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

neglect

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On this blog we have seen just about every variation of misdemeanors by practitioners of so-called alternative medicine (SCAM). Today, I will propose a scale and rank order of these lamentable behaviours. As we regularly discuss chiropractic and homeopathy here, I decided to use these two professions as examples (but I could, of course, have chosen almost any other SCAM).

  1. Treating conditions which are not indicated: SCAM practitioners of all types are often asked by their patients to treat conditions which their particular SCAM cannot not affect. Instead of honestly saying so, they frequently apply their SCAM, wait for the natural history of the condition to do its bit, and subsequently claim that their SCAM was effective.
  2. Over-charging: asking too much money for services or goods is common (not just) in SCAM. It raises the question, what is the right price? There is, of course, no easy answer to it. Over-charging is therefore mostly a judgement call and not something absolute.
  3. Misleading a patient: there are numerous ways in which patients can be misled by their SCAM practitioners. A chiropractor who uses the Dr title, without explaining that it is not a medical title, is misleading his/her patients. A homeopath who implies that the remedy he/she is selling is a proven treatment is also misleading his/her patients.
  4. Being economical with the truth: the line between lying (see below) and being economical with the truth is often blurred. In my view, a chiropractor who does not volunteer the information that acute back pain, in most cases, resolves within a few days regardless of whether he/she mapipulates the patient’s spine or not, is economical with the truth. Similarly, a homeopath who does not explain up front that the remedy he/she prescribes does not contain a single active molecule is economical with the truth.
  5. Employing unreasonably long series of therapy: A chiropractor or homeopath, who treats a patient for months without any improvement in the patient’s condition, should suggest to call it a day. Patients should be given a treatment plan at the first consultation which includes the information when it would be reasonable to stop the SCAM.
  6. Failing to refer: A chiropractor or homeopath, who treats a patient for months without any improvement in the patient’s condition should refer the patient to another, better suited healthcare provider. Failing to do so is a serious disservice to the patient.
  7. Unethical behaviour: there are numerous ways SCAM practitioners regularly violate healthcare ethics. The most obvious one, as discussed often before on this blog, is to cut corners around informed consent. A chiropractor might, for instance, not tell his/her patient before sarting the treatment that spinal manipulation is not supported by sound evidence for efficacy or safety. A homeopathy might not explain that homeopathy is generally considered to be implausible and not evidence-based.
  8. Neglect: medical neglect occurs when patients are harmed or placed at significant risk of harm by gaps in their medical care. If a chiropractor or a homeopath, for instance, claim to be able to effectively treat asthma and fail to insist that all prescribed asthma medications must nevertheless be continued – as both often do – they are guilty of neglect, in my view. Medical neglect can be a reason for starting legal proceedings.
  9. Lying: knowingly not telling the truth can also be a serious legal issue. An example would be a chiropractor who, after beeing asked by a patient whether neck manipulation can cause harm, answers that it is an entirely safe procedure which has never injured anyone. Similarly, if a homeopaths informs his/her patient that the remedy he/she is prescribing has been extensively tested and found to be effective for the patient’s condition, he must be lying. If these practitioners believe what they tell the patient to be true, they might not technically be lying, but they would be neglecting their ethical duty to be adequately informed and they would therefore present an even greater danger to thier patients.
  10. Abuse: means to use something for the wrong purpose in a way that is harmful or morally wrong. A chiropractor who tells the mother of a healty child that they need maintenance care in order to prevent them falling ill in the future is abusing her and the child, in my view. Equally, I think that a homeopath, who homeopathically treats a disease that would otherwise be curable with conventional treatments, abuses his patient.
  11. Fraud: fraud is a legal term referring to dishonest acts that intentionally use deception to illegally deprive another person or entity of money, property, or legal rights. It relies on the use of intentional misrepresentation of fact to accomplish the taking. Arguably, most of the examples listed above are fraud by this definition.
  12. Sexual misconduct: the term refers to any behaviour which is sexual in nature and which is unwelcome and engaged in without consent. It ranges from unwanted groping to rape. There is, for instance, evidence that sexual misconduct is not a rarety in the realm of chiropractic. I have personally served once as an expert witness against a SCAM practitioner is a court case at the Exeter Crown Court.

The 12 categories listed above are not nearly as clearly defined as one would wish, and there is plenty of overlap. I am not claiming that my suggested ‘scale of misdemeanors by SCAM practitioners‘ or the proposed rank order are as yet optimal or even adequate. I am, however, hoping that readers will help me with their suggestions to improve them. Perhaps your input might then generate a scale of practical use for the future.

We are all prone to fall victim to the ‘post hoc ergo propter hoc’ fallacy. It describes the erroneous assumption that something that happened after an event was cased by that event. The fallacy is essentially due to confusing correlation with causation:

  • the sun does not rise because the rooster has crowed;
  • yellow colouring of the 2nd and 3rd finger of a smoker is not the cause of lung cancer;
  • some children developing autism after vaccinations does not mean that autism is caused by vaccination.

As I said, we are all prone to this sort of thing, even though we know better. Scientists, journal editors and reviewers of medical papers, however, should not allow themselves to be fooled by overt cases of the ‘post hoc ergo propter hoc’ fallacy. And if they do, they have lost all credibility – just like the individuals involved in a recent paper on animal homeopathy.

Pododermatitis in penguins usually occurs after changes in normal activity that result from being held captive. It is also called ‘bumlefoot’ (which fails to reflect the seriousness of the condition) and amounts to one of most frequent and important clinical complications in penguins kept in captivity or in rehabilitation centres.

This veterinary case study reports the use of oral homeopathic treatment on acute and chronic pododermatitis in five Magellanic penguins in a zoological park setting. During treatment, the patients remained in the penguins’ living area, and the effect of the treatment on the progression of their lesions was assessed visually once weekly. The treatment consisted of a combination of Arnica montana and Calcarea carbonica.

After treatment, the appearance of the lesions had noticeably improved: in the majority of penguins there was no longer evidence of infection or edema in the feet. The rate of recovery depended on the initial severity of the lesion. Those penguins that still showed signs of infection nevertheless exhibited a clear diminution of the size and thickness of the lesions. Homeopathic treatment did not cause any side effects.

