It’s not (yet) a global emergency, the WHO have announced. But 26 fatalities have today been reported, and soon we will have thousands of people infected with the new coronavirus, experts predict. A vaccine will take at least a year to become available, and experts are alarmed.
But there is no need for panic!
Let’s just ask our homeopaths for help. They are excellent with curing viral infections!
You don’t believe me? But it must be true; take this website, for instance; its message could not be clearer :
… Homeopathic remedies can help you in fighting viral infections effectively… Homeopathy can be effective for viral infections including influenza-like symptoms, viral coughs and serious viral infections like herpes cold sores and genital herpes… The most common oral homeopathic remedy for herpes outbreaks is Rhus Toxicodendron (Rhus Tox in short), which is an extremely diluted form of poison ivy…
Another website offers more detail:
Conventional drugs do not offer comprehensive treatments for viral infections. Certain viruses like Influenza, HIV, etc. have tendencies to mutate (change) very rapidly, thereby lowering the effectiveness of such medicines. Additionally, viruses quickly develop resistance to these drugs, making the development of preventive medicine somewhat challenging. Conventional medications therefore only provide supportive management and suppression of the symptoms.
Homeopathic treatment for viral infections helps ease the symptoms and also enables the body to heal naturally.
Homeopathy treatment for viral infections is steadily gaining popularity as a natural way to deal with viral infections. These medicines help reduce the frequency and intensity of acute symptoms like weakness, fever, body pain, etc. These help with quick recovery. In some cases, they reduce the chances of further complications. Homeopathy treatment for viral infections treats the symptoms not by suppressing them, but by strengthening the immune system. It activates the body’s natural restorative properties by producing symptoms similar to the ones experienced by the patients. This method helps settle underlying internal disturbances in the body. Homeopathy treatment for viral infections also minimizes the weakness and fatigue commonly encountered as an aftermath of the infection.
Viral infections are highly communicable and spread rapidly from one person to another. Homeopathy treatment for viral infections is also preventative and helps reduce the chances of contracting the infection.
Yet another website is equally clear:
For viral ailments with symptoms that are fast and violent, use the following homeopathic remedies: Aconitum and Belladonna.
Aconitum – also known as Devil’s helmet or Queen of All Poisons – is a flowering plant that belongs to the family Ranunculacea. The flowers of this plant are harvested and then processed to treat various ailments, including viral infections.
Belladonna – also known as Deadly Nightshade – is a perennial herbaceous plant – prized for its medicinal benefits. It’s used as a muscle relaxant and pain reliever. The plant contains potent anti-inflammatory properties too. It’s an excellent remedy for viral infections.
What, you are still not convinced? In this case, have a look at what a Devon homeopaths stated only yesterday about the current epidemic:
Panic and anger in Wuhan as China orders city into lockdown.
A Coronavirus is a common virus that causes an infection in your nose, sinuses, or upper throat. Most corona viruses are not dangerous, they can in fact just cause symptoms which look like a mild cold. Earlier this month though, the World Health Organization identified a new type (2019-nCoV) in China and to date there have been over 500 confirmed cases of this Corona virus with 17 fatalities reported so far this month. The Media seems to be covering its progress with great relish, causing a lot of panic.
The virus starts with a fever, followed by a dry cough, and then after a week or so this leads to shortness of breath when some patients are hospitalised. Pneumonia is one complication that can be caused by the virus. Most of the information spread about the virus is gained from these severe cases in hospital.
To protect yourself from any virus, you should boost your own immune symptom with a healthy diet and supplements if necessary. I recommend the best vitamin C & D supplements you can get. I also love Fermented Cod Liver Oil and a good Magnesium supplement. Having homeopathic constitutional treatment is also proven to boost your immune system.
Homeopathic remedies can address every symptom caused by this virus so having an inexpensive homeopathy kit at home is an excellent resource. I love the First Aid Kit by Helios Pharmacy which also comes with a booklet to guide you on which remedy to choose. If you have remedies but feel you’re not equipped to use them, get in touch with me and I will send you a free PDF first aid booklet.
Here are a few homeopathic remedies which will be useful to treat viruses such as this one. If you are confident the remedy is well indicated you need to repeat often in a 30C or 200C until it no longer helps, then move onto another if necessary:
Ferrum-phos: give this at the very first sign of symptoms. Useful when you just don’t feel well, tired. Red inflamed eyes, chill with shivering and fever. Hot, burning eyes. Worse cold, better rest.
Gelsemium: This is for when your symptoms start to feel more severe, especially if they have come on gradually. You will feel dull, sluggish, heavy, often with a headache at the back of the neck. Shivering up and down the spine, aching muscles, burning throat. Worse cold, better after urination.
Pulsatilla: You will feel Chilly, even in a warm room. Nose blocked up, bland and thick mucous. Dry mouth with no thirst. Changing, shifting symptoms, weepy and sorry for oneself. You may often have a sore throat or ear ache with viruses. Worse in a warm room, better in the open air.
Camphora: You will feel very cold, and may have laborious, asthmatic breathing with an accumulation of phlegm in the air tubes, cold, dry skin. Total exhaustion, with coldness and shivering. Weak pulse, irritability. Worse cold.
Phosphorous: For any virus which affects your lungs. You may have bloody sputum and crave cold drinks. Burning, pressure and constriction in the chest; worse lying on the left side or painful side. Better in company, needing reassurance.
