Today is a momentous and desperately sad day. Allow me therefore to deviate from my usual subject and write a very personal post (I promise, it won’t happen often).
This post is not about SCAM but about something that is even closer to my heart.
I first moved to the UK in 1979. The reason was simple, I had fallen in love with Danielle, the woman who now is my wife. I only stayed for about 3 years. However, as luck would have it, this short time would become the most formative period of my life, both privately and professionally. After a brief and unhappy stint as a doctor in a psychiatric hospital, I got a job under John Dormandy who opened my eyes to the wonderous world of science.
I nonetheless went back to Germany because I felt I had to complete my clinical training. In 1987, became a professor first in Hannover and then in Vienna. Even though the Vienna post was grand (to say the least), I soon became unhappy with it (no need to go into details here; if you need to know, read this or this). I thus started looking for other opportunities, ideally in the UK.
Why the UK?
It wasn’t because of the weather.
It also was not because of the food.
Nor was it because of the huge salary (the move roughly halved my previous income).
It was because of the beautiful memories. And it was because of my deep appreciation of the people. I had grown to admire their humour, their tolerance, their openness, their way of life, their way of dealing with problems, their politeness, their understatement, their honesty, their fair play.
Much has been written about my time at Exeter. Not everything was smelling of roses. But, on the whole and despite all the problems encountered, I had a really good time – mainly because my initial judgement of the people was being confirmed over and over again. I began to feel British and, in 2000, I became British. All my life, I had felt the burden of the recent German past weighing heavily on my shoulders. I had never managed to be proud of being a German. Now I was proud to be British, and I had a passport to prove it!
When Cameron announced the ‘in/out referendum’, I was baffled by the sheer stupidity of the move. How could anyone want to get out of the EU? It never made sense to me. The EU had given us peace for decades and was a guarantor that we Europeans would never again start killing each other. Why was that not pointed out in the run-up to the referendum? Most families had lost sons in the last two European wars. Why did hardly anyone use such arguments? Why was the remain campaign fought so half-heartedly? The other side was campaigning with (mostly vile and primitive) emotions; why did we not use positive and ethical ones?
I remember being in tears when I heard the results of the vote.
I remember fighting tears when acquaintances asked my wife (she is French and has, like I, a British passport) and me: ‘are you now going to go home?‘
Since the referendum, I have observed in utter horror and bewilderment how the county that I now call my home has changed.
What happened to the tolerance that I so admired?
What happened to the openness of the people?
What about honesty and fair play?
What happened even to humour?
During our 8 years in Germany, my wife and I had to witness our fair share of xenophobia. I despised my fellow Germans for it. Now I see it in Britain, and I feel nauseous.
What is happening to the county I love?
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.
A 2020 review entitled ‘Prevention, Treatment and Management of Tuberculosis through Combinational Approaches of Different Indian Systems of Medicine’ stated that recent research suggests that Homeopathic treatment along with the antibiotics synergise the effect of antibiotics while reaching to its site of action. This is a surprising finding, if there ever was one. Therefore, I looked a bit closer with a view of determining what the original data were that led to this conclusion.
Here is the unaltered section on homeopathy from the review:
Homeopathy is a special, organic, holistic medicine process which activates the healing responses of the body without any known contraindications or common side effects. In his book Organon of Medicine, aka Organon of Healing Art, the founder of Homeopathy, Samuel Hahnemann, developed these principles. Homoeopathy does not have holistic treatment and hence is incapable of curing TB because of homeopathic portions of water, which is not enough to treat TB, but recent research suggests the use of homeopathic treatment along with the antibiotics, which results in synergising the effect of antibiotics while reaching to its site of action. As standard MDR-TB medicines are second-generation antibiotics taken for 24–27 months, thus, apart from conventional treatment, homeopathy in MDR-TB tends to improve outcome. Hence, it increases the bioavailability of the isoniazid and rifampicin, which resulted in the reduction of tuberculosis therapy. This study has been proving by analysing following parameters as below:
There was no significant difference in smear conversion from positive to negative at 95 % CI between homeopathy (H) and individualised standard treatment regimen (SR) + placebo (P). However, the conversion culture conversion from positive to negative in SR + H was seen in 29 (48.3 %) patients and 23 (38.3 %) patients in SR + P group (p = 0.269) (ITT) and 27 (55.1 %); 21 (42.8 %), p = 0.225 (PP) implying that as compared to SR + P group, culture conversion in SR + H group was more by 10 %. So the difference, although favourable to the SR + H group is not statistically significant as shown in table 4.
