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

naturopathy

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As discussed regularly on this blog, there is plenty of evidence to show that many chiropractors, homeopaths, and naturopaths discourage their patients from getting vaccinated. Now, a further investigation from the US seems to confirm these findings.

This analysis aims to evaluate differences between categories of so-called alternative medicine (SCAM) regarding vaccination behavior among US adults.

The data from the 2017 National Health Interview Survey (NHIS; n = 26,742; response rate 80.7%) was used for this purpose. Prevalences of flu vaccination, consultations with SCAM practitioners in the past 12 months, and their potential interactions were examined.

A total of 42.7% of participants had received the flu vaccination in the past 12 months, 32.4% had seen one or more SCAM practitioners. Users of any type of SCAM were as likely as non-users to have received a flu vaccination (44.8% users versus 41.7% non-users; p = 0,862; adjusted odds ratio [AOR] = 1.01, 95% confidence interval [CI] = 0.95-1.07).

Regarding specific SCAMs, individuals consulting with

  • naturopaths (p < 0.001; AOR = 0.67, 95 %CI = 0.54-0.82),
  • homeopaths (p < 0.001; AOR = 0.55; 95 %CI = 0.44-0.69),
  • chiropractors (p = 0.016; AOR = 0.9, 95 %CI = 0.83-0.98)

were less likely, while other SCAM approaches showed no significant association with flu vaccination behavior. Independent predictors for a flu shot were prior diabetes, cancer, current asthma, kidney disease, overweight and current pregnancy. As well, higher educational level, age, ethnicity, health insurance coverage, and having seen a general physician or medical specialist in the past 12 months were also associated with a higher vaccination rate.

The authors concluded that SCAM users were equally likely to receive an influenza vaccination compared with non-users. Different complementary therapies showed varied associations with vaccination behavior. Further analyses may be needed to distinguish influencing factors among patients’ vaccination behavior.

This investigation confirms the prevalent anti-vax stance within chiropractic, homeopathy, and naturopathy. The effect is strongest by far with homeopaths. Nothing new! We knew this for a very long time. The question is WHAT ARE WE DOING ABOUT IT? Or more specifically, are the professional organizations of these SCAM professions finally going to take any actions against even the most rabid anti-vaxxers in their midst?

And the answer?

You guessed it: NO!

And the irony of all this must not get lost here: chiropractors, homeopaths, naturopaths, and their respective organizations all pride themselves regularly that they attribute particular importance to disease prevention.

Recently, I wrote about the court case of a French naturopath. Last week, the judge has issued his verdict. Miguel Barthéléry was sentenced to a two-year suspended prison term and to a fine of 5 000 Euros. Two cancer patients had died following his treatments and recommendations. Barthéléry was also found guilty of impersonating a doctor and illegally practising medicine. In addition, he was also banned for life from practising as a healthcare professional.

The Paris criminal court found that Miguel Barthéléry had deliberately created confusion about his qualifications by presenting himself as a doctor on the internet and in text messages to the two victims. The defendant had claimed to have a doctorate and a post-doctorate from the United States. The judgment “has the consequence of dissuading all those who engage in the same abuses, they are now warned that we can not do anything with the health of people,” said the judge.

The case had begun in February 2019 with the complaint of the companion of a man who had died two months earlier of testicular cancer. Diagnosed in 2016, the patient had not consulted a doctor but had preferred to follow a “health plan” drawn up by the naturopath. It was based on fasting and cures, raw food, and essential oils. Later, the family of a Belgian physiotherapist, who died of uterine cancer at the age of 39, joined the legal case. However, according to Code Source, the Parisien podcast, the case is more extensive, with seven further suspicious deaths of Barthéléry’s patients.

Barthéléry’s lawyer said that the decision “raises questions more generally about the appreciation that we now have of alternative therapeutic practices, which now seem, although not prohibited by law, to be subject to condemnation by the courts.”

