medical ethics
Warning: Exceptionally, this post is not on so-called alternative medicine but on a different scam.
The current issue of the BMJ carries an editorial that is worth quoting on my blog, I think. I have never made a secret of the fact that I am against Brexit. In fact, I re-took German nationality because of it. Therefore, I am in agreement with Kamran Abbasi, the BMJ editor and author of the editorial. Here are what I consider the two most important paragraphs from his article:
… In the absence of public debate and meaningful data six years after the UK’s Brexit referendum, we asked Richard Vize to examine the effects of Brexit on health and care (doi:10.1136/bmj.o1870).20 The news isn’t all bad, although there isn’t much good. Brexit hasn’t brought about a cut in NHS funding but did fail to deliver the £350m weekly windfall that Boris Johnson and others promised. The European Working Time Directive remains in place, and the predicted “stampede” of European doctors leaving the NHS hasn’t happened. But the impacts on social care and lower paid staff are harming delivery of care in an increasingly multidisciplinary service.
Health technology, life science industries, and research, where integration with Europe was greatest and benefits most obvious, are being damaged. Promises to cut red tape have created new complexities and been tarnished by suspect procurement practices at the height of the pandemic (doi:10.1136/bmj.o1893).21 Perhaps the most damning legacy of Brexit, however, is the state of unreadiness it created for a pandemic that required utmost readiness. Whether or not you agree Brexit was the right decision, you should at least agree that it is a decision worthy of question, analysis, and redoubled effort if the signs are good and possibly even reversal if the damage is too great.
This quote probably makes more sense if one also reads the paper referenced in its 2nd link. So, please allow me to quote from this article as well:
… In a highly critical report, the Commons Public Account Committee accuses the Department of Health and Social Care of “woefully inadequate record keeping” and failing to meet basic requirements to publicly report ministers’ external meetings or deal with potential conflicts of interest when awarding testing contracts to the company.
The committee said that large gaps in the document trail meant it was impossible to say the contracts were awarded properly in the way that would be expected, even allowing for the exceptional circumstances and accelerated processes in place at the time. The first contract, for £132m, was awarded at the height of the covid pandemic in March 2020, when the department had suspended the normal requirements for competition between suppliers in the award of government contracts.
The report noted that officials were aware of contacts between Matt Hancock, the then health and social care secretary, and Owen Paterson, a Conservative MP and paid consultant for Randox, and of hospitality that Hancock received from Randox’s founder Peter Fitzgerald in 2019, but failed to identify any conflicts of interest before awarding the first contract.
The department set up a “VIP lane,” through which suppliers put forward by officials, MPs, ministers, or Number 10 would be given priority. Suppliers coming through priority routes were awarded £6bn out of the total £7.9bn of testing contracts awarded between May 2020 and March 2021, the committee noted…
This is by no means all, and I do encourage you to read these articles in full. Once you have, you might ask yourself as I do:
Has Britain become a banana republic?
The ‘My Resilience in Adolescence (MYRIAD) Trial’evaluated the effectiveness and cost-effectiveness of SBMT compared with teaching-as-usual (TAU).
MYRIAD was a parallel group, cluster-randomised controlled trial. Eighty-five eligible schools consented and were randomized 1:1 to TAU (43 schools, 4232 students) or SBMT (42 schools, 4144 students), stratified by school size, quality, type, deprivation, and region. Schools and students (mean (SD); age range=12.2 (0.6); 11–14 years) were broadly UK population-representative. Forty-three schools (n=3678 pupils; 86.9%) delivering SBMT, and 41 schools (n=3572; 86.2%) delivering TAU, provided primary end-point data. SBMT comprised 10 lessons of psychoeducation and mindfulness practices. TAU comprised standard social-emotional teaching. Participant-level risk for depression, social-emotional-behavioural functioning and well-being at 1 year follow-up were the co-primary outcomes. Secondary and economic outcomes were included.
An analysis of the data from 84 schools (n=8376 participants) found no evidence that SBMT was superior to TAU at 1 year. Standardised mean differences (intervention minus control) were: 0.005 (95% CI −0.05 to 0.06) for risk for depression; 0.02 (−0.02 to 0.07) for social-emotional-behavioural functioning; and 0.02 (−0.03 to 0.07) for well-being. SBMT had a high probability of cost-effectiveness (83%) at a willingness-to-pay threshold of £20 000 per quality-adjusted life year. No intervention-related adverse events were observed.
The authors concluded that the findings do not support the superiority of SBMT over TAU in promoting mental health in adolescence.