All patients had far advanced lung disease as evident from the extensive infiltration, cavitation ns and fibrosis/collapse. Chest X-ray (CXR) were further assessed using RAT (Radiological Assessment Tool), examples of one case rated as + 5 and one case as _4. Significant improvements were seen statistically in CXR in the SR + H 37 (61.7 %); as compared to SR + P 20 (33.3 %), p = 0.002 at 95 % CI (ITT). Homeopathy system having all possibility to enhance the treatment and management of the TB .
To be clear: there is no further mention or discussion of homeopathy in this paper. The above-quoted section (its multiple falsehoods are so obvious that I probably don’t need to mention them here) is thus the only evidence provided for backing up the claim that Homeopathic treatment along with the antibiotics synergise the effect of antibiotics while reaching to its site of action. I fail to see how the information provided supports the claim. Moreover, I am not aware of any sound evidence that would support the claim that homeopathy acts synergistically to antibiotics.
In the reference list, I found one of my own articles cited as reference 13 (see above). It refers to this article: Ernst E. A systematic review of systematic reviews of homeopathy. Dr J Clin Pharmacol 2002; 54: 577–582. Here is its abstract:
Homeopathy remains one of the most controversial subjects in therapeutics. This article is an attempt to clarify its effectiveness based on recent systematic reviews. Electronic databases were searched for systematic reviews/meta-analysis on the subject. Seventeen articles fulfilled the inclusion/exclusion criteria. Six of them related to re-analyses of one landmark meta-analysis. Collectively they implied that the overall positive result of this meta-analysis is not supported by a critical analysis of the data. Eleven independent systematic reviews were located. Collectively they failed to provide strong evidence in favour of homeopathy. In particular, there was no condition which responds convincingly better to homeopathic treatment than to placebo or other control interventions. Similarly, there was no homeopathic remedy that was demonstrated to yield clinical effects that are convincingly different from placebo. It is concluded that the best clinical evidence for homeopathy available to date does not warrant positive recommendations for its use in clinical practice.
I fail to see how my paper backs up the very odd sentence: Homeopathy system having all possibility to enhance the treatment and management of the TB.
This is much more than sloppiness. In fact, it is one of the clearest cases of scientific misconduct I have ever come across. What is more, if its message would get adopted, it has the potential to do considerable harm. The authors of the paper in question, Priyanka Sharma , Ramesh K. Goyal, and Mukesh Nandave, declared no conflicts of interest; their affiliation is provided as ‘Departments of Pharmacology and Toxicology, Delhi Pharmaceutical Sciences and Research University, New Delhi, India’. The journal that published their review is ‘Drug Research‘, a publication which I always had thought was reputable.
I am not sure what I should do next.
Yesterday, we discussed a paper concluding (amongst other things) that there are insufficient high‐quality RCTs to judge the efficacy of acupuncture for cancer‐related pain. Today, we are looking at one that overtly contradicts this verdict.
This systematic review (published in JAMA Oncology) evaluated the existing randomized clinical trials (RCTs) for evidence of the association of acupuncture and acupressure with reduction in cancer pain. Randomized clinical trials that compared acupuncture and acupressure with a sham control, analgesic therapy, or usual care for managing cancer pain were included. The primary outcome was pain intensity measured by the Brief Pain Inventory, Numerical Rating Scale, Visual Analog Scale, or Verbal Rating Scale.
