Guest post by Richard Rawlins
Ever since its inception, Homeopathy has struggled to establish principled medical ethics amongst its practitioners. For sure, Samuel Hahnemann was good doctor who achieved much by denying his patients the bleeding, emetics, expectorants, laxatives and poly-pharmacy conventional at the turn of the nineteenth century. But he then lost his way in spiritism and vitalism, devised a system of care which could not, and did not, provide any benefit beyond placebo responses, and inveigled many colleagues to share his delusion. Many derided him.
As medicine in all developed countries became better regulated, so the associated ethics became better focussed. “First do no harm” is common to all systems, but in the UK, the four ‘A’s of avoiding adultery with a patient, alcohol whilst in a clinical situation, advertising, and association formed the next domain. ‘Association’ meant having a professional medical relationship with anyone not also a GMC registrant. Times, and standards have changed, but quackery, charlatanism and health care fraud has always been unethical. The problem for society has been the GMC’s reluctance to take any action against its registrants who lack integrity, promote quackery, or seek to defraud. The general response has been “we only act on complaints by a patient, health authority or fellow registrant – and complaints have to be specific.”
So it is that about 400 registrants of the GMC continue practising homeopathy with impunity. Sir Simon Stevens has now all but banned homeopathy from the NHS, but a medically qualified practitioner, in the private sector can do as they please, no matter how vulnerable and gullible the patient.
Doctors are of course required to obtain fully informed consent to treatment, and that should mean advising patients that homeopathic remedies are but placebos. Many patients so treated will declare they “feel better” and are content – but in practice, no explanation is offered to patients attending homeopaths. A classic charlatonnade (a charade promulgated by a charlatan).
But perhaps the vicissitudes of Covid-19 is exposing the hypocrisy of the GMC’s position, and might yet enable some redress for patients seeking redress for unethical medically qualified homeopathic attention.
The Guardian and Sunday Times of 22nd March 2020 reported that Dr Mark Ali allegedly made £1.7M profit in one week from selling kits to test for COVID -19.
“The GMC said no doctor should try to ‘profit from the fear and uncertainly caused by the pandemic…We would be concerned to learn that doctors are exploiting patient’s vulnerability or lack of medical knowledge, in order to profit from fear and uncertainty…’ “
The rationale for that fear is surely irrelevant – any health practice which takes advantage of the patient’s vulnerability or lack of medical knowledge is unethical. Simple.
“We also expect doctors… not to offer or recommend tests that are unproven, clinically unverified or otherwise unreliable.”
This is in the context of the serious issues of SARS-CoV-2 (the name of the corona virus which causes the illness COVID-19) – but it is helpful that the GMC’s ethical principles have been clearly stated.
May we take it the GMC will be equally as stringent with their registrants (doctors) who take advantage of the patient’s vulnerability or lack of medical knowledge, and recommend tests such as homeopathic provings “that are unproven, clinically unverified or otherwise unreliable.”?
And if not, why not?
All homeopathic remedy prescriptions are ‘tests’: “Take this, see how you go, I’ll adjust if needed…”. The German word pruefung used by Hahnemann (meaning ‘testing’ or ‘examination’) has been translated into English as ‘proving’. But the word for ‘to prove’ is beweisen, and that is not the word Hahnemann used. The use of ‘proving’ in English implies merit which is not deserved. All part of the delusion.
Clearly, any doctor who recommends homeopathic remedies, but does not explain the conventional view of the remedy, lacks integrity and is unethical – by definition. If the doctor is GMC registered (which a ‘doctor’ does not have to be – e.g., dentists are not) – they should be subject to sanction by the GMC. The GMC should do its duty to protect the public, and not wait for a crisis to stir them into action.
Sadly, if practitioners are not GMC registered, caveat emptor.
[If you do not like black humour or sarcasm, please do NOT read this post!!!]
Donald Trump just announced that, at Easter, he wants to see churches packed, his way of saying the lock-down is over because it is damaging the economy. Many others have put forward similar arguments and have pointed out that caring for the vulnerable, sick, old, etc. creates an economic burden that might eventually kill more people than it saves (see for instance ‘Economic crash could cost more lives than coronavirus, study warns‘).
Many people have also argued that homeopathy is unjustly vilified because it is truly a wholesome and safe medicine that should be used routinely. The notion here is that, alright, the evidence is not brilliant, but 200 years of experience and millions of fans cannot be ignored.