Even though the results are negative, MYRIAD must be praised for its scale and rigor, and for highlighting the importance of large, well-designed studies before implementing measures of this kind on a population basis. Co-author Tim Dalgliesh, director of the Cambridge Centre for Affective Disorders, said: “For policymakers, it’s not just about coming up with a great intervention to teach young people skills to deal with their stress. You also have to think about where that stress is coming from in the first place.”
“There had been some hope for an easy solution, especially for those who might develop depression,” says Til Wykes, head of the School of Mental Health and Psychological Sciences at the Institute of Psychiatry, Psychology, and Neuroscience, King’s College London. “There may be lots of reasons for developing depression, and these are probably not helped by mindfulness,” she says. “We need more research on other potential factors that might be modified, and perhaps this would provide a more targeted solution to this problem.”
Personally, I feel that mindfulness has been hyped in recent years. Much of the research that seemed to support it was less than rigorous. What is now needed is a realistic approach based on sound evidence and critical thinking.
For many years, Dr. Natalie Grams-Nobmann provided evidence-based medical information on social media – including on homeopathy, other forms of so-called alternative medicine, and more recently the COVID pandemic. These activities deservedly earned her plenty of praise but sadly they also made her the target of intolerant, occasionally aggressive people who disagree with the evidence. As I mentioned in yesterday’s post, Natalie has recently deleted her Twitter account. To explain her decision, she gave an interview to Marc Zimmer, MDR AKTUELL. With Natalie’s permission, I have translated sections of it and re-publish them here:
Q: What do you think about the case of your Austrian colleague?
A: The case has affected and frightened me terribly. I followed Kellermayr’s work and everything that came afterward. It is simply a terrible example of how little protection one has as a doctor or vaccination educator on social media. It also is a terrible example of how this “hate” does not stay in the realm of social media but spills over into real life. And that we have nothing to counter this “hate”.
Q: You yourself have also drawn consequences and deleted your Twitter account. Can you explain this step?
A: After seven years of vaccination education and medical education on social media, I thought I couldn’t take it anymore. I can’t stand looking into this hell where people celebrate the death of another human being, the suicide of another human being – and see that as an admission of guilt of this really threatened and persecuted doctor and rise above it like that. I think that when even the death of a human being is no longer free of gloating and hatred, then ideology is above everything. I didn’t know how to deal with it anymore. And, of course, it also scared me. I think my death would be celebrated in the same way, and I find that terribly frightening in human terms.
Q: To what extent have you experienced threats so far?
A: … I’ve experienced an incredible amount of different forms of hate – be it threats, insults, slander, or persecution. This has also spilled over into real life for me. I have sometimes given lectures under police protection. I am very glad that it is still sensible to wear a mask in public spaces… I think that in some cases it really is a life-threatening fear that you have to endure when you speak out on social or other media about vaccination protection or about protective measures. A lot of what you hear has to be reported and followed up. It is not the case that the internet is a lawless space or that my inbox simply has to swallow every insult in the world…
Q: You mentioned the platforms. What about politics? Do you feel supported enough by it and by the authorities?
A: No, not at all and that was certainly the case with the Austrian colleague. In desperation and panic, people turn to the police, and of course, there are individual female officers who react in an excellent way. But I have also heard things like: “Well, then don’t go out in public. Why do you do that? You’re doing it voluntarily, so you have to put up with it”. Or they say that it’s freedom of expression, that everyone is allowed to say anything… If no more discourse is possible, what am I supposed to do? I would like to be able to ensure that I remain objective, that I provide information and do not insult anyone. At the moment I simply don’t see myself in a position to do that because of the many threats.
Q: What do you wish from politics?
A: I would like politicians to draw the right conclusions from this: not just those who shout the loudest must be listened to. The ones who are silenced should be heard as well.
This “silencing” that I have been following throughout the pandemic is a terrible thing. The best and most factual discussants are disappearing more and more from the platforms. I haven’t insulted or threatened or unobjectively excoriated anyone in all my time on social media. Of course, you are allowed to make a joke or use satire. But you’re not allowed to put another person down. And the very people who have always managed to remain objective – despite the well-known strains during the pandemic – are now leaving and this should alarm us all.
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I do, of course, understand and respect Natalie’s decisions. Nevertheless, I am sad that she is partly withdrawing from public life. I feel that, in these difficult times, we need everyone who can contribute to more responsible information for the public. We must try to balance irrationality with rationality. Natalie is particularly gifted in doing just that (she is much more gentle and empathetic in the face of adversity than I, for instance). My hope, therefore, is that things improve, hatred recedes, and she is able to return to public life soon. Regardless of what she decides, I wish her well.
