methodology
The objective of this paper, as stated by its authors, was to develop an evidence-based clinical practice guideline (CPG) through a broad-based consensus process on best practices for chiropractic management of patients with chronic musculoskeletal (MSK) pain.
Using systematic reviews identified in an initial literature search, a steering committee of experts in research and management of patients with chronic MSK pain drafted a set of recommendations. Additional supportive literature was identified to supplement gaps in the evidence base. A multidisciplinary panel of experienced practitioners and educators rated the recommendations through a formal Delphi consensus process using the RAND Corporation/University of California, Los Angeles, methodology.
The Delphi process was conducted January–February 2020. The 62-member Delphi panel reached consensus on chiropractic management of five common chronic MSK pain conditions:
- low-back pain (LBP),
- neck pain,
- tension headache,
- osteoarthritis (knee and hip),
- fibromyalgia.
Recommendations were made for non-pharmacological treatments, including:
- acupuncture,
- spinal manipulation/mobilization,
- other manual therapy;
- low-level laser (LLL);
- interferential current;
- exercise, including yoga;
- mind–body interventions, including mindfulness meditation and cognitive behavior therapy (CBT);
- lifestyle modifications such as diet and tobacco cessation.
Recommendations covered many aspects of the clinical encounter, from informed consent through diagnosis, assessment, treatment planning and implementation, and concurrent management and referral. Appropriate referral and comanagement were emphasized.
Therapeutic recommendations for low back pain:
- Consider multiple approaches. Both active and passive, and both physical and mind–body interventions should be considered in the management plan. The following are recommended, based on current evidence.
- Exercise
- Yoga/qigong (which may also be considered “mind–body” interventions)
- Lifestyle advice to stay active; avoid sitting; manage weight if obese; and quit smoking
- Spinal manipulation/mobilization
- Massage
- Acupuncture
- LLL therapy
- Transcutaneous electrical nerve stimulation (TENS) or interferential current may be beneficial as part of a multimodal approach, at the beginning of treatment to assist the patient in becoming or remaining active.
- Combined active and passive: multidisciplinary rehabilitation
- CBT
- Mindfulness-based stress reduction
Therapeutic recommendations for neck pain:
- Consider multiple approaches. Both active and passive, and both physical and mind–body interventions should be considered in the management plan for maximum therapeutic effect. The following are recommended, based on current evidence.
- Exercise (range of motion and strengthening).
- Exercise combined with manipulation/mobilization.
- Spinal manipulation and mobilization
- Massage
- Low-level laser
- Acupuncture
- These modalities may be added as part of a multimodal treatment plan, especially at the beginning, to assist the patient in becoming or remaining active:
- Transcutaneous nerve stimulation (TENS), traction, ultrasound, and interferential current.
- Yoga
- Qigong
Therapeutic recommendations for tension headache:
- Consider multiple approaches. Both active and passive, and both physical and mind–body interventions should be considered in the management plan for maximum therapeutic effect. The following are recommended, based on current evidence:
- Reassurance that TTH does not indicate presence of a disease.
- Advice to avoid triggers.
- Exercise (aerobic).
- Spinal manipulation
- Acupuncture
- Cold packs or menthol gels
- Combined active and passive
- CBT
- Relaxation therapy
- Biofeedback
- Mindfulness Meditation
Therapeutic recommendations for knee osteoarthritis:
- Consider multiple approaches. Both active and passive, and both physical and mind–body interventions should be considered in the management plan. The following are recommended, based on current evidence:
- Exercise
- Manual therapy
- Ultrasound
- Acupuncture, using “high dose” (greater treatment frequency, at least 3 × week)
- LLL therapy
Therapeutic recommendations for hip osteoarthritis:
- Consider multiple approaches. Both active and passive, and both physical and mind–body interventions should be considered in the management plan. The following are recommended, based on current evidence6
- Exercise
- Manual therapy
Therapeutic recommendations for fibromyagia:
- Consider multiple approaches. Both active and passive, and both physical and mind–body interventions should be considered in the management plan. The following are recommended, based on current evidence:
- Exercise (aerobic and strengthening)
- Advice on healthy lifestyle
- Education on the condition
- Spinal manipulation
- Myofascial release
- Acupuncture
- LLL therapy
- multidisciplinary rehabilitation
- CBT
- mindfulness meditation
- yoga
- Tai chi,
- Qigong
The authors concluded that these evidence-based recommendations for a variety of conservative treatment approaches to the management of common chronic MSK pain conditions may advance consistency of care, foster collaboration between provider groups, and thereby improve patient outcomes.
This paper is an excellent example of a pseudo-scientific process resulting in unreliable outcomes.
- The Delphi process was conducted some 4 years ago
- Because of the truly weird inclusion criteria, the findings are based essentially on just 3 systematic reviews.
- Anyone who has ever tried to conduct a consensus excercise knows that the outcome will almost entirely depend on who is chosen to sit on the panel. So, all you have to do to obtain pro-chiro recommendations is to select a few pro-chiro ‘experts’ who then write the recommendations!
