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

gullible consumer

The history of so-called alternative medicine (SCAM) is rich with ‘discoveries’ that are widely believed to be true events but that, in fact, never happened. Here are 10 examples:

  1. DD Palmer is believed to have cured the deafness of a janitor by manipulating his neck. This, many claim, was the birth of chiropractic. BUT IT NEVER HAPPENED! How can I be so sure? Because the nerve responsible for hearing does not run through the neck.
  2. Samuel Hahnemann swallowed some Cinchona officinalis, a quinine-containing treatment for malaria, and experienced the symptoms of malaria. This was the discovery of the ‘like cures like’ assumption that forms the basis of homeopathy. BUT IT NEVER HAPPENED! How can I be so sure? Because Hahnemann merely had an intolerance to quinine, and like does certainly not cure like.
  3. Edward Bach, for the discovery of each of his flower remedies, suffered from the state of mind for which a particular remedy was required; according to his companion, Nora Weeks, he suffered it “to such an intensified degree that those with him marvelled that it was possible for a human being to suffer so and retain his sanity.” This is how Bach discovered the ‘Bach Flower Remedies‘. BUT IT NEVER HAPPENED! How can I be so sure? His experience was not caused by by the remedy, which contain no active ingredients, but by his imagination.
  4. William Fitzgerald found that pressure on specific areas on the soles of a patient’s feet would positively affect a specific organ of that patient. This was the birth of reflexology. BUT IT NEVER HAPPENED! How can I be so sure? Because there are no nerve connections from the sole of our feet to our inner organs.
  5. Max Gerson observed that his special diet with added liver juice, vitamin B3, coffee enemas, etc. cures cancer. This is how Gerson found the Gerson therapy. BUT IT NEVER HAPPENED! How can I be so sure? Because he never could demonstrate this effect and others never were able to replicate his alleged finfings.
  6. George Goodheart was convinced that the strength of a muscle group provides information about the health of inner organs. This formed the basis for applied kinesiology. BUT IT NEVER HAPPENED! How can I be so sure? Because applied kinesiology has been disclosed as a simple party trick.
  7. Paul Nogier thought that the function of inner organs can be influenced by stimulating points on the outer ear. This was the discovery that became auricular therapy. BUT IT NEVER HAPPENED! How can I be so sure? Because Nogier’s assumptions fly in the face of anatomy and physiology.
  8. Antom Mesmer discovered that by moving a magnet over a patient, he would move her vital fluid and affect her health. This discovery became the basis for Mesmer’s ‘animal magnetism‘. BUT IT NEVER HAPPENED! How can I be so sure? Because there is no vital fluid and neither real nor animal magnetism have specific therapeutic effects.
  9. Reinhold Voll observed that the electric resistance over acupuncture points provides diagnostic information about the function of the corresponding organs. He thus invented his ‘electroacupuncture according to Voll‘ (EAV). BUT IT NEVER HAPPENED! How can I be so sure? Because EAV and the various methods derived from it are not valid and fail to produce reproducible results.
  10. Ignatz von Peczely discovered that discolorations on the iris provide valuable information about the health of inner organs. This was the birth of iridology. BUT IT NEVER HAPPENED! How can I be so sure? Because discolorations develop spontaneously and Peczely’s assumptions about nerval connections between the iris and the organs of the body are pure fantasy.

I hope that you can think of further SCAM discoveries that never happened. If so, please elaborate in the comments section below; you will see, it is good fun!

PS

By sating ‘IT NEVER HAPPENED’, I mean to say that it never happened as reported/imagined by the inventor of the respective SCAM and that the explanations perpetuated by the enthusiasts of the SCAM regarding cause and effect are based on misunderstandings.

We have repeatedly discussed the fact that so-called alternative medicine (SCAM) is related to magical health and pseudoscientific assumptions. Now new evidence has emerged on this subject. This study (Alternative Medicine, COVID-19 Conspiracies, and Other Health-Related Unfounded Beliefs: The Role of Scientific Literacy, Analytical Thinking, and Importance of Epistemic Rationality | Studia Psychologica (savba.sk)) examined how scientific literacy (scientific reasoning, scientific knowledge, and trust in science), analytical thinking and the importance of epistemic rationality relate to the belief in the efficacy of so-called alternative medicine (SCAM) and other health-related unfounded beliefs (COVID-19 conspiracies, pseudoscientific and magical beliefs, and cancer myths).