Bryonia: Excellent in pneumonia or pleurisy, especially when the right side is affected. There is dryness everywhere, dry tongue, with generally a white coating. There may be pain when breathing or coughing where the patient wants to hold steady as any movement hurts. Irritable and thirsty. Better rest, pressure. Worse excitement, bright lights, noise, touch, movement.
This is outrageous, you claim? You insist that homeopathy is bunk, that homeopaths behave irrationally and their remedies are pure placebos? Placebos are no good for life-threatening infections! Anyone who says otherwise is deluded and irresponsible, you suggest.
I see, you might have a point.
Think of the time when homeopaths travelled to Liberia to cure Ebola. That was a homeopathic disaster, if there ever was one. Have homeopaths learnt their lesson since then? Clearly not: there are still hundreds of websites and books promoting homeopathy even for the most serious viral diseases. Do homeopaths provide sound evidence for their claims? I can see none.
Maybe that’s why nobody asks homeopaths to help with medical emergencies.
If you, like many of us, have heavily ‘toxed’, you might now consider ‘detoxing’. What I mean is that we have probably all over-indulged a bit over the holidays. Unless you were the guest of someone, you had to pay dearly for it (Champagne is not cheap!). And now, a whole industry of ‘detox’ entrepreneurs tells you to pay again – this time, for detox.
As you payed ‘through your nose’ for the ‘tox’, you might as well use the same orifice for the ‘detox’. An Indian tradition called Nasiyam (or Nasyam? or Nasya? – I am confused!) makes it possible. This website explains:
Nasal Instillation (Nasyam) is the practice of instilling medicated oils, fresh juices of leaves or flowers in the nostrils … Nasyam is specially directed towards the purification of various parts related to the head…
I don’t know about you, but I always felt that all my parts were related to my head! So, Nasyam is for purification of all my parts? The announcement below – I picked it up on Twitter – is much clearer: detox through the nasal doorway! Who would refuse such an offer after the festivities of late?
This sounds fascinating, I thought. Thus I ran a quick Medline search but only found this abstract:
Ardita (facial paralysis) is a medical condition that disfigures or distorts the facial appearance of the sufferer causing facial asymmetry and malfunction. Ardita patients may benefit from considering alternative treatments such as Ayurveda, including Taila Nasya (nasal instillation of medicated oil).
To synthesize the best available evidence on the effectiveness of different Nasya oils in the treatment of Ardita.
INCLUSION CRITERIA TYPES OF PARTICIPANTS:
Studies conducted on adult sufferers (18-70 years) of Ardita (chronic or acute) in any setting were considered. Studies including participants who were pregnant or suffered allergic rhinitis, fever, intracranial tumor/hemorrhage and bilateral facial palsy were excluded.
Standalone treatment of Nasya (at all dosages and frequencies) compared to Nasya in combination with other Ayurvedic treatments was considered. Comparisons between different interventions including Taila Nasya alone, Taila Nasya in combination with other Ayurvedic interventions and Ayurvedic interventions that did not include Taila Nasya were also considered.
OUTCOMES AND MEASURES:
Changes in Ardita symptoms, including facial distortion, speech disorders and facial pain, were measured.
TYPES OF STUDIES:
All quantitative study designs (experimental, quasi-experimental and observational) were considered.
Relevant studies were identified following a comprehensive literature search. References provided within these key studies identified additional resources. Indian universities were also contacted for results of Ardita studies undertaken in their institutions.A three-step search strategy aimed to find studies of published and unpublished studies was undertaken. Studies published in the English language were considered for inclusion, irrespective of publication date/year. Following an initial limited search of MEDLINE and CINAHL, the text words contained in the title and abstract, and of the index terms used to describe each articles were analyzed. From the identified keywords and index terms, searches were undertaken across all relevant databases such as PubMed, CINHAL, Cochrane (CENTRAL), Scopus, Centre for Review and Dissemination databases, Turning Research into Practice (TRIP), EMBASE, EBM Reviews, DHARA, Google Scholar, MedNar and ProQuest Dissertations. Finally, reference lists of identified theses and articles were searched for additional studies. Universities and website operators related to Ayurvedic research in India were contacted, including the National Institute of Ayurveda for relevant studies. Besides this, the University of Adelaide librarian was contacted to retrieve those studies identified in the reference lists of theses and articles.
Studies were critically assessed by the review author and a secondary reviewer prior to inclusion in the review using the standardized critical appraisal instrument from the Joanna Briggs Institute.
Data was extracted by the primary reviewer using the standardized data extraction tool from the Joanna Briggs Institute.
Different interventions and comparators across studies precluded meta-analysis. Narrative synthesis was performed.
Only two pseudo randomized studies with a small number of participants met inclusion criteria and were included in the review. One study with 20 participants, divided equally into two groups compared the effectiveness of two nasal instillations in alleviating four Ardita symptoms. The second study of 15 participants each in two groups compared the effectiveness of nasal instillation with placement of medicated oil on the head on seven Ardita symptoms. Observational measurements of Ardita symptoms were graded as Mild, Moderate or Marked at baseline and after one month. The study conducted on 30 participants using Nasya intervention showed participants had better relief from the symptoms of facial pain, speech disorder and earache within the range of 78.2% to 90.9%, graded as Marked. Along with statistical data available in the studies, this review found low levels of evidence favoring Taila Nasya intervention. The review did not include any studies examining effectiveness of Nasya compared to conventional treatment for Ardita.