I have often called out unreliable or fraudulent research in the realm of Traditional Chinese Medicine (TCM). I think it is important to do so because the abundance of scientific misconduct is such that it has become a danger to public health. Today, I present yet another example:
This recent review claimed to summarize the evidence on TCM in treating MI, the clinical evaluations of TCM in treating male infertility (MI), and the molecular mechanisms of TCM effects. I was alerted to the fact that the authors cite a paper on acupuncture that I had co-authored. Here is the section in question from the review:
Acupuncture is one of the therapeutic techniques that are part of TCM. Acupuncture is a non-invasive technique and is regarded as free of risk if performed by trained personnel [35]. One of the advantages of acupuncture was that the incidence of adverse effects was substantially lower than that of many drugs or other accepted [35]. Acupuncture has been used in the treatment of male and female infertility and in assisted reproductive technology treatments for many years. A total of 100 patients with MI who met the diagnostic criteria were randomly divided into two groups [7]. Half of the patients received acupuncture treatment, and the other half received placebo acupuncture. After 10 weeks treatment, acupuncture successfully improved the indicators of the semen, including the spermatozoa survival rate, b-level activity rate, sperm density, sperm activity rate. A total of 28 infertile patients with severe oligoasthenozoospermia received acupuncture according to the principles of acupuncture and 29 infertile patients received placebo acupuncture. A significantly higher percentage of motile sperm (World Health Organization categories A-C), but no effect on sperm concentration, was found after acupuncture compared with placebo acupuncture [36]. Of the 279 cases of male sterility treated by the combination of acupuncture, pilose antler essence injection to acupoints and oral administration of Chinese materia medica, 142 cases (47.8%) were cured, 81 cases (27.3%) markedly effective, 53 cases (17.8%) effective and 21 cases (7.1%) ineffective [37]. The therapeutic effect of the combination of these three treatments was satisfactory.
Ref 7
Emerging evidence has shown that cell-cell interactions between testicular cells, in particular at the Sertoli cell-cell and Sertoli-germ cell interface, are crucial to support spermatogenesis. The unique ultrastructures that support cell-cell interactions in the testis are the basal ES (ectoplasmic specialization) and the apical ES. The basal ES is found between adjacent Sertoli cells near the basement membrane that also constitute the blood-testis barrier (BTB). The apical ES is restrictively expressed at the Sertoli-spermatid contact site in the apical (adluminal) compartment of the seminiferous epithelium. These ultrastructures are present in both rodent and human testes, but the majority of studies found in the literature were done in rodent testes. As such, our discussion herein, unless otherwise specified, is focused on studies in testes of adult rats. Studies have shown that the testicular cell-cell interactions crucial to support spermatogenesis are mediated through distinctive signaling proteins and pathways, most notably involving FAK, Akt1/2 and Cdc42 GTPase. Thus, manipulation of some of these signaling proteins, such as FAK, through the use of phosphomimetic mutants for overexpression in Sertoli cell epithelium in vitro or in the testis in vivo, making FAK either constitutively active or inactive, we can modify the outcome of spermatogenesis. For instance, using the toxicant-induced Sertoli cell or testis injury in rats as study models, we can either block or rescue toxicant-induced infertility through overexpression of p-FAK-Y397 or p-FAK-Y407 (and their mutants), including the use of specific activator(s) of the involved signaling proteins against pAkt1/2. These findings thus illustrate that a potential therapeutic approach can be developed to manage toxicant-induced male reproductive dysfunction. In this review, we critically evaluate these recent findings, highlighting the direction for future investigations by bringing the laboratory-based research through a translation path to clinical investigations.
This paper does not relate to the statement it is meant to support by the review authors.