- A “best practices for chiropractic management” may sound reasonable but, looking at the therapeutic recommendation, one easily realizes that the authors cast their nets so wide that the result has little to do with what differentiates chiropractic from Physiotherapists or osteopaths.
It is therefore not surprising that the recommendations are laughably unreliable: can, for instance, anyone explain to me why “advice on healthy lifestyle and education on the condition” are recommended for fibromyalgia but not for any other condition?
This paper is, in my view, chiropractic pseudo-science at its most ridiculous!
All it really does is it tries to legitimise all sorts of therapies as part of the chiropractic toolbox. My advice to patients is to:
- consult a physio if you need exercise therapy or LLL or manual therapy or ultrasound or interferential current or TENS or cold packs or massage;
- consult a clinical psychologist if you need CBT, or mindfulness, biofeedback;
- consult a doctor if you want rehab or education or lifestyle advice or reassurance;
- etc. etc.
And please avoid chiropractors who pretend they can do all of the above, while merely wanting to manipulate your neck.
Homeopathy was founded some two hundred years ago by Dr Samuel Christian Hahnemann. Over time, it has grown to be among the most frequently used forms of alternative medicine in Europe and the USA. It is underpinned by the principle of ‘like cures like’, where highly diluted substances are used for therapeutic purposes, by producing similar symptoms to when the substance is used in healthy people. Many studies have been published on the value of homeopathy in treating diseases such as cancer, depression, psoriasis, allergic rhinitis, asthma, otitis, migraine, neuroses, allergies, joint disease, insomnia, sinusitis, urinary tract infections and acne, to name a few. An international team recently published a “comprehensive review” of the literature on homeopathy and evaluated its effectiveness in clinical practice.
Their conclusions were as follows:
The current evidence supports a positive role for homeopathy in health and wellbeing across a broad range of different diseases in both adult and paediatric populations. However further research to assess its cost-effectiveness and clinical efficacy in larger studies is required. These findings may encourage healthcare providers and policymakers to consider the integration of homeopathic therapies into current medical practice, to provide a greater sense of patient autonomy and improve the consumer experience.
Medicine is dynamic and continues to evolve. Conventional medicine, while backed by the largest body of evidence thus far to support its safety and efficacy, still has its limitations in terms of side effects and subsequent effects on quality of life. This analysis calls for more in-depth assessment of the current research on homeopathy across a larger range of diseases.
And their ‘Key Summary Points’ were:
- While homeopathy is among the most frequently applied forms of alternative medicine, there is a lack of familiarity with this therapeutic modality within everyday medical practice.
- This review examines some of the available evidence in relation to the impact of homeopathy on a variety of common chronic diseases.
- Homeopathy was found to have the potential for symptom improvement in certain diagnoses within the fields of internal medicine, oncology, obstetrics and mental health.
- Although there is a paucity of studies on homeopathy within the context of standard clinical practice, an opportunity exists for further research into its application by utilising conventional study designs.
To understand how the researchers could arrive at these conclusions, we need to have a look at their methodology. This is their full description:
We conducted a literature review to answer the following research questions:
- What is the current knowledge on the use of homeopathy in clinical practice?
- Has the use of homeopathy achieved beneficial results in patients being treated for specific clinical entities?
Results were then appraised in relation to:
- Population: patients using homeopathy, physicians and homeopaths who reported using homeopathic agents in the included studies
- Intervention: homeopathic remedies
- Control: conventional treatment or no treatment
- Outcome: improvement in patients’ conditions (or positive results)
Keywords were searched in respect of homeopathy (homeopathy; formulas, homeopathic; pharmacopoeias, homeopathic; materia medica and vitalism) and clinical practice (complementary and alternative medicine, health). The following search terms were used: (“homeopathy” OR “formulas, homeopathic” OR “pharmacopoeias, homeopathic” OR “materia medica” OR “vitalism”) AND (“health” OR “complementary and alternative medicine”).
Two electronic databases were searched using the search terms homeopathy, cancer therapy, type 2 diabetes, complementary and alternative medicine, COVID-19 and SARS-CoV-2. Material retrieved was examined to omit overlapping results or duplicates. Publications in languages other than English, and those without full texts accessible online, were excluded.
This article is based on previously conducted studies and does not contain any new study with human participants or animals performed by any of the authors.
___________________________
Two crucial things are missing here:
- An adequate description of which articles were included and which were discarded. A look at the reference list discloses that only articles in favour of homeopathy were considered.
- A description of the critical evaluation performed of the included evidence. A look at the text shows that no critical evaluation took place.
Thus this paper turns out to be not a ‘comprehensive review’ but a ‘comprehensive white-wash’ of homeopathy. Using the methodology of the authors it would be easy, for instance, to publish a comprehensive review demonstrating that the earth is flat.
I sugget the journal editors, peer-reviewers and authors of this idiotic paper bow their heads in shame!