This review presents extremely limited evidence from only two small experimental studies that administration of Nasya oil alone may provide some relief from Ardita symptoms of facial distortion, speech disorder, inability to shut eyelids/upward eye rolling and dribbling of saliva in adult patients. No strong conclusions may be drawn from the evidence included in the review due to the limited number of studies, limited number of participants and poor quality of studies.
IMPLICATIONS FOR PRACTICE:
Practitioners should advice Ardita patients that there is extremely limited evidence suggesting the potential effectiveness of Nasya oils alone or Nasya in conjunction with other Ayurvedic treatments in managing symptoms. However, given the absence of a strong evidence base, practitioners should be guided by clinical wisdom and patient preference.
IMPLICATIONS FOR RESEARCH:
Well controlled clinical trials comparing standalone Nasya therapy to other Ayurvedic treatments and/or conventional medicine for Ardita symptoms need to be conducted to examine the relative effectiveness of different Nasya oils in treating.
I think you agree, that’s nothing to write home about.
So, on second thought I might give Nasya (or whatever it is called) a miss. The same applies, by the way, to any other form of detox.
At the heart of this story is Joseph Mercola, a dietary supplement entrepreneur and osteopath.
His website states that:
EVERYONE can benefit from Dr Mercola’s unparalleled knowledge. For expertise in alternative healthcare and high quality supplemental medicine, it’s hard to beat visionary Dr Joseph Mercola. The Chicago-based health wizard has his own website, Mercola.com (‘Take Control of Your Health’), but you can find so many of his health support products right here at Evolution Organics. Our customers swear by them. They love the diversity of the range, and that the products are priced affordably, meaning that everyone can benefit from Dr Mercola’s vast experience and unmatched know-how. And it’s not just men, women and children who can feel better ‘the Dr Mercola way’ – his brand includes health support products for pets, too.
However, an article in the Washington Post tells a different story; allow me to quote a few excerpts:
The National Vaccine Information Center was founded in 1982 by Barbara Loe Fisher, who has said that her son was injured by a vaccine. The group claimed credit this year for helping to defeat legislation in a dozen states that would have made it harder for parents to opt out of vaccinating their children. At the beginning of last year’s flu season, Fisher and Mercola appeared in a YouTube video urging people to be skeptical about flu shots. Mercola claimed that vaccines have been associated with “deaths and permanent neurological complications,” and he said vitamin D supplements were among “far more effective, less expensive and less risky alternatives.” … Fisher said in an interview that Mercola has asked for nothing in exchange for his donations and that the National Vaccine Information Center does not sell or advertise Mercola’s products on its site. “I do not take funding for a quid pro quo,” she said. “When [Mercola] called me, he said, ‘I admire your work. I’d like to help you.’ ” The center’s homepage, which the group says was visited more than 1.2 million times last year, displays Mercola.com’s logo. An affiliated website run by Fisher’s group refers numerous times to Mercola.com as one of the most popular health and wellness websites…
In recent years, the center has been at the forefront of a movement that has led some parents to forgo or delay immunizing their children against vaccine-preventable diseases such as measles… The Northern Virginia-based National Vaccine Information Center lists Mercola.com as a partner on its homepage and links to the website, where readers can learn about and purchase Mercola’s merchandise…Asked if his companies benefit from his donations to the anti-vaccine group, Mercola said in an email that “being an adversary to powerful industries is not a positive for a business like mine.” …
On this blog, I have repeatedly warned that many so-called alternative medicine (SCAM) practitioners recommend against vaccinations. Specifically implicated are:
- Physicians practising integrative medicine
- Doctors of anthroposophical medicine
We knew about the ‘ideology’ and the misinformation pushing SCAM-related anti-vaccination sentiments. The article in the Washington Post is a stark reminder of the financial interests behind all this. As a result, SCAM-use is associated with low vaccination-uptake (as we have discussed ad nauseam – see for instance here, here, here and here). Anyone who needs more information will find it by searching this blog. Anyone claiming that this is all my exaggeration might look at papers which have nothing to do with me (there are plenty more for those who are willing to conduct a Medline search):
- Lehrke P, Nuebling M, Hofmann F, Stoessel U. Attitudes of homeopathic physicians towards vaccination. Vaccine. 2001;19:4859–4864. doi: 10.1016/S0264-410X(01)00180-3. [PubMed]
- Halper J, Berger LR. Naturopaths and childhood immunizations: Heterodoxy among the unorthodox. Pediatrics. 1981;68:407–410. [PubMed]
- Colley F, Haas M. Attitudes on immunization: A survey of American chiropractors. Journal of Manipulative and Physiological Therapeutics. 1994;17:584–590. [PubMed]
Many patients with chronic pain (CP) are prescribed opioids, a situation which has led to the much-discussed opioid crisis. Integrative medicine (IM), which combines pharmacological and so-called alternative medicine (SCAM), has been proposed as a solution. Yet, the role of SCAM therapies in reducing opioid use remains unclear.
This systematic review explored the effectiveness of the IM approach or any of the SCAM therapies to reduce or cease opioid use in CP patients. Electronic searches yielded 5,200 citations. Twenty-three studies were selected. Eight studies were randomized controlled trials, seven were retrospective studies, four studies were prospective observational, three were cross-sectional, and one was quasi-experimental. The majority of the studies showed that opioid use was reduced significantly after using IM/SCAM. Cannabinoids were among the most commonly investigated approaches in reducing opioid use, followed by multidisciplinary approaches, cognitive-behavioral therapy, and acupuncture. The majority of the studies had limitations related to sample size, duration, and study design.