Ref 35
The review by Qin et al (1) includes 5 trials none of which should have been included in a quality metaanalysis as the methodology was unconvincing: In the trial by Alraek et al., patients were randomised to receive either acupuncture or no treatment. This means that no attempt was made to control for the effects of placebo or extra attention. Therefore, this study does not demonstrate an effect of acupuncture as the outcome could be due to non-specific effects unrelated with this therapy. By contrast, the trial by Aune et al. did attempt to control for placebo effects by using a sham control group. Sham acupuncture was given using six needles superficially inserted in the calves, thighs or abdomen outside known acupuncture points or meridians. Needles were not manipulated in the sham group. Sham or placebo controls have the purpose of rendering patients unaware of whether they receive the real or the sham treatment. The method used here cannot achieve this aim; patients would be easily able to tell which intervention they received. In other words, this study also did not adequately control for placebo effects. The remaining three trials are all not Medline-listed, authored by Chinese investigators and published in inaccessible journals. This should disqualify them from inclusion as they were unverifiable by the peer review process. According to the published table, they were equivalence trials of acupuncture versus antibiotics with a sample size around 30. This means they are grossly underpowered and thus unable to generate reliable results. Unless BJOG peer reviewers could see the primary articles, or be provided with translations from Chinese, the systematic review should not have been accepted. The “many eyes of science” requires transparency, testing, challenge and verification. Although in the past, inconclusive results of acupuncture have not been thought to be due to Chinese influence (2), it has been noted that virtually all recent published acupuncture trials are “positive” (3), raising questions of publication and other biases. Our colleagues are under tremendous pressure to publish, but we do them no favours by effectively lowering the standard of scientific peer review. Elite journals too have an obligation to train and reiterate about publication ethics and sound scientific writing (4). As none of the primary studies convincingly demonstrated that acupuncture is an effective therapy for recurrent urinary tract infections, no positive conclusion was warranted. Although Qin et al. did state that the risk of bias of the included trials was generally high or unclear (1), the BJOG nevertheless allowed them to turn massive uncertainty into relatively firm, positive conclusions in the abstract (“Acupuncture appeared to be beneficial for treatment and prophylaxis of rUTIs”) and tweetable abstract (“This review found that acupuncture may improve treatment and prevent recurrence of urinary tract infection in women”), thus leading to excited media headlines that inevitably mislead the public. ‘May’ is a weasel word which should be avoided as it is unfalsifiable (for example, pigs do not fly but they ‘may’ fly in the future). The definite, straightforward conclusion must be “There is no good evidence to support the use of acupuncture for the treatment and prophylaxis of recurrent UTIs”. It is not acceptable to give international credibility to an implausible modality that no objective, independent high-quality review has found effective beyond placebo (5). The dampening accompanying mini-commentary (6) does not undo the damage.
The review should be withdrawn while the primary papers are translated for peer reviewers to examine, the above limitations discussed in the text, and the positive ‘spin’ in conclusions corrected. These improvements would consolidate the researchers’ probity and justify the accolade of BJOG publication.
Our letter to the editor does not bear any relation to the statement it is meant to support by the review authors.
Ref 36
In this first prospective, randomized, single-blind, placebo-controlled study, 28 infertile patients with severe oligoasthenozoospermia received acupuncture according to the principles of traditional Chinese medicine (TCM) and 29 infertile patients received placebo acupuncture. A significantly higher percentage of motile sperm (World Health Organization categories A–C), but no effect on sperm concentration, was found after acupuncture compared with placebo acupuncture.
This small study is far from convincing and does not lend itself to far-reaching conclusions
Ref 37
Of the 279 cases of male sterility treated by the combination of acupuncture, pilose antler
essence injection to acupoints and oral administration of Chinese materia medica, 142
cases (47.8%) were cured, 81 cases (27.3%) markedly effective, 53 cases (17.8%) effective
and 21 cases (7.1%) ineffective. The therapeutic effect of the combination of these three
treatments was satisfactory.
This study had no control group and used two different therapies. Therefore, it does not allow any conclusion about the effectiveness of acupuncture.
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Perhaps you feel that these errors are trivial. But I would disagree. The review authors’ praise of acupuncture for MI is misplaced and will mislead the public. There are plenty of reviews on the subject, and those that are not overtly biased arrive at conclusions like these:
- The current evidence on acupuncture for oligoasthenozoospermia is inadequate to draw a solid conclusion due to the poor methodological quality. Rigorous full-scale RCTs are needed to validate the therapeutic efficacy and safety of acupuncture in treating oligoasthenozoospermia.
- The current evidence showing that acupuncture might improve poor semen quality is insufficient because of the small number of studies, inadequacy of procedures and/or insufficient information for semen analysis, high levels of heterogeneity, high risk of bias, and poor quality of reporting. Further large, well-designed RCTs are required.
So, how did this sloppy review come about?
Its authors are affiliated to the TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China, and the Tea Research Institute, Sichuan Academy of Agricultural Sciences, Chengdu 610066, China. A footnote tells us that their review was supported by the National Natural Science Foundation of China [No. 81973647] and the Xinglin scholar discipline promotion talent program of Chengdu University of traditional Chinese medicine [No. BSH2021018]. This sounds respectable enough.
The journal that published the review is ‘Pharmacological Research – Modern Chinese Medicine‘. Its stated aims are as follows: The journal publishes articles reporting on advances in our comprehension of mechanism and safety in experimental pharmacology and clinical efficacy and safety of pharmacologically active substances, including compound prescriptions, utilized in Traditional Chinese Medicine applying modern scientific research methods. Studies reporting also on the mechanisms of actions of the active substance(s) investigated are encouraged.