A total of 17 RCTs (with 1111 patients) were included, and data from 14 RCTs (with 920 patients) were used in the meta-analysis. Seven sham-controlled RCTs (35%) were notable for their high quality, being judged to have a low risk of bias for all of their domains, and showed that real (compared with sham) acupuncture was associated with reduced pain intensity. A favourable association was also seen when acupuncture and acupressure were combined with analgesic therapy in 6 RCTs for reducing pain intensity and in 2 RCTs for reducing opioid dose. The evidence grade was moderate because of the substantial heterogeneity among studies.
The authors concluded that this systematic review and meta-analysis found that acupuncture and/or acupressure was significantly associated with reduced cancer pain and decreased use of analgesics, although the evidence level was moderate. This finding suggests that more rigorous trials are needed to identify the association of acupuncture and acupressure with specific types of cancer pain and to integrate such evidence into clinical care to reduce opioid use.
So, which of the two conclusions should we trust?
Personally, I find the JAMA paper unimpressive to the point of being suspect. Here are some of my reasons:
- About half of the primary studies are Chinese; and we have seen repeatedly that they are unreliable and report only positive results.
- Many of the trials are published in Chinese and can thus not be checked by non-Chinese readers (nor, presumably, by the experts who acted as peer-reviewers for JAMA Oncology).
- I have my doubts about the rigor of the peer-review of some of the journals that published the primary studies included in the review.
- One paper included in the review is even a mere doctoral thesis which usually is not peer-reviewed in the usual sense.
- The authors state that they included only clinical trials that compared acupuncture and acupressure with a sham control, analgesic therapy, or usual care. However, this is evidently not true; many of the studies had the infamous A+B versus B design comparing acupuncture plus a conventional therapy against the conventional therapy. As we have discussed ad nauseam on this blog, such trials cannot produce a negative finding even if ‘A’ is a placebo.
- Contrary to what the authors claim, the quality of most of the included studies was extremely poor, as far as I can see.
- One included paper which I cannot access is entitled ‘Clinical observation on 30 cases of moderate and severe cancer pain of bone metastasis treated by auricular acupressure‘. Are the review authors seriously claiming that this is an RCT?
The more I study the details of the JAMA Oncology paper, the more I feel it might be worth a complaint to the editor with a view of initiating a thorough investigation and a possible retraction.
At the heart of this story is Joseph Mercola, a dietary supplement entrepreneur and osteopath.
His website states that:
EVERYONE can benefit from Dr Mercola’s unparalleled knowledge. For expertise in alternative healthcare and high quality supplemental medicine, it’s hard to beat visionary Dr Joseph Mercola. The Chicago-based health wizard has his own website, Mercola.com (‘Take Control of Your Health’), but you can find so many of his health support products right here at Evolution Organics. Our customers swear by them. They love the diversity of the range, and that the products are priced affordably, meaning that everyone can benefit from Dr Mercola’s vast experience and unmatched know-how. And it’s not just men, women and children who can feel better ‘the Dr Mercola way’ – his brand includes health support products for pets, too.
