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

prevention

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THE SUN (…yes, I know! …) reported last Sunday that figures from 20 trusts show they forked out for questionable treatments for more than 3,000 patients. Treatments also including acupuncture and aromatherapy cost a total of £269,000. If the figure is applied across all 120-plus trusts the true cost could be well over £1.5 million. Hull University Teaching Hospitals spent the most, at £170,000.

The Taxpayers’ Alliance, which did the analysis, said: “With long waiting lists, quack remedies cannot be allowed to divert precious resources.” Alternative medicine expert Dr Edzard Ernst said: “The NHS often uses complementary medicine rarely based on good evidence but on lobbying of proponents of quackery.”

End of quote

Whenever I am asked by journalists to provide a critical comment on so-called alternative medicine (SCAM), I have mixed feelings. On the one hand, I find it important to get a rational message out, particularly into certain papers. On the other hand, I dread what they might do with my comment, particularly certain papers. If I had £5 for every time I have been misquoted, I could probably buy a decent second-hand car! This is why I nowadays tend to give my comments in writing via e-mail.

To my relief, THE SUN quoted me (almost) correctly. Almost correctly, but not fully! Here is the question I was asked to respond to: NHS statistics show the health service spending more than £250,000 on complementary and alternative medicines last year. Do you think this is a sensible use of NHS funding? Are the benefits well proven enough to spend taxpayer money on these therapies?

And here is my attempt to respond in a concise way that SUN readers might still understand:

Complementary medicine is an umbrella term for more than 400 treatments and diagnostic techniques. Some of them work but many don’t; some are safe but many are not. If the NHS would spend £250000 – a tiny amount considering the overall expenditure in the NHS – on those few that do generate more good than harm, all might be fine. The problem, I think, is that the NHS currently uses complementary medicine rarely based on good evidence but often based on the lobbying of influential proponents of quackery. 

As you see, it is good to deal with requests from journalists in writing!

The objective of the present double-blind, randomized, placebo-controlled, feasibility trial was to identify the effects of individualized homeopathic medicinal products (IHMPs) against placebos in post-COVID-19 conditions. Sixty participants with post-COVID-19 conditions were randomised into either:

  • group verum (n = 30; IHMPs plus concomitant care),
  • group control (n = 30; placebos plus concomitant care).

Feasibility issues; primary—post-COVID-19 symptoms checklist; secondary—Measure Yourself Medical Outcomes Profile version 2 (MYMOP-2); all of them were measured at baseline, and monthly intervals, up to 3 months. The intention-to-treat sample was analyzed; group differences were reported using descriptive statistics: means, 95% confidence intervals (CIs), and between group effect sizes (Cohen’s d).

Feasibility concerns showed promise; recruitment, retention, and attrition rates were 34.2%, 95%, and 5%, respectively. Group differences in both primary and secondary outcomes favored IHMPs against placebos: symptoms checklist score mean difference after 3 months: −4.2, 95% CI −4.9 to −3.4, d = 2.854 and MYMOP-2 mean difference after 3 months: −2.2, 95% CI −2.8 to −1.7, d = 2.082, respectively. Natrum muriaticum (11.7%), Pulsatilla nigricans (10%), Rhus toxicodendron (8.3%), and Calcarea carbonica (8.3%) were the most frequently prescribed remedies.

The authors concluded that IHMPs produced better results than placebos in reducing symptoms checklist scores and MYMOP-2 scores in the treatment of post-COVID-19 conditions. Definitive trials are warranted to confirm the findings.

A feasibility study (the authors employ this term repeatedly) has – as I have often pointed out – the purpose of testing whether a trial disign, set-up, etc. is FEASIBLE. It is not meant to report other outcome data.

Why?

Mainly because such studies are far too underpowered for generating reliable results!

This means that the present findings can be ignored. They are most likely caused by chance.

Why are they published anyway, and why could the authors find a journal that goes along with such nonsense?

Are they too stupid or are they biased or both?