The editors in chief of the journal are Guan-Hua Du, PhD, China Academy of Chinese Medical Sciences Institute of Chinese Materia Medica, Beijing, China and Emilio Clementi, M.Mus, MD, PhD, University of Milan, Milan, Italy. No doubt, these are respectable scientists. And because they are, they should make sure that what they publish is correct – a criterion this recent review clearly does not meet.
The interest in the medicinal properties of honey is lively. A recent review, for instance, concluded that honey is a safe natural substance, effective in the inhibition of bacterial growth and the treatment of a broad range of wound types, including burns, scratches, diabetic boils (Skin abscesses associated with diabetic), malignancies, leprosy, fistulas, leg ulcers, traumatic boils, cervical and varicose ulcers, amputation, burst abdominal wounds, septic and surgical wounds, cracked nipples, and wounds in the abdominal wall. Honey comprises a wide variety of active compounds, including flavonoids, phenolic acid, organic acids, enzymes, and vitamins, that may act to improve the wound healing process. Tissue-engineered scaffolds have recently attracted a great deal of attention, and various scaffold fabrication techniques are being researched. 
But there is also reason to be cautious. The U.S. Food and Drug Administration (FDA) posted warning letters to four companies for illegally selling honey-based products that may pose a significant health risk to consumers. The FDA’s laboratory testing found that product samples contained active drug ingredients not listed on the product labels, including the active drug ingredients found in Cialis (tadalafil) and Viagra (sildenafil), which are FDA approved drugs used to treat men with erectile dysfunction. Sildenafil and tadalafil are restricted to use under the supervision of a licensed health care professional. These undeclared ingredients may interact with nitrates found in some prescription drugs, such as nitroglycerin, and may lower blood pressure to dangerous levels. People with diabetes, high blood pressure, high cholesterol, or heart disease often take nitrates.
“Tainted honey-based products like these are dangerous because consumers are likely unaware of the risks associated with the hidden prescription drug ingredients in these products and how they may interact with other drugs and supplements they may take,” said FDA Associate Commissioner for Regulatory Affairs Judy McMeekin, Pharm.D., “Products marketed with unidentified ingredients may be dangerous and, in some cases, deadly to consumers. We encourage consumers to remain vigilant when shopping online or in stores to avoid purchasing products that put their health at risk, and instead seek effective, FDA-approved treatments.”
Today’s warning letters outline how companies violated federal law by selling active drug ingredients in products marketed as foods, like honey, and by making unauthorized claims that their products treat disease or improve health. These products are promoted and sold for sexual enhancement on various websites and online marketplaces, and possibly in some retail stores.
The warning letters were issued to:
- Thirstyrun LLC (also known as US Royal Honey LLC),
- MKS Enterprise LLC,
- Shopaax.com,
- 1am USA Incorporated dba Pleasure Products USA
Companies marketing food products containing tadalafil and/or sildenafil violate federal law. Some of the products cited in the warning letters are also unapproved new drugs because they are intended for use in the cure, mitigation, treatment, or prevention of disease and they lack FDA approval. In some cases, product claims reference diseases that can only be diagnosed or treated under medical supervision. Additionally, some products cited in the warning letters are represented as dietary supplements even though tadalafil and sildenafil products are excluded from the dietary supplement definition.
The FDA has requested responses from the companies within 15 working days stating how they will address these issues or providing their reasoning and supporting information as to why they think the products are not in violation of the law. Failure to promptly address the violations may result in legal action, including product seizure and/or injunction.
Consumers using or considering using any over-the-counter product marketed for sexual enhancement should talk to a health care professional first, as some ingredients may interact with medications or dietary supplements. The FDA’s health fraud products database can help consumers identify nearly 1,000 of these potentially dangerous products.
The FDA previously warned consumers about more than 10 honey-based products containing hidden drug ingredients. The FDA’s laboratory testing found that product samples contained undeclared active ingredients, including sildenafil and tadalafil. The agency also previously warned consumers to avoid products with hidden drug ingredients sold through Amazon, eBay, Walmart and other retailers. The FDA is committed to protecting consumers by identifying and removing these potentially dangerous products from the market and urges stores, websites, and online marketplaces to stop selling these products.
If a consumer thinks that a product might have caused a reaction or an illness, they should immediately stop using the product and contact their health care provider. The FDA also encourages health care providers and consumers to report adverse reactions associated with FDA-regulated products to the agency using MedWatch or the Safety Reporting Portal.
Look what I found on Facebook:
Learn how to offer the healing energy of Reiki to yourself, people, and animals while enhancing your animal connection skills!