A representative sample of 1038 Slovaks (age = 42.08, SD = 13.99) participated in the study. While SCAM belief correlated with COVID-19 conspiracy theories, pseudoscientific beliefs, magical health-related beliefs, and cancer myths, it appeared that belief in SCAM was primarily driven by lower trust in science, lower analytical thinking, and, interestingly, a higher need to be epistemically rational. Other components of scientific literacy did not significantly predict SCAM belief but they did predict other health-related unfounded beliefs, which may suggest that a more fine-tuned approach to studying SCAM beliefs is needed.

The authors commented that SCAM is moderately related to magical health beliefs and pseudoscientific beliefs and only weakly related to COVID-19 conspiracy theories. However, the weak association between SCAM and conspiracy beliefs is in line with previous findings (Mijatović et al., 2022; Vujić et al., 2022). Similar to previous studies (Fasce & Picó, 2019; Lobato et al., 2014), we found that different unfounded beliefs tend to correlate with each other. However, it appears that COVID-19 conspiracy beliefs are distinct from magical and pseudoscientific beliefs (as evidenced by weaker correlations), whereas SCAM beliefs overlap more with magical health and pseudoscientific beliefs. SCAM beliefs correlated positively with all types of unfounded beliefs, from low to moderate levels (r values between -.16 and -.50) but did not have the same predictors. Contrary to previous findings about the stronger predictive power of scientific reasoning compared to analytical thinking in unfounded beliefs (Čavojová et al., 2020; 2022), our results point to more balanced strengths, except for belief in SCAM, which was not predicted by scientific reasoning. One of the possible explanations lies in the very low reliability of the Scientific Reasoning Scale in this study. On the other hand, other studies using the same scale showed only slightly higher reliability (e.g., Bašnáková et al., 2021, Čavojová et al., 2020; 2023; Čavojová & Ersoy, 2020) and it predicted both COVID-19 conspiracy theories, as well as pseudoscientific/magical component, similarly to the results of previous studies.

This study evaluated the effect of ear acupressure (auriculotherapy) on the weight-gaining pattern of overweight women during pregnancy. It was a single-blinded randomized clinical trial conducted between January and September 2022 and took place in health centers of Qom University of Medical Sciences in Iran.

One-hundred thirty overweight pregnant women were selected by a purposeful sampling method and then divided into two groups by block randomization method. In the intervention group, two seeds were placed in the left ear on the metabolism and stomach points, while two seeds were placed in the right ear on the mouth and appetite points. Participants in the intervention group were instructed to press the seeds six times a day, 20 minutes before a meal for five weeks. For the placebo group, the Vaccaria seedless label was placed at the same points as the intervention group.

A digital scale with an accuracy of 0.1 kg was used to weigh the pregnant women during each visit. Descriptive statistics, independent T-test, chi-square, and repeated measure ANOVA (analysis of variance) test were used to check the research objectives.

There was a statistically significant difference between the auriculotherapy and placebo groups immediately after completing the study (1120.68 ± 425.83 vs. 2704.09 ± 344.96 (g);  = 0.018), respectively. Also, there was a substantial difference in the weight gain of women two weeks (793.10 ± 278.38 vs. 1090.32 ± 330.31 (g);  < 0.001) and four weeks after the intervention (729.31 ± 241.52 vs. 964.51 ± 348.35 (g);  < 0.001) between the auriculotherapy and placebo groups.

The authors concluded that the results of the present study indicated the effectiveness of auriculotherapy in controlling the weight gain of overweight pregnant women. This treatment could be used as a safe method, with easy access, and low cost in low-risk pregnancies. 