The authors concluded that homeopathy offers a useful treatment option for pododermatitis in captive penguins, with easy administration and without side effects.

So, the homeopathic treatment happened before the recovery and, according to the ‘post hoc ergo propter hoc’ fallacy, the recovery must have been caused by the therapy!

I know, this is a tempting conclusion for a lay person, but it is also an unjustified one, and the people responsible for this paper are not lay people. Pododermitis does often disappear by itself, particularly if the hygenic conditions under which the penguins had been kept are improved. In any case, it is a potentially life-threatening condition (a bit like an infected bed sore in an immobilised human patient) that can be treated, and one should certainly not let a homeopath deal with it.

I think that the researchers who wrote the article, the journal editor who accepted it for publication, and the referees who reviewed the paper should all bow their heads in shame and go on a basic science course (perhaps a course in medical ethics as well) before they are let anywhere near research again.

It has been reported that Karnataka’s Deputy Chief Minister, Dr CN Ashwathnarayan, has launched eight products, several of which fall in the category of so-called alternative medicine (SCAM), aimed at mitigating COVID-19, developed by various start-ups at Bangalore Bioinnovation Centre (BBC). Dr CN Ashwathnarayan said the launch of the products shows that Karnataka has emerged as a leading state in developing solutions to fight the COVID 19 pandemic.

Here are short descriptions of the innovations:

  • Padma Vitals +: Developed by Innovator start-up Dr. Madan Gopal of Cardiac Design labs,Padma Vitals + is a  centralized monitoring system for ECG, respiration, Spo2 and body temperature, which can measure the vitals continuously and the analysis sent through telemetry, with an alerting system embedded in it. The device is much needed for contactless monitoring of patients during COVID 19 Pandemic. The product has been validated at Narayana Hrudayalaya.
  • Malli’s Cordytea: Developed by Dr. Moushmi Mondal from Mallipatra Neutraceuticals, this product is an Immunity booster tea prepared from medicinal mushroom – Cordyceps. The mushroom variety grown under laboratory conditions is developed by the Innovator. Cordicepin, an active ingredient is known to have anti-viral properties too. In the COVID 19 times, it will be helpful in boosting the immunity levels. The product has been patented and is approved by FSSAI.
  • CD4 Shield : Developed by Dr. Vijay Lanka and his team from Stabicon, this product is a chewable tablet containing curcumin and Vitamin B12. Both the ingredients fight inflammation and infection. The product ensures activation of innate immunity by activating CD4+, CD8+ and IFN 1 to virus specific effect and has immunomodulatory properties. It also reduces cytokine storm in response to viral infection. The product is approved by FSSAI.
  • BeamRoti : Developed by Dr. Srinivas from Aspartika, the product is an immunity booster chapati having mixture of herbs recommended by AYUSH ministry. The ingredients have been prepared using supercritical fluid extraction technology to ensure optimum concentration of herbal extract reaches the body. The chapatis are easy to store with good shelf life and Patent application has been filed. The product is approved by FSSAI.
  • Immune booster daily drops: Developed by Dr. Srinivas from Aspartika, the product is an immunity booster drop having mixture of herbs recommended by AYUSH ministry. The ingredients have been prepared using supercritical fluid extraction technology to ensure optimum concentration of herbal extract reaches the body by mixing just one drop of the product in a glass of hot water. The product is approved by FSSAI.
  • VegPhal – Fruit and Vegetable Sanitizer: Developed by Deepak Bhajantri from Krimmi Biotech, this fruit and vegetable sanitizer is prepared using edible ingredients effective against microbes and removal of pesticides. It is chorine and alcohol free.
  • Water Sanitizer – Kitchen Tap: The product is developed by Ravi Kumar from Biofi and is a miniaturized version of UV purifier that can be attached to a water tap and kill 99% of microbes including viruses such as phages.
  • nti-Micobial HVAC module: The product is developed by Ravi Kumar from Biofi and is a module that can be fitted to HVAC system to ensure circulating air is sanitized. This is especially useful during COVID 19 times as many enclosed spaces in which AC circulated air may be contaminated. Based on UV-silver titanium dioxide technology, the product is patented and has been validated.

Karnataka is of course a state in the south western region of India. The region has so far about one million COVID-19 cases, while almost 12 000 people have died. One would therefore very much hope that the newly launched innovations can make a difference.

But will they?

As far as the SCAM-related products (e.g. ‘immune boosters’) are concerned, I see no convincing evidence to assume that they are effective. If anyone has information to the contrary, please let me know.

But why not? They can’t do any harm!

Sadly, I am am not so sure. I see the potential for considerable harm from all the useless SCAMs that are being promoted left right and centre for protecting the public against COVID-19. Firstly, there is the financial harm of paying for products that are useless. Secondly, ineffective effords might distract from finding and adhering to efforts that are effective. Thirdly, believing in a SCAM that does not work will create a sense of false security which, in turn, renders consumers more vulnerable to catch the virus.

As always in healthcare, even harmless interventions that do not work can become dangerous, as they lead to neglecting effective measures. I shudder to think of how many deaths have been caused by the many SCAM merchants who see the current pandemic as an opportunity.

In 2012, we published a systematic review of adverse effects of homeopathy. Here is its abstract:

Aim: The aim of this systematic review was to critically evaluate the evidence regarding the adverse effects (AEs) of homeopathy.

Method: Five electronic databases were searched to identify all relevant case reports and case series.

Results: In total, 38 primary reports met our inclusion criteria. Of those, 30 pertained to direct AEs of homeopathic remedies; and eight were related to AEs caused by the substitution of conventional medicine with homeopathy. The total number of patients who experienced AEs of homeopathy amounted to 1159. Overall, AEs ranged from mild-to-severe and included four fatalities. The most common AEs were allergic reactions and intoxications. Rhus toxidendron was the most frequently implicated homeopathic remedy.

Conclusion: Homeopathy has the potential to harm patients and consumers in both direct and indirect ways. Clinicians should be aware of its risks and advise their patients accordingly.

The paper prompted a number of angry reactions from proponents of homeopathy who claimed, for instance, that homeopathic remedies are highly diluted and thus safe. We responded that homeopaths can nevertheless be dangerous to patients through neglect and bad advice by homeopaths, and that not all homeopathic remedies are highly diluted, and that some might be toxic because of poor quality control of the manufacturing process.