From daily support for health or challenges during times of crisis, Reiki helps restore balance on physical, emotional, spiritual, and mental levels for all living beings, enabling the body to do what it does best—heal itself. These benefits extend to other people, animals, trees/plants, and self-healing.
Reiki offers so many benefits for animals and for their human caregivers that I call it the gift that keeps on giving!
Reiki also enables students to connect and communicate more deeply with animals. If you think animals like you now, wait until they discover you’ve got Reiki—you’ll become an animal magnet!
For 25+ years Reiki has blessed me, my animal companions, students, and as a teacher I love sharing those benefits with as many people and animals as possible.
AVAILABLE WORLDWIDE
For many years I’ve taught a LIVE personally-mentored 6-week audio class where students learn all the basic skills needed by a beginning Reiki practitioner in addition to foundational principles of energy healing. And you don’t even need to leave the comfort of your home!
TAKEN REIKI BEFORE but don’t feel confident? Students who have retaken Reiki with me share that the weekly calls, opportunities to practice, online community, and opportunity to ask questions and receive guidance have helped them make Reiki a part of their daily lives and feel confident in offering it to loved ones.
REIKI LEVEL 1 CLASS SERIES
August 3 – September 7, 2022
LIVE WEEKLY CALLS and PERSONAL MENTORING
Every Wednesday at 6:00 p.m. Pacific for six weeks. Each call will be recorded and available for replay for students, including those in other time zones/countries. You do not have to attend live to take this class.
In addition to the 60-90 minute weekly calls, each student receives handouts and personal guidance for practice sessions.
When the class concludes, and all requirements have been fulfilled, each student receives a Reiki Level 1 certificate.
To learn more or register:
AND NOW FOR THE IMPORTANT BIT:
Choose one payment for all six classes. Payment is available with Visa, MC, or PayPal (choose PayPal credit card option for payment with Amex or Discover). PayPal also offers a payment plan option. Confirmation will be sent after registration along with instructions on how to join the first call. If you were unable to register in time to attend the first class live you can very easily catch up with the replay. Final deadline for registration is the day of the second class.
Single Pay Plan: $249.00
____________________________
This seems like a good little earner to me!
Congratulations to whoever invented it.
Yet I do feel that something has been forgotten:
the evidence.
If you search for Reiki on Pubmed, you find a baffling array of papers many of which arrive at positive conclusions. If you then check out the primary studies, you realize that most of them are of extremely poor quality, published by members of the Reiki cult (often in 3rd class journals for the nursing professions). If you search for independent systematic reviews that adequately account for the quality of the primary studies, you discover that, in fact, the evidence does not support the notion that Reiki is effective for anything. Here are a few examples:
- There is insufficient evidence to say whether or not Reiki is useful for people over 16 years of age with anxiety or depression or both.
- The serious methodological and reporting limitations of limited existing Reiki studies preclude a definitive conclusion on its effectiveness.
- In total, the trial data for any one condition are scarce and independent replications are not available for each condition. Most trials suffered from methodological flaws such as small sample size, inadequate study design and poor reporting.
And what about Reiki for animals?
As far as I can see, there is no good evidence at all.
So, does this render the above and similar courses fraudulent?
I let you answer this question for yourselves.
The UK Chiropractic Council is inviting you to help them re-formulate their educational standards. It is an occasion, some of my readers might find interesting. I, therefore, copy the relevant part of their announcement:
… Following a scoping review in 2021, which determined that the existing Education Standards, published in 2017, required development and updating, the GCC began revising the Education Standards in January 2022.
The revision will ensure that the Education Standards:
- Provide a realistic and comprehensive set of outcomes to be met by graduates on approved qualifications, demonstrating an ability to practise in accordance with the GCC Code.
- Take into account developments within the profession, increase focus on multi-disciplinary learning and different professions working more closely together across the UK, ensuring that graduates are well placed to meet the opportunities to care for patients in different contexts.
- Remain consistent, as appropriate, with the outcomes set by other UK healthcare frameworks and standards.
Purpose: why we are consulting
This consultation sets out our draft Education Standards for providers and Learning Outcomes for students, which reflect and build on the evidence and feedback we have obtained through our scoping review.
We seek stakeholders’ views on these draft Education Standards to ensure our final proposals are future-proof and fit for purpose.
We welcome all responses to the consultation.
Documents
The draft Education Standards on which we invite comments.
The equality impact assessment of the Education Standards, with comments invited within the consultation.
The GCC Education Standards consultation document in Word format.
Ways to respond
Submissions to this consultation can be made online (see below) or by email at [email protected] (click here to download the consultation document).
