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

panacea

In response to yesterday’s post, I received a lengthy comment from ‘Stan’. Several readers have already commented on it. Therefore, I can make my arguments short. In this post, will repeat Stan’s points each followed by my comments (in bold). Here we go:

Seven Reasons Homœopathy is Not Placebo Effect

Sorry, Stan, but your heading is not proper English; I have therefore changed it for the title of this post.

1. Homeopathic remedies work on babies, animals, plants and people in a coma. Biodynamic farmers use homeopathic remedies to repel pests and treat plant diseases. Some organic ranchers rely on homeopathic remedies to treat their herds. Some “placebo by proxy” effect has been shown for children but its doubtful that it could be shown for a herd of cattle or crops in a field. Farmers can’t rely on wishful thinking to stay in business.

As discussed ad nauseam on this blog, homeopathic remedies do not work on babies or animals better than placebos. I don’t know of any studies with “people in a coma” (if you do, Stan, please let me know). The fact that ranchers rely on homeopathy is hilarious but does not prove anything.

2. The correct curative remedy will initially cause a worsening of the condition being cured if it is given in too strong (i.e. too dilute) a dose. A placebo might only cause a temporary improvement of the condition being treated; certainly not an aggravation.

The ‘homeopathic aggravation’ is a myth created by homeopaths. It disappears if we try to systematically research it; see here, for instance.

3. One can do a “proving” of an unknown homeopathic remedy by taking it repeatedly over several days and it will temporarily cause symptoms that one has never experienced previously – symptoms it will cure in a sick person. This is a repeatable scientific experiment used to determine the scope of a new remedy, or confirm the effects of an already proven remedy. A placebo might possibly have an effect if the individual taking it has been “prepared” by being told what they are taking but it likely wouldnt match previously recorded symptoms in the literature.

Homeopathic provings are rubbish and not reproducible when done rigorously; see here.

4. One can treat simple acute (self-limiting) conditions (e.g. minor burns, minor injuries, insect bites, etc.) and see unusually rapid cures with homeopathic remedies. A placebo might only cause a temporary improvement of the condition being treated while taken. Placebos have been found mostly effective in conditions with a strong psychological component like pain.

You mean like using Arnica for cuts and bruises? Sadly, it does not work.

5. One can get homeopathic treatment for long term chronic (non self-limiting) conditions and see a deep lasting cure, as has been documented clinically for a couple centuries. A placebo might only cause a temporary partial improvement of the condition being treated while the placebo is being taken.

You mean like asthma, eczema, or insomnia?

6. There is over 200 years worth of extensive documentation from around the world, of the clinical successes of homeopathy for both acute and chronic conditions of all types. As Dr Hahn has said you have throw out 90% of the evidence to conclude that homeopathy doesnt work. The Sheng et al meta-analysis in 2005 Lancet that was supposedly the death knell of homeopathy used only 8 studies, excluding hundreds of others. Unsurprisingly homeopathy was found wanting. So-called Skeptics see what they want to see in the science. There is relatively little documentation of placebo usage. A few recent studies have been done showing the limited temporary benefits of placebos.

What Hahn wrote is understandably liked by homeopaths but it nevertheless is BS. If you don’t trust me, please rely on independent bodies from across the world.

7. Homeopathic remedies have been shown to have a very weak electromagnetic signature and contain some nano-particles. Some believe this explains their mechanism. An exciting new potential field of research is the subtle cell signalling that has been found to direct the development of stem cells. Scientists have created double-headed planeria worms and this trait has been found to be inherited by their offspring without any change in the genes or epigenetics. Until now we had no idea how a single fertilized ovum could evolve into a complex creature that is bilateral and has multiple cell types. It is possible that the very subtle electromagnetic signature or some other unknown effect of homeopathic remedies is effecting this subtle cell signalling.

The homeopathic nano-myth is nonsense. And so is the rest of your assumptions.