I have been wondering whether these two lines of thinking could not be profitably combined. Here is my suggestion based on the following two axioms.
- The economy is important for all our well-being.
- Homeopaths have a point in that the value of experience must not be ignored.
What follows is surprisingly simple: in view of the over-riding importance of the economy, let’s prioritise it over health. As it would look bad to deny those poor corona victims all forms of healthcare, let’s treat them homeopathically. This would make lots of people happy:
- those who think the economy must take precedent,
- those who fear the huge costs of saving corona patients (homeopathy is very cheap),
- those who argued for decades that we never gave homeopathy a fighting chance to show its worth.
There is a downside, of course. There would be a most lamentable mortality rate. But, to paraphrase Dominic Cummings, if a few oldies have to snuff it, so be it!
Once we get used to this innovative approach – I suggest we call it integrative medicine – we might even consider adopting it for other critical situations. When we realise, for instance, that the pension pots are empty, we could officially declare that homeopathy is the ideal medicine for anybody over 60.
What do you think?
I missed this article by Canadian vascular surgeons when it came out in 2018. It is well-argued, and I think you should read it in full, if you can get access (it’s behind a pay wall). It contains interesting details about the anti-vax attitude of doctors of integrative medicine (something we discussed before), as well as the most dubious things that go on in the ‘Cleveland Clinic’. Here is at least the abstract of the article:
Evidence-based medicine, first described in 1992, offers a clear, systematic, and scientific approach to the practice of medicine. Recently, the non-evidence-based practice of complementary and alternative medicine (CAM) has been increasing in the United States and around the world, particularly at medical institutions known for providing rigorous evidence-based care. The use of CAM may cause harm to patients through interactions with evidence-based medications or if patients choose to forego evidence-based care. CAM may also put financial strain on patients as most CAM expenditures are paid out-of-pocket. Despite these drawbacks, patients continue to use CAM due to media promotion of CAM therapies, dissatisfaction with conventional healthcare, and a desire for more holistic care. Given the increasing demand for CAM, many medical institutions now offer CAM services. Recently, there has been controversy surrounding the leaders of several CAM centres based at a highly respected academic medical institution, as they publicly expressed anti-vaccination views. These controversies demonstrate the non-evidence-based philosophies that run deep within CAM that are contrary to the evidence-based care that academic medical institutions should provide. Although there are financial incentives for institutions to provide CAM, it is important to recognize that this legitimizes CAM and may cause harm to patients. The poor regulation of CAM allows for the continued distribution of products and services that have not been rigorously tested for safety and efficacy. Governments in Australia and England have successfully improved regulation of CAM and can serve as a model to other countries.
Those who have been following this blog a little know how much I agree with these authors. In fact, in the peer-reviewed literature, I have been publishing similar arguments for almost 20 years, e.g:
- Integrative medicine: not a carte blanche for untested nonsense. Ernst E. Arch Intern Med 2002. PMID 12153386
- Disentangling integrative medicine Ernst E. Mayo Clin Proc 2004 – Review. PMID 15065622
- Integrated medicine. Ernst E. J Intern Med 2012. PMID 21682782 Free article.
- Integrative medicine: more than the promotion of unproven treatments? Ernst E. Med J Aust 2016. PMID 26985838
What is pseudoscience and how can it be differentiated from science? This ‘demarcation problem’ has occupied many of our best minds and which nevertheless is largely unresolved. Two brave academics have recently published a paper aimed at providing organisations within the justice system with an overview of:
a) what science is and is not;
b) what constitutes an empirically driven, theoretically founded, peer-reviewed approach;
c) how to distinguish science from pseudoscience.
In it, they demonstrate that not all information which is presented as comprehensively evaluated is methodologically reliable for use in the justice system. Even though it does not really solve the old demarcation problem, I found their article important and informative and therefore take the liberty of quoting a brief excerpt here:
Organisations within the justice system do use empirically and theoretically supported approaches. However, some implemented approaches lack empirical evidence. In more perturbing cases, police officers, lawyers and judges may resort to pseudoscience – that is, bodies of information that may appear to be scientific but, in reality, lack the characteristics of scientific knowledge. … if members of the justice community are not advised about the publishing process then pseudoscientists can be fairly proficient at providing counterarguments. In addition, pseudoscientists can use several other fallacious arguments to achieve maximum support for their approaches.
