probably find it hard to be concise – and who could blame you: you are fuming with anger and overflowing with emotion.

I am sure the recipient of your complaint will understand that you have to use a few colorful sentences to introduce the subject properly. If you feel like elaborating that you have been a reader of the paper since 1972, or that you slept badly last night, or that your last dinner was indigestible, or why you are opposed to COVID vaccinations – by all means, please go ahead. The editor will be delighted to receive a little background and can thus empathize with your concerns.

Self-aggrandizement

Despite these efforts, there is always the danger that the editor reading your complaint does not take you seriously. This must be avoided at all costs. Therefore, you must make sure he/she understands how important you truly are. As your complaint is healthcare-related, it is helpful to stress your unique standing in this area. Do not worry if you have not studied medicine, are not a scientist, or understand buggar all about anything. The least you must do is to state that you have years of experience in health. Such phraseology is non-commital – after all, you probably have been ill once or twice – and it makes it clear that you know what you are talking about.

Your objection

Now it is time to state what you actually object to and why. This might not be as easy as it sounds. Most people who complain about my work are unable to pinpoint what exactly it is that they don’t like. They never dispute a concrete fact or finding I presented but they disagree with my stance in general terms. Therefore, they cannot define a precise error or misinterpretation in my text. In such cases, it might be best to claim that you have read several or all of my articles and you are scandalized by my general attitude, ignorance, or malice. You might add that my articles systematically defame SCAMs that:

  • have clearly stood the test of time,
  • are used by millions,
  • are holistic,
  • have cured your goldfish, etc.

Do never include any actual data in your complaint. This can only expose you to criticism; and that’s the last thing you want to achieve.

Ad hominem

The less specific material you complain about, the more important it is to display true conviction by going on a personal attack. I can highly recommend the ad hominem principle for this purpose. Go for it!

In a previous post, I listed some ideas that might help you here. You could claim that:

  • I am not qualified
  • I only speak tosh
  • I do not understand science
  • I never did any ‘real’ research
  • Exeter Uni fired me
  • I have been caught red-handed (not quite sure at what)
  • I am on BIG PHARMA’s payroll
  • I faked my research papers

Feel free to come up with your own ideas; use your imagination. I am sure the editor who reads your inspired lines will thank you for it.

Generalizations

Now that you have thoroughly dealt with me (Prof Ernst) as a person, you need to generalize in order to lend more relevance and impact to your complaint. You could point out, for example, that not just I but all scientists or skeptics are corrupt, ignorant, etc. Or you might explain that, in any case, science is over-rated and cannot be trusted. Such enlightened remarks are important because they put things into perspective and show that you are well-informed.

Threats

To end your letter, it is advisable to ensure that the editor who is trying to make sense of your complaint cannot dismiss it easily. For this purpose, I find it helpful to add a few actual threats. The editor needs to know that he would disregard your concerns at his own peril.

For instance, you could state that, if this paper/journal in question should dare to ever again publish a single line of Ernst’s writings, you will never again buy this publication. If you want to sound alarmingly dangerous, add that you will tell all your friends to do likewise. And if you wish to scare the hell out of the poor editor, tell him/her that you will file a report with the ombudsman.

______________________________

 GOOD LUCK

 

I have tried!

Honestly!

But at present, it is simply not possible to escape the revelations and accusations by Harry Windsor.

So, eventually, I gave in and had a look at the therapy he often refers to. He claims that he is deeply traumatized by what he had to go through and, to help him survive the ordeal, Harry has been reported to use EMDR.

Eye Movement Desensitization and Reprocessing (EMDR) is a fringe psychotherapy that was developed to alleviate the distress associated with traumatic memories. It is supposed to facilitate the accessing and processing of traumatic memories and other adverse life experiences with a view of bringing these to an adaptive resolution. The claim is that, after successful treatment with EMDR therapy, affective distress is relieved, negative beliefs are reformulated, and physiological arousal is reduced.