 

I was asked by the ‘Science Media Centre’ (SMC) to provide a short comment on the following press release (which was embargoed until today):

Daily use of cannabidiol (‘CBD’) oil may be linked to lung cancer regression 

… The report authors describe the case of a woman in her 80s, diagnosed with non-small cell lung cancer. She also had mild chronic obstructive pulmonary disease (COPD), osteoarthritis, and high blood pressure, for which she was taking various drugs.

She was a smoker, getting through around a pack plus of cigarettes every week (68 packs/year).

Her tumour was 41 mm in size at diagnosis, with no evidence of local or further spread, so was suitable for conventional treatment of surgery, chemotherapy, and radiotherapy. But the woman refused treatment, so was placed under ‘watch and wait’ monitoring, which included regular CT scans every 3-6 months.

These showed that the tumour was progressively shrinking, reducing in size from 41 mm in June 2018 to 10 mm by February 2021, equal to an overall 76% reduction in maximum diameter, averaging 2.4% a month, say the report authors.

When contacted in 2019 to discuss her progress, the woman revealed that she had been taking CBD oil as an alternative self-treatment for her lung cancer since August 2018, shortly after her original diagnosis.

She had done so on the advice of a relative, after witnessing her husband struggle with the side effects of radiotherapy. She said she consistently took 0.5 ml of the oil, usually three times a day, but sometimes twice.

The supplier had advised that the main active ingredients were Δ9-­tetrahydrocannabinol (THC) at 19.5%, cannabidiol at around 20%, and tetrahydrocannabinolic acid (THCA) at around 24%.

The supplier also advised that hot food or drinks should be avoided when taking the oil as she might otherwise feel stoned. The woman said she had reduced appetite since taking the oil but had no other obvious ‘side effects’. There were no other changes to her prescribed meds, diet, or lifestyle. And she continued to smoke throughout.

This is just one case report, with only one other similar case reported, caution the authors. And it’s not clear which of the CBD oil ingredients might have been helpful.

“We are unable to confirm the full ingredients of the CBD oil that the patient was taking or to provide information on which of the ingredient(s) may be contributing to the observed tumour regression,” they point out.

And they emphasise: “Although there appears to be a relationship between the intake of CBD oil and the observed tumour regression, we are unable to conclusively confirm that the tumour regression is due to the patient taking CBD oil.”

Cannabis has a long ‘medicinal’ history in modern medicine, having been first introduced in 1842 for its analgesic, sedative, anti-inflammatory, antispasmodic and anticonvulsant effects. And it is widely believed that cannabinoids can help people with chronic pain, anxiety and sleep disorders; cannabinoids are also used in palliative care, the authors add.

“More research is needed to identify the actual mechanism of action, administration pathways, safe dosages, its effects on different types of cancer and any potential adverse side effects when using cannabinoids,” they conclude.

The SMC published three invited comments:

Prof David Nutt, The Edmond J Safra Chair in Neuropsychopharmacology, Imperial College London, said: 

“This is one of many such promising single case reports of medical cannabis self-treatment for various cancers.  Such case reports are biologically credible given the adaptogenic nature of the endocannabinoid system.  A case report itself is not sufficient to give any form of proof that one thing caused the other – we need trials for that.  There are some controlled trials already started and more are required to properly explore the potential of medical cannabis in a range of cancers.”

Prof Edzard Ernst, Emeritus Professor of Complementary Medicine, University of Exeter, said: 

“Cannabinoids have been shown to reduce the size of prostate cancer tumours in animal models.  Previous case reports have yielded encouraging findings also in human cancers.  However, case reports cannot be considered to be reliable evidence, and there are currently no data from rigorous clinical trials to suggest that cannabis products will alter the natural history of any cancer.” 

Dr Tom Freeman, Senior Lecturer and Director of the Addiction and Mental Health Group, University of Bath, said: 

“These results are exciting and very encouraging for this patient.  However as a single case study the quality of scientific evidence is low and should not be used to change clinical practice.  People with lung cancer should always seek guidance from a healthcare professional when deciding on an appropriate treatment. 

“The product used by this patient reportedly contained high levels of THC (the intoxicating component of cannabis), and was sourced from outside the UK.  This type of product is very different to most CBD oils which predominantly contain CBD.  Unlike prescribed medicines, CBD wellness products lack assurance of quality, safety or efficacy and should not be used for medicinal purposes.”