In order to understand these findings, it is worth reading the methods section of the paper. It explains what actually happened with the two groups:

After providing explanations to familiarize the participants with the working method and answering their questions, the participants were requested to be comfortable. The first author who has an auriculotherapy certificate did the intervention. The intervention began by disinfecting both ears with a 70% alcohol solution. After determining the location of metabolism and stomach points in the left ear and mouth and appetite points in the right ear related to weight and appetite control, the researcher placed the seeds on the desired points… The intervention lasted for a total of 5 weeks. The seeds were changed twice a week (once every three days) by the researcher. The participants in the intervention group were taught to press the seeds 6 times a day for one minute each time. The pressure method was to use moderate stimulation with continuous pressure. In the first session, the researcher fully taught the participants the amount of pressure and the duration of it in a practical way and asked them to do this once in her presence to ensure that it was correct. Participants were recommended to do this preferably 20 minutes before eating. The researcher reminded the participants in the intervention group of their daily interventions by phone or text message. Each night, they were asked to check if they had followed the instructions and completed the daily registration checklist. In each seed replacement session, which was performed every three days, the checklist of the previous session was viewed and checked, and a checklist was received every week at the same time as the participants were weighed. Subjects were also emphasized in case of any symptoms of allergies or infections and pain as soon as possible through the contact number provided to them to discuss the issue with the researcher to remove the seeds.

In the placebo group, instead of real seeds, a label without Vaccaria seed (waterproof fabric adhesive) was placed by the researcher at the desired points in both ears, and the participants did not receive training to compress the points. They also did not receive the list of daily pressing points. All follow-ups and replacement of labels were performed in the same way as the intervention group in the placebo group. Finally, all participants were requested to notify the researcher if any seeds or labels were removed for any reason. It should be noted that pregnant mothers were unaware of the nature of the group to which they belonged.

It seems clear, therefore, that the patients were NOT blinded and that the verum patients received different care and more attention/encouragement than the placebo group. This means firstly that the trial was NOT single-blind, as the authors claim. Secondly, it means that the outcomes were most likely NOT due to ear acupressure at all – they were caused by the non-specific effects of expectation, extra attention, etc. which, in turn, motivated the women to better control their weight. Consequently, the conclusions of this study should be re-phrased:

The results of the present study fail to indicate the effectiveness of auriculotherapy in controlling the weight gain of overweight pregnant women.

In addition, I feel that the researchers, supervisors, peer-reviewers, editors should all bow their heads in shame for trying to mislead us.

Anja Zeidler (born 1993) became known in 2012 as the most successful fitness personality in Switzerland. After joining the bodybuilding scene in Los Angeles, a phase of self-discovery followed. Anja published her development and became what one nowadays calls an ‘INFLUENCER’. As Managing Director and Content Director of her own company, Anja Zeidler GmbH, Anja has made a name for herself as a public figure far beyond the fitness market with her activities as a ‘Selflove Influencer’, blogger, book author, motivational speaker, presenter and expert in the food & health sector. Furthermore, she is completing a degree at the Academy of Naturopathy for Holistic Health.

About a year and a half ago, Anja Zeidler had a desmoid tumor removed from under her left breast – and now it was reported to be back. The conventional treatment methods are clear: another surgical procedure or radiation. But Zeidler said she wants to wait with such interventions. For the time being, she has decided to go her own way. She wants to “balance any imbalances” with her naturopathic doctor and wishes to fight the disease on her own and with a “positive mindset.”

“On a spiritual level, they say that tumors can be related to trauma. That’s why I’ve tried breathing exercises and cocoa ceremonies. With these methods, I get into my subconscious and get closer to traumas, which I am not aware of, and try to dissolve them. So far, blatant things have come up that I had long forgotten and repressed,” she says enthusiastically. In addition, Zeidler wants to give up refined sugar with immediate effect, keep better control of her diet in general – even in her stressful everyday life – and drink freshly squeezed celery and beetroot juice every morning. In addition, she relies on “natural capsules with and grape seed OPC.” “I’ve read in studies that certain types of fungi and strong antioxidants like OPC are supposed to fight tumor cells.” There I follow the motto: ‘if it doesn’t help, at least it does not harm.'”

Zeidler’s tumor is a desmoid tumor, an abnormal growth that arises from connective tissues. These tumors are generally not considered malignant because they do not spread to other parts of the body; however, they can aggressively invade the surrounding tissue and can be very difficult to remove surgically. These tumors often recur, even after apparently complete removal.