For example, pseudoscientists might argue that their approaches are supported by a select number of articles, theses or books, and that they are reliable due to their acceptance by important organisations. However, if upon reading such literature it becomes apparent that there is no empirical or theoretical support, or that the steps leading to the conclusions are not thoroughly justified (be this methodologically or through evaluation), the implementation of their approaches remains merely destitute of vision. In addition, such reference to important organisations – often known as ‘name-dropping’–is detrimental by nature; doing so lends support to the notion that one might be unable to distinguish pseudoscience from science and may not understand the role that science plays in developing better professional practice.
Fallacious arguments from pseudoscientists can also address negative comments in a way that attempts to discourage further criticism from members of the scientific community. They can engage in legal threats and ad hominem attacks – that is, opposition to an argument ‘by questioning the personal circumstances or personal trustworthiness of the arguer who advanced it’. For example, if academics raise concerns regarding a particular pseudoscience without having attended its associated seminars, pseudoscientists might assert that the academics do not have the required understanding and that, as such, their criticism is of no value. If the academics had indeed attended the seminars, the pseudoscientists might instead suggest that their concerns are raised out of obscure or malicious reasons. Pseudoscientists might even state that they are criticised due to their revolutionary approach and refer to a quote dubiously attributed to the German philosopher Arthur Schopenhauer: ‘All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as self-evident’. However, as Sagan rightly points out,
the fact that some geniuses were laughed at does not imply that all who are laughed at are geniuses. They laughed at Columbus, they laughed at Fulton, they laughed at the Wright brothers. But they also laughed at Bozo the Clown.
‘HOMEOPATHY360’ are fiercely decided to defend homeopathy, no matter what. They state that we promise to stand by your side always to fight against the critical attacks on Homeopathy… Therefore, I was not really surprised when, a couple of days ago, I received an email by them urging me to support US homeopaths against the threat by the FDA. Here is part of this correspondence:
… If you want to know more about the FDA’s proposed new rules for homeopathic medicines, here’s a summary of the most important points:
- The new rules, if adopted, will allow the FDA to withdraw even properly manufactured and labeled homeopathic medicines from the marketplace. This is puzzling because these have never posed any sort of safety concern according to an initial review of public FDA records by Americans for Homeopathy Choice.
- It is clear that the FDA intends to use this authority and has even mentioned specific medicines such as Belladonna, Nux vomica and Lachesis muta in its public statements regarding enforcement.
- The authority for this kind of assault on homeopathy will result from the declaration by the FDA that all homeopathic medicines are “new drugs.” We all know this is nonsense. Homeopathic medicines have been around for 200 years.
- But this nonsense declaration means that under U.S. law all homeopathic remedies will become technically “illegal” and subject to withdrawal from the marketplace. If the FDA just thinks there is a problem with a homeopathic medicine, it can withdraw it forever without conducting any sort of investigation.
- Since the agency has already said that it thinks that Belladonna, Nux vomica, Lachesis muta and several other remedies are dangerous, we can anticipate that it will try to remove them from the marketplace as soon as its new rules are adopted.
- But, it won’t be possible for Americans to get remedies that are banned sent to them from abroad. The FDA will simply stop these remedies at the border.
I could tell you more, but what I’ve told you so far should convince you that we ought to help the American homeopathy community defeat these unreasonable and misinformed rules. The rules simply do not reflect the realities of homeopathic medicines, namely, that they are nontoxic, mild, effective and have few, if any, side-effects. And, homeopaths use them in ways that individualize treatment. That this is the best way to treat patients was discovered by Samuel Hahnemann 200 years ago.
The enemies of homeopathy are everywhere and they appear to be stepping up their attacks. That’s why the world homeopathy community must work together to stand up to them…
I have reported about the FDA initiatives on homeopathy before. In 2015, they started it with a public hearing. Since then, the FDA also issued several warnings to manufacturers who were putting consumers at risk (see, for instance, here, here, and here).
What the FDA seem to be trying to do is nothing else but meeting their ethical, moral and legal responsibility vis a vis consumer safety. Homeopathy has had a free ride for far too long. It is high time that this sector joins the 21st century.
The above quote, with its bonanza of bogus claims and falsehoods, shows the urgency of this task. The defenders of homeopathy seem to live on a different planet where rationality, facts and evidence can easily be over-ruled by creed, dogma and wishful thinking. If homeopaths want their trade to join the realm of real medicine they need, at the very minimum, to show with sound evidence:
- that their remedies generate more good than harm,
- that they adhere to acceptable quality standards.