I recently published an article in the German newspaper ‘DIE WELT‘ about the Bavarian Homeopathy trial. My comments did not go down well with the German Association of Homeopathic Doctors (DZVhÄ). Here is their ‘OPEN LETTER’ (my translation) in response to my article (the numbers [in bold brackets refer to my comments below):
Berlin, 11 December 2024: Open letter to Ulf Poschardt, editor-in-chief of the daily newspaper Die Welt, asking whether Prof. Edzard Ernst is really still acceptable as a WELT author. This letter refers to E. Ernst’s article ‘Why a globule study was discontinued’ (DIE WELT, Tuesday, 3 December 2024).
Edzard Ernst is a member of the GWUP (Gesellschaft zur Wissenschaftlichen Untersuchung von Parawissenschaften). (1) This organisation within the so-called sceptic movement has set itself the task of pointing out in the health sector that belief in alternative medicine (‘pseudoscience’) prevents more effective therapies from being used. (2) From this point of view alone, Ernst’s polemic against the iHOM study by the Technical University of Munich[1] misses the mark by a mile, as the study design explicitly does not envisage treating patients with recurrent cystitis ‘either with individually selected homeopathic remedies or a placebo’. On the contrary, it provides for all patients to be treated strictly in accordance with the rules of evidence-based medicine if necessary and if the findings are clear, but also to investigate whether concomitant homeopathic treatment could lead to a reduction in the frequency of antibiotic use. It must be assumed that Ernst has read the study design, but either he is deliberately omitting the true aim of the study or he is simply unable to recognise the difference between a study and his personal fight against homeopathy (3). In both cases, he cannot be taken seriously (!) as an expert on scientific issues in the field of medicine, and certainly not in a serious print medium such as WELT.
Health services research shows: Homeopathy can save antibiotics
The members of the Bavarian state parliament, some of whom were cross-party supporters of this study, were clearly aware of the results of healthcare research, according to which homeopathy can help to reduce the use of antibiotics in defined clinical pictures. In France, for example, a large survey (EPI3-MSD cohort study[2]) came to the conclusion that GPs who use homeopathy for respiratory diseases only use around half as many antibiotics as their conventionally working colleagues. (4) To date, however, there have been no studies that have investigated this at the highest scientific level (randomised, double-blind, placebo-controlled). Against the background of increasing antibiotic resistance worldwide, it was therefore neither ‘ignorance on the part of the Bavarian state government’ nor a foreseeable ‘waste of money’ to investigate this option.(5) If you add to this the fact that panel doctors with an additional qualification in ‘homeopathy’ can even get confirmation in black and white from their panel doctors’ association that their antibiotic consumption is below the average for their respective specialist group, then it would be “unethical” – in complete contrast to Ernst’s assessment – not to have attempted this study. (6)
The article shows the ideological ‘blinding’ of Edzard Ernst
It is clear that Mr (7) Ernst’s ideological ‘blinding’ as an exponent of the sceptic movement (8) leads him, consciously or unconsciously, to draw conclusions that are contrary to open-ended science (9). Reducing the use of antibiotics in the fight against the increasing development of resistance is simply a medical necessity, and those who do not or do not want to face up to this task are manoeuvring themselves into scientific obscurity with flimsy interpretations. (10) The fact that there are individual cases (Italy, child, middle ear infection, globules, dead) in which a method was not applied with sufficient care or expertise does not change this. It should be added at this point that there are always examples in the field of conventional medicine where misdiagnoses can lead to complications or even death. In addition, the RKI (Robert Koch Institute) estimates 9,700 deaths[3] due to antimicrobial resistance, and the trend is rising! Against this dramatic backdrop, Mr Ernst’s polemic should actually be out of the question. (11)
One must come to the same conclusion if one scrutinises the meaning of the reference to a ‘series of experiments in the Third Reich’ and a ‘Homeopathy World Congress’ under Nazi rule. The attempt to discredit homeopathy by pointing out the involvement of homeopathically orientated doctors in the Third Reich is well known. (12) Of course, this usually ignores the fact that the doctors convicted of crimes against humanity at the Nuremberg medical trial were exclusively representatives of the scientific medicine of the time. (13)
However, Ernst’s references to the ‘Third Reich’ conceal something else: the ‘Society of Truth-Loving Men’, which studied the effectiveness of homeopathy in 1835, was a Masonic lodge, and although it was a ‘double-blind trial’, it was of course not ‘the first randomised, placebo-controlled double-blind trial in the history of medicine’, as it is accepted and applied today as a scientific experiment with strict ethical and legal regulations. The first such study worthy of its name was not conducted until 1947 (treatment of tuberculosis with streptomycin). (14)
And of course there was the so-called ‘Donner Report’ (after Dr Fritz Donner), which Ernst indirectly refers to and which summarises the results of drug trials in the ‘Third Reich’. The result was indeed not convincing in favour of homeopathy (15), but this report had a not inconsiderable ‘flaw’: it is extremely problematic in terms of source criticism because it was not written until around two decades after the end of the Second World War, and the original documents Donner referred to have not reappeared and must therefore be considered lost. (16)