The nature of the journal might provide a hint for answering these questions (J Integr Complement Med), and so does the list of authors and their affiliations:

  • 1Department of Organon of Medicine and Homoeopathic Philosophy, D. N. De Homoeopathic Medical College and Hospital, Govt. of West Bengal, Kolkata, India.
  • 2Department of Pathology and Microbiology, D. N. De Homoeopathic Medical College & Hospital, Govt. of West Bengal, Kolkata, India.
  • 3Department of Practice of Medicine, D. N. De Homoeopathic Medical College and Hospital, Govt. of West Bengal, Kolkata, India.
  • 4Department of Homeopathy, East Bishnupur State Homoeopathic Dispensary, Chandi Daulatabad Block Primary Health Centre, Department of Health & Family Welfare, Govt. of West, Kolkata, India.
  • 5Department of Repertory, D. N. De Homoeopathic Medical College and Hospital, Govt. of West Bengal, Kolkata, India.
  • 6Department of Community Medicine, D. N. De Homoeopathic Medical College and Hospital, Govt. of West Bengal, Kolkata, India.

I rest my case.

An article entitled “The use of ayurvedic medicine in the management of hypertension” was recently published in the ‘Journal of Ayurveda and Naturopathy’ (no, I did not know either that this journal existed). Here I show you merely its conclusion, but encourage you to read the entire paper.

Hypertension, a significant risk factor for cardiovascular diseases, necessitates effective and sustainable management strategies. Ayurveda, with its holistic approach, offers a comprehensive framework for managing hypertension by addressing the underlying dosha imbalances through dietary and lifestyle modifications, herbal formulations, and therapeutic procedures. This review has highlighted the
efficacy of various Ayurvedic interventions, including the use of specific herbs like Ashwagandha, Arjuna, Brahmi, Gokshura, and Sarpagandha, which have demonstrated significant benefits in reducing blood pressure and improving overall health. Panchakarma therapies such as Virechana, Basti, Nasya, and Shirodhara have also been shown to detoxify the body, restore balance, and promote
long-term well-being.

Integrating Ayurvedic practices with modern medical approaches can enhance treatment outcomes, offering a more personalized and holistic approach to hypertension management. This synergy can potentially reduce the reliance on pharmaceuticals, minimize side effects, and improve patient compliance and quality of life. Future research should focus on rigorous clinical trials and the standardization of Ayurvedic formulations to further validate their efficacy and facilitate their integration into mainstream healthcare.

By embracing the principles of Ayurveda, individuals can achieve better control over hypertension, reduce the risk of associated complications, and enhance their overall health and well-being. This comprehensive approach not only addresses the symptoms but also tackles the root causes, promoting a sustainable and balanced lifestyle.

END OF QUOTE

Not only does the author, Dr. Zafar Siddiqa (from the Faculty of Natural Medicine and Holistic Sciences, Rajshahi Holistic Health College, Rajshahi, Bangladesh) re-write the current knowledge of hypertonology, he also provides no evidence for any of the far-reaching statements he makes in this paper. In particular, he cites no rigorous studies that “highlighted the efficacy of various Ayurvedic interventions” (most likely because such studies do not exist).

The autor is correct in the 1st sentence of his conclusion: “Hypertension, a significant risk factor for cardiovascular diseases, necessitates effective and sustainable management strategies”. But he is wrong in almost everything else! Because hypertension is such an important risk factor for stroke and ischaemic heart disease, we MUST treat it effectively.

Today, we fortunately have many conventional treatments that control hypertension well and with no or just minimal adverse effects. Advocating quackary or unproven therapies for managing hypertension is thus deeply unethical. It could contribute to the premature deaths of millions. I thus fear that the ‘Faculty of Natural Medicine and Holistic Sciences, Rajshahi Holistic Health College’ is in urgent need of taking a few courses in proper science and medical ethics.

While the evidence base on web-based cancer misinformation continues to develop, relatively little is known about the extent of such information on the world’s largest e-commerce website, Amazon. Multiple media reports indicate that Amazon may host on its platform questionable cancer-related products for sale, such as books on purported cancer cures. This context suggests an urgent need to evaluate Amazon.com for cancer misinformation.