However, an article in the Washington Post tells a different story; allow me to quote a few excerpts:
The National Vaccine Information Center was founded in 1982 by Barbara Loe Fisher, who has said that her son was injured by a vaccine. The group claimed credit this year for helping to defeat legislation in a dozen states that would have made it harder for parents to opt out of vaccinating their children. At the beginning of last year’s flu season, Fisher and Mercola appeared in a YouTube video urging people to be skeptical about flu shots. Mercola claimed that vaccines have been associated with “deaths and permanent neurological complications,” and he said vitamin D supplements were among “far more effective, less expensive and less risky alternatives.” … Fisher said in an interview that Mercola has asked for nothing in exchange for his donations and that the National Vaccine Information Center does not sell or advertise Mercola’s products on its site. “I do not take funding for a quid pro quo,” she said. “When [Mercola] called me, he said, ‘I admire your work. I’d like to help you.’ ” The center’s homepage, which the group says was visited more than 1.2 million times last year, displays Mercola.com’s logo. An affiliated website run by Fisher’s group refers numerous times to Mercola.com as one of the most popular health and wellness websites…
In recent years, the center has been at the forefront of a movement that has led some parents to forgo or delay immunizing their children against vaccine-preventable diseases such as measles… The Northern Virginia-based National Vaccine Information Center lists Mercola.com as a partner on its homepage and links to the website, where readers can learn about and purchase Mercola’s merchandise…Asked if his companies benefit from his donations to the anti-vaccine group, Mercola said in an email that “being an adversary to powerful industries is not a positive for a business like mine.” …
On this blog, I have repeatedly warned that many so-called alternative medicine (SCAM) practitioners recommend against vaccinations. Specifically implicated are:
- Physicians practising integrative medicine
- Doctors of anthroposophical medicine
We knew about the ‘ideology’ and the misinformation pushing SCAM-related anti-vaccination sentiments. The article in the Washington Post is a stark reminder of the financial interests behind all this. As a result, SCAM-use is associated with low vaccination-uptake (as we have discussed ad nauseam – see for instance here, here, here and here). Anyone who needs more information will find it by searching this blog. Anyone claiming that this is all my exaggeration might look at papers which have nothing to do with me (there are plenty more for those who are willing to conduct a Medline search):
- Lehrke P, Nuebling M, Hofmann F, Stoessel U. Attitudes of homeopathic physicians towards vaccination. Vaccine. 2001;19:4859–4864. doi: 10.1016/S0264-410X(01)00180-3. [PubMed]
- Halper J, Berger LR. Naturopaths and childhood immunizations: Heterodoxy among the unorthodox. Pediatrics. 1981;68:407–410. [PubMed]
- Colley F, Haas M. Attitudes on immunization: A survey of American chiropractors. Journal of Manipulative and Physiological Therapeutics. 1994;17:584–590. [PubMed]
If you had thought that HRH Prince Charles, soon to be King, would calm down regarding his royal bee under his alternative bonnet, you evidently were mistaken. In June 2019, he became the patron of the ‘Faculty of Homeopathy‘ the professional organisation of UK doctor homeopaths. And a few days ago, it has been announced that he now has also become the patron of the ‘College of Medicine and Integrated Health’ (CMIH). The College chair, Michael Dixon, was quoted stating: ‘This is a great honour and will support us as an organisation committed to taking medicine beyond drugs and procedures. This generous royal endorsement will enable us to be ever more ambitious in our mission to achieve a more compassionate and sustainable health service.”
I find it hard to be surprised by Charles’ latest move. After all, the CHIM is the direct successor of Charles’ ‘Foundation for Integrated Health‘ (FIH). When this bizarre organisation had to close in 2010 amid claims of fraud, money laundering and misuse of charity status (its chief executive later went to prison!), Dixon quickly organised the creation of the CMIH. Even though he was clearly involved, Charles was probably wise to keep his distance after the scandal. But now, almost a decade later, the dust has settled and he feels he can again patronise (= become a patron).
Dixon who was the medical director of the FIH did not go to prison; why should he? He had done nothing wrong! On the contrary, he collected another gong and even aspired to become the president of the ‘Royal College of General Practitioners‘. He failed, but his honours and appointments are still second to none:
- LVO (2015)
- OBE (2001)
- Visiting Professor University College of London
- Visiting Professor Westminster University
- Honorary Senior Fellow, HSMC Birmingham University
- Honorary Senior Lecturer Peninsula Medical School, Exeter
- Medical Advisor to the Prince of Wales
Don’t I just admire my ex-friend Michael?!
And so should you!!!