Now, a different group of researchers have looked at the problem from a slightly different angle and with different methodologies. This systematic review and meta-analysis by researchers from NAFKAM focused on observational studies, as a substantial amount of the research base for homeopathy are observational.

Eight electronic databases, central webpages and journals were searched for eligible studies, and a total of 1,169 studies were identified, 41 were included in this review. Eighteen studies were included in a meta-analysis that made an overall comparison between homeopathy and control (conventional medicine and herbs).

Eighty-seven percent (n = 35) of the studies reported adverse effects. They were graded as CTCAE 1, 2 or 3 and equally distributed between the intervention and control groups. Homeopathic aggravations (homeopaths believe that, when the optimal remedy is given, patients will experience an aggravation of their presenting symptoms) were reported in 22,5% (n = 9) of the studies and graded as CTCAE 1 or 2. The frequency of adverse effects for control versus homeopathy was statistically significant (P < 0.0001). Analysis of sub-groups indicated that, compared to homeopathy, the number of adverse effects was significantly higher for conventional medicine (P = 0.0001), as well as other complementary therapies (P = 0.05).

The authors concluded that adverse effects of homeopathic remedies are consistently reported in observational studies, while homeopathic aggravations are less documented. This meta-analysis revealed that the proportion of patients experiencing adverse effects was significantly higher when receiving conventional medicine and herbs, compared to patients receiving homeopathy. Nonetheless, the development and implementation of a standardized reporting system of adverse effects in homeopathic studies is warranted in order to facilitate future risk assessments.

While these results are interesting, they have to be taken with a pinch of salt and beg a number of questions:

  • Is there proof that aggravations exist at all?
  • How can one differentiate them from adverse effects?
  • As even placebos are known to cause adverse effects (nocebo effects), how can one be sure that the adverse effects of homeopathy are not nocebo effects?
  • Is it a good reason to focus on largely inconclusive observational studies, because a substantial amount of the research base for homeopathy are observational?
  • Can one produce conclusive results by meta-analysing inconclusive studies?

For me, the most impressive findings of this review is that in total 86 studies had to be excluded by the authors because they reported no adverse effects or aggravations. I think this renders the interpretation of the evidence from the 41 studies they did include even more flimsy. In fact, I don’t see how any meaningful conclusion can be drawn at all – except of course that many researchers of homeopathy violate the rules of research ethics by not reporting adverse effects in their studies.

As to aggravations, we clearly need to rely on placebo controlled studies, if we want to find out whether they exist at all. This we have done in our 2003 paper:

Homeopathic aggravations have often been described anecdotally. However, few attempts have been made to scientifically verify their existence. This systematic review aimed at comparing the frequency of homeopathic aggravations in the placebo and verum groups of double-blind, randomised clinical trials. Eight independent literature searches were carried out to identify all such trials mentioning either adverse effects or aggravations. All studies thus found were validated and data were extracted by both authors. Twenty-four trials could be included. The average number of aggravations was low. In total, 50 aggravations were attributed to patients treated with placebo and 63 to patients treated with homoeopathically diluted remedies. We conclude that this systematic review does not provide clear evidence that the phenomenon of homeopathic aggravations exists.

What is interesting, from my perspective, is the fact that the NAFKAM authors chose to ignore our 2012 paper completely (even though it is highly relevant to their paper and was not published in an obscure journal) and elected to completely misinterpret the findings of our 2003 paper (stating this about it: Grabia and Ernst reported a total of 103 cases of homeopathic aggravations in 3437 participants (3%), while, in fact, our paper demonstrated that aggravations are a homeopathic figment of imagination).

I wonder why.

In the past, NAFKAM did not have the reputation of doing research that was overtly biased towards homeopathy. Recently, the head of the team retired and was replaced by Miek C. Jong who is a co-author of the present review (plus head of CAMcancer, an organisation of which I am a founding member and which did, I think, some good work in the past). She happens to have a long history as a homeopath or homeopathic researcher and is co-author of many papers in this area. Here are three of her conclusions:

Could it be that, within NAFKAM, the attitude towards homeopathy has changed?

Acupuncture-moxibustion therapy (AMT) is a so-called alternative medicine (SCAM) that has been used for centuries in treatment of numerous diseases. Some enthusiasts even seem to advocate it for chemotherapy-induced leukopenia (CIL)  The purpose of this review was to evaluate the efficacy and safety of acupuncture-moxibustion therapy in treating CIL.

Relevant studies were searched in 9 databases up to September 19, 2020. Two reviewers independently screened the studies for eligibility, extracted data, and assessed the methodological quality of selected studies. Meta-analysis of the pooled mean difference (MD) and risk ratio (RR) with their respective 95% confidence intervals (CI) were calculated.

Seventeen studies (1206 patients) were included, and the overall quality of the included studies was moderate. In comparison with medical therapy, AMT has a better clinical efficacy for CIL (RR, 1.24; 95% CI, 1.17-1.32; P < 0.00001) and presents advantages in increasing leukocyte count (MD, 1.10; 95% CI, 0.67-1.53; P < 0.00001). Also, the statistical results show that AMT performs better in improving the CIL patients’ Karnofsky performance score (MD, 5.92; 95% CI, 3.03-8.81; P < 0.00001).

The authors concluded that this systematic review and meta-analysis provides updated evidence that AMT is a safe and effective alternative for the patients who suffered from CIL.

A CIL is a serious complication. If I ever were afflicted by it, I would swiftly send any acupuncturist approaching my sickbed packing.

But this is not an evidence-based attitude!!!, I hear some TCM-fans mutter. What more do you want that a systematic review showing it works?