This study sought to

  • (1) examine to what extent are misleading cancer cure books for sale on Amazon.com’
  • (2) determine how cancer cure books on Amazon.com provide misleading cancer information.

The investigators searched “cancer cure” on Amazon.com and retrieved the top 1000 English-language book search results. They reviewed the books’ descriptions and titles to determine whether the books provided misleading cancer cure or treatment information. They considered a book to be misleading if it suggested scientifically unsupported cancer treatment approaches to cure or meaningfully treat cancer. Among books coded as misleading, they conducted an inductive latent thematic analysis to determine the informational value the books sought to offer.

Nearly half (494/1000, 49.4%) of the sampled “cancer cure” books for sale on Amazon.com appeared to contain misleading cancer treatment and cure information. Overall, 17 (51.5%) out of 33 Amazon.com results pages had 50% or more of the books coded as misleading. The first search result page had the highest percentage of misleading books (23/33, 69.7%). Misleading books (n=494) contained eight themes:

  • (1) claims of efficacious cancer cure strategies (n=451, 91.3%),
  • (2) oversimplifying cancer and cancer treatment (n=194, 39.3%),
  • (3) falsely justifying ineffective treatments as science based (n=189, 38.3%),
  • (4) discrediting conventional cancer treatments (n=169, 34.2%),
  • (5) finding the true cause of cancer (n=133, 26.9%),
  • (6) homogenizing cancer (n=132, 26.7%),
  • (7) discovery of new cancer treatments (n=119, 24.1%),
  • (8) cancer cure suppression (n=82, 16.6%).

The authors concluded that the results demonstrate that misleading cancer cure books are for sale, visible, and prevalent on Amazon.com, with prominence in initial search hits. These misleading books for sale on Amazon can be conceived of as forming part of a wider, cross-platform, web-based information environment in which misleading cancer cures are often given prominence. Our results suggest that greater enforcement is needed from Amazon and that cancer-focused organizations should engage in preemptive misinformation debunking.

This is an excellent paper that is long overdue. The plethora of dangerous books on so-called alternative medicine (SCAM) targeted at lay people is nothing short of a scandal. It was high time that we expose it, because it kills vulnerable patients. It is difficult, if not impossible, to quantify the damage done by such books but I am sure it runs in the thousands.

I have been aware of this scandal for a long time, in fact, it was the main motivation for publishing my own book on the subject. Obviously, it is not much more than a drop in the ocean.

Tragically, this scandal is not confined to just cancer. It relates to all potentially serious conditions. What could be more despicable and unethical than earning money through making desperately ill patients suffer? As the authors point out, Amazon urgently needs to address this problem. Failing this, Amazon should be legally held responsible, in my view.

Advocates of so-called alternative medicine (SCAM) almost uniformly stress the importance of prevention and pride themselves to make much use of SCAM for the purpose of prevention. SCAM, they often claim, is effective for prevention, while conventional medicine tends to neglect it. Therefore, it seems timely to ponder a bit about the subject.

It makes sense to differentiate three types of prevention:

  1. Primary prevention aims to prevent disease or injury before it ever occurs.
  2. Secondary prevention aims to reduce the impact of a disease or injury that has already occurred.
  3. Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting effects.

Here I will includes all three and I will ask what SCAM has to offer in any form of prevention. I will do this by looking at what we have previously discussed on this blog in relation to several specific SCAM and add in each case a very brief evaluation of the evidence.

Acupuncture

Chiropractic

Herbal medicine

Homeopathy

Mind-body therapies

Osteopathy

Does Osteopathy Prevent Motion Sickness? – NO CONVINCING EVIDENCE

Supplements

Yoga

I hope you agree: this list is impressive!

  • Impressive in the way of showing how often we have discussed SCAM for prevention in one form or another.
  • Impressive also to see how little positive evidence there is for effective prevention with SCAM

Of course, this is merely based on posts that were published on my blog. Some will argue that I missed out on some effective SCAMs for prevention. Others might claim that I judged some of the the above cited articles too harshly. If you share such sentiments, I invite you to show me the evidence – and I promise to look at it and evaluate it critically.