Just read the abstract of his study of spiritual healing. If you are not impressed by this work of beauty, there must be something wrong with you.
This study was designed to examine the effects of a healer seeing chronically ill patients in a large semirural practice. The 57 patients were allocated alternately either to receive ten weekly healing sessions or to become waiting-list controls. Two weeks after completion of ‘healing’ 22 (81%) of the 27 study patients thought their symptoms had improved and 15 of these thought they had improved substantially. Study patients scored better than controls on both measures of symptoms (P < 0.05, P < 0.01), on anxiety and depression ratings (P < 0.01, P < 0.05) and on general function measured by the Nottingham Health Profile (P < 0.01). Treatment differences were still evident three months later for one of the measures of symptom change (P < 0.05) and for both anxiety and depression ratings (P < 0.01, P < 0.05). The percentages of natural killer cells (CD16, CD56) did not change greatly in either group. These results suggest that healing may be an effective adjunct for the treatment of chronically ill patients presenting in general practice. They do not distinguish between any specific effects of spiritual healing and non-specific effects such as relaxation; for further investigation, randomized controlled trials will be needed.
Sorry, I digress – this should be about Charles, not Michael.
Now that he is patron of both the FoH and the CMIH, what might be next? As he has already tried his own brand of herbal remedies, I suggest the next launches a brand of homeopathics. What about
‘HRH – Hopeless Royal Homeopathy‘?
‘HRH – Hopeless Royal’s Homeopathy’
Well, suggest something better then!
According to WebMed, the shark cartilage (tough elastic tissue that provides support, much as bone does) used for medicine comes primarily from sharks caught in the Pacific Ocean. Several types of extracts are made from shark cartilage including squalamine lactate, AE-941, and U-995.
Shark cartilage is most famously used for cancer. Shark cartilage is also used for osteoarthritis, plaque psoriasis, age-related vision loss, wound healing, damage to the retina of the eye due to diabetes, and inflammation of the intestine (enteritis).
A more realistic picture is pained by this abstract:
The promotion of crude shark cartilage extracts as a cure for cancer has contributed to at least two significant negative outcomes: a dramatic decline in shark populations and a diversion of patients from effective cancer treatments. An alleged lack of cancer in sharks constitutes a key justification for its use. Herein, both malignant and benign neoplasms of sharks and their relatives are described, including previously unreported cases from the Registry of Tumors in Lower Animals, and two sharks with two cancers each. Additional justifications for using shark cartilage are illogical extensions of the finding of antiangiogenic and anti-invasive substances in cartilage. Scientific evidence to date supports neither the efficacy of crude cartilage extracts nor the ability of effective components to reach and eradicate cancer cells. The fact that people think shark cartilage consumption can cure cancer illustrates the serious potential impacts of pseudoscience. Although components of shark cartilage may work as a cancer retardant, crude extracts are ineffective. Efficiencies of technology (e.g., fish harvesting), the power of mass media to reach the lay public, and the susceptibility of the public to pseudoscience amplifies the negative impacts of shark cartilage use. To facilitate the use of reason as the basis of public and private decision-making, the evidence-based mechanisms of evaluation used daily by the scientific community should be added to the training of media and governmental professionals. Increased use of logical, collaborative discussion will be necessary to ensure a sustainable future for man and the biosphere.
To be clear: there is no good evidence that the supplements commercially available currently are effective for any condition.
Now, there is more news on this topic:
The objective of this study was to analyse labelling practices and compliance with regulatory standards for shark cartilage supplements sold in the United States. The product labels of 29 commercial shark cartilage supplements were assessed for compliance with U.S. regulations. Claims, including nutrient content, prohibited disease, and nutritional support statements, were examined for compliance and substantiation.
Overall, 48% of the samples had at least one instance of non-compliance with labelling regulations. The most common labelling violations observed were:
- missing a domestic address/phone number,
- non-compliant nutrient content claim,
- missing/incomplete disclaimer,
- missing statement of identity,
- prohibited disease claims,
- incomplete “Supplement Facts” label.