If, like Mr Ernst, one sets out in search of arguments against homeopathy and goes back more than half a century (17), then it would also be fair and obvious to mention that the homeopathic medical profession commissioned the Institute for the History of Medicine of the Robert Bosch Foundation years ago to scientifically investigate the role of homeopathic doctors during National Socialism (Mildenberger 2016[4]). The result: to quote Mr Ernst from a different context, there is no more ‘dirt on their sleeves’ than with other professional and socially relevant groups. (18)
Edzard Ernst ignores the current state of homeopathic research
‘Sugar pellets are the basis of many homeopathic treatments. However, all previous research (19) has shown that their effect does not exist.’ This statement by Edzard Ernst is simply wrong! The current state of research is described by the University of Bern as follows: ‘Summarising the current state of preclinical and clinical research, it can be concluded that homeopathic preparations show specific effects that differ from placebo when they are used appropriately…’[5]. (20)
But Ernst could have come up with the idea of comparing the quality of old studies with the current meta-analyses up to a systematic review of six such meta-analyses (Hamre and Kiene, 2023[6]). But he didn’t! If he had, he would have had to admit that the quality and rigour of the latest scientific homeopathy research need not shy away from comparison with studies in conventional medicine. (21)
Based on positive study results, additional homeopathic treatment was included as a treatment option in the medical S3 guideline ‘Complementary medicine in the treatment of oncological patients’[7] in 2021. Ernst also deliberately ignores this treatment recommendation from scientific medical societies. (22)
Edzard Ernst is part of a sceptic association and not the international research community
As an activist of the GWUP (23), Ernst is known for the fact that he has not been scientifically active for a long time (24), but regularly tries to discredit those scientists who conduct research into complementary medical procedures. (25) This uncollegial behaviour has meant that Ernst has not been invited to speak at international scientific research congresses on integrative and complementary medicine for a long time. (26) Agitation, however, is no substitute for a fact-based exchange, but prevents dialogue, in this specific case about the meaning of the Bavarian state government’s commitment. Furthermore, polemics do not contribute in the slightest to coming even a small step closer to a solution to the obvious problem of increasing antibiotic resistance (27). As a reputable print medium, WELT is therefore advised to distance itself from Mr Ernst and his comments or to dismiss him.
[1] https://www.ihom.nephrologie.med/de#iHOM-Studie
[2] https://www.dzvhae.de/homoeopathische-arzneimittel-antibiotika-notstand/epi3laser_study_de-18/
[3] https://www.rki.de/DE/Content/Service/Presse/Pressemitteilungen/2022/06_2022.html
[4] https://www.wallstein-verlag.de/9783835318793-der-deutsche-zentralverein-homoeopathischer-aerzte-im-nationalsozialismus.html
[5] https://www.ikim.unibe.ch/forschung/uebersichten_zum_stand_der_forschung/homoeopathie/index_ger.html
[6] https://pubmed.ncbi.nlm.nih.gov/37805577/
[7] https://register.awmf.org/de/leitlinien/detail/032-055OL
_____________________________________
- If you want to demonstrate how well informed you are, it is always a good idea to start with a falsehood: I left the GWUP about a year ago, a move that created considerable huhah in Germany.
- Wrong again: “The GWUP has set itself the task of promoting science and scientific thinking.”
- My description of the study did not mention that homeopathy was to be used as an add-on. I thought this was obvious (not least because otherwise the study would have not been ethical) but I gladly admit it was my mistake to not spell this out for those who are slow on the uptake.
- These studies merely show that homeopaths tend to prescribe less antiiotics, and the quoted French study was so convincing that the French government promptly ceased the reimbursement of homeopathy.
- I would still argue that my comment is entirely correct here.
- The notion that it might be unethical not to study homeopathy in expensive clinical trials flies in the face of medical ethics.
- Have I been demoted?
- I probably should be flattered to be called an ‘exponend for the skeptic movement’; however, this is far from what I am. I am simply a scientist trying his best to inform the public responsibly.
- In my WELT article, I point out that virtually every respectable panel worldwide looking at the evidence has concluded that homeopathy is a dangerous nonsense. Does that not suggest that my conclusions might be more accurate than those of homeopaths?
- I am all for rigorous research into the over-prescribing of antibiotics, antibiotic resistance, etc. – so much so that I would have used the Euro 800 000 not for the nonsensical homeopathy study but for that purpose.
- Do I detect a bit of the ‘Tu quoque’ fallacy here?
- I mentioned the project not primarily because I wanted to discredit homeopathy, but mostly because it was the largest research project ever conducted in homeopathy. Omitting it in a review of the history would have been wrong.
- The Nuremberg Doctors Tribunal tried barely more than a handfull of physicians, while, in total, hundreds had committed crimes agaimst humanity.
- The 1835 study was a placebo-controlled, randomised study; the streptomycin trial was the first to be generally aknowledged.
- From all we know, the results were devastatingly negative, not just “not convincingly in favour”.
- The original files of the project disappeared in the hands of homeopaths after WWII.
- No, I did a review of the history, for which puropose it is inevitable to go back in time.
- Do I detect more ‘Tu quoque’ fallacy here?
- Mea culpa: I should have written: “all previous credible research”.
- Yes, we recently discussed the current state of research on my blog.
- And we also discussed this review; in neither instance were we impressed!