I beg to differ. Why? Because the ‘evidence’ is hardly what critical thinkers can accept as evidence. Have a look at the list of the primary studies included in this review:

  1. Lin Z. T., Wang Q., Yu Y. N., Lu J. S. Clinical observation of post-chemotherapy-leukopenia treated with ShenMai injectionon ST36. World Journal of Integrated Traditional and Western Medicine2010;5(10):873–876. []
  2. Wang H. Clinical Observation of Acupoint Moxibustion on Leukopenia Caused by Chemotherapy. Beijing, China: Beijing University of Chinese Medicine; 2011. []
  3. Fan J. Y. Coupling of Yin and Yang between Ginger Moxibustion Improve the Clinical Effect of the Treatment of Chemotherapy Adverse Reaction. Henan, China: Henan University of Chinese Medicine; 2013. []
  4. Lu D. R., Lu D. X., Wei M., et al. Acupoint injection with addie injection for patients of nausea and vomiting with cisplatin induced by chemotherapy. Journal of Clinical Acupuncture and Moxibustion2013;29(10):33–38. []
  5. Yang J. E. The Clinical Observation on Treatment of Leukopenia after Chemotherapy with Needle Warming Moxibustion. Hubei, China: Hubei University of Chinese Medicine; 2013. []
  6. Fu Y. H., Chi C. Y., Zhang C. Y. Clinical effect of acupuncture and moxibustion on leukopenia after chemotherapy of malignant tumor. Guide of China Medicine2014;12(12) []
  7. Wang J. N., Zhang W. X., Gu Q. H., Jiao J. P., Liu L., Wei P. K. Protection of herb-partitioned moxibustion on bone marrow suppression of gastric cancer patients in chemotherapy period. Chinese Archives of Traditional Chinese Medicine2014;32(12):110–113. []
  8. Zhang J. The Clinical Research on Myelosuppression and Quality of Life after Chemotherapy Treated by Grain-Sized Moxibustion. Nanjing, China: Nanjing University of Chinese Medicine; 2014. []
  9. Tian H., Lin H., Zhang L., Fan Z. N., Zhang Z. L. Effective research on treating leukopenia following chemotherapy by moxibustion. Clinical Journal of Chinese Medicine2015;7(10):35–38. []
  10. Hu G. W., Wang J. D., Zhao C. Y. Effect of acupuncture on the first WBC reduction after chemotherapy for breast cancer. Beijing Journal of Traditional Chinese Medicine2016;35(8):777–779. []
  11. Zhu D. L., Lu H. Y., Lu Y. Y., Wu L. J. Clinical observation of Qi-blood-supplementing needling for leukopenia after chemotherapy for breast cancer. Shanghai Journal of Acupuncture and Moxibustion2016;35(8):964–966. []
  12. Chen L, Xu G. Y. Observation on the prevention and treatment of chemotherapy-induced leukopenia by moxibustion therapy. Zhejiang Journal of Traditional Chinese Medicine2016;51(8):p. 600. []
  13. Mo T., Tian H., Yue S. B., Fan Z. N., Zhang Z. L. Clinical observation of acupoint moxibustion on leukocytopenia caused by tumor chemotherapy. World Chinese Medicine2016;11(10):2120–2122. []
  14. Nie C. M. Nursing observation of acupoint moxibustion in the treatment of leucopenia after chemotherapy. Today Nurse2017;4:93–95. []
  15. Wang D. Y. Clinical Research on Post-chemotherapy-leukopenia with Spleen-Kidney Yang Deficiency in Colorectal Cancer Treated with Point-Injection. Yunnan, China: Yunnan University of Chinese Medicine; 2017. []
  16. Gong Y. Q, Zhang M. Q, Zhang B. C. Prevention and treatment of leucocytopenia after chemotherapy in patients with malignant tumor with ginger partitioned moxibustion. Chinese Medicine Modern Distance Education of China2018;16(21):135–137. []
  17. Li Z. C., Lian M. J., Miao F. G. Clinical observation of fuzheng moxibustion combined with wenyang shengbai decoction in the treatment of 80 cases of leukopenia after chemotherapy. Hunan Journal of Traditional Chinese Medicine2019;35(3):64–66. []

Notice anything peculiar?

  • The studies are all from China where data fabrication was reported to be rife.
  • They are mostly unavailable for checking (why the published adds links that go nowhere is beyond me).
  • Many do not look at all like randomised clinical trials (which, according to the authors, was an inclusion criterion).
  • Many do not look as though their primary endpoint was the leukocyte count (which, according to the authors, was another inclusion criterion).

Intriguingly, the authors conclude that AMT is not just effective but also ‘safe’. How do they know? According to their own data extraction table, most studies failed to mention adverse effects. And how exactly is acupuncture supposed to increase my leukocyte count? Here is what the authors offer as a mode of action:

Based on the theory of traditional Chinese medicine (TCM), CIL belongs to the category of consumptive disease, owing to the exhaustion of genuine qi in the zang-fu viscera and the insufficiency of kidney essence and qi-blood. Researchers believe that there is an intimate association between the occurrence of malignant tumors and the deficiency of genuine qi. During attacking the cancer cells, chemotherapeutics also damaged the function of zang-fu viscera and qi-blood, leading to CIL. According to the theory of TCM and meridian, acupuncture-moxibustion is an ancient therapeutic modality that may be traced back more than 3500 years in China. Through meridian conduction, acupuncture-moxibustion therapy stimulates acupoints to strengthen the condition of zang-fu viscera and immune function, supporting genuine qi to improve symptoms of consumption.

I think it is high time that we stop tolerating that the medical literature gets polluted with such nonsense (helped, of course, by journals that are beyond the pale) – someone might actually believe it, in which case it would surely hasten the death of vulnerable patients.

THE FIRST WORLDWIDE MANIFESTO AGAINST PSEUDOSCIENCE

2750 signatories from 44 countries have signed it [I was number 11] and today is its official launch. I am delighted to present to you the full text of the English version:

 

Let’s be clear: pseudoscience kills. And they are being used with total impunity thanks to European
laws that protect them.
They kill thousands of people, with names and families. People such as Francesco Bonifaz, a 7-yearold boy whose doctor prescribed homeopathy instead of antibiotics. He died in Italy [1]. People like Mario Rodríguez, who was 21 years old and was told to use vitamins to treat his cancer. He died in Spain [2]. People like Jacqueline Alderslade, a 55-year-old woman whose homeopath told her to stop taking her asthma medication. She died in Ireland [3]. People like Cameron Ayres, a 6-month-old baby, whose parents did not want to give their child “scientific medicine”. He died in England [4]. People like Victoria Waymouth, a 57-year-old woman who was prescribed a homeopathic medication to treat her heart problem. She died in France [5]. People like Sofia Balyaykina, a 25-year-old woman, who had a cancer that was curable with chemotherapy but was recommended an “alternative treatment”, a mosquito bite treatment. She died in Russia [6]. People like Erling Møllehave, a 71-year-old man whose acupuncturist pierced and damaged his lung with a needle. He died in Denmark [7]. People like Michaela Jakubczyk-Eckert, a 40-year-old-woman whose therapist recommended the German NewMedicine to treat her breast cancer. She died in Germany [8]. People like Sylvia Millecam, a 45-year-old woman whose New Age healer promised to cure her cancer. She died in the Netherlands [9].