The original paper has now been published and can be found here.

The global market for dietary supplements has grown continuously during the past years. In 2019, it amounted to around US$ 353 billion. The pandemic led to a further significant boost in sales. Evidently, many consumers listened to the sly promotion by the supplement industry. Thus they began to be convinced that supplements might stimulate their immune system and thus protect them against COVID-19 infections.

During the pre-pandemic years, the US sales figures had typically increased by about 5% year on year. In 2020, the increase amounted to a staggering 44 % (US$435 million) during the six weeks preceding April 5th, 2020 relative to the same period in 2019. The demand for multivitamins in the US reached a peak in March 2020 when sales figures had risen by 51.2 %. Total sales of vitamins and other supplements amounted to almost 120 million units for that period alone. In the UK, vitamin sales increased by 63 % and, in France, sales grew by around 40–60 % in March 2020 compared to the same period of the previous year.

Vis a vis such impressive sales figures, one should ask whether dietary supplements really do produce the benefit that consumers hope for. More precisely, is there any sound evidence that these supplements protect us from getting infected by COVID-19? In an attempt to answer this question, I conducted several Medline searches. Here are the conclusions of the relevant clinical trials and systematic reviews that I thus found:

Confused?

Me too!

Does the evidence justify the boom in sales of dietary supplements?

More specifically, is there good evidence that the products the US supplement industry is selling protect us against COVID-19 infections?

No, I don’t think so.

So, what precisely is behind the recent sales boom?

It surely is the claim that supplements protect us from Covid-19 which is being promoted in many different ways by the industry. In other words, we are being taken for a (very expensive) ride.

Traditional European Medicine (TEM) is an increasingly popular yet ill-defined term. Like Traditional Chinese Medicine (TCM), it encompasses all the traditional therapies from the respective region. One website describes it with this very odd graph:

On Medline, I found only very few papers on TEM. One article reported about a congress based on the concept of TEM but confusingly called it ‘European Traditional Medicine (ETM). Here are a few excerpts:

… the aim of this congress is to explore and survey, very old and modern traditional based therapies and treatments curing the principles of scientific medicine (). Discussions of the links between ETM and other traditional medicines therefore are mandatory, particularly when considering the importance of traditionally based therapies that are still a source of primary health care to about 70 percent of the world’s population. Connections between traditional medicine and human health have been addressed and commented upon by many national and international political and sanitary bodies because: a) the good health of populations requires enlightened management of our social resources, economic relations, and of the natural world, and b) that many of today’s public-health issues have their roots in lack of scientifically sustainable holistic approach to the patient c) many socioeconomic inequalities and irrational consumption patterns that jeopardize the future economic sustainability of health.

In the same context the conventional biomedical approach to health is based on methods of diagnosing and treating specific pathologies: one pathogen = one disease, an approach that does not take into account connections between diseases, humanity, and some psychological aspects of suffering, and other socioeconomic factors such as poverty and education, and even the connections between disease and the environment in which sick people lives (,).

Other authors, like the one on this website, are much more concrete. Again, a few excerpts must suffice:

Bloodletting
When bloodletting according to Hildegard von Bingen max. 150 ml of blood taken. It is one of the most valuable and fastest detoxification options in TEM. In some people, no blood comes, because the body has no need to excrete something. For others, the doctor may say a lot about human health after the blood has been left for about 2 hours. If the serum is yellowish or whitish, this indicates excess fats. If certain threads form, they are signs of inflammation. Then the doctor gives recommendations for certain herbs and applications.

Wraps and packs
Whether neck wrap or hay flower sack. In TEM, there are many natural remedies made from natural materials (clay, pots) and herbs that support the body’s self-healing powers.

Wyda instead of yoga
Wyda is a holistic philosophy that is about getting in touch with yourself. In doing so, one can relax through flowing exercises and energy sounds, strengthen one’s mind or stimulate the metabolism. The exercises are similar in some ways to yoga. Here you can learn more about European yoga!

Which archetype are you?