The authors concluded that there is a small but defined body of literature demonstrating positive preliminary evidence that the IM approach including SCAM therapies can help in reducing opioid use. As the opioid crisis continues to grow, it is vital that clinicians and patients be adequately informed regarding the evidence and opportunities for IM/SCAM therapies for CP.
I am unimpressed by this review.
And here is why:
- Because of their design, most of the included studies do not allow any conclusions about cause and effect.
- The 8 RCTs that would allow such conclusions are mostly of poor quality.
- Some of the 8 RCTs are not even what the review authors claim to be. Here is just one example:
Background: Current levels and dangers of opioid use in the U.S. warrant the investigation of harm-reducing treatment alternatives.
Purpose: A preliminary, historical, cohort study was used to examine the association between enrollment in the New Mexico Medical Cannabis Program (MCP) and opioid prescription use.
Methods: Thirty-seven habitual opioid using, chronic pain patients (mean age = 54 years; 54% male; 86% chronic back pain) enrolled in the MCP between 4/1/2010 and 10/3/2015 were compared to 29 non-enrolled patients (mean age = 60 years; 69% male; 100% chronic back pain). We used Prescription Monitoring Program opioid records over a 21 month period (first three months prior to enrollment for the MCP patients) to measure cessation (defined as the absence of opioid prescriptions activity during the last three months of observation) and reduction (calculated in average daily intravenous [IV] morphine dosages). MCP patient-reported benefits and side effects of using cannabis one year after enrollment were also collected.
Results: By the end of the 21 month observation period, MCP enrollment was associated with 17.27 higher age- and gender-adjusted odds of ceasing opioid prescriptions (CI 1.89 to 157.36, p = 0.012), 5.12 higher odds of reducing daily prescription opioid dosages (CI 1.56 to 16.88, p = 0.007), and a 47 percentage point reduction in daily opioid dosages relative to a mean change of positive 10.4 percentage points in the comparison group (CI -90.68 to -3.59, p = 0.034). The monthly trend in opioid prescriptions over time was negative among MCP patients (-0.64mg IV morphine, CI -1.10 to -0.18, p = 0.008), but not statistically different from zero in the comparison group (0.18mg IV morphine, CI -0.02 to 0.39, p = 0.081). Survey responses indicated improvements in pain reduction, quality of life, social life, activity levels, and concentration, and few side effects from using cannabis one year after enrollment in the MCP (ps<0.001).
Conclusions: The clinically and statistically significant evidence of an association between MCP enrollment and opioid prescription cessation and reductions and improved quality of life warrants further investigations on cannabis as a potential alternative to prescription opioids for treating chronic pain.
This study is evidently NOT an RCT!
Most of the 8 RCTs investigate whether SCAM is useful for weaning opioid-dependent patients off their drug. To equate this with the question whether IM/SCAM can reduce or cease opioid use in CP patients is, I think, wrong. The way to reduce opioid use in CP patients is to prescribe less opioids. And for prescribing less opioids, we need no SCAM but we need to remember what we learned in medical school: opioids are not for routine treatment of CP!
So, why do the authors of this review try to mislead us?
Could it have something to do with some of their affiliations and the bias that goes with it?
- Canadian College of Naturopathic Medicine, North York, Ontario, Canada.
- Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Australia.
- Pacific College of Oriental Medicine, San Diego, California, USA.
What do you think?
So-called alternative medicine (SCAM) could easily be described as a business that exists mainly because it profits from the flaws of conventional medicine. I know, this is not a good definition, and I don’t want to suggest it as one, but I think it highlights an important aspect of SCAM.
Let me explain.
If we ask ourselves why consumers feel attracted to SCAM, we can identify a range of reasons, and several of them relate to the weaknesses of conventional medicine as it is practised today. For instance:
- People feel the need to have more time with their clinician in order to discuss their problems more fully. This means that their GP does not offer them sufficient time, empathy and compassion they crave.
- Patients are weary of the side-effects of drugs and prefer treatments that are gentle and safe. This shows that they realise that conventional medicine can cause harm and they hope to avoid this risk.
- Patients find it often hard to accept that their symptoms are ‘nothing to worry about’ and does not require any treatment at all. They prefer to hear that the clinician knows exactly what is wrong and can offer a therapy that puts it right.
Conventional medicine and the professionals who administer it have many flaws. Most doctors have such busy schedules that there is little time for building an empathetic therapeutic relationship with their patients. Thus they often palm them off with a prescription and fail to discuss the risks in sufficient detail. Even worse, they sometimes prescribe drugs in situations where none are needed and where a reassuring discussion would be more helpful. It is too easy to excuse such behaviours with work pressures; such flaws are serious and cannot be brushed under the carpet in this way.
Recently, the flawed behaviour of doctors has become the focus of media attention in the form of
- opioid over-prescribing
- over-use of anti-biotics.
In both cases, SCAM providers were quick to offer the solution.
- Acupuncturists and chiropractors claim that their treatments are sensible alternatives to opioids. Yet, there is no good evidence that either acupuncture or chiropractic have analgesic effects that are remotely comparable to those of opioids. They only are seemingly successful in cases where opioids were not needed in the first place.
- Homeopaths claim that their remedies can easily replace antibiotics. Yet, there is not a jot of evidence that homeopathics have antibiotic activity. They only are seemingly successful in cases where the antibiotic was not needed in the first place.