European directive 2001/83/CE has made –and still makes— possible the daily deception of thousands of hundreds of European citizens [10]. Influential lobbyists have been given the opportunity to redefine what a medicine is, and now they are selling sugar to sick people and making them believe it can cure them or improve their health. This has caused deaths and will continue to do so until Europe admits an undeniable truth: scientific knowledge cannot yield to economic interests, especially when it means deceiving patients and violating their rights.

Europe is facing very serious problems regarding public health. Overmedication, multi-resistant bacteria and the financial issues of the public systems are already grave enough, without the additional problem of gurus, fake doctors or even qualified doctors claiming they can cure any disease by manipulating chakras, making people eat sugar or using “quantic frequencies”. Europe must not only stop the promotion of homeopathy but also actively fight to eradicate public health scams. More than 150 pseudo-therapies have been identified as being in use throughout Europe. Thousands of citizens lives depend on this being prevented. In fact, according to a recent research, 25.9 % of Europeans have used pseudo-therapies last year. In other words, 192 million patients have been deceived [11].

Some believe there is a conflict between freedom of choice for a treatment and the removal of pseudo-therapies, but this is not true. According to article 25 of the Universal Declaration of Human Rights, every person has a right to medical care. Lying to patients in order to sell them useless products that could kill them breaks their right to correct information about their health. This way, even if a citizen has a right to refuse medical treatment when he or she is properly informed, it is also true that nobody has the right to lie to obtain profit at the expense of someone else’s life. Only in a world in which lying to a sick person would be considered ethical, could homeopathy —or any other pseudo-therapy— be allowed to continue to be sold to citizens.

Effective treatments being replaced by false ones is not the only danger of pseudo-therapies. Obvious delays in therapeutic care occur when a person gets false products instead of medication at the early stages of a disease. Many times, it is then too late by the time they get treated with proper medicine. Moreover, several of these practices have serious effects on their own and may cause damage or even death because of their side effects.

Many pseudo-therapists argue that “the other medicine” comes with side effects as well, which is indeed true. However, the difference resides in that pseudo-therapies cannot cure a disease or improve your health, and because of that patients assume risks in exchange of promises that are a scam, according to the full weight of the scientific evidence available. Lying to a sick person is not another type of medicine, it is simply lying to a sick person.
Every country has to face the pseudo-therapies issue in its own ways. Yet it is not acceptable that European laws protect the distortion of scientific facts so that thousands of citizens can be deceived or even lead to their deaths.

We, the signatories of this manifest, therefore declare that:

1. Scientific knowledge is incompatible with what pseudo-therapies postulate, as in the case
of homeopathy.
2. European laws that protect homeopathy are not acceptable in a scientific and technological
society that respects the right of the patients not to be deceived.
3. Homeopathy is the best known pseudo-therapy, but it is not the only one nor the most
dangerous one. Others, such as acupuncture, reiki, German New Medicine, iridology,
biomagnetism, orthomolecular therapy and many more, are gaining ground and causing
victims.
4. Measures must be taken to stop pseudo-therapies, since they are harmful and result in
thousands of people being adversely affected.
5. Europe needs to work towards creating legislation that will help stop this problem.

Europe being concerned about the misinformation phenomena but at the same time protecting one the most dangerous types of it, health misinformation, is just not coherent. This is why the people signing this manifesto urge the governments of European countries to end a problem in which the name of science is being used falsely and which has already cost too many lives.

 

[1] Homeopathy boy died of encephalitis. Redazione ANSA, 2017.
http://www.ansa.it/english/news/general_news/2017/05/29/homeopathy-boy-died-of-encephalitis-3_13e02493-
4e62-4787-9162-12d831121ef6.html
[2] Grieving dad sues over ‘cure cancer with vitamins’ therapy, The local. Emma Anderson, 2016.
https://www.thelocal.es/20160412/grieving-father-sues-naturopath-over-son-cure-cancer-vitamins-leukaemia
[3] Asthmatic ‘told to give up drugs’. The Irish News, 2001.
https://www.independent.ie/irish-news/asthmatic-told-to-give-up-drugs-26063764.html
[4] Homeopaths warn of further tragèdies. BBC News, 2000.
http://news.bbc.co.uk/2/hi/health/702699.stm
[5] Alternative cure doctor suspended. BBC News, 2007.
http://news.bbc.co.uk/2/hi/uk_news/england/london/6255356.stm
[6] Футболист рассказал трагичную историю жены. Она умерла от рака в 25 лет. Sport24, 2018.
https://sport24.ru/news/football/2018-08-28-futbolist-rasskazal-tragichnuyu-istoriyu-zheny-ona-umerla-ot-raka-v-25-let
[7] Mand døde efter akupunktur – enke vil nu lægge sag an mod behandleren, TV2, 2018.
http://nyheder.tv2.dk/samfund/2018-01-23-mand-doede-efter-akupunktur-enke-vil-nu-laegge-sag-an-modbehandleren

[8] The price of refusing science-based medical and surgical therapy in breast càncer, Science Blogs, 2012.
https://scienceblogs.com/insolence/2012/08/30/the-price-of-refusing-science-based-medical-and-surgical-therapy-inbreast-cancer
[9] Psychic ‘misled actress to hopeless cancer death’. Expatica. 2004.
http://web.archive.org/web/20070208144309/http://www.expatica.com/actual/article.asp?subchannel_i
d=19&story_id=4821
[10] Directive 2001/83/EC of the European Parliament and of the Council of 6 November 2001.
https://ec.europa.eu/health/sites/health/files/files/eudralex/vol1/dir_2001_83_consol_2012/dir_2001_83_cons_2012_en.pdf
[11] Use of complementary and alternative medicine in Europe: Health-related and sociodemographic
determinants. Scandinavian Journal of Public Health. Laura M. Kemppainen et al. 2018.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5989251/

This recent review claimed to evaluate the evidence on the use of human and veterinary homeopathy, evidence level 1a studies were considered. Focusing on the external evidence on the use of homeopathy in infections, some evidence level 1a, 1b, 2c studies, and a case report, are described in more detail.