Meanwhile, I will draw the following conclusion:

Despite the prominent place prevention assumes in discussions about SCAM, the actual evidence fails to show that it has an important role to play in primary, secondary or tertiary prevention.

 

In January 2024, this remarkable paper was published in a top journal:

Macrophages are associated with innate immune response and M1-polarized macrophages exhibit pro-inflammatory functions. Nanoparticles of natural or synthetic compounds are potential triggers of innate immunity. As2O3 is the major component of the homeopathic drug, Arsenic album 30C.This has been claimed to have immune-boosting activities, however, has not been validated experimentally. Here we elucidated the underlying mechanism of Ars. alb 30C-mediated immune priming in murine macrophage cell line. Transmission Electron Microscopy (TEM) and X-ray diffraction (XRD) used for the structural analysis of the drug reveals the presence of crystalline As2O3 nanoparticles of cubic structure. Similarly, signatures of M1-macrophage polarization were observed by surface enhanced Raman scattering (SERS) in RAW 264.7 cells with concomitant over expression of M1 cell surface marker, CD80 and transcription factor, NF-κB, respectively. We also observed a significant increase in pro-inflammatory cytokines like iNOS, TNF-α, IL-6, and COX-2 expression with unaltered ROS and apoptosis in drug-treated cells. Enhanced expression of Toll-like receptors 3 and 7 were observed both in transcriptional and translational levels after the drug treatment. In sum, our findings for the first time indicated the presence of crystalline As2O3 cubic nanostructure in Ars. alb 30C which facilitates modulation of innate immunity by activating macrophage polarization.

On 21 August 2024, this paper was retracted; here is the retraction notice:

After publication, concerns were raised about the reagents used in this study, in particular that the arsenic trioxide solution is diluted beyond the point at which any active molecules are expected to be present. Post-publication peer review confirmed that the nature of the particles detected in the study is unclear. This means that without further corroborative evidence, the data presented in the paper are not sufficient to attribute the effects observed after treating cells with the compound. The Editors therefore no longer have confidence in the results reported in this Article.

Swift retractions of sloppy science, errors, fraud, scientific misconduct, misinterpretaton of results, etc. are necessary to prevent the harm caused by such unfortunate publications. The editors of SCIENTIFIC REPORTS should be congratulated to have achieved this so quickly and elegantly. This is in sharp contrast to similar events like the protracted hoo-hah that occurred until THE LANCET finally retracted the fraudulent study of Andrew Wakefield or the deplorable ongoing saga of  THE ONCOLOGIST, the editor of which has still not retracted the fraudulent paper by Michael Frass et al claiming that homeopathy could prolong the survival of cancer patients.

 

The German Magazine FürSie recently published an article on homeopathy. To be exact it is an article on how to lose weight with homeopathy. Here are a few excerpts:

Globules are used in homeopathy and are said to be able to alleviate complaints. Some globules are also said to have a positive effect on weight loss. We present them to you below.

Which globules help with weight loss?

Calcium carbonicum D12 helps against eating out of grief and frustration and brings body and soul back into balance. Dosage and intake: 5 globules 3 times a day.

Fucus vesiculosus D2 stimulates the metabolism and reduces appetite. Dosage and administration: 5 globules 3 times a day. Important: The remedy should not be used for thyroid disorders.

Coffea D6 promotes fat burning and helps you lose weight. Dosage and intake: Melt 3 globules on the tongue in the morning before breakfast.

Is your weight loss stagnating? Then Capsicum D4 can help. Metabolism and fat burning are boosted. It also produces happiness hormones. Dosage and intake: 5 globules 3 times a day.

Lycopodium D12 helps against an unpleasant bloated stomach. The remedy stimulates fat metabolism and regulates digestion. Dosage and intake: 5 globules twice daily.

Argentum nitricum D12 has a balancing effect and curbs cravings in stressful situations. Calorie intake is regulated. Dosage and intake: 5 globules 3 times a day.