The use of prohibited disease claims and nutritional support statements without the required disclaimer is concerning from a public health standpoint because consumers may delay seeking professional treatment for a disease.
The authors concluded that the results of this study indicate a need for improved labelling compliance among shark cartilage supplements.
In summary, it seems that shark cartilage supplements are bad for all concerned:
- Patients who rely on them might hasten their death.
- Sharks are becoming an endangered species.
- Consumers are being mislead and misinformed.
There is just one party smiling: the supplement manufacturers who make a healthy profit destroying the health of gullible consumers and patients.
Many patients with chronic pain (CP) are prescribed opioids, a situation which has led to the much-discussed opioid crisis. Integrative medicine (IM), which combines pharmacological and so-called alternative medicine (SCAM), has been proposed as a solution. Yet, the role of SCAM therapies in reducing opioid use remains unclear.
This systematic review explored the effectiveness of the IM approach or any of the SCAM therapies to reduce or cease opioid use in CP patients. Electronic searches yielded 5,200 citations. Twenty-three studies were selected. Eight studies were randomized controlled trials, seven were retrospective studies, four studies were prospective observational, three were cross-sectional, and one was quasi-experimental. The majority of the studies showed that opioid use was reduced significantly after using IM/SCAM. Cannabinoids were among the most commonly investigated approaches in reducing opioid use, followed by multidisciplinary approaches, cognitive-behavioral therapy, and acupuncture. The majority of the studies had limitations related to sample size, duration, and study design.
The authors concluded that there is a small but defined body of literature demonstrating positive preliminary evidence that the IM approach including SCAM therapies can help in reducing opioid use. As the opioid crisis continues to grow, it is vital that clinicians and patients be adequately informed regarding the evidence and opportunities for IM/SCAM therapies for CP.
I am unimpressed by this review.
And here is why:
- Because of their design, most of the included studies do not allow any conclusions about cause and effect.
- The 8 RCTs that would allow such conclusions are mostly of poor quality.
- Some of the 8 RCTs are not even what the review authors claim to be. Here is just one example:
Background: Current levels and dangers of opioid use in the U.S. warrant the investigation of harm-reducing treatment alternatives.
Purpose: A preliminary, historical, cohort study was used to examine the association between enrollment in the New Mexico Medical Cannabis Program (MCP) and opioid prescription use.
Methods: Thirty-seven habitual opioid using, chronic pain patients (mean age = 54 years; 54% male; 86% chronic back pain) enrolled in the MCP between 4/1/2010 and 10/3/2015 were compared to 29 non-enrolled patients (mean age = 60 years; 69% male; 100% chronic back pain). We used Prescription Monitoring Program opioid records over a 21 month period (first three months prior to enrollment for the MCP patients) to measure cessation (defined as the absence of opioid prescriptions activity during the last three months of observation) and reduction (calculated in average daily intravenous [IV] morphine dosages). MCP patient-reported benefits and side effects of using cannabis one year after enrollment were also collected.
Results: By the end of the 21 month observation period, MCP enrollment was associated with 17.27 higher age- and gender-adjusted odds of ceasing opioid prescriptions (CI 1.89 to 157.36, p = 0.012), 5.12 higher odds of reducing daily prescription opioid dosages (CI 1.56 to 16.88, p = 0.007), and a 47 percentage point reduction in daily opioid dosages relative to a mean change of positive 10.4 percentage points in the comparison group (CI -90.68 to -3.59, p = 0.034). The monthly trend in opioid prescriptions over time was negative among MCP patients (-0.64mg IV morphine, CI -1.10 to -0.18, p = 0.008), but not statistically different from zero in the comparison group (0.18mg IV morphine, CI -0.02 to 0.39, p = 0.081). Survey responses indicated improvements in pain reduction, quality of life, social life, activity levels, and concentration, and few side effects from using cannabis one year after enrollment in the MCP (ps<0.001).