In both instances, SCAM is trying to profit from the weaknesses of conventional medicine. In both cases, the offered solutions are clearly bogus. Yet, in both cases, scientifically illiterate politicians are seriously considering the alleged solutions. Few seem to be smart enough to take a step backwards and contemplate the only viable solution to these problems. If doctors over-prescribe, they need to be stopped; and the best way to stop them is to give them adequate support, more time with their patients and adequate recognition of the importance of reassuring and talking to patients when they need it.
To put it differently:
The best way to reduce the use of bogus SCAMs is to make conventional medicine less flawed.
Radiation-induced xerostomia (RIX) is a common, often debilitating, adverse effect of radiation therapy among patients with head and neck cancer. Quality of life can be severely affected, and current treatments have limited benefit. Acupuncture is often recommended, but does it work? This study was aimed at finding out whether acupuncture can prevent RIX in patients with head and neck cancer undergoing radiation therapy.
The 2-center, phase 3, randomized clinical trial compared a standard care control (SCC) with true acupuncture (TA) and sham acupuncture (SA) among patients with oropharyngeal or nasopharyngeal carcinoma who were undergoing radiation therapy in comprehensive cancer centres in the United States and China. Patients were enrolled between December 16, 2011, and July 7, 2015. Final follow-up was August 15, 2016. Analyses were conducted February 1 through 28, 2019. Either TA or SA using a validated acupuncture placebo device were performed 3 times per week during a 6- to 7-week course of radiation therapy. The primary end point was RIX, as determined by the Xerostomia Questionnaire in which a higher score indicates worse RIX, for combined institutions 1 year after radiation therapy ended. Secondary outcomes included incidence of clinically significant xerostomia (score >30), salivary flow, quality of life, salivary constituents, and role of baseline expectancy related to acupuncture on outcomes.
Of 399 patients randomized, 339 were included in the final analysis, including 112 patients in the TA group, 115 patients in the SA group, and 112 patients in the SCC group. For the primary aim, the adjusted least square mean (SD) xerostomia score in the TA group (26.6 [17.7]) was significantly lower than in the SCC group (34.8 [18.7]) (P = .001; effect size = -0.44) and marginally lower but not statistically significant different from the SA group (31.3 [18.6]) (P = .06; effect size = -0.26). Incidence of clinically significant xerostomia 1 year after radiation therapy ended followed a similar pattern, with 38 patients in the TA group (34.6%), 54 patients in the SA group (47.8%), and 60 patients in the SCC group (55.1%) experiencing clinically significant xerostomia (P = .009). Post hoc comparisons revealed a significant difference between the TA and SCC groups at both institutions, but TA was significantly different from SA only at Fudan University Cancer Center, Shanghai, China (estimated difference [SE]: TA vs SCC, -9.9 [2.5]; P < .001; SA vs SCC, -1.7 [2.5]; P = .50; TA vs SA, -8.2 [2.5]; P = .001), and SA was significantly different from SCC only at the University of Texas MD Anderson Cancer Center, Houston, Texas (estimated difference [SE]: TA vs SCC, -8.1 [3.4]; P = .016; SA vs SCC, -10.5 [3.3]; P = .002; TA vs SA, 2.4 [3.2]; P = .45).
The authors concluded that this randomized clinical trial found that TA resulted in significantly fewer and less severe RIX symptoms 1 year after treatment vs SCC. However, further studies are needed to confirm clinical relevance and generalizability of this finding and to evaluate inconsistencies in response to sham acupuncture between patients in the United States and China.
In essence this two-centre study shows that:
- real acupuncture is better than usual care, but the effect size is small and of doubtful clinical relevance;
- real acupuncture is not significantly better than sham acupuncture;
- the findings differ remarkably between the US and the Chinese centre.
I find the last point the most interesting one. We know from previous research that acupuncture studies from China are notoriously unreliable; they never report a negative result and there is evidence that data fabrication is rife in China. The new findings seems to throw more light on this notion. In the US centre, real and sham acupuncture generated practically identical results. By contrast, in the Chinese centre, real acupuncture generated significantly better results than sham. The authors offer several hypotheses to explain this remarkable phenomenon. Yet, in my view, the most likely one is that Chinese researchers are determined to show that acupuncture is effective. Thus all sorts of unconscious or even conscious biases might get introduced into such studies.
In essence, trial therefore confirms that acupuncture is little more than a theatrical placebo, particularly if we consider the US data which, in my opinion, are more trustworthy.
Lorenzo Cohen, Professor of Palliative, Rehabilitation, and Integrative Medicine and director of the Integrative Medicine Program as well as senior author of the paper unsurprisingly disagrees. He was quoted saying: “The evidence is to a point where patients should incorporate acupuncture alongside radiation treatment as a way to prevent the severity of dry mouth symptoms. I think with this study we can add acupuncture to the list for the prevention and treatment of xerostomia, and the guidelines for the use of acupuncture in the oncology setting should be revised to include this important chronic condition.”
Who do you think is closer to the truth?
Maintenance Care is an approach whereby patients have chiropractic manipulations even when symptom-free. Thus, it is an ideal method to keep chiropractors in clover. Previous reviews concluded that evidence behind this strategy is lacking. Since then, more data have emerged. It was therefore timely to review the evidence.
Fourteen original research articles were included in the review. Maintenance Care was defined as a secondary or tertiary preventive approach, recommended to patients with previous pain episodes, who respond well to chiropractic care. Maintenance Care is applied to approximately 30% of Scandinavian chiropractic patients. Both chiropractors and patients believe in the efficacy of Maintenance Care. Four studies investigating the effect of chiropractic Maintenance Care were identified, with disparate results on pain and disability of neck and back pain. However, only one of these studies utilized all the existing evidence when selecting study subjects and found that Maintenance Care patients experienced fewer days with low back pain compared to patients invited to contact their chiropractor ‘when needed’. No studies were found on the cost-effectiveness of Maintenance Care.