Failing this – and so far, homeopaths not only failed at this task but continue bombarding us with an incessant flow of bogus and dangerous claims – homeopathics cannot be considered to be medicines, and homeopaths cannot be called responsible healthcare professionals. It is high time to stop turning a blind eye to the double standards that have been applied for 200 years.
Every now and then, I come across a SCAM paper that is so ‘far out’ that, when reading it, my mind wants to boggle. This one (recently published in ‘Medical Acupuncture’) is about ‘paediatric scupuncture’ – no, not acupuncture performed by kids – it’s acupuncture for kids. The temptation to show you the full, unaltered abstract is too strong to resist:
Background: Approaching pediatric acupuncture from a spiritual perspective is the most effective means for providing a valuable holistic relatively noninvasive approach to pediatric acupuncture, as well as preventive treatments for the repulsion of disease and the correction of Qi (i.e., vital energy) imbalances.
Objectives: Parents may be taught to apply acupressure to their children with an excellent response, especially when given with loving kindness.
Materials and Methods: Methods include the use of acupressure, laser techniques, and acupuncture for children who do not display fear toward the shallow insertion of needles.
Results: Owing to the young age of the patients, children will display fast and effective positive responses to therapy, just as they are susceptible to negative effects in similar timeframes. Children will respond faster than adults to such treatments, which can also increase immune system functionality and bolster resistance to invasive forms of Qi imbalances and disease. Such treatments will also relieve pain and distress and improve concentration and mental attitudes in children. Difficult conditions such as attention-deficit/hyperactivity disorder (ADHD) and attention deficit disorder (ADD) can also be effectively treated through a spiritual approach to pediatric acupuncture.
Conclusions: Pediatric acupuncture from a spiritual perspective provides a specific, safe, and effective therapy for a wide variety of painful and nonpainful conditions through Qi balancing in children. Moreover, parents may be taught to apply acupressure to their children with an excellent response, especially when given with loving kindness. Such techniques not only resolve acute symptoms but also provide preventive measures and enable parent–child relationships to thrive. Overall, medical acupuncture from a spiritual perspective is one of the best complementary therapies in pediatrics.
Of course, you now wonder who is the genius able to produce such deep wisdom. It is Dr. Steven K.H. Aung. He says of himself that he is a pioneer in the integration of western, traditional Chinese and complementary medicine. His efforts have helped to make Alberta and Canada an active centre in the field of integrated and complementary medicine. His unique approach to medicine, combined with the remarkable compassion he brings to all that he does, has made him a highly respected teacher, researcher and physician.
Doctor Aung’s affiliations are impressive:
- Clinical Professor, Departments of Medicine & Family Medicine Faculty of Medicine and Dentistry, University of Alberta (Edmonton, Alberta, Canada)
- Adjunct Professor, Faculty of Rehabilitation Medicine, University of Alberta (Edmonton, Alberta, Canada)
- Chief instructor, examiner and curriculum consultant for the Medical Acupuncture Program (MAP), Faculty of Medicine and Dentistry, Continous Professional Learning, University of Alberta (Edmonton, Alberta, Canada)
In addition, he holds visiting professor appointments at:
- Beijing University of TCM and Research Institute,
- Capital University of Medical Sciences (Beijing),
- Heilongjiang University of TCM (Harbin, China),
- Showa University School of Medicine (Tokyo),
- California Institute for Human Science (Encinitas, California),
- Royal Melbourne Institute of Technology (Melbourne, Australia).
And now my mind truly boggles!
There are no representative studies using a probability sample examining whether US physicians recommend so-called alternative medicines (SCAMs) to their patients. This article fills a void in the current literature for robust data on recommendations for SCAMs by office-based physicians in the US.
Descriptive statistics and multivariable regression analyses of physician-level data were from the 2012 Physician Induction Interview of the National Ambulatory Medical Care Survey (NAMCS PII), a nationally representative survey of office-based physicians. Weighted response rate among eligible physicians sampled for the 2012 NAMCS PII was 59.7%.
Recommendations by physicians to their patients were recorded for any SCAM, and the following individual SCAMs: massage therapy, herbs/nonvitamin supplements, chiropractic/osteopathic manipulation, yoga, acupuncture, and mind–body therapies.