Zeidler commented: “I am convinced that with a positive mindset you can contribute extremely much to the healing process. If the checks reveal rapid growth, I will of course seek medical treatment. Then I would opt for radiation.”

The trouble with ‘influencers’ is that they are gullible and influence the often gullible public to become more gullible. Thus their influence might cost many lives. Personally, I hope that the young woman does well with her erstwhile refusal of evidence-based treatments. Yet, I fear that the ‘Academy of Naturopathy for Holistic Health’ will teach her a lot of BS about the power of natural cancer cures. The sooner she agrees to have her tumor treated based on evidence, the better her prognosis, I’m sure.

This sudy made me speachless. I best show the abstract in its full and unadulterated beauty:

Background

Studies have shown homoeopathy to effectively control blood sugar levels and improve quality of life (QOL), though a standard treatment protocol is required.

Objective

This study intended to assess the homoeopathic practice, prescription habits, experience, and perception of Indian Homeopathic Practitioners (HPs) in treating DM.

Methodology

A web-based cross-sectional with a snowball sampling method was conducted between 30th July 2021 and 18th August 2021. A questionnaire to record clinical attributes of Indian HPs in the management of DM was formed after the consensus of the subject experts and pilot testing for feasibility.

Results

Participants were 513 HPs with mean age [Standard Deviation (SD)] of 40.44 years (11.16) and a mean duration of the homoeopathic medical practice of 14.67 years [95% Confidence Interval (CI) = 13.71–15.63]. The majority of HPs made classical homoeopathic prescription (201, 39.2%) though the success in the management of DM was better among HPs who prescribed more than one potentized medicine [vs classical prescription, Odds Ratio (OR) = 2.34, p = 0.032]. As perceived by the HPs, homoeopathic treatment resulted in a major improvement in QOL of the diabetic patients (418, 81.5%) with very few adverse effect (100, 19.5%). The blood sugar level was controlled better when homoeopathy was given alongside conventional medicine (348, 67.8%).

Conclusion

The clinical experience of HPs in this study has shown that homoeopathic treatment can benefit DM patients in preventing complications and improving QOL. It further reported that homoeopathy can be an important adjuvant to conventional treatment in managing DM.

Let’s be clear: there is no reliable evidence that DM – a life-threatening disease –  can be effectively treated with homeopathy. And let’s be blunt: HPs who claim otherwise are in my view criminal.

I should mention that some of the patients had type 1 diabetes. Many HPs felt that “there was a lack of awareness about the effectiveness of homoeopathy in DM among the general population”. The data show that in 7% the HPs discontinued conventional ant-diabetic drugs completely, and in 73% they reduced them.

It seems that the general population is well advised to ignore homeopathy and its alleged effectiveness for DM. I would even go one step further and postulate that:

if patients rely on homeopathy to treat their diabetes, they risk their lives!

The COVID-19 pandemic has been notable for the widespread dissemination of misinformation regarding the virus and appropriate treatment. The  objective of this study was to quantify the prevalence of non–evidence-based treatment for COVID-19 in the US and the association between such treatment and endorsement of misinformation as well as lack of trust in physicians and scientists.

This single-wave, population-based, nonprobability internet survey study was conducted between December 22, 2022, and January 16, 2023, in US residents 18 years or older who reported prior COVID-19 infection.

Self-reported use of ivermectin or hydroxychloroquine, endorsing false statements related to COVID-19 vaccination, self-reported trust in various institutions, conspiratorial thinking measured by the American Conspiracy Thinking Scale, and news sources.

A total of 13 438 individuals (mean [SD] age, 42.7 [16.1] years; 9150 [68.1%] female and 4288 [31.9%] male) who reported prior COVID-19 infection were included in this study. In this cohort, 799 (5.9%) reported prior use of hydroxychloroquine (527 [3.9%]) or ivermectin (440 [3.3%]). In regression models including sociodemographic features as well as political affiliation, those who endorsed at least 1 item of COVID-19 vaccine misinformation were more likely to receive non–evidence-based medication (adjusted odds ratio [OR], 2.86; 95% CI, 2.28-3.58). Those reporting trust in physicians and hospitals (adjusted OR, 0.74; 95% CI, 0.56-0.98) and in scientists (adjusted OR, 0.63; 95% CI, 0.51-0.79) were less likely to receive non–evidence-based medication. Respondents reporting trust in social media (adjusted OR, 2.39; 95% CI, 2.00-2.87) and in Donald Trump (adjusted OR, 2.97; 95% CI, 2.34-3.78) were more likely to have taken non–evidence-based medication. Individuals with greater scores on the American Conspiracy Thinking Scale were more likely to have received non–evidence-based medications (unadjusted OR, 1.09; 95% CI, 1.06-1.11; adjusted OR, 1.10; 95% CI, 1.07-1.13).