Every conventional drug has “side effects” that match the symptoms for which it is indicated! Aspirin can cause headaches and fever, ritalin can cause hyperactive effects, radiation can cause cancer. Conventional doctors are just practicing bad homeopathy. They are prescribing Partially similar medicines. If their drugs were homeopathic (i.e. similar) to the patients symptoms on all levels they would be curative. Radiation sometimes does cure cancer instead of just suppressing it per usual.

Even if this were true, what would it prove? Certainly not that homeopathy works!

Dr Hahneman did forbid mixing homeopathy and conventional medicine. In his day doctors commonly used extensive blood letting and extreme doses of mercury. Its not Quite as bad now.

You evidently did not read Hahnemann’s writings.

Just because we dont know how extremely dilute homeopathic remedies work, doesn’t discount that they Do work. Homeopathy seems to fly in the face of Known science. In no way is it irrational or unscientific. There are lots of phenomena in the universe that cant be explained yet, like dark energy and dark matter effects and even consciousness!

Not knowing how a treatment works has not stopped science to test whether it works (e.g. Aspirin). In the case of homeopathy, the results of these endeavors were not positive.

The assumption that the moon is made of cheese also flies in the face of science; do you perhaps think that this makes it true?

The actions of homeopathy can and have been well-explained: they are due to placebo effects.

________________________

Stan, thank you for this entertaining exercise. But, next time, please remember to supply evidence for your statements.

There are debates in acupuncture-related systematic reviews and meta-analyses on whether searching Chinese databases to get more Chinese-language studies may increase the risk of bias and overestimate the effect size, and whether the treatment effects of acupuncture differ between Chinese and non-Chinese populations.

For this meta-epidemiological study, a team of investigators searched the Cochrane Library from its inception until December 2021, and identified systematic reviews and meta-analyses with acupuncture as one of the interventions. Paired reviewers independently screened the reviews and extracted the information. They repeated the meta-analysis of the selected outcomes to separately pool the results of Chinese- and non-Chinese-language acupuncture studies and presented the pooled estimates as odds ratios (OR) with 95% confidence interval (CI). They calculated the Ratio of ORs (ROR) by dividing the OR of the Chinese-language trials by the OR of the non-Chinese-language trials, and the ROR by dividing the OR of trials addressing Chinese population by the OR of trials addressing non-Chinese population. The researchers thus explored whether the impact of a high risk of bias on the effect size differed between studies published in Chinese- and in non-Chinese-language, and whether the treatment effects of acupuncture differed between Chinese and non-Chinese populations.

The researchers identified 84 Cochrane acupuncture reviews involving 33 Cochrane groups, of which 31 reviews (37%) searched Chinese databases. Searching versus not searching Chinese databases significantly increased the contribution of Chinese-language literature both to the total number of included trials (54% vs. 15%) and the sample size (40% vs. 15%). When compared with non-Chinese-language trials, Chinese-language trials were associated with a larger effect size (pooled ROR 0.51, 95% CI 0.29 to 0.91). The researchers also observed a higher risk of bias in Chinese-language trials in blinding of participants and personnel (97% vs. 51%) and blinding of outcome assessment (93% vs. 47%). The higher risk of bias was associated with a larger effect estimate in both Chinese language (allocation concealment: high/unclear risk vs. low risk, ROR 0.43, 95% CI 0.21 to 0.87) and non-Chinese-language studies (blinding of participants and personnel: high/unclear risk vs. low risk, ROR 0.41, 95% CI 0.23 to 0.74). However, the team found no evidence that the higher risk of bias would increase the effect size of acupuncture in Chinese-language studies more often than in non-Chinese-language studies (the confidence intervals of all ROR in the high-risk group included 1, Table 3). The researchers further found acupuncture appeared to be more effective in Chinese than in non-Chinese populations.

The authors concluded that the findings of this study suggest the higher risk of bias may lead to an overestimation of the treatment effects of acupuncture but would not increase the treatment effects in Chinese-language studies more often than in other language studies. The difference in treatment effects of acupuncture was probably associated with differences in population characteristics.