In Traditional European Medicine (TEM), the archetype of a human is first determined so that the TEM doctor can coordinate the treatments. There are 4 temperatures:

Sanguine: He is active, open-hearted, energetic and mostly optimistic and cheerful. He is not resentful and does what he enjoys.
Suitable use: cool applications such as chest and liver wrap, whole body rubbings with grape seed and lemon balm oils.
Abandonment: too much sweet and fat, animal foods, sweet alcohol.

Choleric: He has a hot temper, shows leadership qualities, is prone to hyperbole, emotional and outbursts of anger, is extroverted, but often uncontrolled. Suitable application: cooling and calming applications. Massages with thistle, almond and lavender oils.
Avoidance of: too much animal protein, alcohol, hot spices and fatty foods.

Phlegmatic: enjoyment is important to him. He is reliable, can accomplish things, but seldom initiate. To get going causes him problems when he “runs”, then persistently and with energy.
Suitable application: warming and drying applications, warm chest wraps. Abdominal massages with camelina oil, marigold ointment.
Abandonment: too much sweets, milk, whole grains, tropical fruits, pork, too many carbohydrates.

Melancholic: He is an admonisher and a thinker, appreciates beauty and intelligence, is more introverted. He tends to ponder and pessimism, struggling for an activity.
Suitable use: warm applications such as warm chest wraps and liver wrap. Clay in water in the morning relieves gastrointestinal discomfort. Massages with strengthening cedar nut oil.
No: Frozen food, raw food, hard to digest, too much salt and sugar.

Yes, much of this is dangerous nostalgic nonsense that would lead us straight back into the dark ages.

Do we need more of this in so-called alternative medicine (SCAM)?

Definitely not!

TCM was created by Mao as a substitute for real medicine, at a time when China was desperately short of medicine. The creators of TEM have no such reason or motivation. So, why do they do it?

Search me!

Mesotherapy is a treatment where fine needles or a high-pressure ‘gun’ are used to inject vitamins, enzymes, hormones, plant extracts, etc. into the skin of a patient. Michel Pistor, a French doctor, developed the therapy in 1952. It was originally used to relieve pain. Today, mesotherapy is also employed for a range of further indications:

  • remove fat in areas like the stomach, thighs, buttocks, hips, legs, arms, and face
  • reduce cellulite
  • fade wrinkles and lines
  • tighten loose skin
  • recontour the body
  • lighten pigmented skin
  • treat alopecia, a condition that causes hair loss

Mesotherapy is said to deliver drugs into the middle layer (mesoderm) of the skin. It is claimed to correct underlying issues like poor circulation and inflammation that cause skin damage.

Many different drugs can be used for mesotherapy, including:

  • prescription medicines like vasodilators and antibiotics
  • hormones such as calcitonin and thyroxin
  • enzymes like collagenase and hyaluronidase
  • herbal extracts
  • homeopathic remedies
  • vitamins and minerals
  • vaccines

According to the Italian Mesotherapy Society, the mechanisms of action of mesotherapy can be summarised as follows:

But is there at all any sound evidence that mesotherapy works?

It turns out that there are few rigorous studies. The most recent review concluded that mesotherapy proved to be more effective than systemic therapy in the treatment of local pain and functional limitations caused by a variety of musculoskeletal conditions. However, because of the heterogeneity of the analysed studies in terms of injected drugs, administration technique, associated treatments, frequency and total number of sessions, more randomized controlled trials are needed, comparing a standardized mesotherapy protocol with a systemic treatments.

Mesotherapy is not free of serious adverse effects. They include bacterial infections, hair loss, scarring, panniculitis, tissue necrosis, allergic reactions, and other complications.

So, is mesotherapy a treatment that might be recommended?

  • Its effectiveness remains unproven.
  • It can cause serious adverse effects.
  • It is by no means cheap.

I think these facts answer the question fairly well.