Taking Petroselinum D6 will make you look slimmer. The ingredients support the elimination of excess water in the body. Dosage and intake: 3 globules 5 times a day…

Slimming globules are particularly impressive because they contain active ingredients that are satiating, boost the metabolism and stimulate fat burning. Another positive aspect is that, as is usual in homeopathy, the globules are purely herbal remedies. Chemical-free, they are regarded as virtually risk-free miracle pills.

Slimming processes, the disappearance of annoying kilos and a good sense of well-being can be achieved more quickly with homeopathic remedies.

I find this article so very remarkable because the author(s) (who is/are not named) managed to make all the above statements without a single one of them being true, supported by evidence or even remotely plausible. The only way one might lose weight by using homeopathy is, if one pays for it with a handful of coins from ones pocket. There is not a shred of sound evidence that homeopathy reduces body weight.

The magazine includes this disclaimer: “This article contains, among other things, product recommendations. When selecting the products, we are free from the influence of third parties. For a referral via our affiliate links, we receive a commission from the relevant service provider/online shop when a purchase or referral is made, with the help of which we can continue to offer independent journalism.”

Independent journalism?

I beg to differ: this is not independent nor is it journalism.

The question I ask myself is this: are such magazines allowed to publish any nonsense, or is there an authority that might control or reprimand them in an attempt to protect consumers?

Recent studies have demonstrated that sociopolitical attitudes partially explain variance in (SARS-CoV-2) vaccine hesitancy and uptake. Other attitudes, such as those towards esoteric beliefs, so-called alternative medicine (SCAM), and religion, have also been proposed. However, pertinent studies provide limited direction for public health efforts, as the impact of such attitudes has been tested in isolation or on different outcomes. Moreover, related associations between SARS-CoV-2 immunization drivers as well as views towards other modes of immunization (e.g., routine pediatric immunization), remain unclear.

Based on a sample of ~7400 survey participants (Germany), where esoteric belief systems and SCAM (Waldorf, homeopathy) are rather prevalent, and controlling for other sociological factors, this study found that:

  • individuals with positive attitudes towards Waldorf education and homeopathy are significantly less likely to have received a (further) dose of SARS-CoV-2 vaccine compared to those with positive views of mainstream medicine;
  • for the former, immunization decisions are primarily driven by external pressures, and for the latter overwhelmingly by voluntary considerations;
  • attitudes influencing adult SARS-CoV-2 vaccine uptake similarly influence views towards routine pediatric immunization.

The authors concluded that their findings provide significant evidence informing a more nuanced design of public health and communication campaigns, and pertinent policies.

As the authors of this study point out, the attitudes towards mainstream medicine remained the single most influential factor for vaccine uptake. Individuals who viewed mainstream medicine highly favorably, received on average an estimated 1.48 (p < 0.001) more doses of SARS-CoV-2 vaccine than those who held very negative views. In contrast, those who viewed homeopathy highly positively received on average 0.51 (p < 0.001) fewer doses than those who viewed homeopathy highly negatively.

Regarding religious denominations, individuals self-classifying as Roman-Catholic or Protestant received on average 0.17 (p < 0.001) and 0.15 (p < 0.001) more vaccine doses than those self-classifying as non-denominational. The associations between other denominations and vaccine doses were statistically insignificant.

While these associations have been observed before or at least seem logical to me (and we discusses them frequently on this blog), one finding is, I think new (albeit not surprising, in my view): Supporters of the right-wing populist AfD received 1.37 (p < 0.001) fewer vaccine doses than the reference category Christian democrats.

So, does that in essence mean that the typical (German) vaccination hesitant person votes extereme right and loves SCAM?

Proponents of so-called alternative medicine tend to be critical of COVID-19 vaccines and often claim that they do more harm than good. Therefore, I have in the past repeatedly discussed studies that alleviate their concerns and will continue to do so in future. A new study will provide a valuable contribution to this ongoing discussion.