In conclusion, evidence for the effectiveness of human and veterinary homeopathy in general, and in particular, of homeopathic treatment for infections, is available. Especially, individualized homeopathy demonstrates effects at all quality levels according to Cochrane criteria, even in the methodologically high-quality studies. As in most areas of veterinary medicine and medicine, further good/excellent studies are necessary. In compliance with the principles of homeopathy, further methodologically high-quality trials focusing on the homeopathic treatment of infections are the next logical step. The selection of the simile (individually fitting homeopathic medicinal product) by appropriately trained homeopathic doctors/veterinarians is essential for the effectiveness of homeopathy. Implementation of studies at university facilities is a prerequisite for quality assurance. Consequently, further integration of homeopathy at universities is a necessary requirement for the patients’ best interests.

Who wrote this bizarre paper?

The authors who state to have no conflicts of interest are P Weiermayer 1M Frass 2T Peinbauer 3L Ellinger 4

  • 1Tierärztin, Tierarztpraxis Dr. Weiermayer, Diplom der Europ. Akademie für Veterinärhomöopathie (EAVH), Fachtierärztin für Homöopathie, Sprecherin der Sektion Forschung der Wissensch. Gesellsch. für Homöopathie (WissHom), Präsidentin ÖGVH, Wien, Österreich.
  • 2Facharzt für Innere Medizin und Internistische Intensivmedizin, em. Professor für Innere Medizin der Medizinischen Universität Wien, Diplom der Österreichischen Ärztekammer (ÖÄK) für Homöopathie sowie für Begleitende Krebsbehandlung, Wien, Österreich.
  • 3Arzt für Allgemeinmedizin, ÖÄK-Diplom für Homöopathie, Universitätslektor für Allgemeinmedizin und Modulbeauftragter für Komplementärmedizin, Medizinische Fakultät, Johannes Kepler Universität Linz, Österreich.
  • 4Tierärztin, Centaurea, Apeldoorn, Holland.

This already explains quite a lot, I think.

The paper itself is in German, so I will try to make some sense of part of it for you.

In their ‘methods section’, the authors explain that they evaluated meta-analyses and systematic reviews (SRs) of homeopathy for various conditions. Furthermore, they considered the ‘1st and 2nd’ NHMRC reports. Specifically for the question whether homeopathy is the answer to antibiotic resistance, the authors also considered RCTs, observational studies, heath service research and even case-studies. The authors then elaborate at length on the assumptions of homeopathy, on legal issues and on the nature of evidence-based medicine all of which I disregard for the moment (suffice to say that this material has been often and better reviewed before).

When finally discussing the evidence on homeopathy for human conditions, the authors state that, up until 2014, six comprehensive SRs had been published. In their opinion, these are the following 6 papers:

  1. Kleijnen, J., Knipschild, P., Ter Riet, G. (1991): Clinical trials
    of homeopathy. BMJ 302(6772): 316-23.
  2. Linde, K., Clausius, N., Ramirez, G., Melchart, D., Eitel, F.,
    Hedges, L.V., Jonas, W.B. (1997): Are the clinical effects of
    homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 350(9081): 834–843.
  3. Linde, K., Scholz, M., Ramirez, G., Clausius, N., Melchart,
    D., Jonas, W.B. (1999): Impact of study quality on outcome
    in placebo-controlled trials of homeopathy. J Clin Epidemiol 52(7): 631–636.
  4. Cucherat, M., Haugh, M.C., Gooch, M., Boissel, J.P. (2000): Evidence of clinical efficacy of homeopathy. A meta-analysis of clinical trials. HMRAG. Homeopathic Medicines Research Advisory Group. Eur J Clin Pharmacol 56(1): 27–33.
  5. Mathie, R.T., Lloyd, S.M., Legg, L.A., Clausen, J., Moss, S.,Davidson, J.R.T., Ford, I. (2014a): Randomised placebocontrolled trials of individualised homeopathic treatment: systematic review and meta-analysis. Syst Rev 3: 142.
  6. Shang, A., Huwiler-Müntener, K., Nartey, L., Jüni, P., Dörig, S., Sterne, J.A.C., Pewsner, D., Egger, M. (2005): Are the clinical effects of homeopathy placebo effects? Comparative study of placebo-controlled trials of homeopathy and allopathy. Lancet 366(9487): 726–32.

(As it happens, I have reviewed these papers here and come to very different conclusions)

Without bothering about a critical assessment of these papers, the authors report that all arrived at a positive conclusion, except the last one. They then claim that the ‘1st’ NHMRC report was partly positive but was initially suppressed by the Australian government. Instead it was replaced with the 2nd NHMRC report which was designed to arrive at a wholly negative conclusion. Likewise, the ‘EASAC Statement’ neglected some of the available positive evidence. These facts, the authors believe, discredits all of these negative reports.

The authors then discuss the various reviews by Mathie et al and point out that, in their view, these papers are superior to all other documents as they arrive at very clearly positive conclusions.

Next the authors focus on the field of veterinary homeopathy, while admitting weaker and weaker evidence, inclusing case-reports. This is also where I lost the will to live and gave up my detailed criticism of the text; the task is too tedious and simply not worth it, I felt.

In summary, here are few points relating to the human evidence:

The authors seem to have no intention of conducting an objective, systematic review. Such a project is essentially based on two principles. Firstly, it needs to include all eligible evidence according to pre-defined criteria. Secondly, it must include a critical evaluation of the admitted evidence. This review fails on both of these principles.