The authors concluded that, in this survey study of US adults, endorsement of misinformation about the COVID-19 pandemic, lack of trust in physicians or scientists, conspiracy-mindedness, and the nature of news sources were associated with receiving non–evidence-based treatment for COVID-19. These results suggest that the potential harms of misinformation may extend to the use of ineffective and potentially toxic treatments in addition to avoidance of health-promoting behaviors.

This study made me wonder to what extend a lack of trust in physicians or scientists, and conspiracy-mindedness are also linked to the use of so-called alternative medicine (SCAM) for treatning COVID infections. As I have often discussed, such associations have been reported regularly, e.g.:

The authors point out that the endorsement of misinformation related to COVID-19 has been shown to decrease the intention to vaccinate against COVID-19, to decrease the belief that it is required for herd immunity, and to correlate with forgoing various COVID-19 prevention behaviors. Such false information is largely spread online and often originates as disinformation intentionally spread by political actors and media sources, as well as illicit actors who profit from touting supposed cures for COVID-19.  A substantial minority of the public endorses false information related to COVID-19, although certain subgroups are more likely to do so, including those who are more religious, who distrust scientists, and who hold stronger political affiliations. Cultivating and maintaining trust is a crucial factor in encouraging the public to engage in prosocial health behaviors. The extent to which addressing conspiratorial thinking could represent a strategy to address obstacles to public health merits further investigation.

When the media does not adhere to reporting guidelines regarding so-called alternative medicine (SCAM), this may deceive or mislead consumers about the safety and efficacy of these practices. A team of researchers analyzed whether Serbian online media adheres to reporting guidelines and described dominant psychological appeals used to promote TM/CAM.

They conducted a content analysis of 182 articles from six news and six magazine websites, published July–December 2021. Biologically based treatments – predominantly herbal products – were the most common (205/289 practices). SCAM practices were claimed to:

  • improve general health (71/386 claims),
  • alleviate respiratory problems,
  • boost the immunity,
  • and detox the body.

The tone was overwhelmingly positive, with most of the positive articles (145/176) neglecting to disclose the potential harms of SCAM. Few articles provided a recommendation to speak with a healthcare provider (24/176). Articles tended to appeal to SCAM’s long tradition of use (115/176), naturalness (80/176), and convenience (72/176). They used vague pseudoscientific jargon (105/176) and failed to cite sources for the claims that SCAM use is supported by science (39/176).

The authors concluded that given that SCAM use may lead to harmful outcomes (such as adverse events, avoidance of official treatment or interaction with it), Serbian online media reports on SCAM are inadequate to assist consumers’ decision-making. Our findings highlight issues that need to be addressed towards ensuring more critical health reporting, and, ultimately, better informed SCAM consumption choices.

A long time agao, in 2000, we did a similar survey. We compared what UK newspapers published about SCAM and conventional medicine to what German papers did. We found that the proportion of articles about SCAM seems to be considerably larger in the UK (15% v 5%), and, in contrast to articles on medical matters in general, reporting on SCAM in the UK was overwhelmingly positive. I wonder whether, 23 years later, the situation has changed.

Blood electrification? If you had not heard about it, you are in good company. What is it? The Internet has many columns on it. Here is an article that I abbreviated a bit for the purpose of this blog:

Dr. Robert C. Beck is the inventor of blood electrification, which can be traced back to the work of Dr. Hulda Clark and Dr. Robert J. Thiel. The method is based on the assumption that parasites, bacteria, viruses and fungi are paralyzed by a low current pulse of 50 to 100 microamperes. As a result, the pathogens are no longer able to infect the body and the immune system can readily eliminate.