Massage therapy was the most commonly recommended SCAM (30.4%), followed by chiropractic/osteopathic manipulation (27.1%), herbs/nonvitamin supplements (26.5%), yoga (25.6%), and acupuncture (22.4%). The most commonly recommended SCAMs by general/family practice physicians were chiropractic/osteopathic manipulation (54.0%) and massage therapy (52.6%). Of all U.S. physicians, 53.1% recommended at least one SCAM to patients during the previous 12 months. Multivariable analyses found physician’s sex, race, specialty, and U.S. region to be significant predictors of SCAMrecommendations. Female physicians were more likely than male physicians to recommend massage therapy, herbs/nonvitamin supplements, yoga, acupuncture, and mind–body therapies to patients. Psychiatrists, OB/GYNs, and paediatricians were all less likely to recommend chiropractic/osteopathic manipulation than general and family practitioners.
The authors concluded that, overall, more than half of office-based physicians recommended at least one SCAM to their patients. Female physicians recommended every individual SCAM at a higher rate than male physicians except for chiropractic and osteopathic manipulation. These findings may enable consumers, physicians, and medical schools to better understand potential differences in use of SCAMs with patients.
Yes, I know!
Who cares what type of SCAMs US physicians recommended to their patients 7 years ago?
And who knows what the true figures would have looked like, if the ~40% who did not respond would have been included?
Such surveys usually tell us little of relevance. What is worse, they are misused for exploiting the ‘appeal to authority’ fallacy which hold that, if physicians recommend SCAMs, they must be fine. That this is a fallacy becomes obvious, if we remind ourselves that US physicians also are the main cause for the current opioid crisis in the US (if physicians recommend opioids, they must be fine???).
More importantly, I think, this survey also suggests the following:
- 73% of US physicians do NOT recommend chiropractic/osteopathic manipulations.
- 73% of them do NOT recommend herbal medicine.
- 74% of them do NOT recommend yoga.
- 77% of them do NOT recommend acupuncture.
I wonder why!
Carl Sagan was a giant in critical thinking and has inspired many, including myself. His book THE DEMON HAUTED WORLD is a classic. In it, he published his ‘BALONEY DETECTION KIT’. As it relates to SCAM and so much more that troubles us today, I today take the liberty of citing it here.
- Wherever possible there must be independent confirmation of the “facts.”
- Encourage substantive debate on the evidence by knowledgeable proponents of all points of view.
- Arguments from authority carry little weight — “authorities” have made mistakes in the past. They will do so again in the future. Perhaps a better way to say it is that in science there are no authorities; at most, there are experts.
- Spin more than one hypothesis. If there’s something to be explained, think of all the different ways in which it could be explained. Then think of tests by which you might systematically disprove each of the alternatives. What survives, the hypothesis that resists disproof in this Darwinian selection among “multiple working hypotheses,” has a much better chance of being the right answer than if you had simply run with the first idea that caught your fancy.
- Try not to get overly attached to a hypothesis just because it’s yours. It’s only a way station in the pursuit of knowledge. Ask yourself why you like the idea. Compare it fairly with the alternatives. See if you can find reasons for rejecting it. If you don’t, others will.
- Quantify. If whatever it is you’re explaining has some measure, some numerical quantity attached to it, you’ll be much better able to discriminate among competing hypotheses. What is vague and qualitative is open to many explanations. Of course there are truths to be sought in the many qualitative issues we are obliged to confront, but finding them is more challenging.
- If there’s a chain of argument, every link in the chain must work (including the premise) — not just most of them.
- Occam’s Razor. This convenient rule-of-thumb urges us when faced with two hypotheses that explain the data equally well to choose the simpler.
- Always ask whether the hypothesis can be, at least in principle, falsified. Propositions that are untestable, unfalsifiable are not worth much. Consider the grand idea that our Universe and everything in it is just an elementary particle — an electron, say — in a much bigger Cosmos. But if we can never acquire information from outside our Universe, is not the idea incapable of disproof? You must be able to check assertions out. Inveterate skeptics must be given the chance to follow your reasoning, to duplicate your experiments and see if they get the same result.
As I said, this is a good book; I warmly recommend it to you.
Leah Bracknell, started raising funds ~3 years ago for alternative cures of her stage 4 lung cancer. Bracknell who, after her acting career, had become a yoga teacher said at the time that, in the UK, she was given “a fairly brutal and bleak diagnosis, but one I am determined to challenge”. Her partner, Jez Hughes, who helped with the fund-raising said the money would be used for “immunotherapy and integrative medicine, which are seeing previously ‘incurable’ cancers going into complete remission”.