During EMDR therapy the patient must attend to emotionally disturbing material in brief sequential doses while simultaneously focusing on an external stimulus. Therapist-directed lateral eye movements are commonly used as external stimulus but a variety of other stimuli including hand-tapping and audio stimulation can also be employed.

Francine Shapiro, the psychologist who invented EMDR claims to have serendipitously discovered this technique by experiencing spontaneous saccadic eye movements in response to disturbing thoughts during a walk in the woods. Yet, as GM Rosen explains, this explanation is difficult to accept because normal saccadic eye movements appear to be physiologically undetectable and are typically triggered by external stimuli.

Shapiro hypothesizes that EMDR therapy facilitates the access to the traumatic memory network, so that information processing is enhanced, with new associations forged between the traumatic memory and more adaptive memories or information. These new associations are alleged to result in complete information processing, new learning, elimination of emotional distress, and development of cognitive insights.

EMDR therapy uses a three-pronged protocol:

  • (1) the past events that have laid the groundwork for dysfunction are processed, forging new associative links with adaptive information;
  • (2) the current circumstances that elicit distress are targeted, and internal and external triggers are desensitized;
  • (3) imaginal templates of future events are incorporated, to assist the client in acquiring the skills needed for adaptive functioning.

The question I ask myself is, of course: Does EMDR work?

The evidence is mixed and generally flimsy. A systematic review showed that “limitations to the current evidence exist, and much current evidence relies on small sample sizes and provides limited follow-up data”.

What might be particularly interesting in relation to Harry Windsor is that EMDR techniques have been associated with memory-undermining effects and may undermine the accuracy of memory, which can be risky if patients, later on, serve as witnesses in legal proceedings.

Personally, I think that Harry’s outbursts lend support to the hypothesis that EMDR is not effective. In the interest of the royal family, we should perhaps see whether so-called alternative medicine (SCAM) does offer an effective treatment against navel gazing?

Every now and then, I like to look at what our good friend and SCAM entrepreneur Gwyneth Paltrow is offering via her extraordinary ripoff called GOOP. When I recently browsed through her goodies, I find lots of items that made me blush (common decency does not permit me to go into details here). But I also found something that I am sure many of us might need after the over-indulgence of recent weeks:Preview Changes (opens in a new tab)

“The Martini” Emotional Detox Bath Soak

The product is described as follows:

This body-and-spirit-centering bath soak, infused with Himalayan pink salt, helps take the edge off during turbulent times (or after a crazy day). Called “The Martini” after the traditional name for the last take of the day in filmmaking,  the soak is made with pharmaceutical-grade Epsom salts, chia-seed oil, passionflower, valerian root, myrrh, Australian sandalwood, and wild-crafted frankincense.

Here at goop we believe in making every choice count, which is why we’ve always been outspoken about the toxic ingredients used in personal-care and beauty products (all are effectively unregulated in this country). We’re also passionate about the idea that beauty comes from the inside out. So we use clinically proven and best-in-class ingredients at active levels to create skin care, skin-boosting ingestibles, and body essentials that are luxurious, deliver high-performance results, and enliven the senses with exquisite textures and beautiful scents. We don’t rest until we think our products are perfect—safe enough and powerful enough for noticeable results. (All our products are formulated without parabens, petroleum, phthalates, SLS, SLES, PEGs, TEA, DEA, silicones, or artificial dyes or fragrances. And our formulas are not tested on animals.) We hope you love them as much as we do.

Yes, there is a whole world out there of which a retired chap like myself knows as good as nothing. And it has its very own terminology: 

  • emotional detox
  • body-and-spirit-centering
  • pharmaceutical-grade Epsom salts
  • wild-crafted
  • clinically proven and best-in-class ingredients
  • skin-boosting ingestibles
  • body essentials
  • high-performance results

By now, I am sure, you are dying to learn what the Emotional Detox Bath Soak contains:

Sodium Chloride, Magnesium Sulfate, Passiflora Incarnata Extract, Valeriana Officinalis Root Extract, Salvia Hispanica Seed Oil, Helianthus Annuus (Sunflower) Seed Oil, Rosmarinus Officinalis (Rosemary), Leaf Extract, Maltodextrin, Boswellia Carterii Oil, Commiphora Myrrha Oil, Fusanus Spicatus Wood Oil, Cyperus Scariosus (Nagarmotha) Oil, Vetiveria Zizanoides Root Oil, Simmondsia Chinensis (Jojoba) Seed Oil, Tocopherol.