Dr. Beck found that the current flow, i.e., blood electrification, is more important than the frequency. Unlike previous ‘zappers’, the “Beck-Zapper” works only with a frequency of 3.920 Hz. Beck believes that the lower the frequency, the greater the current absorption, i.e. the more effective the therapy. Moreover, the Beck zapper is in harmony with the body’s own rhythm and is therefore not a stress trigger. Since the Beck zapper works with a higher voltage (27 volts) than the Clark zapper (9 volts), it is attached directly to the pulse vein and not held in the hands. Here’s how the Beckzapper works:

  1. The “enemy in the blood,” as Beck called parasites, viruses and bacteria, is fought with mild electricity between 50 and 100 microamperes at half the Schumann frequency of 3.92 Hz, he said.
  2. During blood electrification, colloidal silver is added to prevent secondary infection. Colloidal silver is extremely small silver particles dissolved in water, which are held in suspension by the water molecules. Although collodial silver enjoyed great importance in medicine hundreds of years ago, it fell into oblivion due to the introduction of antiobiotics and has only been gradually rediscovered in recent years.
  3. Powerful magnetic pulses are said to carry pathogens from the lymphatic system back into the bloodstream, where they can then be eliminated by the immune system.

Beck was able to prove that his patients became virus-free and symptom-free after the exact application of the blood electrification device. However, he also found that some of his patients became ill again with the same virus after a few months. After further study, he realized that the repeated infections were due to lingering viruses in the lymph fluid. Starting from the lymph fluid, the viruses returned to the bloodstream, where they re-infected cells and multiplied, causing the repeated symptoms of the disease. Beck then invented another device, the so-called magnetic pulser.

This generated an electrical flow by means of a magnetic pulse, which triggered contractions in the lymphatic channels. This forced movement of the lymph, causing the microbes to be forced back into the bloodstream where they could be electrified. Beck applied the Magnetpluser to some patients in combination with the blood electrifier and obtained surprisingly positive results.

Dr. Beck assumed that parasites were responsible for the development of diseases. Beck also believed that parasites in the blood would limit human life expectancy to 70 to 80 years. Dr. Beck himself was convinced of the effectiveness of his zapper and lost 60 kg through it. He explained this weight loss by the fact that the parasites had previously consumed a large part of the nutrients, causing him to experience constant ravenous hunger. In addition, Beck’s blood pressure dropped significantly, as did his blood sugar. He also regained a full head of hair as an almost 70-year-old bald man. Beck attributed all these benefits to his zapper, which he was able to prove after a three-week treatment by means of a blood test using the dark field method: His blood count was perfect.

The blood zapper also helps with herpes diseases, AIDS, chicken pox, lung ulcers, leukemia and other types of cancer, as well as chronic fatigue syndrome, diabetes, flu-like infections, asthma and gastritis. In short, the blood zapper has been able to treat many diseases that are usually considered incurable.

Beck recommends performing blood electrification for two hours daily for 3 to 6 weeks, or longer if necessary.

  • The Beckzapper can be carried in the breast pocket or on the belt.
  • The cathode and anode are to be placed where on the one hand the blood flows and on the other hand the pulse beat can be felt.
  • This can be, for example, on the wrist or feet.
  • For the greatest possible freedom of movement during treatment, the “miniZAP” is recommended.
  • This is a matchbox-sized zapper that can be worn comfortably on the wrist.
  • The method of blood electrification can be performed by anyone. There are no known side effects when using the blood zapper.

Dr. Alfons Weber has presented research according to which most cancers are caused by excessive microbial infestation of blood cells. According to the findings of Prof. Pappa, this circumstance, in turn, can be attributed to a too low energy status. The use of electrotherapy can therefore achieve considerable success in the treatment of parasitic and energy-related cancers in particular.

  • The use of the Beckzapper in cancer patients should be continuous
  • According to Dr. Weber, the carcinoma protozoa are located in the blood cells and eat the hemoglobin here.
  • The carcinoma protozoa located in the blood cells are first hardly affected by the increased current flow in the blood plasma.
  • Only when the respective blood cell has been eaten empty do the carcinoma protozoa leave the blood cell in search of a new one.
  • Once the carcinoma protozoa are outside the plasma, they can be eliminated by the continuous surge of the Beckzapper.
  • In this way, new blood cells cannot be attacked in the first place.