The authors discuss that, although searching Chinese databases can substantially increase the number of eligible studies and sample size in acupuncture reviews, the potentially higher risk of bias is an argument that needs to be considered in the inclusion of Chinese-language studies. Patients, investigators, and guideline panels should be cautious when adopting evidence from acupuncture reviews where studies with a high risk of bias contributed with a high weight to the meta-analysis.

The authors observed larger treatment effects of acupuncture in Chinese-language studies than in studies published in other languages. Although the treatment effects of acupuncture tended to be greater in studies with a high risk of bias, this potential overestimation did not differ between studies published in Chinese and in other languages. In other words, the larger treatment effects in Chinese-language studies cannot be explained by a high risk of bias. Furthermore, our study found acupuncture to be more effective in Chinese populations than in other populations, which could at least partly explain the larger treatment effects observed in Chinese-language studies.

I feel that this analysis obfuscates more than it clarifies. As we have discussed often here, acupuncture studies by Chinese researchers (regardless of what language they are published in) hardly ever report negative results, and their findings are often fabricated. It, therefore, is not surprising that their effect sizes are larger than those of other trials.

The only sensible conclusion from this messy and regrettable situation, in my view, is to be very cautious and exclude them from systematic reviews.

Seventeen years after S.K. lost his thyroid gland to cancer, he was promised a miracle by Kyung Chun Oh, an acupuncturist based in the Toronto area: acupuncture could regrow the vital organ. Oh told his patient it would only work if S.K. stopped the thyroid medication he’d been on since his surgery in 2003.

Within just a few months the patient had to be admitted to hospital with a life-threatening case of hypothyroidism. His thyroid had not regenerated. “It was fortunate that the patient did not die,” a college panel wrote in a disciplinary decision, suspending Oh’s license for 12 months. “Telling the patient that he should not take his thyroid medication was irresponsible and had disastrous repercussions.”

The panel found that Oh had engaged in professional misconduct in multiple ways:

  • he had provided unnecessary treatment,
  • he had failed to advise his patient to consult a medical doctor when he learned that S.K. was suffering
    from symptoms that he knew or ought to have known indicated an urgent medical problem,
  • he had treated a condition that he ought to have known that he did not have the knowledge, skills, or judgment to treat,
  • he had failed to keep records in accordance with the standards of the profession,
  • he had falsified a record relating to his practice,
  • he had made a claim about a treatment that could not be supported by reasonable professional opinion (the claim that acupuncture combined with cessation of thyroid medicine could regrow a surgically removed thyroid gland, and the claim that S.K.’s thyroid gland was regrowing).

This is clearly an extreme incidence of misconduct and one would hope that such cases occur only rarely. But looking at the points listed above, I get the feeling that similar yet less severe cases of misconduct happen regularly in the practices of SCAM practitioners:

  • most so-called alternative medicine (SCAM) treatments are unnecessary,
  • SCAM practitioners refer patients only rarely to doctors,
  • SCAM practitioners often treat conditions that they fail to understand adequately,
  • SCAM practitioners frequently make unreasonable claims.

 

 

The claim that homeopathy has a role in oncology does not seem to go away. Some enthusiasts say it can be used as a causal therapy, while others insist it might be a helpful symptomatic adjuvant. Almost all oncologists agree that homeopathy has no place at all in cancer care.

Who is right?

This systematic review included clinical studies from 1800 until 2020 to evaluate evidence of the effectiveness of homeopathy on physical and mental conditions in patients during oncological treatment.

In February 2021 a systematic search was conducted searching five electronic databases (Embase, Cochrane, PsychInfo, CINAHL and Medline) to find studies concerning use, effectiveness, and potential harm of homeopathy in cancer patients.