Conclusions: The clinically and statistically significant evidence of an association between MCP enrollment and opioid prescription cessation and reductions and improved quality of life warrants further investigations on cannabis as a potential alternative to prescription opioids for treating chronic pain.
This study is evidently NOT an RCT!
Most of the 8 RCTs investigate whether SCAM is useful for weaning opioid-dependent patients off their drug. To equate this with the question whether IM/SCAM can reduce or cease opioid use in CP patients is, I think, wrong. The way to reduce opioid use in CP patients is to prescribe less opioids. And for prescribing less opioids, we need no SCAM but we need to remember what we learned in medical school: opioids are not for routine treatment of CP!
So, why do the authors of this review try to mislead us?
Could it have something to do with some of their affiliations and the bias that goes with it?
- Canadian College of Naturopathic Medicine, North York, Ontario, Canada.
- Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Australia.
- Pacific College of Oriental Medicine, San Diego, California, USA.
What do you think?
Radiation-induced xerostomia (RIX) is a common, often debilitating, adverse effect of radiation therapy among patients with head and neck cancer. Quality of life can be severely affected, and current treatments have limited benefit. Acupuncture is often recommended, but does it work? This study was aimed at finding out whether acupuncture can prevent RIX in patients with head and neck cancer undergoing radiation therapy.
The 2-center, phase 3, randomized clinical trial compared a standard care control (SCC) with true acupuncture (TA) and sham acupuncture (SA) among patients with oropharyngeal or nasopharyngeal carcinoma who were undergoing radiation therapy in comprehensive cancer centres in the United States and China. Patients were enrolled between December 16, 2011, and July 7, 2015. Final follow-up was August 15, 2016. Analyses were conducted February 1 through 28, 2019. Either TA or SA using a validated acupuncture placebo device were performed 3 times per week during a 6- to 7-week course of radiation therapy. The primary end point was RIX, as determined by the Xerostomia Questionnaire in which a higher score indicates worse RIX, for combined institutions 1 year after radiation therapy ended. Secondary outcomes included incidence of clinically significant xerostomia (score >30), salivary flow, quality of life, salivary constituents, and role of baseline expectancy related to acupuncture on outcomes.
Of 399 patients randomized, 339 were included in the final analysis, including 112 patients in the TA group, 115 patients in the SA group, and 112 patients in the SCC group. For the primary aim, the adjusted least square mean (SD) xerostomia score in the TA group (26.6 [17.7]) was significantly lower than in the SCC group (34.8 [18.7]) (P = .001; effect size = -0.44) and marginally lower but not statistically significant different from the SA group (31.3 [18.6]) (P = .06; effect size = -0.26). Incidence of clinically significant xerostomia 1 year after radiation therapy ended followed a similar pattern, with 38 patients in the TA group (34.6%), 54 patients in the SA group (47.8%), and 60 patients in the SCC group (55.1%) experiencing clinically significant xerostomia (P = .009). Post hoc comparisons revealed a significant difference between the TA and SCC groups at both institutions, but TA was significantly different from SA only at Fudan University Cancer Center, Shanghai, China (estimated difference [SE]: TA vs SCC, -9.9 [2.5]; P < .001; SA vs SCC, -1.7 [2.5]; P = .50; TA vs SA, -8.2 [2.5]; P = .001), and SA was significantly different from SCC only at the University of Texas MD Anderson Cancer Center, Houston, Texas (estimated difference [SE]: TA vs SCC, -8.1 [3.4]; P = .016; SA vs SCC, -10.5 [3.3]; P = .002; TA vs SA, 2.4 [3.2]; P = .45).
The authors concluded that this randomized clinical trial found that TA resulted in significantly fewer and less severe RIX symptoms 1 year after treatment vs SCC. However, further studies are needed to confirm clinical relevance and generalizability of this finding and to evaluate inconsistencies in response to sham acupuncture between patients in the United States and China.