- The guidelines had to rely on the Frass study which has since been disclosed as fraudulent.
- When you issue a falsehood, it is best to repeat it; only then you can make sure to discredit yourself completely.
- And when you tell one lie, you might as well tell a few more (a simple Medline search would have told them that I am ‘research-active’ to the present day!)
- I have often noticed that homeopaths find it tough to accept or even deal with criticism; they thus often prefer to interpret it as a personal attack and discreditation.
- Yes, why not? It’s fun to add yet another falsehood to the hilarious mix of lies and ad hominem attacks!
- A comment in a newspaper cannot possibly find “a solution to the obvious problem of increasing antibiotic resistance”. This has to be found with rigorous research – something homeopaths would not recognise if it bit them in their behinds.
I am, of course, not surprised that the German homeopath did not like my article. Yet, I am truly amazed by their emarrassingly poor (but highly amusing) arguments against me and my comments. I had hoestly thought they had more sense.
- 85 were controlled trials;
- 79 of these were randomized.
There were many areas where the quality of the studies could be improved. About two-thirds of the 85 controlled trials had either high (42 percent) or unclear (24 percent) risk of bias according to internationally recognized standards for internal validity.
Of the 14 observational (cohort) studies, over one-third did not control for important confounders in the outcome analyses. Regarding external validity, adherence was reported in less than a third of studies (n=31). Forty percent of studies (79% of observational studies) did not report on safety. Regarding model validity, fewer than two-thirds of the studies were consistent with homeopathic principles.
- Iris Bell, M.D., Ph.D., University of Arizona College of Medicine (Retired) and Sonoran University of Health Sciences;
- Dan Cherkin, Ph.D., Osher Center for Integrative Health, Department of Family Medicine, University of Washington;
- Roger Chou, M.D., Department of Medical Informatics & Clinical Epidemiology and Department of Medicine, Oregon Health & Science University;
- Katharina Gaertner, MBBS, Research Faculty of Health, University Witten/Herdecke;
- Klaus Linde, M.D., Ph.D., Scientific Coordinator, Technische Universität München, Institute of General Practice and Health Services Research;
- Alexander Tournier, Ph.D., Homeopathy Research Institute and Institute of Complementary and Integrative Medicine, University of Bern;
- Esther van der Werf, M.Sc., Ph.D., Clinical Research Lead, Homeopathy Research Institute, and Honorary Senior Lecturer, Primary Care Infection, Bristol Medical School, University of Bristol;
- Harald Walach, Ph.D., CHSInstitute.
Two very obvious things should be noted about this panel:
- There are not 9 but only 8 members.
- Almost all are individuals who are pro-homeopathy, and no informed critic of homeopathy was invited.
The latter fact seems important. Anyone who has worked with panels knowns that one can pre-determine the outcome of the deliberations by the choice of the members.
The panel essentially concluded that homeopathic research could be substantially improved. Considering its highly biased composition, this is remarkable. It means that, in fact,
HOMEOPATHIC RESEARCH IS DISMAL.
In this case study, the authors describe an adult patient who struggled with persistent warts on the plantar surface of the foot for several years. All medical therapies were exhausted, so the patient turned to medical hypnosis as a last resort.
The patient experienced complete resolution of all his warts after three sessions of medical hypnosis. The suggestions used in the treatment included:
- strengthening the immune system,
- increasing blood flow in the foot,
- visualizing immune mechanisms destroying infected cells,
- the regrowth of healthy tissue.
After 3 years, the authors are still in contact with the patient, and he reports no recurrence of the disease.
The authors concluded that this case report adds to the existing body of the literature supporting the use of medical hypnosis in the treatment of warts. It demonstrates that medical hypnosis can be a valuable complementary or alternative treatment option for patients with persistent warts who have not responded to conventional therapies. It also highlights the need for further research to better understand the mechanisms by which hypnosis influences the resolution of warts and to identify the most effective types of suggestions for treatment.
Oh, dear!
Warts are viral infections. They can persist for months and years and disappear suddenly without apparent reason. What the authors of this case report observed is exactly this phenomenon of spontaneous recovery. There is no sound evidence that hypnotherapy or any similar treatment will speed up the disappearance of warts.
Many years ago, we did a trial of ‘distant healing’ for warts. It confirmed the ineffectiveness of this approach:
Purpose: Distant healing, a treatment that is transmitted by a healer to a patient at another location, is widely used, although good scientific evidence of its efficacy is sparse. This trial was aimed at assessing the efficacy of one form of distant healing on common skin warts.
Subjects and methods: A total of 84 patients with warts were randomly assigned either to a group that received 6 weeks of distant healing by one of 10 experienced healers or to a control group that received a similar preliminary assessment but no distant healing. The primary outcomes were the number of warts and their mean size at the end of the treatment period. Secondary outcomes were the change in Hospital Anxiety and Depression Scale and patients’ subjective experiences. Both the patients and the evaluator were blinded to group assignment.