Clinically proven, you ask?

Well, perhaps not in the sense that sad, retired academics tend to understand the term, but you have to realize, this is a different world where words have different meanings, the meaning entretreneurs want them to have. What is proven though is this: at $40 a tiny jar, the detox bath will eliminate some cash from your pocket – after all, that’s what detox is all about, isn’t it?

Before the New Year, many journals publish retrospectives of the things that have been happening in the year that is about to end. I have often thought that this is mainly due to the laziness of the journalists and editors. These pieces can be prepared in advance and thus do not disturb their holiday routine between Christmas and New Year. Well, I have to admit that I too am a lazy chap who has prepared a post about the preceding year.

Listed below are all the posts of 2022 that prompted at least 50 comments.

  1. British MP, Andrew Bridgen, claims that mRNA Covid vaccines are “not safe, not effective and not necessary”
  2. Homeopathy kills vulnerable patients
  3. Individualized exercise therapy for chronic low back pain
  4. ‘Arguments’ used to defend so-called alternative medicine
  5. The market for homeopathics is predicted to grow significantly
  6. Catastrophic injuries after chiropractic treatment
  7. A residential health programme that poses “a risk to the health and safety of members of the public”
  8. Homeopathy for COVID-19: A randomized, double-blind, placebo-controlled trial shows that it does not work
  9. The body of evidence on homeopathy is rotten to the core
  10. Excess mortality due to the COVID-19 pandemic
  11. Preference of so-called alternative medicine predicts negative attitudes to vaccination
  12. “Nothing much new here about Chucky Windsor’s credulity …” A review of the reactions to my biography of Prince Charles
  13. Acute Subdural Hemorrhage Following Cervical Chiropractic Manipulation
  14. Double-sided vertebral artery dissection in a 33-year-old man. The chiropractor is not guilty?
  15. Chiropractic spinal manipulation is not safe!
  16. Best Practices for the Chiropractic Care of Children
  17. The ‘moral and intellectual decay’ of COVID disinformants
  18. What are the reasons for opposing COVID vaccinations?
  19. No-Vax Djokovic: an “anti-scientific crank hiding in plain sight”

In 2022, I published in excess of 300 posts. Some attracted no comments at all; most prompted about a dozen, and some generated many more comments (the record was in excess of 200). The latter group is not necessarily the most popular, perhaps just the most controversial set of posts. They are also not necessarily my best articles; they are just the ones that caused you, my readers, to submit the most comments.

So, what were the best posts? I am probably not in the best position to judge but, for what it’s worth, here are some that I felt were better than average:

  1. Osteopathy: an absence of good-quality evidence
  2. ‘Arguments’ used to defend so-called alternative medicine
  3. INSTRUCTIONS FOR CHILD ABUSE: Three best-selling books on homeopathy for kids
  4. Most healthcare interventions tested in Cochrane Reviews are not supported by high-quality evidence
  5. Widespread fraud in natural health products research 
  6. Quackery is on the rise, and the placebo effect is part of the problem
  7. Protecting vulnerable patients from charlatans: a story of superb teamwork
  8. What motivates a doctor to work as an integrative medical practitioner?
  9. Beyond the headlines: an analysis of 22 articles from ‘THE DAILY EXPRESS’
  10. The ‘golden rules’ of so-called alternative medicine (SCAM)
  11. Comments by a chiropractor: insights into quasi-religious zeal
  12. Chiropractic spinal manipulation is not safe!
  13. Prince Charles’ advocacy of quackery is by no means harmless
  14. Anti-vax arguments used by proponents of SCAM are stupid, or wrong, or both

Is there a common denominator between the two sets of posts (other than SCAM)? Not really! This probably is because I try to cover many diverse topics under the umbrella of SCAM (and very occasionally also beyond it). If there is anything at all that most posts might have in common, it must be the fact that I often make a conscious effort to educate the public about SCAM and try to counter-balance the uncritical hype the subject enjoys almost everywhere else.