From all 1352 search results, 18 studies with 2016 patients were included in this SR. The patients treated with homeopathy were mainly diagnosed with breast cancer. The therapy concepts included single and combination homeopathic remedies (used systemically or as mouth rinses) of various dilutions. The outcomes assessed were:

  • the influence on toxicity of cancer treatment (mostly hot flashes and menopausal symptoms),
  • the time to drain removal in breast cancer patients after mastectomy,
  • survival,
  • quality of life,
  • global health,
  • subjective well-being,
  • anxiety and depression,
  • safety and tolerance.

The included studies reported heterogeneous results: some studies described significant differences in quality of life or toxicity of cancer treatment favoring homeopathy, whereas others did not find an effect or reported significant differences to the disadvantage of homeopathy or side effects caused by homeopathy. The majority of the studies had low methodological quality.

The authors concluded that, the results for the effectiveness of homeopathy in cancer patients are heterogeneous, mostly not significant and fail to show an advantage of homeopathy over other active or passive comparison groups. No evidence can be provided that homeopathy exceeds the placebo effect. Furthermore, the majority of the included studies shows numerous and severe methodological weaknesses leading to a high level of bias and are consequently hardly reliable. Therefore, based on the findings of this SR, no evidence for positive effectiveness of homeopathy can be verified.

This could not be clearer. Some might argue that, of course, homeopathy cannot change the natural history of cancer, but it might improve the quality of life of those patients who believe in it via a placebo response. I would still oppose this notion: there are many effective treatments in the supportive treatment of cancer, and it seems much better to use those options and tell patients the truth about homeopathy.

I have been informed by the publisher, that my book has been published yesterday. This is about two months earlier than it was announced on Amazon. It is in German – yes, I have started writing in German again. But not to worry, I translated the preface for you:

Anyone who falls ill in Germany and therefore needs professional assistance has the choice, either to consult a doctor or a non-medical practitioner (Heilpraktiker).

– The doctor has studied and is licensed to practice medicine; the Heilpraktiker is state-recognized and has passed an official medical examination.
– The doctor is usually in a hurry, while the Heilpraktiker takes his time and empathizes with his patient.
– The doctor usually prescribes a drug burdened with side effects, while the Heilpraktiker prefers the gentle methods of alternative medicine.

So who should the sick person turn to? Heilpraktiker or doctor? Many people are confused by the existence of these parallel medical worlds. Quite a few finally decide in favor of the supposedly natural, empathetic, time-tested medicine of the Heilpraktiker. The state recognition gives them the necessary confidence to be in good hands there. The far-reaching freedoms the Heilpraktiker has by law, as well as the coverage of costs by many health insurances, are conducive to further strengthening this trust. “We Heilpraktiker are recognized and respected in politics and society,” writes Elvira Bierbach self-confidently, the publisher of a standard textbook for Heilpraktiker.

The first consultation of our model patient with the Heilpraktiker of his choice is promising. The Heilpraktiker responds to the patient with understanding, usually takes a whole hour for the initial consultation, gives explanations that seem plausible, is determined to get to the root of the problem, promises to stimulate the patient’s self-healing powers naturally, and invokes a colossal body of experience. It almost seems as if our patient’s decision to consult a Heilpraktiker was correct.

However, I have quite significant reservations about this. Heilpraktiker are perhaps recognized in politics and society, but from a medical, scientific, or ethical perspective, they are highly problematic. In this book, I will show in detail and with facts why.

The claim of government recognition undoubtedly gives the appearance that Heilpraktiker are adequately trained and medically competent. In reality, there is no regulated training, and the competence is not high. The official medical examination, which all Heilpraktiker must pass is nothing more than a test to ensure that there is no danger to the general public. The ideas of many Heilpraktiker regarding the function of the human body are often in stark contradiction with the known facts. The majority of Heilpraktiker-typical diagnostics is pure nonsense. The conditions that they diagnose are often based on little more than naive wishful thinking. The treatments that Heilpraktiker use are either disproven or not proven to be effective.