Results: The baseline characteristics of the patients were similar in the distant healing (n = 41) and control groups (n = 43). The mean number and size of warts per person did not change significantly during the study. The number of warts increased by 0.2 in the healing group and decreased by 1.1 in the control group (difference [healing to control] = -1.3; 95% confidence interval = -1.0 to 3.6, P = 0.25). Six patients in the distant healing group and 8 in the control group reported a subjective improvement (P = 0.63). There were no significant between-group differences in the depression and anxiety scores.
Conclusion: Distant healing from experienced healers had no effect on the number or size of patients’ warts.
My conclusion of the above case study is therefore very different from that of the original authors:
This case report adds nothing to the existing body of the literature on medical hypnosis or on the treatment of warts other than misleading the public.
Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition affecting children
and adults, characterized by symptoms of inattention, hyperactivity, and impulsivity. Despite the effectiveness of conventional treatments, such as stimulants, side effects drive interest in alternative therapies like homeopathy. This systematic review was aimed at determining the effectiveness of homeopathy as a treatment for ADHD.
A comprehensive search of PubMed, SCOPUS, and Google Scholar was conducted to identify clinical studies evaluating homeopathic treatments for ADHD. After applying selection criteria, eight studies were reviewed, consisting of randomized controlled trials, comparative studies, randomized open-label Pilot study, and clinical trials, were included in the final review.
The results suggest that some homeopathic treatments showed potential in reducing ADHD symptoms, particularly inattention and hyperactivity.
The authors concluded that homeopathy, particularly individualized treatment, shows promise as an adjunct or alternative treatment for ADHD, especially for those children whose caregivers seek alternatives to stimulant medications. Studies report that homeopathic treatment can significantly improve ADHD symptoms in some children, particularly when the correct remedy is identified. However, the evidence is mixed, with several studies showing improvements that may be attributable to the consultation process rather than the remedy itself. Given the increasing interest in Complementary and Alternative Medicine (CAM) among parents of children with ADHD, homeopathy may provide a valuable therapeutic option. Nevertheless, larger, more rigorous trials are required to confirm these findings and establish clear guidelines for its use in clinical practice. The potential for homeopathy to serve as an adjunct to conventional treatments, especially for younger patients or those intolerant to stimulants, remains an area worthy of further exploration.
What journal publishes such misleading drivel? It’s the African Journal of biomedical Research. No, I also had never heard of it! And who are the authors of this paper, their titles and affiliations? Here they are:
- Professor & HOD, Department of Anatomy, Dr. D.Y. Patil Homoeopathic Medical College & Research Centre, Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pimpri, Pune, Maharashtra, India,
- Professor & HOD, Department of Homoeopathic Pharmacy, Dr. D.Y. Patil Homoeopathic Medical College &
Research Centre, Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pimpri, Pune, Maharashtra, India, - Department of Homoeopathic Pharmacy, Dr. D.Y. Patil Homoeopathic Medical College & Research Centre, Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pimpri, Pune, Maharashtra, India,
- Department of Homoeopathic Pharmacy, Dr. D.Y. Patil Homoeopathic Medical College & Research Centre, Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pimpri, Pune, Maharashtra, India,
- Principal, Professor & HOD, Department of Forensic Medicine and Toxicology, Dr. D.Y. Patil Homoeopathic
Medical College & Research Centre, Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pimpri, Pune,
Maharashtra, India.
Five guys with the same name?
No, one chap with 5 rather pomopous titles!
And what is wrong with this ‘systematic review’?
Everything!
It has almost none of the qualities that render a paper a systematic review. Foremost, it does not account for the quality of the primary studies – the most reliable show no effect!
Therefore, I’d like to re-phrase and shorten the conclusions as follows:
There is no reliable evidence to shoe that homeopathy is effective for ADHD.
The alleged harm of Covid-vaccinations is a topic that still leads to misunderstandings, perhaps nowhere more than in the realm of so-called alternative medicine. Therefore, this paper seems relevant.
The first dose of COVID-19 vaccines led to an overall reduction in cardiovascular events, and in rare cases, cardiovascular complications. There is less information about the effect of second and booster doses on cardiovascular diseases. Using longitudinal health records from 45.7 million adults in England between December 2020 and January 2022, this study compared the incidence of thrombotic and cardiovascular complications up to 26 weeks after first, second and booster doses of brands and combinations of COVID-19 vaccines used during the UK vaccination program with the incidence before or without the corresponding vaccination.
The incidence of common arterial thrombotic events (mainly acute myocardial infarction and ischaemic stroke) was generally lower after each vaccine dose, brand and combination. Similarly, the incidence of common venous thrombotic events, (mainly pulmonary embolism and lower limb deep venous thrombosis) was lower after vaccination. There was a higher incidence of previously reported rare harms after vaccination: vaccine-induced thrombotic thrombocytopenia after first ChAdOx1 vaccination, and myocarditis and pericarditis after first, second and transiently after booster mRNA vaccination (BNT-162b2 and mRNA-1273).
The authors concluded that these findings support the wide uptake of future COVID-19 vaccination programs.
The authors stress that their study has several limitations.
- First, residual confounding, including that linked to delayed vaccination in high-risk individuals, may persist despite extensive adjustments for available covariates. We were able to identify some, but not all people who were clinically vulnerable (and hence might have been eligible for earlier vaccination): for example, younger adults in long-stay settings could not be reliably identified.