Kneipp therapy goes back to Sebastian Kneipp (1821-1897), a catholic priest who was convinced to have cured himself of tuberculosis by using various hydrotherapies. Kneipp is often considered by many to be ‘the father of naturopathy’. Kneipp therapy consists of hydrotherapy, exercise therapy, nutritional therapy, phototherapy, and ‘order’ therapy (or balance). Kneipp therapy remains popular in Germany where whole spa towns live off this concept.

The obvious question is: does Kneipp therapy work? A team of German investigators has tried to answer it. For this purpose, they conducted a systematic review to evaluate the available evidence on the effect of Kneipp therapy.

A total of 25 sources, including 14 controlled studies (13 of which were randomized), were included. The authors considered almost any type of study, regardless of whether it was a published or unpublished, a controlled or uncontrolled trial. According to EPHPP-QAT, 3 studies were rated as “strong,” 13 as “moderate” and 9 as “weak.” Nine (64%) of the controlled studies reported significant improvements after Kneipp therapy in a between-group comparison in the following conditions:

  • chronic venous insufficiency,
  • hypertension,
  • mild heart failure,
  • menopausal complaints,
  • sleep disorders in different patient collectives,
  • as well as improved immune parameters in healthy subjects.

No significant effects were found in:

  • depression and anxiety in breast cancer patients with climacteric complaints,
  • quality of life in post-polio syndrome,
  • disease-related polyneuropathic complaints,
  • the incidence of cold episodes in children.

Eleven uncontrolled studies reported improvements in allergic symptoms, dyspepsia, quality of life, heart rate variability, infections, hypertension, well-being, pain, and polyneuropathic complaints.

The authors concluded that Kneipp therapy seems to be beneficial for numerous symptoms in different patient groups. Future studies should pay even more attention to methodologically careful study planning (control groups, randomisation, adequate case numbers, blinding) to counteract bias.

On the one hand, I applaud the authors. Considering the popularity of Kneipp therapy in Germany, such a review was long overdue. On the other hand, I am somewhat concerned about their conclusions. In my view, they are far too positive:

  • almost all studies had significant flaws which means their findings are less than reliable;
  • for most indications, there are only one or two studies, and it seems unwarranted to claim that Kneipp therapy is beneficial for numerous symptoms on the basis of such scarce evidence.

My conclusion would therefore be quite different:

Despite its long history and considerable popularity, Kneipp therapy is not supported by enough sound evidence for issuing positive recommendations for its use in any health condition.

Last week, a naturopath who has been practicing naturopathy for more than three years, appeared in the Paris High Court. He is accused of “illegal practice of medicine” and of “usurpation of the title of doctor” after two of his cancer patients died.

Charles B. was diagnosed with testicular cancer in 2016 but wanted to avoid traditional medicine. In March 2017, he consulted the naturopath, Miguel B., who studied for fourteen years in the United States and has a degree in biochemistry and a doctorate in molecular medicine. He knew that his qualifications did not allow him to practice in France and presented himself as a naturopath. Knowing about his client’s cancer, Miguel B. drew up a health plan for him that included numerous fasts and purges to detox his body.

In the following months, the cancer spreads to the lungs and brain. Charles B. wrote to his naturopath in early February: “Great pain, don’t know what to do”. The naturopath continued his advice: “You should go on a diet, rest and purge in the evening. In court, Charles B.’s father recalled a conversation between his son and Miguel B. during which the latter had said to Charles B.: “It would be a pity if you were to undergo this chemotherapy.” On 22 February 2018, now weighing only 59 kg, Charles B. finally decided to start chemotherapy. But it was already too late, and he died on 18 December 2018, at the age of 41, of a cancer from which more than 98% of patients usually recover. Charles B.’s wife stated that the naturopath had told her husband that he would not need chemotherapy. She believes that the defendant is “responsible and even guilty” of her husband’s death.

The family of another patient of Miguel B. has also joined the case. Catherine F., who had been suffering from cervical cancer, died at the age of 39. She had followed, among other treatments, a fast recommended by the naturopath and was one of 149 further patients whose list was found on a USB stick belonging to the defendant.

 

 

Prior research has generated inconsistent results regarding vaccination rates among patients using so-called alternative medicine (SCAM). Given that SCAM includes a wide range of therapies – about 400 different treatments have been counted – variable vaccination patterns may occur within consultations with different types of SCAM practitioners.