The authors concluded that knowledge of chiropractic Maintenance Care has advanced. There is reasonable consensus among chiropractors on what Maintenance Care is, how it should be used, and its indications. Presently, Maintenance Care can be considered an evidence-based method to perform secondary or tertiary prevention in patients with previous episodes of low back pain, who report a good outcome from the initial treatments. However, these results should not be interpreted as an indication for Maintenance Care on all patients, who receive chiropractic treatment.
I have to admit, I have problems with these conclusions.
- Maintenance Care is not normally defined as secondary or tertitary prevention. It also includes primary prevention, which means that chiropractors recommend it for just about anyone. By definition it is long term care, that is not therapeutically necessary, but performed at regular intervals to help prevent injury and enhance quality of life. This form of care is provided after maximal therapeutic benefit is achieved, without a trial of treatment withdrawal, to prevent symptoms from returning or for those without symptoms to promote health or prevent future problems.
- I am not convinced that the evidence would be positive, even if we confined it to secondary and tertiary prevention.
To explain my last point, let’s have a look at the 4 RCT and check whether they really warrant such a relatively positive conclusion.
FIRST STUDY For individuals with recurrent or persistent non-specific low back pain (LBP), exercise and exercise combined with education have been shown to be effective in preventing new episodes or in reducing the impact of the condition. Chiropractors have traditionally used Maintenance Care (MC), as secondary and tertiary prevention strategies. The aim of this trial was to investigate the effectiveness of MC on pain trajectories for patients with recurrent or persistent LBP.
This pragmatic, investigator-blinded, two arm randomized controlled trial included consecutive patients (18–65 years old) with non-specific LBP, who had an early favorable response to chiropractic care. After an initial course of treatment, eligible subjects were randomized to either MC or control (symptom-guided treatment). The primary outcome was total number of days with bothersome LBP during 52 weeks collected weekly with text-messages (SMS) and estimated by a GEE model.
Three hundred and twenty-eight subjects were randomly allocated to one of the two treatment groups. MC resulted in a reduction in the total number of days per week with bothersome LBP compared with symptom-guided treatment. During the 12 month study period, the MC group (n = 163, 3 dropouts) reported 12.8 (95% CI = 10.1, 15.5; p = <0.001) fewer days in total with bothersome LBP compared to the control group (n = 158, 4 dropouts) and received 1.7 (95% CI = 1.8, 2.1; p = <0.001) more treatments. Numbers presented are means. No serious adverse events were recorded.
MC was more effective than symptom-guided treatment in reducing the total number of days over 52 weeks with bothersome non-specific LBP but it resulted in a higher number of treatments. For selected patients with recurrent or persistent non-specific LBP who respond well to an initial course of chiropractic care, MC should be considered an option for tertiary prevention.
SECOND STUDY Back and neck pain are associated with disability and loss of independence in older adults. Whether long‐term management using commonly recommended treatments is superior to shorter‐term treatment is unknown. This randomized clinical trial compared short‐term treatment (12 weeks) versus long‐term management (36 weeks) of back‐ and neck‐related disability in older adults using spinal manipulative therapy (SMT) combined with supervised rehabilitative exercises (SRE).
Eligible participants were ages ≥65 years with back and neck disability for ≥12 weeks. Coprimary outcomes were changes in Oswestry Disability Index (ODI) and Neck Disability Index (NDI) scores after 36 weeks. An intent‐to‐treat approach used linear mixed‐model analysis to detect between‐group differences. Secondary analyses included other self‐reported outcomes, adverse events, and objective functional measures.
THIRD STUDY A prospective single blinded placebo controlled study was conducted. To assess the effectiveness of spinal manipulation therapy (SMT) for the management of chronic nonspecific low back pain (LBP) and to determine the effectiveness of maintenance SMT in long-term reduction of pain and disability levels associated with chronic low back conditions after an initial phase of treatments. SMT is a common treatment option for LBP. Numerous clinical trials have attempted to evaluate its effectiveness for different subgroups of acute and chronic LBP but the efficacy of maintenance SMT in chronic nonspecific LBP has not been studied. Sixty patients, with chronic, nonspecific LBP lasting at least 6 months, were randomized to receive either (1) 12 treatments of sham SMT over a 1-month period, (2) 12 treatments, consisting of SMT over a 1-month period, but no treatments for the subsequent 9 months, or (3) 12 treatments over a 1-month period, along with “maintenance spinal manipulation” every 2 weeks for the following 9 months. To determine any difference among therapies, we measured pain and disability scores, generic health status, and back-specific patient satisfaction at baseline and at 1-, 4-, 7-, and 10-month intervals. Patients in second and third groups experienced significantly lower pain and disability scores than first group at the end of 1-month period (P = 0.0027 and 0.0029, respectively). However, only the third group that was given spinal manipulations (SM) during the follow-up period showed more improvement in pain and disability scores at the 10-month evaluation. In the nonmaintained SMT group, however, the mean pain and disability scores returned back near to their pretreatment level.SMT is effective for the treatment of chronic nonspecific LBP. To obtain long-term benefit, this study suggests maintenance SM after the initial intensive manipulative therapy.