There are virtually dozens of systematic reviews which the authors decided to ignore. Here are just six of them:

  1. … homoeopathy as a whole may be considered as a placebo treatment.
  2. We tested whether p-curve accurately rejects the evidential value of significant results obtained in placebo-controlled clinical trials of homeopathic ultramolecular dilutions. Our results suggest that p-curve can accurately detect when sets of statistically significant results lack evidential value.
  3. We found no evidence to support the efficacy of homeopathic medicinal products
  4. … no firm conclusions regarding the effectiveness and safety of homeopathy for the treatment of IBS can be drawn.
  5. Due to both qualitative and quantitative inadequacies, proofs supporting individualized homeopathy remained inconclusive.
  6. … the use of homeopathy currently cannot claim to have sufficient prognostic validity where efficacy is concerned.

Why do they do it? A reasonable reply to this question might be, because their findings did not fit the preconceived ideas of the authors. This omission alone makes the article little more than a poorly conceived marketing brochure.

Even more important is the second omission. The paper  lacks any kind of critical evaluation of the included evidence. On the contrary, the authors praise the evidence that generated what they think was a positive result (even in cases where the actual result was not all that positive; for instance: A meta-analysis of all extractable data leads to rejection of our null hypothesis, but analysis of a small sub-group of reliable evidence does not support that rejection. Reliable evidence is lacking in condition-specific meta-analyses, precluding relevant conclusions) and bash all negative findings. This goes as far as perpetuating untruth about the two NHMRC reports: what they call the 1st report was a draft that had been rejected because it was deemed to be of sub-standard quality. What is here called the ‘2nd’ report is thus the only valid document ever published. Similarly, the authors pretend that the Mathie reviews were all clearly positive and fail to mention even the most obvious problems with these articles, such as the facts that Mathie was paid by a homeopathy-lobby group or that even he included important caveats in his conclusions.

As to the focus of the review, the question whether homeopathy might be a solution to antibiotic resistance, the authors found virtually no compelling evidence from trials directly comparing antibiotics with homeopathy. This seems to bother the authors little – they conclude that “the data demonstrate the potential of a significant reduction of antibiotic usage through homeopathic treatments”. They seem to have reached this conclusion by turning a blind eye to all the evidence that does not fit their preconceived idea.

As the paper is published in German and in a journal which hardly anyone will ever read, one could easily argue that none of all this does really matter because it is merely a storm in a very small tea cup. Perhaps that’s true. But this paper nevertheless might attain some significance because it is already being heavily promoted by the homeopathy lobby. And no doubt, it will thus be cited in the English literature which, in turn, will be read by people who do not read German, unable to check the original and are thus likely to believe the nonsense promoted by Frass and friends.

For this reason, I want to conclude by making it quite clear that

this ‘review’ is a dilettante attempt to white-wash the evidence on homeopathy and mislead the public.

 

Steiner with his wife (right) and Ita Wegman, his lover (left).

Anthroposophic medicine was founded by Steiner and Ita Wegman in the early 20th century. Currently, it is being promoted as an extension of conventional medicine. Proponents claim that “its unique understanding of the interplay among physiological, soul and spiritual processes in healing and illness serves to bridge allopathy with naturopathy, homeopathy, functional/nutritional medicine and other healing systems.” Its value has repeatedly been questioned, and clinical research in this area is often less than rigorous.

Anthroposophic education was developed in the Waldorf school that was founded by Steiner in 1919 to serve the children of employees of the Waldorf-Astoria cigarette factory in Stuttgart, Germany. Pupils of Waldorf or Steiner schools, as they are also frequently called, are encouraged to develop independent thinking and creativity, social responsibility, respect, and compassion.

Waldorf schools implicitly infuse spiritual and mystic concepts into their curriculum. Like some other alternative healthcare practitioners – for instance, doctors promoting integrative medicine, chiropractors, homeopaths and naturopaths – some doctors of anthroposophic medicine take a stance against childhood immunizations. In a 2011 paper, I summarised the evidence which showed that in the UK, the Netherlands, Austria and Germany, Waldorf schools have been at the centre of measles outbreaks due to their stance regarding immunisations.

More recently, a study evaluated trends in rates of personal belief exemptions (PBEs) to immunization requirements for private kindergartens in California that practice alternative educational methods. The investigators used California Department of Public Health data on kindergarten PBE rates from 2000 to 2014 to compare annual average increases in PBE rates between schools.

Alternative schools had an average PBE rate of 8.7%, compared with 2.1% among public schools. Waldorf schools had the highest average PBE rate of 45.1%, which was 19 times higher than in public schools (incidence rate ratio = 19.1; 95% confidence interval = 16.4, 22.2). Montessori and holistic schools had the highest average annual increases in PBE rates, slightly higher than Waldorf schools (Montessori: 8.8%; holistic: 7.1%; Waldorf: 3.6%).

The authors concluded that Waldorf schools had exceptionally high average PBE rates, and Montessori and holistic schools had higher annual increases in PBE rates. Children in these schools may be at higher risk for spreading vaccine-preventable diseases if trends are not reversed.

As the world is hoping for the arrival of an effective vaccine against the corona virus, these figures should concern us.

New German Medicine?

German New Medicine?

What on earth is that?

German New Medicine (GNM) is the creation of Ryke Geerd Hamer (1935-2017), a German doctor. The name is reminiscent of the ‘Neue Deutsche Heilkunde’ created by the Nazis during the Third Reich. Hamer received his medical licence in 1963 but was later struck off because of malpractice. He then continued his practice as a ‘Heilpraktiker’. According to proponents, GNM Therapy is a spoken therapy based on the findings and research of the Germanic New Medicine of Dr.Hamer. On the understanding that every disease is triggered by an isolating and shocking event, GNM Therapy assists in finding the DHS (shocking moment) in our lives that preceded the dis-ease and in turn allowing our bodies to complete its natural healing cycle back to full health. Hamer believed to have discovered the ‘5 laws of nature’:

  • The Iron Rule of Cancer
  • The two-phased development of disease
  • Ontogenetic system of tumours and cancer equivalent diseases
  • Ontogenetic system of microbes
  • Natures biological meaning of a disease

Hamer also postulated that:

  • All diseases are caused by psychological conflicts.
  • Conventional medicine is a conspiracy of Jews to decimate the non-Jewish population.
  • Microbes do not cause diseases.
  • AIDS is just an allergy.
  • Cancer is the result of a mental shock.