It has been shown that the first dose of COVID-19 vaccines leads to an overall reduction in cardiovascular events, and in rare cases, cardiovascular complications. There is less information about the effect of second and booster doses on cardiovascular diseases. Using longitudinal health records from 45.7 million adults in England between December 2020 and January 2022, this study compared the incidence of thrombotic and cardiovascular complications up to 26 weeks after first, second and booster doses of brands and combinations of COVID-19 vaccines used during the UK vaccination program with the incidence before or without the corresponding vaccination.

The findings reveaal that:

  • The incidence of common arterial thrombotic events (mainly acute myocardial infarction and ischaemic stroke) was generally lower after each vaccine dose, brand and combination.
  • The incidence of common venous thrombotic events, (mainly pulmonary embolism and lower limb deep venous thrombosis) was lower after vaccination.
  • There was a higher incidence of previously reported rare harms after vaccination: vaccine-induced thrombotic thrombocytopenia after first ChAdOx1 vaccination, and myocarditis and pericarditis after first, second and transiently after booster mRNA vaccination (BNT-162b2 and mRNA-1273).

The authors concluded that these findings support the wide uptake of future COVID-19 vaccination programs.

This England-wide study offers reassurance regarding the cardiovascular safety of COVID-19 vaccines, with lower incidence of common cardiovascular events outweighing the higher incidence of their known rare cardiovascular complications. No novel cardiovascular complications or new associations with subsequent doses were found. The findings thus support the wide uptake of future COVID-19 vaccination programs.

Vaccine hesitancy has been defined as a continuum of attitudes, ranging from accepting vaccines with doubts to rejecting them. For good reasons, the topic has featured regularly on this blog, e.g.:

This new study aimed to explore the heterogeneity of a childhood-vaccine-hesitant group by using a person-oriented approach, i.e. latent profile analysis.

A non-representative cross-sectional sample of vaccine-hesitant Slovenians (N = 421, Mage = 35.21, 82.9% women) was used to identify differences based on their

  • reliance on personal research (“self” researching instead of relying on science),
  • over-confidence in knowledge,
  • endorsement of conspiracy theories,
  • complementary and alternative medicine,
  • trust in the healthcare system.

The analysis revealed three profiles of vaccine-hesitant individuals. The most hesitant profile—vaccine rejecting—expressed the greatest reliance on personal research, expressed the highest endorsement of conspiracy theories and complementary and alternative medicine, showed moderate overconfidence in their knowledge, and expressed the highest levels of distrust in the healthcare system. Furthermore, the researchers found differences in sociodemographic structure and noted that the identified profiles differed in their attitudes regarding MMR, HPV, and Seasonal Influenza vaccinations.

The authors concluded as follows: our findings not only further confirm the heterogeneous nature of vaccine-hesitant groups but also offer critical insights for public health interventions. By acknowledging the existence of distinct profiles within the vaccine-hesitant population, strategies can be tailored to address the nuanced beliefs and attitudes of these subgroups more effectively.

The authors suggest the following approaches:
  • Skeptics who already express a certain level of trust in healthcare, may be most receptive to messages from medical professionals. Given that skeptics are typically older, higher-educated men, interventions could focus on leveraging their existing trust in healthcare professionals and providing detailed, evidence-based information to address their specific concerns.
  • Self-directed researchers, who are characterized by high endorsement of CAM and conspiracy theories and moderate over-confidence, could benefit from interventions involving trusted community figures or CAM medicine experts who can bridge the gap between traditional and CAM perspectives. In addition, reaching out to younger women in this group through online platforms and providing credible information that counteracts misinformation could be effective.
  • Conventionalists, who have the highest trust in the healthcare system and tend to include more educated individuals with a left-leaning political orientation, may respond well to public health messages that emphasize the collective benefits of vaccination. Campaigns could focus on reinforcing their positive views on the efficacy, safety, and importance of vaccines while leveraging their trust in physicians and public health institutions.

The effectiveness of targeted interventions for each specific subgroup could then also be examined, employing insights from the present study. For instance, tailored communication strategies could be tested to determine which messages and messengers are the most effective in regard to changing attitudes and behaviors within each profile.

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