FORTH STUDY Evidence indicates that supervised home exercises, combined or not with manual therapy, can be beneficial for patients with non-specific chronic neck pain (NCNP). The objective of the study is to investigate the efficacy of preventive spinal manipulative therapy (SMT) compared to a no treatment group in NCNP patients. Another objective is to assess the efficacy of SMT with and without a home exercise program.Ninety-eight patients underwent a short symptomatic phase of treatment before being randomly allocated to either an attention-group (n = 29), a SMT group (n = 36) or a SMT + exercise group (n = 33). The preventive phase of treatment, which lasted for 10 months, consisted of meeting with a chiropractor every two months to evaluate and discuss symptoms (attention-control group), 1 monthly SMT session (SMT group) or 1 monthly SMT session combined with a home exercise program (SMT + exercise group). The primary and secondary outcome measures were represented by scores on a 10-cm visual analog scale (VAS), active cervical ranges of motion (cROM), the neck disability index (NDI) and the Bournemouth questionnaire (BQ). Exploratory outcome measures were scored on the Fear-avoidance Behaviour Questionnaire (FABQ) and the SF-12 Questionnaire. Our results show that, in the preventive phase of the trial, all 3 groups showed primary and secondary outcomes scores similar to those obtain following the non-randomised, symptomatic phase. No group difference was observed for the primary, secondary and exploratory variables. Significant improvements in FABQ scores were noted in all groups during the preventive phase of the trial. However, no significant change in health related quality of life (HRQL) was associated with the preventive phase. This study hypothesised that participants in the combined intervention group would have less pain and disability and better function than participants from the 2 other groups during the preventive phase of the trial. This hypothesis was not supported by the study results. Lack of a treatment specific effect is discussed in relation to the placebo and patient provider interactions in manual therapies. Further research is needed to delineate the specific and non-specific effects of treatment modalities to prevent unnecessary disability and to minimise morbidity related to NCNP. Additional investigation is also required to identify the best strategies for secondary and tertiary prevention of NCNP.
I honestly do not think that the findings from these 4 small trials justify the far-reaching conclusion that Maintenance Care can be considered an evidence-based method… For that statement to be evidence-based, one would need to see more and better studies. Therefore, the honest conclusion, I think, is that maintenance care is not supported by sound evidence for effectiveness; as chiropractic manipulations are costly and not risk-free, its risk/benefit balance fails to be positive. Therefore, this approach cannot be recommended.
On this blog and elsewhere, I have repeatedly claimed that as early as 2002 I published data to show that UK homeopaths advise their patients against vaccinations.
So sorry, but this not entirely true!
The truth is that I had forgotten about this article published 1995 in the British Journal of General Practice. As it is quite short and reveals several interesting facts, allow me to provide it here in full:
Homoeopathic remedies are believed by doctors and patients to be almost totally safe. Is homoeopathic advice safe, for example on the subject of immunization? In order to answer this question, a questionnaire survey was undertaken in 1995 of all 45 homoeopaths listed in the Exeter ‘yellow pages’ business directory. A total of 23 replies (51%) were received, 10 from medically qualified and 13 from non-medically qualified homoeopaths.
The homoeopaths were asked to suggest which conditions they perceived as being most responsive to homoeopathy. The three most frequently cited conditions were allergies (suggested by 10 respondents), gynaecological problems (seven) and bowel problems (five). They were then asked to estimate the proportion of patients that were referred to them by orthodox doctors and the proportion that they referred to orthodox doctors. The mean estimated percentages were 1 % and 8%, respectively. The 23 respondents estimated that they spent a mean of 73 minutes on the first consultation.
The homoeopaths were asked whether they used or recommended orthodox immunization for children and whether they only used and recommended homoeopathic immunization. Seven of the 10 homoeopaths who were medically qualified recommended orthodox immunization but none of the 13 non-medically qualified homoeopaths did. One non-medically qualified homoeopath only used and recommended homoeopathic immunization.
Homoeopaths have been reported as being against orthodox immunization and advocating homoeopathic immunization for which no evidence of effectiveness exists. As yet there has been no attempt in the United Kingdom to monitor homoeopaths’ attitudes in this respect. The above findings imply that there may be a problem.
The British homoeopathic doctors’ organization (the Faculty of Homoeopathy) has distanced itself from the polemic of other homoeopaths against orthodox immunization, and editorials in the British Homoeopathic Journal call the abandonment of mass immunization ‘criminally irresponsible’ and ‘most unfortunate, in that it will be seen by most people as irresponsible and poorly based’.’ Homoeopathic remedies may be safe, but do all homoeopaths merit this attribute?
Yes indeed! These findings indicate that there may be a problem with non-medically trained homeopaths in the UK. It is good to see that now (24 years later) the NHS has taken note of it. At the same time, it is not at all good to see that non-medically trained homeopaths and their professional organisations have managed to remain in complete denial of it.
The UK homeopathy sector have issued a joint statement. The reason for this action is a series of allegedly negative press stories about homeopathy. Here is the full statement:
Homeopathy registers including the Society of Homeopaths, Faculty of Homeopathy and Alliance of Registered Homeopaths in conjunction with other homeopathy partners have come together to provide clarification for patients seeking advice and homeopathy treatment.
The joint homeopathy sector statement
“Recent media reports have incorrectly linked homeopathy to the anti-vaccination movement. A registered homeopath provides care according to the guidelines outlined in the Code of Practice of their registering body. This code ensures that the homeopath operates professionally, safely, and within their bounds of competence. Homeopathic medicines are prescribed on an individual basis to match a patient’s specific symptoms. Questions about vaccination from the public to a registered homeopath should be deferred to those medically trained to answer them, such as GPs.”