There is no question in my mind that Heilpraktiker are a danger to anyone who is seriously ill. And even if Heilpraktiker do not cause obvious harm, they almost never offer what is optimally possible. In my opinion, patients have the right to receive the most effective treatment for their condition. Consumers should not be misled about health-related issues. Only those who are well-informed will make the right decisions about their health.

My book provides this information in plain language and without mincing words. It is intended to save you from a dangerous misconception of the Heilpraktiker profession. Medical parallel worlds with the radically divergent quality standard – doctor/Heilpraktiker – are not in the interest of the patient and are simply unacceptable for an enlightened society.

Homeopathy is touted as a panacea, we all know that. It is thus hardly surprising that it is also claimed to be an effective detox option. Here is a German article on the subject that I translated for you:

It was published on the independent health portal Lifeline. It claims that it “offers comprehensive, high-quality and understandably written information on health topics, diseases, nutrition, and fitness. Our editorial team is supported by doctors and freelance medical authors in the continuous creation and quality assurance of our content. Much of our information is multimedia-based with videos and informative image galleries. Numerous self-tests encourage interaction. In our expert advice and forums on various topics, Lifeline users can discuss topics with experts or exchange information with other users. Our information is in no way intended to be a substitute for a visit to the doctor. Rather, our aim is to qualitatively improve and support the relationship between doctor and patient through the information provided. Therefore, our contents do not serve the purpose of arbitrary diagnosis or treatment.”

And here is the article in question:

Environmental toxins, medications, nicotine, alcohol, unhealthy food – the human body is burdened daily by many substances, waste products and toxins. It is therefore sensible and beneficial to detoxify the liver regularly – preferably naturally. With these homeopathic remedies, this can be done gently.

To stay healthy or to prevent acute diseases from becoming chronic: The reasons to regularly rid the body of accumulated toxins are many. Toxins and waste products weaken the organism or can even cause illness themselves. Especially after drug treatments with antibiotics or cortisone, with frequently recurring colds and flu-like infections, it can be useful to detoxify the body naturally – with homeopathy.

In the body, the liver is the central organ where toxins are broken down. The kidneys, as organs of elimination, also play an important role in detoxification. To support the liver and kidneys in natural detoxification, various medicines are available. In homeopathy, detoxification is also called elimination.

Homeopathic medicines particularly suitable for the detoxification cure:

Sulfur: This classic homeopathic medicine has a strong detoxifying effect on connective tissue and mucous membranes, as well as a cleansing effect on the entire organism. In homeopathy, sulfur is mainly used for natural detoxification after drug treatments with antibiotics and cortisone. If the body is so heavily burdened with waste products that other homeopathic medicines have no effect, Sulfur can be used for natural detoxification.

Nux vomica: A very versatile homeopathic medicine is Nux vomica. It is particularly suitable for detoxifying the body naturally when one has consumed too many stimulants such as coffee or alcohol. It can also be used to eliminate harmful substances caused by medication. Nux vomica has proven particularly useful for the accompanying treatment of side effects after chemotherapy.

Pulsatilla: In homeopathy, Pulsatilla is considered an important natural remedy for detoxification, acting primarily on the mucous membranes and the stomach and intestines. Pulsatilla helps alleviate physical discomfort caused by eating too fatty, unhealthy foods, drinks that irritate the stomach such as coffee and alcohol, and taking medications. Pulsatilla works similarly to the detoxification classic sulfur, only the natural detoxification of liver and kidneys as well as connective tissue proceeds even more gently.

Arsenicum album: Within homeopathy, the remedy Arsenicum album is considered a universal remedy for poisoning, for example by heavy metals. It is mainly used for physical signs of exhaustion and weakness and can compensate for negative consequences of unhealthy nutrition. In addition, Arsenicum album is also said to have an anxiety-relieving effect.

Okoubaka: Okoubaba is also considered a medicine with a strong detoxifying effect, acting mainly on the gastrointestinal tract and used for abdominal cramps, flatulence, constipation, as well as acute diarrhea. Especially after a treatment with antibiotics or after having gone through an illness with norovirus, rotavirus or salmonella, Okoubaba can help to detoxify naturally and restore the intestinal flora.