Comparing the two sets of posts, the most striking observation might be that the 1st one mainly relates to defined SCAM interventions, while the 2nd set of posts tends to be about general issues related to SCAM. Another finding might also be relevant: posts that I feel are amongst my ‘best’ are clearly not the ones that generate the most comments. This, of course, begs the question as to what I define as ‘best’ in the context of this blog. I have to admit that I find this is far from easy. ‘Best’, I suppose, means informative/relevant/well-researched/most thoughtful.

I kept the most important issue emerging from all this to the last. As the year 2022 ends, I have the urge to thank all of you, the folks that read my posts and sometimes even provide comments to them. Some are supportive, others are the opposite; some are informative, others are infuriating; some are correct, others are not. But all have one thing in common: they are the lifeblood of my blog!

Let me use the occasion of the last post of 2022 to thank you all for your interest in my work.

See you next year.

 

 

It has been reported that a Vancouver naturopath has been fined and temporarily suspended after a patient complained he failed to notice a rectal tumor during four months of treatment for hemorrhoids.

Jordan Atkinson will have to pay $5,000 and lose his license for 16 days after signing a consent agreement with the College of Naturopathic Physicians of B.C., according to a public notice posted by the COLLEGE OF NATUROPATHIC PHYSICIANS OF BRITISH COLUMBIA.

A former patient had filed the complaint when another medical professional diagnosed a tumor on the rectum following “several appointments” with Atkinson for hemorrhoid treatment. “The patient complained that Dr. Atkinson failed to detect the tumor because he did not perform a competent examination,” the college notice says.  ‘Doctor’ Atkinson disagreed with that allegation but admitted that he didn’t fully document his appointments with the patient.

The college’s inquiry committee, which investigates complaints, found that “Dr. Atkinson’s treatment of the patient fell short of the standard of practice required of a naturopathic doctor in these circumstances.”  Atkinson who is also the subject of a lawsuit from a patient who alleges he seriously injured her while injecting Botox into her face at the base of her nose, has also agreed to a reprimand and “to make reasonable efforts when a language barrier exists to ensure that his patients understand the treatment plan and provide informed consent.” 

Personally, I find it hard to believe that any health professional can administer a prolonged treatment for hemorrhoids, while the patient is actually suffering from a rectal tumor which might well be malign. I find it even harder to believe that, after a complaint had been filed by a victim, the professional body of this professional suspends his license for just 16 days.

In my view, this suggests that this professional body (like so many in the realm of so-called alternative medicine (SCAM)) is not fit for purpose. That is to say, it does clearly not fulfill its main task adequately which is to protect the public from the malpractice of its members. Rather it seems to prioritize the interests of the member over those of the public. Yet, on its website the COLLEGE OF NATUROPATHIC PHYSICIANS OF BRITISH COLUMBIA state that “the College protects the public interest by ensuring that naturopathic physicians in British Columbia practice safely, ethically, and competently.” As so often in SCAM, what is being stated and what is being done differs dramatically.

At the heart of this and many similar cases, I fear, is that consumers find it difficult to differentiate between well-educated healthcare professionals and poorly trained charlatans. And who could blame them? Calling naturopaths ‘doctors’ cannot be helpful, particularly if the ‘Dr.-title’ is used without a clear qualification that the person who carries it has never seen the inside of a medical school; instead he has learned an abundance of nonsense taught by a quack institution.

In summary one is tempted to conclude that this case yet again confirms that naturopaths are medically incompetent graduates of schools of incompetence protected by organizations of incompetence.

This systematic review, meta-analysis, and meta-regression investigated the effects of individualized interventions, based on exercise alone or combined with psychological treatment, on pain intensity and disability in patients with chronic non-specific low-back pain.