A recent analysis aimed to evaluate differences between categories of SCAM regarding vaccination behavior among US adults.

Data from the 2017 National Health Interview Survey (NHIS; n = 26,742; response rate 80.7%) were used. Prevalences of flu vaccination, consultations with SCAM practitioners in the past 12 months, and their potential interactions were examined. 42.7% of participants had received the flu vaccination in the past 12 months, 32.4% had seen one or more SCAM practitioners. Users of any type of SCAM were as likely as non-users to have received a flu vaccination (44.8% users versus 41.7% non-users; p = 0,862; adjusted odds ratio [AOR] = 1.01, 95% confidence interval [CI] = 0.95–1.07).

Regarding specific SCAM types,

  • individuals consulting with naturopaths (p < 0.001; AOR = 0.67, 95 %CI = 0.54–0.82),
  • homeopaths (p < 0.001; AOR = 0.55; 95 %CI = 0.44–0.69)
  • chiropractors (p = 0.016; AOR = 0.9, 95 %CI = 0.83–0.98)

were less likely to be vaccinated. Other SCAMs showed no significant association with flu vaccination behavior. Independent predictors for a flu shot were prior diabetes, cancer, current asthma, kidney disease, overweight and current pregnancy. As well, higher educational level, age, ethnicity, health insurance coverage, and having seen a general physician or medical specialist in the past 12 months were also associated with a higher vaccination rate.

The authors concluded that SCAM users were equally likely to receive an influenza vaccination compared with non-users. Different SCAM therapies showed varied associations with vaccination behavior. Further analyses may be needed to distinguish influencing factors among patients’ vaccination behavior.

This survey confirms what we have discussed repeatedly on this blog (see, for instance here, here, here, here, and here). The reason why consumers who consult naturopaths, homeopaths, or chiropractors get vaccinated less regularly is presumably that these practitioners tend to advise against vaccinations. And why do they do that?

  • Naturopaths claim that vaccines are toxic and their therapeutic options protect against infections.
  • Homeopaths claim that vaccines are toxic and their therapeutic options protect against infections.
  • Chiropractors claim that vaccines are toxic and their therapeutic options protect against infections.

Do these ‘therapeutic options’ – detox, nosodes, spinal manipulation – have anything in common?

Yes, they are bogus!

Conclusion:

Many naturopaths, homeopaths, and chiropractors seem to be a risk to public health.

It has recently been reported that a Canadian naturopath claims he can treat autism with fecal transplants at a clinic in Mexico.  The College of Naturopathic Physicians of B.C. has thus barred him stating that it has taken “extraordinary action” against Jason Klop in response to a complaint from a whistle-blowing former employee, who alleges that he manufactured these products in a “household lab” in B.C. without standard procedures or quality control.

While the complaint is under investigation, Klop cannot manufacture, advertise or sell fecal microbiota transplants (FMT). He’ll also be subject to random on-site audits to make sure he’s not violating his conditions.

This is the first public sign of concrete action by the college since CBC News reported on Klop’s business in January 2020 — nearly 20 months ago. Klop has been charging about $15,000 US for autistic children as young as two years old to have FMT treatment at a clinic near Tijuana. The process isn’t approved as a treatment of autism and carries serious risks of infection.

An illustration shows how fecal microbiota transplants are produced. (Vancouver Island Health Authority)

In a promotional video posted in January, Klop says he believes that “precision manipulation of the gut microbiome will solve every single chronic disease.” He also issued an affidavit boasting that he has a new lab that “produces the best and safest FMT materials in the world” and described the former employee who complained as “manifestly unreliable.” Klop argued that “lives are at stake” if he were to stop what he’s doing and described his therapy as a “life-saving measure.”

_____________________

Is there any evidence at all for FMT as a treatment of autism? A recent systematic review drew this conclusion: evidence from human studies suggesting beneficial effects of probiotic, prebiotic, and combination thereof, as well as fecal transplants in autism spectrum disorder, is limited and inconclusive.

 

 

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