None of Hamer’s ‘discoveries’ and assumptions are plausible or based on facts, and none of his therapeutic approaches have been shown to be effective.

 These days, I do not easily get surprised by what I read about so-called alternative medicine (SCAM), but this article entitled ‘Homoeopathy And New German Medicine: Two German Siblings‘ baffled me greatly. Here are a few short excerpts:

… German New Medicine (GNM) like Homoeopathy is one of the gentle healing methods. As siblings, they have some common features as well as their own unique features. So, let’s explore a unique relationship between these two siblings.

1) Holistic aspect:
Both therapeutic methods are believed in holistic concept of body. The disease condition in Homoeopathy and conflict in GNM are very similar in expression as they are reflecting on mental as well as physical level also. In Homoeopathy, Mind, Body and Soul are one of the important trios to understand the Homoeopathic philosophy. While in GNM, Psyche, Brain, Body are important aspect in learning the GNM. Let’s see these trio in their founder’s language,

• Homoeopathy:
Dr. Hahnemann in his oragnon of medicine, 6th edition mentioned about a unity of materialistic body and vital force. Last lines of aphorism 15 are as follows, “…although in thought our mind separates these two unities into distinct conceptions for the sake of easy comprehension.

• German New Medicine:
Dr. Ryke Geerd Hamer, founder of GNM said that, “The differentiation between psyche, brain and the body is purely academic. In reality, they are one.”

2) Disease origin concept:

• Homoeopathy:
In Homoeopathy, disease originates from the dynamic disturbances and followed by functional and pathological changes.

• German New Medicine:
In GNM, morbid condition starts from conflict in the psyche level and later it reflects on body. The common feature is the disturbance is at the all levels of man.

3) Cause of disease:

• Homoeopathy:
In Homoeopathy, among the web of causations, psyche (mind) is also considers as a cause of disease.

• German New Medicine:
So, in GNM, psyche is playing important role in cause of disease. When Conflict starts, its dynamic effect perceived first at mind level.

4) Individuality:

• Homoeopathy:
In Homoeopathy, diathesis is a predisposition for disease condition. i.e. According to the diathesis every individual suffers with their own individual morbid dispositions. Rheumatic diathesis, gouty diathesis, etc. are the examples of diathesis.

• German New Medicine:
In GNM, every individual suffers from the disease condition after the receiving conflict. It is different and depending upon the type of conflict they are receiving. E.g. lung cancer- death fright conflict, cervical cancer –female sexual conflict…

Conclusion:
Some similarities and with some own characteristics, these two healing methods are developing at a good length in medical science. The main aim of these both methods is – “to serve the suffering humanity in gentle way”…

_____________________

Could it be that the author forgot the most striking similarities between GNM and homeopathy? How about these points:

  • There is nothing truly gentle about either methods.
  • Both are based on bizarre fantasies, far removed from reality.
  • Both pretend to be a panacea.
  • Both lack proof of efficacy.
  • Both have the potential to kill patients (mostly through neglect).
  • Both mislead consumers.
  • Both are deeply anti-scientific.
  • Both dissuade patients from using evidence-based healthcare.
  • Both are in conflict with medical ethics.
  • Both have cult-like features.
  • Both are far from being recognised by proper healthcare.
  • Both have been repeatedly in conflict with the law.
  • Both were invented by deludes fanatics.

The Society of Homeopaths (SoH) is the UK’s professional organisation of ‘lay-homeopaths’, therapists who treat patients without having studied medicine. They prefer the term ‘professional homeopathy’, but there is little professional about them, it seems. The SoH has a long track record of endangering public health by promoting anti-vaxx nonsense.

A few months ago, it was reported that Linda Wicks, chair of the Society of Homeopaths (S0H), has shared a series of petitions claiming that childhood immunisations are unsafe. Mrs Wicks also posted a petition supporting Andrew Wakefield, the disgraced former doctor who falsely linked the MMR vaccine to autism claiming that the scientific establishment’s rejection of his flawed research was ‘the greatest lie ever told’.

In 2018, I pointed out that the SoH was violating its own code of ethics. At the time, two new members were appointed to the Society’s Public Affairs (PAC) and Professional Standards (PSC)  committees, and both were promoting the deeply anti-vaxx CEASE therapy.

Today, THE TELEGRAPH reports that Sue Pilkington, the SoH’s ‘Head of Standards’, has been promoting anti-vaxx propaganda online. On April 14, she posted anti-vaxx content made by the ‘Children’s Health Defense’ – an organisation accused by NBC News last year as being one of the largest global creators of spreading misinformation’. The page advised that any new vaccine could trigger “lethal” immune reactions.

In a separate post on Facebook, Pilkington shared a post that describes vaccines as “poison” – alongside medical advice declaring that no child should be vaccinated, if any member of their family has a skin disorder. Pilkington also tried to contact Health Secretary Matt Hancock, attempting to share with him a video of content from an American comedian claiming that it’s ‘realistic’ for vaccines to cause autism.

As though this were not enough nonsense, Pilkington also promotes homeopathy as a solution to the current epidemic. On her homeopathy business website, she has section on coronavirus which states the following: “The current primary homeopathic remedy advised for Coronavirus (2019-nCoV) symptoms is Gelsemium with a possible following remedy of Eupatorium Perforatum, Bryonia or Belladonna depending on how the symptoms progress”. Other homeopathic remedies are in common use for people with influenza and pneumonia, according to Pilkington, these do not “prevent viruses” but may “reduce the severity and length of illness”. She also claims that homeopathy has a “great track record of success in epidemics” – referencing both the Spanish influenza pandemic and the bird flu pandemic.

“In our opinion, the Professional Standards Authority (PSA) has a simple choice to make: remove the SoH and their uninformed vaccination paranoia from the register, or continue to allow homeopaths to make these dangerous claims with the tacit approval of the PSA.” said Michael Marshall, projector director of the Good Thinking Society.

A government health spokesperson was quoted in today’s TELEGRAPH article stating this: “Vaccine misinformation in any form – book, film, website or otherwise – is completely unacceptable.” The spokesperson added that NICE does not recommend homeopathy for the treatment of any health condition and noted that vaccines “save lives and are a foundation of public health.”

 

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