In essence this two-centre study shows that:
- real acupuncture is better than usual care, but the effect size is small and of doubtful clinical relevance;
- real acupuncture is not significantly better than sham acupuncture;
- the findings differ remarkably between the US and the Chinese centre.
I find the last point the most interesting one. We know from previous research that acupuncture studies from China are notoriously unreliable; they never report a negative result and there is evidence that data fabrication is rife in China. The new findings seems to throw more light on this notion. In the US centre, real and sham acupuncture generated practically identical results. By contrast, in the Chinese centre, real acupuncture generated significantly better results than sham. The authors offer several hypotheses to explain this remarkable phenomenon. Yet, in my view, the most likely one is that Chinese researchers are determined to show that acupuncture is effective. Thus all sorts of unconscious or even conscious biases might get introduced into such studies.
In essence, trial therefore confirms that acupuncture is little more than a theatrical placebo, particularly if we consider the US data which, in my opinion, are more trustworthy.
Lorenzo Cohen, Professor of Palliative, Rehabilitation, and Integrative Medicine and director of the Integrative Medicine Program as well as senior author of the paper unsurprisingly disagrees. He was quoted saying: “The evidence is to a point where patients should incorporate acupuncture alongside radiation treatment as a way to prevent the severity of dry mouth symptoms. I think with this study we can add acupuncture to the list for the prevention and treatment of xerostomia, and the guidelines for the use of acupuncture in the oncology setting should be revised to include this important chronic condition.”
Who do you think is closer to the truth?
This survey investigated how many chiropractors in the Canadian province of Alberta promote a theory of subluxation, which health ailments or improvements were linked to subluxation, and whether the subluxation discourse was used to promote chiropractic for particular demographics.
Using the search engine on the Canadian Chiropractic Associations’ website, the researchers made a list of all clinics in Alberta. They then used Google searches to obtain a URL for each clinic with a website, totalling 324 URLs for 369 clinics. They then searched on each website for “subluxation” and performed content analysis on the related content.
One hundred twenty-one clinics’ websites (33%) presented a theory of vertebral subluxation. The ailments and improvements discussed in relation to subluxation were wide-ranging; they included the following:
- back pain,
- bed wetting
- blood pressure,
- ear infection,
- heart disease,
- hormonal imbalance,
- learning problems,
- menstrual cramps,
- Parkinson’s disease,
- problems with hearing,
- problems with vision,
- prostate cancer,
- respiratory disease,
- sleeping problems,
- spinal decay,
- sudden infant death syndrome,
- and many more.
The marketing of chiropractic for children was observed on 8% of the clinic websites.
The researchers concluded that, based on the controversy surrounding vertebral subluxation, the substantial number of clinic websites aligning their practice with vertebral subluxation should cause concern for regulatory bodies.
Why do so many chiropractors cling so tightly to the long obsolete concept of subluxation? The way I see it there are at least three reasons:
- If they abandoned subluxation, they would quickly become physiotherapists, only with a much reduced scope of practice.
- Using the subluxation myth avoids the need of the knowledge of any complicated pathophysiology.
- Subluxation is ever so good for business, as it renders chiropractic manipulation a cure all.
D. D. Palmer, the magnetic healer who invented chiropractic about 120 years ago, claimed that a vital energy, which he called the “innate”, controls all body functions. In the presence of “vertebral subluxation,” it cannot work adequately, he postulated. In other words, subluxations block the flow of the innate which, in turn, is the cause of all disease. Palmer therefore developed spinal manipulations to correct such subluxations and de-block the flow of the innate. Palmer defined chiropractic as a system of healing based on the premise that the body requires unobstructed flow through the nervous system of innate intelligence. This effectively makes the adjustment of subluxation a panacea.
To put it simply: subluxation is the carte blanche required for making unlimited bogus claims, while ripping off the public.