Databases were searched up to January 31, 2022, to retrieve respective randomized clinical trials of individualized and/or personalized and/or stratified exercise interventions with or without psychological treatment compared to any control.

The findings show:

  • Fifty-eight studies (n = 10084) were included. At short-term follow-up (12 weeks), low-certainty evidence for pain intensity (SMD -0.28 [95%CI -0.42 to -0.14]) and very low-certainty evidence for disability (-0.17 [-0.31 to -0.02]) indicates superior effects of individualized versus active exercises, and very low-certainty evidence for pain intensity (-0.40; [-0.58 to -0.22])), but not (low-certainty evidence) for disability (-0.18; [-0.22 to 0.01]) compared to passive controls.
  • At long-term follow-up (1 year), moderate-certainty evidence for pain intensity (-0.14 [-0.22 to -0.07]) and disability (-0.20 [-0.30 to -0.10]) indicates effects versus passive controls.

Sensitivity analyses indicate that the effects on pain, but not on disability (always short-term and versus active treatments) were robust. Pain reduction caused by individualized exercise treatments in combination with psychological interventions (in particular behavioral-cognitive therapies) (-0.28 [-0.42 to -0.14], low certainty) is of clinical importance.

The certainty of the evidence was downgraded mainly due to evidence of risk of bias, publication bias, and inconsistency that could not be explained. Individualized exercise can treat pain and disability in chronic non-specific low-back pain. The effects in the short term are of clinical importance (relative differences versus active 38% and versus passive interventions 77%), especially in regard to the little extra effort to individualize exercise. Sub-group analysis suggests a combination of individualized exercise (especially motor-control-based treatments) with behavioral therapy interventions to boost effects.

The authors concluded that the relative benefit of individualized exercise therapy on chronic low back pain compared to other active treatments is approximately 38% which is of clinical importance. Still, sustainability of effects (> 12 months) is doubtable. As individualization in exercise therapies is easy to implement, its use should be considered.

Johannes Fleckenstein, the 1st author from the Goethe-University Frankfurt, Institute of Sports Sciences, Department of Sports Medicine and Exercise Physiology, sees in the study “an urgent health policy appeal” to strengthen combined services in care and remuneration. “Compared to other countries, such as the USA, we are in a relatively good position in Germany. For example, we have a lower prescription of strong narcotics such as opiates. But the rate of unnecessary X-ray examinations, which incidentally can also contribute to the chronicity of pain, or inaccurate surgical indications is still very high.”

Personally, I find the findings of this paper rather unsurprising. As a clinician, many years ago, prescribing exercise therapy for low back pain was my daily bread. None of my team would have ever conceived the idea that exercise does not need to be individualized according to the needs and capabilities of each patient. Therefore, I suggest rephrasing the last sentence of the conclusion: As individualization in exercise therapies is easy to implement, its use should be standard procedure.

 

In recent weeks, I have been thinking a lot about ‘INTEGRATIVE MEDICINE‘. Skeptics mostly see it as a way of smuggling quackery into conventional healthcare. This is undoubtedly true and important. But it occurred to me that there also is a somewhat different perspective that has so far been neglected. Let me try to explain by recounting a story. It is fictive, of course, but the fiction is based on the observation of many cases during previous decades.

The story is about a doctor – let’s call him George – who, to be frank, is not the most gifted of his colleagues. Already at medical school, he was not as dedicated as his teachers would have hoped. In fact, medicine had not been his first choice at all. Yet he ended up as a general practitioner and eventually became a partner in a practice with 5 GPs.

Over the years, it became clear that George lacked something to be a good doctor. He knew his stuff, alright, got most of the diagnoses correct, and made not too many mistakes. But something was not quite right. One could say that, relative to his colleagues, he lacked kindness, dedication, compassion, and empathy. He often found it unnecessary to respect his patients. Sometimes, he even joked about them and about what he perceived as their stupidity.