- Second, we did not adjust for potential confounding by time-varying post-baseline factors that may have influenced receipt of vaccination and the outcomes of interest: for example, development of respiratory symptoms or being admitted into hospital leading to postponement of vaccination. Such confounding may explain estimated lower hazard ratios soon after vaccination.
- Third, ascertainment of some outcomes may have been influenced by public announcements from regulatory agencies, such as the European Medicines Agency Pharmacovigilance Risk Assessment Committee announcement or the CDC announcement on myocarditis. This was addressed in sensitivity analyses for myocarditis and pericarditis, censoring follow-up at the time of public announcements of these adverse effects of vaccination, although the shorter follow-up times and corresponding smaller numbers of events in the restricted analyses meant that aHRs were estimated with reduced precision.
- Fourth, outcomes may be underreported, particularly from people in nursing homes or among those with severe health conditions, due to diagnostic challenges; also, routine electronic health records, not intended for research, may under-ascertain less severe, non-hospitalised events. Both forms of potential underreporting, however, are expected to be uncommon for hospitalised thrombotic events.
- Fifth, we restricted follow-up to 26 weeks after vaccination to prevent an influence of subsequent vaccinations on estimated associations and limit the impact of delayed vaccination on our findings. Horne et al. demonstrated selection bias in estimated HRs for non-COVID-19 death arising from deferred next-dose vaccination in people with a recent confirmed COVID-19 diagnosis or in poor health.
- Sixth, we did not address long-term safety of vaccination, or the impact of subsequent booster doses.
Nonetheless, this study offers reassurance regarding the cardiovascular safety of COVID-19 vaccines, with lower incidence of common cardiovascular events outweighing the higher incidence of their known rare cardiovascular complications. No novel cardiovascular complications or new associations with subsequent doses were found. These findings support the wide uptake of future COVID-19 vaccination programs. The authors express their hope that this evidence addresses public concerns, supporting continued trust and participation in vaccination programs and adherence to public health guidelines.
Will the evidence convince the notorious anti-vaxers that regularly comment on my blog?
I very much doubt it – not because of the limitations of the study but because of the fact that anti-vaxers seem to be immune to any evidence that is out of line with their beliefs and conspiracy theories.
Dry needling (DN) is a treatment used by various healthcare practitioners, including physical therapists, physicians, and chiropractors. It involves the use of either solid filiform needles or hollow-core hypodermic needles for therapy of muscle pain, including pain related to myofascial pain syndrome. DN is mainly used to treat myofascial trigger points, but it is also used to target connective tissue, neural ailments, and muscular ailments. There is conflicting evidence regarding the effectiveness of DN for any condition.
Orofacial pain (OFP) typically has a musculoskeletal, dental, neural, or sinogenic origin. Our systematic review was aimed at evaluating the evidence base for the effectiveness of DN for OFP.
We searched Medline, Cochrane Central, and Web of Science (from their respective inceptions to February 2024) for RCTs evaluating the effectiveness of DN in patients with OFP. Studies with patients suffering from cervicogenic or tension type headaches as well as observational studies were excluded. Primary outcomes were pain intensity and severity; secondary outcomes were disability, quality of life, and adverse effects (AEs). The review adhered to the methods described by in the Cochrane Handbook.
Twenty-four RCTs with a total of 1,318 patients suffering from OFP could be included. Most had an unclear or high risk of bias, and the quality of the evidence ranged from very low to low for all comparisons and outcomes. A meta-analysis suggested that, compared with usual care alone, DN + usual care had no effect on pain intensity (visual analogue scale) (standardized mean difference = −1.89, 95% confidence intervals −5.81 to 2.02, very low certainty evidence) at follow-ups of up to 6 weeks. Only 6 RCTs (25%) mentioned AEs, and none of them reported that AEs had occurred. The remaining 18 (75%) studies failed to report AEs.
We concluded that DN cannot be considered as an effective treatment option for OFP. This is due to the uncertainties of the available evidence. We believe that larger, rigorous, and better reported trials with more homogeneous comparators might potentially reduce the current uncertainties. Such trials should strictly adhere to the classifications provided by the International Headache Society and published in the International Classification of Orofacial Pain.
Yet again, I need to stress that the vast majority od RCTs failed to mention AEs. When will the last (pseudo-) researcher have learnt that the non-reporting of AEs is a violation of research ethics?
The Bavarian homeopathy study has been aborted!
As I posted in 2019, the Bavarian government has given the go-ahead to a major study of homeopathy.
The study was aimed at clarifying whether the use of homeopathic remedies can reduce the use of antibiotics in humans and animals. The vote was carried because of the CDU delegates being in favour. The debate of the project was, however, controversial. Critics stressed that, at best, the study is superfluous and pointed out that the project is negligent because it implies that homeopathics might be effective, whereas the evidence shows the opposite. A SPD delegate stated that he is ‘open moth’, homeopathy works because of the doctor-patient contact and not because of its remedies which are pure placebos. The project was tabled because some people had worried about antibiotic resistance and felt that homeopathy might be an answer. Some CSU delegates stated that in ENT medicine, there is evidence that homeopathics can reduce the use of antibiotics. Even in cases of severe sepsis, there was good evidence, they claimed.