Magnesium fluoratum: When cold symptoms such as cough and cold flare up again and again after administration of fever-reducing medications and other cold preparations, recovery is protracted and the body is weakened, natural detoxification with magnesium fluoratum can help.

Echinacea: Echinacea is known to increase the body’s defenses. As a homeopathic medicine, it can also help to naturally detoxify underlying conditions that have not been cured.

Detoxify naturally: Typical potencies and their dosage
Low potencies from D3 to D12 are commonly used for self-treatment in natural detoxification. However, choosing the right homeopathic remedy is not always easy. If there are uncertainties, an experienced homeopath should be asked for advice, if possible, in order to determine the drug, potency and dosage on the basis of a detailed anamnesis.

___________________________

Impressed?

No?

But I am – though not in a positive sense.

The article contains far too many unsubstantiated statements to mention. In fact, they are not just unsubstantiated, they are false! As the author does not even attempt to provide evidence for them, one cannot even dispute it. Suffice to say that ‘detox’ is BS and homeopathy too. And in healthcare ‘minus X minus’ does sadly not give ‘plus’.

What renders this otherwise trivial article rather important, in my view, is this: such web-based information is not the exception; quite the opposite: German consumers are bombarded with BS of this type.

Ever wondered why Germany is such a huge market for health fraud?

Now you know the answer!

 

 

 

So-called alternative medicine (SCAM) is widely used in Arabia. One of the commonly used methods is camel urine alone or mixed with camel milk. Camel urine is a liquid by-product of camel metabolism. Urine from camels has been used as prophetic medicine for centuries, being a part of ancient Bedouin practices. Camel urine comes out as a concentrated, viscous syrup because the kidneys and intestines of a camel are very efficient at reabsorbing water.

Camel urine is consumed and used for treating numerous ailments. Some employ it as a treatment for hair loss, for instance. The camel urine from a virgin camel is priced at twenty dollars per liter, with herders saying that it has curative powers.

A recent paper offers more information:

Camel is one of the important livestock species which plays a major role in the pastoral mode of life by fulfilling basic demands of livelihood. Traditionally, camel urine has been used in the treatment of human diseases. With regard to the health benefits of drinking the urine of camels, it has been proven by modern scientific researches. Camel urine has an unusual and unique biochemical composition that contributes to medicinal values. The chemical composition of camel urine showed the presence of purine bases, hypoxanthine, sodium, potassium, creatinine, urea, uric acid, and phosphates. The nano-particles in the camel’s urine can be used to fight cancer. Camel urine has antimicrobial activity against pathogenic bacteria. Its chemical and organic constituents have also inhibitory properties against fungal growth, human platelets, and parasitic diseases mainly fasciollosis in calves. The healthy status of the liver can be restored through ingestion of diet and minerals in camel urine. Camel urine is used by the camel owners and Bedouins as medicine in different ways. The Bedouin in the Arab desert used to mix camel urine with milk. Recently; the WHO has warned against drinking camel urine due to the modern attempt to limit Outbreaks of Respiratory Syndrome (MRS) in the Middle East. There is no scientific dosage for camel urine to be applied as medicine for different diseases and the ways of camel urine formulation and utilization for the care of patients varies from country to country. Therefore, the purposes of the present review describe the biochemical composition of camel urine will be scientifically extracted and formulated as a therapy rather than drinking raw urine and people’s health impact.

Researchers from the Medical Oncology Department, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia wanted to determine whether camel urine shows promise in the treatment of cancer. The aim of their study was to observe cancer patients who insisted on using camel urine and to devise some clinically relevant recommendations.

The authors observed 20 cancer patients (15 male, 5 female) from September 2020 to January 2022 who insisted on using camel urine. They documented the demographics of each patient, the method of administering camel urine, the reasons for refusing conventional treatment, the period of follow-up, and the outcome and side effects.