If we view medicine as being both a science and an art, one might conclude that George was just about alright with the science but notably deficient in the art of healthcare. Most of his patients were aware that something was amiss; many even avoided him and tried to consult one of his colleagues instead. On more than one occasion, patients had told George that they were disappointed with his attitude. Some had even told him to the face that he lacked kindness. Such conversations made George think. He had to admit to himself that his colleagues were better at building good relationships with their patients. Eventually, George decided that something ought to change.

As it happened, George’s wife had a friend who was a Reiki healer. One day, he asked the healer – let’s call her Liz – whether she would like to try working alongside the GPs in his practice. Liz was delighted and accepted. George did not believe for a minute that Reiki was more than hocus-pocus, but he knew that Liz was kind and had loads of the compassion that he was so obviously lacking.

Hence force George and Liz formed a team: George looked after his patients the best he could and whenever he felt that more empathy and compassion were required, he would send the patient to Liz. This partnership changed everything. The patients were content, George was happy, and Liz was beaming.

As some patients frowned at the idea of Reiki, George soon recruited an aromatherapist as well. After that, a lay homeopath and a reflexologist were employed. George’s GP partners (who made little use of the alternative practitioners) were sure that none of these therapies had any specific effects (incidentally, a belief not shared by the practitioners in question who felt they were doing wonders). But for George, the therapists clearly did supplement his limited interpersonal skills. Patients were delighted and the GP practice began to thrive. As for George, he became an increasingly outspoken and prominent advocate of INTEGRATED MEDICINE. The fact that there was no evidence to support it did hardly matter to him; what counted was that it rendered his own incompetence less visible.

About a year later, George convinced his slightly bewildered partners to rename their practice ‘THE INTEGRATIVE HEALTH CENTRE’.

End of story

In case you did not get my point, let me make it more bluntly: INTEGRATIVE MEDICINE can be a way for some doctors to delegate the art of medicine to quacks. Good doctors don’t need to do this because they are able to show compassion and treat their patients as whole human beings. Less gifted doctors, however, find INTEGRATIVE MEDICINE a practical solution to their own incompetence.

So, is INTEGRATIVE MEDICINE a good compromise then?

No, certainly not!

The last thing we need in healthcare is for doctors to start delegating the art of medicine to others. It would be a serious mistake, nothing less than abandoning the core values of medicine to charlatans.

But what is the solution?

Obviously, it is to make sure all doctors are competent. We need to select medical students adequately, tell them much more about the importance of kindness, compassion, empathy, holism, etc., and teach them how to show and use these qualities. We need to train doctors to be competent in both the science and the art of medicine. This has to begin in medical school and must continue throughout their professional career. We need to make sure that doctors like George understand the message; if they prove to be unable to do so, we should direct them to professions where compassion is not essential.

The worst solution we can possibly envisage is to allow charlatans to cover up the incompetence of people like George and call it INTEGRATED MEDICINE.

 

Shiatsu is a Japanese form of so-called alternative medicine (SCAM) derived from Traditional Chinese Medicine using deep pressure on the paths of the postulated acupuncture meridians. Clinical observations on this topic are said to be encouraging, especially for the treatment of sleep and conduct disorders, but there is a lack of empirical data.

The objective of this study was to examine the possible therapeutic effects of shiatsu in a clinical population of children treated in child and adolescent psychiatry. It was designed as a qualitative descriptive and non-interventional study, conducted on children treated in day-care hospital units and outpatient clinical settings. Shiatsu was administered, at least during 3 sessions, to children with an autism spectrum disorder or other disorders according to ICD-11 criteria (such as conduct disorders with impulsivity or attention deficit).

The evaluation was performed by two independent researchers (a child psychiatrist and a psychologist who were not the caregivers) based on direct observation of children during the shiatsu sessions, combined with semi-structured non-inductive interviews with their parents, and data collected from focus groups conducted with the children’s caregivers. A phenomenological interpretive analysis (IPA) approach with Nvivo coding software was used to analyze the data.