It is advisable to make a copy of your submission to prevent the loss of information due to internet, portal or connectivity issues. This should be done before pressing the submit button.
Information in responses, including personal information, may need to be published or disclosed under the access to information regimes (mainly the Freedom of Information Act 2000, the General Data Protection Regulation, the Data Protection Act 2018, and the Environmental Information Regulations 2004).
The GCC is a data controller registered with the Information Commissioner’s Office. We use personal data to support our work as the regulatory body for chiropractors. We may share data with third parties to meet our statutory aims and objectives, and when using our powers and meeting our responsibilities.
Closing date
The deadline for responses to this consultation on the draft Education Standards is 16 September 2022 at noon. The consultation will be publicised and stakeholders will be invited to comment…
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Personally, I think the GCC desperately needs to improve its educational (and other) standards. They claim that, “as the regulator for chiropractors, our role is to protect the public”. The case of the late John Lawler is one of many examples to show how unfit for this purpose the GCC truly is.
So, perhaps you might want to contribute to the consultation with a view to making UK chiropractors less of a danger to the public?
Earlier this year, I started the ‘WORST PAPER OF 2022 COMPETITION’. You will ask what is there to win in this competition? I agree: a competition without a prize is no fun. Therefore, I suggest offering the winner (that is the author of the winning paper) one of my books that best fits his/her subject. I am sure this will over-joy him or her. And how do we identify the winner? I suggest that I continue blogging about nominated papers (I hope to identify about 10 in total), and towards the end of the year, I let my readers decide democratically.
In this spirit of democratic voting, let me suggest to you ENTRY No 6:
This study was to ascertain the efficacy of dry cupping therapy (DCT) and optimal cup application time duration for cervical spondylosis (CS). It was designed as a randomized clinical trial involving 45 participants with clinically diagnosed CS. The eligible subjects were randomly allocated into three groups, each having 15 participants. Each of the three groups, i.e., A, B, and C, received DCT daily for 15 days for 8 min, 10 min, and 12 min, respectively. All the participants were evaluated at the baseline, 7th, and 15th day of the trial using the neck disability index (NDI) as well as the visual analog scale (VAS).
The baseline means ± SD of NDI and VAS scores were significantly reduced in all three groups at the end of the trial. Although all three groups were statistically equal in terms of NDI, group C demonstrated greater efficacy in terms of VAS.
The authors concluded that the per-protocol analysis showed that dry cupping effectively alleviated neck pain across all treatment groups. Although this effect on neck disability index was statistically equal in all three groups, the 12-min protocol was more successful in reducing pain.
Who would design such a study and why?
- The authors claim they wanted to ascertain the efficacy of DCT. A trial is for testing, not ascertaining. And this study does certainly not test for efficacy.
- The groups were too small to generate a meaningful result of what, in fact, was an equivalence study.
- Intra-group changes in symptoms between baseline and time points during treatment are irrelevant in a controlled trial.
- The slightly better results of group C are most likely due to chance or non-specific effects (a longer application of a placebo would generate better outcomes that a shorter one).
- The study participants had cervical spondylosis, yet the conclusion is about neck pain. The two are not identical.
- The title of the paper promises that we learn something about the safety of DCT. Sadly, a trial with just 45 patients has no chance in hell to pick up adverse effects in a reliable way.
- As there is no control group, the study cannot tell us anything about possible specific effects of DCT.
The authors of the study have impressive affiliations:
- Department of Ilaj bil Tadbir, Luqman Unani Medical College Hospital and Research Center, Bijapur, India.
- Department of Ilaj bil Tadbir, National Institute of Unani Medicine, Bengaluru, India.
- Department of Moalajat, Luqman Unani Medical College Hospital and Research Center, Bijapur, India.
I would have hoped that researchers from national institutions and medical colleges should be able to design a trial that has at least a small chance to produce a meaningful finding. As it turns out, my hope was badly disappointed.
HISC (HOMEOPATHY IN THE SUSSEX COMMUNITY) was formed in 2011 and has established effective partnerships with organisations that support those in need. Projects include working with domestic and sexual violence charities as well as supporting people recovering from long-term and enduring mental health illness issues. They enable vulnerable and marginalised members of the Sussex community to access low cost treatment with highly experienced homeopaths.
On 22 July, HISC made the following announcement:
Homeopathy in the Sussex Community (HISC) has been awarded a grant from The National Lottery Community Fund to provide homeopathy to survivors of domestic abuse and sexual violence.
HISC works in partnership with Sussex-based organisations; RISE, and Survivors Network, offering long-term and low-cost homeopathic support to women who have experienced abuse and sexual violence.