All the patients had radiological investigations before and after finishing treatment with camel urine. All patients used a combination of camel urine and milk, and treatment ranged from a few days up to 6 months. The average amount of urine/milk consumed was 60 ml/day. No clinical benefit was observed and two patients developed brucellosis. Eleven patients changed their minds and eventually accepted conventional antineoplastic treatments but 7 were too weak to receive further treatment and died from their disease.

The authors concluded that camel urine had no clinical benefits in cancer patients, and may even have caused zoonotic infection. The promotion of camel urine as a traditional medicine should be stopped because there is no scientific evidence to support it.

I fear that, yet again, ‘ancient wisdom’ turns out to be just ‘old bullshit’.

Acupuncture is a panacea, we are often told.

But is it true?

Of course not!

This study was aimed at evaluating the effect of acupuncture on myelosuppression and quality of life in women with breast cancer during treatment with anthracyclines (ANT).

Women with an indication for ANT chemotherapy were randomized into two groups:

  • the acupuncture group (AG) was submitted to an acupuncture intervention, starting before the first chemotherapy infusion, and continuing throughout the treatment;
  • the control group (CG) received no acupuncture.

A quality of life questionnaire (FACT-G) and peripheral blood levels of the participants were evaluated before and at the end of treatment.

A total of 26 women were randomized into 2 groups: AG (10) and CG (16). Of these, 26.9% had a dense dose indication according to the service’s protocol for the administration of granulocyte-stimulating factor (G-CSF) from the first cycle, not participating in the analysis. The need for secondary prophylaxis with G-CSF occurred in 72.7% in the control group versus 12% in the acupuncture group. Regarding quality of life (QoL), it was observed that the groups did not initially differ from each other. At the end of the treatment, there was a significant difference in the AG for the physical (GP) (p-value=0.011), social/family (GS) (p-value=0.018), and functional (GF) (p-value=0.010) domains, regarding the initial and final FACT-G showed a difference between the groups, where the GA average at the end rose from 80.68 to 90.12 (p-value = 0.004) and in the CG the average dropped from 81.95 to 70.59 (p-value=0.003).

The authors concluded that acupuncture was efficient in the secondary prophylaxis of myelosuppression during chemotherapy and the quality of life of women during treatment has increased.

My interpretation of these results is quite different from that of the authors.

Please let me explain.

The improvement of the quality of life can easily be explained via a placebo effect; acupuncture itself has not necessarily any part in it. But what about the effect on the bone marrow? Might it too be due to a placebo response, or the additional attention? Probably not.

Does that mean that this study proves a definite positive effect of acupuncture?

No!

Why not?

Because firstly the study was far too small for allowing such a far-reaching conclusion, and secondly one would need independent confirmation before accepting such a far-reaching conclusion.

A recent article in ‘The Lancet Regional Health‘ emphasized the “need for reimagining India’s health system and the importance of an inclusive approach for Universal Health Coverage” by employing traditional medicine, including homeopathy. This prompted a response by Siddhesh Zadey that I consider worthy of reproducing here in abbreviated form:

… Since the first trial conducted in 1835 that questioned homeopathy’s efficacy, multiple randomized controlled trials (RCTs) and other studies compiled in several systematic reviews and meta-analyses have shown that there is no reliable and clinically significant effect of non-individualized or individualized homeopathic treatments across disease conditions ranging from irritable bowel syndrome in adults to acute respiratory tract infections in children when compared to placebo or other treatments. Even reviews that support homeopathy’s efficacy consistently caution about low quality of evidence and raise questions on its clinical use. The most recent analysis of reporting bias in homeopathic trials depicted problematic trial conduction practices that further obscure reliability and validity of evidence. Homeopathic treatments have also been linked to aggravations and non-fatal and fatal adverse events.