The continuous application of the Beckzapper, possibly in combination with a magnetic pulse generator with collodial silver, can significantly reduce the number of protozoa.

Vis a vis so much nonsense, I am almost speechless. I did try to find any credible publications that might back up the multityde of claims made above. Neddless to say, I was not successful.

And what makes that anyone who promotes ‘blood electrification’ as a cure of anything?

The answer is easy:

A DANGEROUS CHARLATAN

This case report aims to describe the effects of craniosacral therapy and acupuncture in a patient with chronic migraine.
A 33-year-old man with chronic migraine was treated with 20 sessions of craniosacral therapy and acupuncture for 8 weeks. The number of migraine and headache days were monitored every month. The pain intensity of headache was measured on the visual analog scale (VAS). Korean Headache Impact Test-6 (HIT-6) and Migraine Specific Quality of Life (MSQoL) were also used.
The number of headache days per month reduced from 28 to 7 after 8 weeks of treatment and to 3 after 3 months of treatment. The pain intensity of headache based on VAS reduced from 7.5 to 3 after 8 weeks and further to < 1 after 3 months of treatment. Furthermore, the patient’s HIT-6 and MSQoL scores improved during the treatment period, which was maintained or further improved at the 3 month follow-up. No side effects were observed during or after the treatment.
The authors concluded that this case indicates that craniosacral therapy and acupuncture could be effective treatments for chronic
migraine. Further studies are required to validate the efficacy of craniosacral therapy for chronic migraine.

So, was the treatment period 8 weeks long or was it 3 months?

No, I am not discussing this article merely for making a fairly petty point. The reason I mention it is diffteren. I think it is time to discuss the relevance of case reports.

What is the purpose of a case report in medicine/healthcare. Here is the abstract of an article entitled “The Importance of Writing and Publishing Case Reports During Medical Training“:

Case reports are valuable resources of unusual information that may lead to new research and advances in clinical practice. Many journals and medical databases recognize the time-honored importance of case reports as a valuable source of new ideas and information in clinical medicine. There are published editorials available on the continued importance of open-access case reports in our modern information-flowing world. Writing case reports is an academic duty with an artistic element.

An article in the BMJ is, I think, more informative:

It is common practice in medicine that when we come across an interesting case with an unusual presentation or a surprise twist, we must tell the rest of the medical world. This is how we continue our lifelong learning and aid faster diagnosis and treatment for patients.

It usually falls to the junior to write up the case, so here are a few simple tips to get you started.

First steps

Begin by sitting down with your medical team to discuss the interesting aspects of the case and the learning points to highlight. Ideally, a registrar or middle grade will mentor you and give you guidance. Another junior doctor or medical student may also be keen to be involved. Allocate jobs to split the workload, set a deadline and work timeframe, and discuss the order in which the authors will be listed. All listed authors should contribute substantially, with the person doing most of the work put first and the guarantor (usually the most senior team member) at the end.

Getting consent

Gain permission and written consent to write up the case from the patient or parents, if your patient is a child, and keep a copy because you will need it later for submission to journals.

Information gathering

Gather all the information from the medical notes and the hospital’s electronic systems, including copies of blood results and imaging, as medical notes often disappear when the patient is discharged and are notoriously difficult to find again. Remember to anonymise the data according to your local hospital policy.

Writing up

Write up the case emphasising the interesting points of the presentation, investigations leading to diagnosis, and management of the disease/pathology. Get input on the case from all members of the team, highlighting their involvement. Also include the prognosis of the patient, if known, as the reader will want to know the outcome.

Coming up with a title

Discuss a title with your supervisor and other members of the team, as this provides the focus for your article. The title should be concise and interesting but should also enable people to find it in medical literature search engines. Also think about how you will present your case study—for example, a poster presentation or scientific paper—and consider potential journals or conferences, as you may need to write in a particular style or format.