This grant will fund these projects for the next year, allowing HISC to build on the valuable work already being done and reaching even more vulnerable women who want access to homeopathic support.
Society Fellow Caroline Jurdon and Registered members Michael Bird, Therese Eriksen, Tara Lavelle and Jo Magowan have all worked on the project with colleagues from the wider community. HISC received one of the Society of Homeopath’s Community Clinic awards in 2018.
HISC also offer volunteering and sitting in opportunities for students.
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The ‘National Lottery Community Fund’ make the following points on their website:
- “Our funding is public money. This means that it cannot be used to give organisations an unlawful advantage.”
- “We fund projects that support people and communities across the UK to thrive.”
I would argue that, for the following reasons, the award is misplaced:
- Public money should not be wasted. It must be invested in projects that have a reasonable chance to do more good than harm.
- A broad consensus exists today that homeopathy has no effect beyond placebo. In fact, the NHS has stopped funding homeopathy and states that “there’s been extensive investigation of the effectiveness of homeopathy. There’s no good-quality evidence that homeopathy is effective as a treatment for any health condition.”
- Homeopathy can endanger lives. If people are misled into believing that it is effective and thus treat serious conditions with homeopathy, they needlessly prolong their suffering or, in the worst case scenario, hasten their death. Awards of the above nature can undoubtedly have this effect.
In my view, this means that the award given to HISC by the National Lottery Community Fund gives an unlawful advantage to an organisation promoting a bogus therapy. At best, it is a waste of public funds, at worst it causes serious harm.
Surely, women who have experienced abuse and sexual violence deserve better!
I have been warning the public about the indirect dangers of so-called alternative medicine (SCAM) for a very long time. It is now 25 years ago, for instance, that I published an article in the ‘European Journal of Pediatrics’ entitled “The attitude against immunisation within some branches of complementary medicine“. Here is the discussion section of this paper:
… certain groupings within COMPLEMENTARY MEDICINE (CM) may advise their patients against immunisation. Within these groupings, there is, of course, a considerable diversity of attitudes towards immunisation. Therefore
generalisations are difficult and more detailed investigations are required to clarify the issue.
The question arises whether the level of advice against immunisation as it exists today represents a real or only a potential risk. One study from the U.K. demonstrates homoeopathy to be the most prevalent reason for non-compliance with immunisation [30]. The problem may not be confined to naturopathy, chiropractic and homoeopathy. Books relating to CM in general [e.g. 19] also strongly advise against immunisation: “Vaccination may provoke the illness which it is supposed to prevent. People who are vaccinated can transmit the illness, even if they are not ill themselves. The vaccine can make the person more susceptible to the illness … The vaccinated child is a contaminated child”.
At present, our data is insufficient to de®ne which proportion of which complementary practitioners share this
attitude. The origin of this stance against vaccination is largely unknown. For instance, there is nothing in Hahnemann’s writings against immunisation [14]. It may therefore stem from a general antipathy toward modern medicine which seems to be prevalent within CM [7, 19, 23]. A more specific reason is that immunisation is viewed as detrimental, burdened with long-term side effects. It is also felt that it is not fully effective and unnecessary because
better methods of protection exist within CM [16].
Anti-immunisation activists are often unable to argue their case rationally, yet they place advertisements in the daily press warning about immunisation. In Britain, one tragic case has recently been publicised. A physician advised parents against measles vaccination for their child who was suspected of suffering from convulsions. Five years later, the child suffered severe brain damage after contracting measles. The doctor was sued by the parents and found guilty of negligence and ordered to pay £825,000 in damages [1].
In medicine we must, of course, always be vigilant about the risks of our interventions. Each form of immunisation should therefore be continuously scrutinised for its possible risks and benefits. Most forms of immunisation are clearly not entirely free of risk [e.g. 22] – in fact, no effective intervention will ever be entirely risk-free. Therefore the risks have to be discounted against the benefits. It follows that any blanket rejection of immunisation, in general, must be misleading. It endangers not only the individual patient but (if prevalent) also the herd immunity of the community at large. Such unreflected rejection of immunisation, in general, will inevitably do more harm than good.
It is concluded that the advice of some, by no means all complementary practitioners in relation to immunisation represents an area for concern, which requires further research. Complementary practitioners and patients alike should be educated about the risks and benefits of immunisation. Paediatricians should be informed about the present negative attitude of some complementary practitioners and discuss the issue openly with their patients.
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I suspect that, had we heeded my caution, researched the subject more thoroughly, and taken appropriate action, the current pandemic might have produced fewer and less vocal anti-vaxxers, and fewer patients might have died.