The FRANKFURTER ALLGEMEINE just reported more details about this remarkable project and its failure to produce meaningful results:
The double-blind, placebo-controlled RCT carried out at the Technical University of Munich examined women with regular urinary tract infections – all were to be given antibiotics or ibuprofen if necessary. Around 120 of the women were to receive either placebo or individually selected globules as a preventative measure. Differences were to be measured by whether infections occurred less frequently in the globule group and whether antibiotics were necessary.
The results should have been available a long time ago. However, as the lead-investigator of the study, nephrologist Lutz Renders, has now revealed that the study has apparently come to nothing. ‘The study has cancelled recruitment because the required number of test subjects could not have been reached within a reasonable period of time,’ he explains. Only the women who have already been included will now be followed up until the beginning of 2025.
‘Of the 200 or so women who registered, around 40 were found to have urinary tract infections’, says Renders, ‘so that they could be included in the study. It is a pity that the actual aim of the study was not achieved, as it is possible that something could be learnt about urinary tract infections in general from the extensive examinations of the women. I don’t have much to do with homeopathy,’ says Renders.
Georg Schmidt, head of the ethics committee at the Technical University of Munich, says that the committee found it ‘extremely difficult’ to authorise the study at all. ‘We had a heated discussion along the lines that you can’t compare nothing with nothing. We all agreed that homeopathy is ineffective.’ The commission decided to ensure that the risk of a false-positive result is as low as possible – the statistics have been tightened up for this purpose’.
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The notion that a definitive test of homeopathy is needed seems to beset German govenments from time to time – the last such initiative occurred during the Third Reich. Perhaps, one day, even politicians will understand that, on the scientific level, the discussion about homeopathy is now well and truly over, and that no more money needs to be wasted on it?
This study evaluated the real-world impact of acupuncture on analgesics and healthcare resource utilization among breast cancer survivors.
The authors selected from a United States (US) commercial claims database (25% random sample of IQVIA PharMetrics® Plus for Academics) 18–63 years old malignant breast cancer survivors who were experiencing pain and were ≥ 1 year removed from cancer diagnosis. Using the difference-in-difference technique, annualized changes in analgesics [prevalence, rates of short-term (< 30-day supply) and long-term (≥ 30-day supply) prescription fills] and healthcare resource utilization (healthcare costs, hospitalizations, and emergency department visits) were compared between acupuncture-treated and non-treated patients.
Among 495 (3%) acupuncture-treated patients (median age: 55 years, stage 4: 12%, average 2.5 years post cancer diagnosis), most had commercial health insurance (92%) and experiencing musculoskeletal pain (98%). Twenty-seven percent were receiving antidepressants and 3% completed ≥ 2 long-term prescription fills of opioids. Prevalence of opioid usage reduced from 29 to 19% (P < 0.001) and NSAID usage reduced from 21 to 14% (P = 0.001) post-acupuncture. The relative prevalence of opioid and NSAID use decreased by 20% (P < 0.05) and 19% (P = 0.07), respectively, in the acupuncture-treated group compared to non-treated patients (n = 16,129). However, the reductions were not statistically significant after adjustment for confounding. Patients receiving acupuncture for pain (n = 264, 53%) were found with a relative decrease by 47% and 49% (both P < 0.05) in short-term opioid and NSAID fills compared to those treated for other conditions. High-utilization patients (≥ 10 acupuncture sessions, n = 178, 36%) were observed with a significant reduction in total healthcare costs (P < 0.001) unlike low-utilization patients.
The authors concluded that, although adjusted results did not show that patients receiving acupuncture had better outcomes than non-treated patients, exploratory analyses revealed that patients treated specifically for pain used fewer analgesics and those with high acupuncture utilization incurred lower healthcare costs. Further studies are required to examine acupuncture effectiveness in real-world settings.
Oh, dear!
Which institutions support such nonsense?
- School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, 802 W Peltason Dr, Irvine, CA, 92697-4625, USA.
- School of Pharmacy, Chapman University, RK 94-206, 9401 Jeronimo Road, Irvine, CA, 92618, USA.
- College of Korean Medicine, Kyung Hee University, Seoul, South Korea.
- Integrative Medicine Program, Departments of Supportive Care Medicine and Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
- School of Pharmacy, Chapman University, RK 94-206, 9401 Jeronimo Road, Irvine, CA, 92618, USA. [email protected].
- School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, 802 W Peltason Dr, Irvine, CA, 92697-4625, USA. [email protected].
And which journal is not ashamed to publish it?
It’s the BMC Med!
The conclusion is, of course, quite wrong.
Please let me try to formulate one that comes closer to what the study actually shows:
This study failed to show that a ‘real world impact’ of acupuncture exists. Since the authors were dissatisfied with a negative result, subsequent data dredging was undertaken until some findings emerged that were in line with their expectations. Sadly, no responsible scienctist will take this paper seriously.