The Lancet has previously published on another kind of harm that uptake of homeopathy encourages in India: delay to evidence-based clinical care that can lead to fatality. Authors have pointed out that evidence for some of the alternative systems of medicine may not come from RCTs. I agree that more appropriate study designs and analytical techniques are needed for carefully studying individualized treatment paradigms. However, the need for agreement on some consistent form of evidence synthesis and empirical testing across diverse disciplines cannot be discounted. Several other disciplines including psychology, economics, community health, implementation science, and public policy have adopted RCTs and related study designs and have passed the empirical tests of efficacy. Moreover, the ideas around mechanism of action in case of homeopathy still remain controversial and lack evidence after over a century. On the contrary, biochemical, molecular, and physiological mechanistic evidence supporting allopathic treatments has grown abundantly in the same period.

Owing to lack of evidence on its efficacy and safety, the World Health Organization had previously warned against the use of homeopathic treatments for severe diseases. Additionally, multiple countries, including Germany where the practice originated, have initiated mechanisms that discourage uptake of homeopathy while others are considering banning it. Homeopathy doesn’t work, could be harmful, and is not a part of Indian traditional medicine. While we should welcome pluralistic approaches towards UHC, we need to drop homeopathy.

(for references, see original text)

___________________

Yes, in the name of progress and in the interest of patients, “we need to drop homeopathy” (not just in India but everywhere). I quite agree!

Is acupuncture more than a theatrical placebo? Acupuncture fans are convinced that the answer to this question is YES. Perhaps this paper will make them think again.

A new analysis mapped the systematic reviews, conclusions, and certainty or quality of evidence for outcomes of acupuncture as a treatment for adult health conditions. Computerized search of PubMed and 4 other databases from 2013 to 2021. Systematic reviews of acupuncture (whole body, auricular, or electroacupuncture) for adult health conditions that formally rated the certainty, quality, or strength of evidence for conclusions. Studies of acupressure, fire acupuncture, laser acupuncture, or traditional Chinese medicine without mention of acupuncture were excluded. Health condition, number of included studies, type of acupuncture, type of comparison group, conclusions, and certainty or quality of evidence. Reviews with at least 1 conclusion rated as high-certainty evidence, reviews with at least 1 conclusion rated as moderate-certainty evidence and reviews with all conclusions rated as low- or very low-certainty evidence; full list of all conclusions and certainty of evidence.

A total of 434 systematic reviews of acupuncture for adult health conditions were found; of these, 127 reviews used a formal method to rate the certainty or quality of evidence of their conclusions, and 82 reviews were mapped, covering 56 health conditions. Across these, there were 4 conclusions that were rated as high-certainty evidence and 31 conclusions that were rated as moderate-certainty evidence. All remaining conclusions (>60) were rated as low- or very low-certainty evidence. Approximately 10% of conclusions rated as high or moderate-certainty were that acupuncture was no better than the comparator treatment, and approximately 75% of high- or moderate-certainty evidence conclusions were about acupuncture compared with a sham or no treatment.

Three evidence maps (pain, mental conditions, and other conditions) are shown below

The authors concluded that despite a vast number of randomized trials, systematic reviews of acupuncture for adult health conditions have rated only a minority of conclusions as high- or moderate-certainty evidence, and most of these were about comparisons with sham treatment or had conclusions of no benefit of acupuncture. Conclusions with moderate or high-certainty evidence that acupuncture is superior to other active therapies were rare.

These findings are sobering for those who had hoped that acupuncture might be effective for a range of conditions. Despite the fact that, during recent years, there have been numerous systematic reviews, the evidence remains negative or flimsy. As 34 reviews originate from China, and as we know about the notorious unreliability of Chinese acupuncture research, this overall result is probably even more negative than the authors make it out to be.

Considering such findings, some people (including the authors of this analysis) feel that we now need more and better acupuncture trials. Yet I wonder whether this is the right approach. Would it not be better to call it a day, concede that acupuncture generates no or only relatively minor effects, and focus our efforts on more promising subjects?

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