The team thus raised over £50 000 and went to Germany, a country that is well-known for its liberal stance on quackery. In Britain, there are just a few physicians who are devoted to this or that alternative medicine. In Germany, there are thousands of them. In addition, Germany has a healthcare profession called the ‘Heilpraktiker’, a poorly-regulated left-over from the Third Reich. A Heilpraktiker has not studied medicine, yet is legally permitted to make all sorts of unsubstantiated claims and treat many serious diseases, including cancer, with unproven therapies.
It was reported that Leah Bracknell went to the ‘Hallwang Private Oncology Clinic’, an institution which claims that “Healing-oriented and individualised medicine considers all aspects of lifestyle and not only relies on conventional treatments and recent cutting-edge developments in medicine, but also takes into account our experience in natural remedies and is open for alternative treatment options in order to work in synergy with conventional treatment strategies. We always try to be as natural as possible and as conventional as needed to achieve the best results. Integrative Health Concepts are successfully used in many diseases including malignant diseases, neurological disorders as well as in prevention and rehabilitation.” The SCAMs used there include homeopathy, micronutrients, natural supplements, whole body hyperthermia and ozone therapy.
The evidence does not support these or other alternative cancer ‘cures’. In fact, the very notion of an alternative cancer cure is nonsensical: if an alternative cancer therapy showed even the slightest shimmer of promise, it would get investigated and, if shown to work, become part of routine oncology. The suggestion that there are treatments out there that are effective, yet shunned by oncologists because they originate from nature or from some exotic tradition is insulting and utterly barmy.
Yet cancer patients can easily fall for such claims. They are understandably desperate and listen to anyone promissing a cure. Therefore, they all too easily believe in weird conspiracy theories of ‘Big Parma’, the evil ‘establishment’ etc. who allegedly suppress the news of an effective therapy, as it might threaten their profits. If they do fall for such lies, they not only lose pots of money but also their lives.
Last Wednesday, it was reported that Leah Bracknell had died of cancer.
Burning mouth syndrome (BMS) is a rare but potentially debilitating condition. So far, individualised homeopathy (iHOM) has not been evaluated or reported in any peer-reviewed journal as a treatment option. Here is a recently published case-report of iHOM for BMS.
At the Centre of Complementary Medicine in Bern, Switzerland, a 38-year-old patient with BMS and various co-morbidities was treated with iHOM between July 2014 and August 2018. The treatment involved prescription of individually selected homeopathic single remedies. During follow-up visits, outcome was assessed with two validated questionnaires concerning patient-reported outcomes. To assess whether the documented changes were likely to be associated with the homeopathic intervention, an assessment using the modified Naranjo criteria was performed.
Over an observation period of 4 years, an increasingly beneficial result from iHOM was noted for oral dysaesthesia and pains as well as for the concomitant symptoms.
The authors concluded that considering the multi-factorial aetiology of BMS, a therapeutic approach such as iHOM that integrates the totality of symptoms and complaints of a patient might be of value in cases where an association of psychological factors and the neuralgic complaints is likely.
BMS can have many causes. Some of the possible underlying conditions that can cause BMS include:
- hormonal imbalances
- acid reflux
- infections in the mouth
- various medications
- nutritional deficiencies in iron or zinc
Threatemnt of BMS consists of identifying and eliminating the underlying cause. If no cause of BMS can be found, we speak of primary BMS. This condition can be difficult to treat; the following approaches to reduce the severity of the symptoms are being recommended:
- avoiding acidic or spicy foods
- reducing stress
- avoiding any other known food triggers
- exercising regularly
- changing toothpaste
- avoiding mouthwashes containing alcohol
- sucking on ice chips
- avoiding alcohol if it triggers symptoms
- drinking cool liquids throughout the day
- smoking cessation
- eating a balanced diet
- checking medications for potential triggers
The authors of the above case-report state that no efficient treatment of BMS is known. This does not seem to be entirely true. They also seem to think that iHOM benefitted their patient (the post hoc ergo propter hoc fallacy!). This too is more than doubtful. The natural history of BMS is such that, even if no effective therapy can be found, the condition often disappears after weeks or months.
The authors of the above case-report treated their patient for about 4 years. The devil’s advocate might assume that not only did iHOM contribute nothing to the patient’s improvement, but that it had a detrimental effect on BMS. The data provided are in full agreement with the notion that, without iHOM, the patient would have been symptom-free much quicker.