Based on semi-structured interviews with 13 parents cross-referenced with data from 2 focus groups and direct observations of 7 children during 2 full shiatsu sessions for each observation, the results show that shiatsu has positive effects on

  • internal tension (a relief effect, notably on aggressive behaviors directed against others or self),
  • sleep (including improvement of sleep quality),
  • social interaction,
  • attention,
  • verbalization of affects and traumatic memories of early childhood,
  • perception of bodily limits.

As these children had several other treatments as well, it cannot be proved that the positive effects observed in this study are related specifically to shiatsu practice. Shiatsu may participate and facilitate the effects of other treatments. It is noteworthy that most of the children came willingly to the shiatsu sessions, ask their parents to repeat the shiatsu sessions at home, and indicate to the practitioner, from one session to the next, their elective body points where they wish to receive the application of shiatsu.

The authors concluded that the findings suggest therapeutic benefits of shiatsu, especially on externalize violence with a relief of aggressive behavior directed against others or self (knowing, moreover, that internal tension, sleep disorders and non-verbalization of affects or traumatic memories, all improved by shiatsu, are also all risk factors for externalize violence). These results highlight, therefore, the need to develop a daily practice of shiatsu in child and adolescent psychiatry. Further research is required to clarify the effects of shiatsu and ascertain better its underlying mechanisms based on this exploratory pilot study.

I do appreciate that, with a treatment that has not been submitted to many controlled clinical trials, researchers feel that they have to start from scratch, e.g. simple observations. However, they also must realize that their observations do not lend themselves to firm conclusions about the effects of the treatment. In the present case, the researchers do seem to be aware of this caveat but nevertheless make statements that go way beyond of what is warranted:

  • the results show that shiatsu has positive effects on …
  • Shiatsu may participate and facilitate the effects of other treatments
  • the findings suggest therapeutic benefits of shiatsu, especially on externalize violence
  • These results highlight, therefore, the need to develop a daily practice of shiatsu in child and adolescent psychiatry

I fear that these statements are not merely exaggerated but suspect they are also untrue. Testing them in properly controlled clinical trials would show whether my suspicion is correct. Meanwhile, I would like to remind

  • researchers,
  • reviewers,
  • and journal editors

of their duty to be truthful and not mislead the public.

 

In this paper, a team of US researchers mined opinions on homeopathy for COVID-19 expressed on Twitter. Their investigation was conducted with a dataset of nearly 60K tweets collected during a seven-month period ending in July 2020. The researchers first built text classifiers (linear and neural models) to mine opinions on homeopathy (positive, negative, neutral) from tweets using a dataset of 2400 hand-labeled tweets obtaining an average macro F-score of 81.5% for the positive and negative classes. The researchers applied this model to identify opinions from the full dataset.

The results show that the number of unique positive tweets is twice that of the number of unique negative tweets; but when including retweets, there are 23% more negative tweets overall indicating that negative tweets are getting more retweets and better traction on Twitter. Using a word shift graph analysis on the Twitter bios of authors of positive and negative tweets, the researchers observed that opinions on homeopathy appear to be correlated with political/religious ideologies of the authors (e.g., liberal vs nationalist, atheist vs Hindu).

The authors drew the following conclusions: to our knowledge, this is the first study to analyze public opinions on homeopathy on any social media platform. Our results surface a tricky landscape for public health agencies as they promote evidence-based therapies and preventative measures for COVID-19.

I am not clear on how to interpret this study. What does it show and why is it important? The authors state this:

… our study cannot lead to meaningful conclusions about homeopathy’s overall online landscape. We also enforced the English language constraint while analyzing the tweets which excludes the views and opinions of all the non-English speaking users, who constitute an overwhelming majority of the world’s population. However, our effort is a first step in the direction of examining the support for alternative medicines especially for homeopathy which has not been studied in the past. At least on Twitter, our findings indicate that negative opinions are gaining more traction in the context of COVID-19.

Opinions expressed on Twitter are influenced by an array of entirely different factors many of which are unpredictable or even unknown. Therefore, I am unsure what to make of these findings. Perhaps some of my readers have an idea?

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