Background research

Research the disease/pathology that is the focus of your article and write a background paragraph or two, highlighting the relevance of your case report in relation to this. If you are struggling, seek the opinion of a specialist who may know of relevant articles or texts. Another good resource is your hospital library, where staff are often more than happy to help with literature searches.

How your case is different

Move on to explore how the case presented differently to the admitting team. Alternatively, if your report is focused on management, explore the difficulties the team came across and alternative options for treatment.

Conclusion

Finish by explaining why your case report adds to the medical literature and highlight any learning points.

Writing an abstract

The abstract should be no longer than 100-200 words and should highlight all your key points concisely. This can be harder than writing the full article and needs special care as it will be used to judge whether your case is accepted for presentation or publication.

What next

Discuss with your supervisor or team about options for presenting or publishing your case report. At the very least, you should present your article locally within a departmental or team meeting or at a hospital grand round. Well done!

Both papers agree that case reports can be important. They may provide valuable resources of unusual information that may lead to new research and advances in clinical practice and should offer an interesting case with an unusual presentation or a surprise twist.

I agree!

But perhaps it is more constructive to consider what a case report cannot do.

It cannot provide evidence about the effectiveness of a therapy. To publish something like:

  • I had a patient with the common condition xy;
  • I treated her with therapy yz;
  • this was followed by patient feeling better;

is totally bonkers – even more so if the outcome was subjective and the therapy consisted of more than one intervention, as in the article above. We have no means of telling whether it was treatment A, or treatment B, or a placebo effect, or the regression towards the mean, or the natural history of the condition that caused the outcome. The authors might just as well just have reported:

WE RECENTLY TREATED A PATIENT WHO GOT BETTER

full stop.

Sadly – and this is the reason why I spend some time on this subject – this sort of thing happens very often in the realm of SCAM.

Case reports are particularly valuable if they enable and stimulate others to do more research on a defined and under-researched issue (e.g. an adverse effect of a therapy). Case reports like the one above do not do this. They are a waste of space and tend to be abused as some sort of indication that the treatments in question might be valuable.

 

The current BMJ has an article entitled UK could have averted 240 000 deaths in 2010s if it matched other European nations. Here is its staring passage:

The UK has fallen far behind its international peers on a range of health outcomes and major policy reforms are required to reverse this, a report1 has concluded.

Analysts from the Institute for Public Policy Research (IPPR) calculated that there would have been 240 000 fewer deaths in the UK between 2010 and 2020 if the UK matched average avoidable mortality in comparable European nations.

The report says the UK’s poor outcomes are partly down to people’s inability to access healthcare in a timely manner, a problem that has intensified since the pandemic.

To tackle this, the progressive think tank has put forward a 10 point plan to shift the NHS from a sickness service to a prevention service. It says primary care should be placed at the heart of a “prevention first” NHS with a nationwide rollout of neighbourhood health hubs to deliver integrated health and care services in every local area…

INTEGRATED HEALTH?

Isn’t that the nonsense Charles III, Michael Dixon, THE COLLEGE OF MEDICINE AND INTEGRATED HEALTH and many others promote? The integrated health we discussed so often before, e.g.:

The UK ‘Integrated Medicine Alliance’ offers information sheets on all of the following treatments: AcupunctureAlexander TechniqueAromatherapyHerbal MedicineHomeopathyHypnotherapyMassage, ,NaturopathyReflexologyReikiTai ChiYoga Therapy. The one on homeopathy, for example, tells us that “homeopathy … can be used for almost any condition either alone or in a complementary manner.” Is the BMJ thus promoting homeopathy and similar dubious treatments?

The answer is, of course, NO!

The BMJ supports INTEGRATED HEALTH as defined not by quacks but by real experts: “Integrated care, also known as integrated health, coordinated care, comprehensive care, seamless care, or transmural care, is a worldwide trend in health care reforms and new organizational arrangements focusing on more coordinated and integrated forms of care provision. Integrated care may be seen as a response to the fragmented delivery of health and social services being an acknowledged problem in many health systems.”

I have often wondered why quacks use established terms, give it a different meaning and use it for confusing the public. I suppose the answer is embarrassingly simple: they thrive on confusion, want to hide the fact that they have no convincing arguments of their own, and like to use the established terminology of others in order to push their agenda and maximize their benefits.

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