Emily Buttrum Chief Executive of the Society of Homeopaths commented that she was positive the joint statement would bring the homeopathic community together and protect the future of homeopathy and in turn patient choice. The joint statement reflects the Society’s clear guidance on professional standards.
The Society’s position statements may be viewed here
The Homeopathy sector statement may be viewed here
When homeopaths try to issue a serious ‘statement’, hilarity is rarely very far. Let me suggest what, in my view, the main reasons for hilarity are in the recent outburst:
- Homeopaths and homeopathic organisations are hubs of anti-vaccination propaganda. To deny this means being in denial.
- The anti-vaccination stance of UK lay homeopaths has repeatedly been demonstrated (we have shown this already in 2002).
- The recent media reports were not incorrect.
- These reports were necessary steps to protect the public from charlatans.
- Homeopaths provide care according to guidelines, unless they violate them.
- Violations have happened repeatedly.
- The homeopathic organisations have a long history of failing to adequately address this problem.
- Arguably, homeopaths do not operate within any bounds of competence; if they did, they would not prescribe ineffective treatments.
- Homeopathic remedies are individualised, except in ‘clinical homeopathy’ where they are not.
- Questions about vaccination should be referred to GPs; except they are often not, as the recent evidence has shown.
I am glad to hear that Mrs Buttrum believes that a bunch of pranks, porkies and outright falsehoods will bring homeopaths together. In fact, I am optimistic they will, not lease because, for more than 200 years, homeopathy is being held together by little more than that.
As reported, the Bavarian government has set aside almost half a million Euros for research to determine whether the over-use of antibiotics can be reduced by replacing them with homeopathic remedies. Homeopaths in and beyond Germany were delighted, of course, but many experts were bewildered (see also this or this, if you read German).
While the Bavarians are entering the planning stage of this research, I want to elaborate on the question what methodology might be employed for this task. As far as I can see, there are, depending on the precise research questions, various options.
IN VITRO TESTS OF HOMEOPATHICS
The most straight forward way to find out whether homeopathics are an alternative to antibiotics would be to screen them for antibiotic activity. For this, we would take all homeopathic remedies in several potencies that are commonly used, for instance D12 and C30, and add them to bacterial cultures. To cover even part of the range of homeopathic remedies, several thousand such tests would be required. The remedies that show activity in vitro would then be candidates for further clinical tests.
I doubt that this will generate meaningful findings. As homeopaths would probably point out quickly, they never claimed that their remedies have any antibiotic effects. Homeopathics work not via pharmacological mechanisms (there is none), they stimulate the vital force, the immune system, or whatever mystical force you fancy. Faced with the inevitably negative results of in vitro tests, homeopaths would merely shrug their shoulders and say: ‘we told you so’.
Thus it might be more constructive to go directly into animal models. Such tests could take several shapes and forms. For instance, scientists could infect animals with a bacterium and subsequently treat one group with a high potency homeopathic remedy and the control group with a placebo. If the homeopathic animals survive, while the controls die, the homeopathic treatment was effective.
Such concepts would run into problems on at least two levels. Firstly, any ethics committee worth its name would refuse to pass such a protocol and argue that it is not ethical to infect and then treat animals with two different types of placebo. Secondly, the homeopathic fraternity would explain that homeopathy must be individualised which cannot be done properly in animals. Faced with the inevitably negative results of such animal studies, homeopaths would merely shrug their shoulders and say: ‘we told you so’.
Homeopathy may, according to some homeopaths, defy in vitro and animal tests, but it is most certainly amenable to being tested in clinical trials. The simplest version of a clinical study would entail randomising a group of patients with bacterial infections – say pneumonia – into receiving either individualised homeopathy or placebo. Possibly, one could add a third group of patients being treated with appropriate antibiotics.
The problem here would again be the ethics; no proper ethic committee would pass such a concept (see above). Another problem might be that even the homeopathic fraternity would oppose such a study. Why? Because all but the most deluded homeopaths know only too well that the result of such a trial would be devastatingly negative for homeopathy.
Therefore, homeopaths are likely to go for a different study design, for instance, one where patients suspected to have a bacterial infection are randomised to two groups of GPs. One group of ‘normal’ GPs would proceed as usual, while the other group are also trained in homeopathy and would be free to give whatever they feel is right for each individual patient. With a bit of luck, the ‘normal’ GPs would over-prescribe antibiotics (because that’s what they are apparently doing routinely), while the homeopathic GPs would often use homeopathics instead.
Such a study would indeed generate a result alleging that the use of homeopathy reduces the use of antibiotics. Of course, to be truly ‘positive’ it would need to exclude any clinical outcome such as time to recovery, because that might not be in favour of homeopathy.
The problem might again be the ethics committee. Assuming they are scientifically switched on, they will see through the futility of a trial designed to produce the desired result. They might also argue that science is not for testing one faulty approach (over-prescribing) against another (homeopathy) and insist that science is about finding the best treatment (which is neither of the two).
There are, of course, many other study designs that could be considered. Generally, they fall into two different categories: if they are rigorous tests of a hypothesis, they are sure to produce a result unfavourable to homeopathy. Such studies will therefore be opposed to by the powerful homeopathic fraternity. If, however, studies are flimsily designed to generate a positive finding, they might be liked by homeopaths, yet rejected by scientists and ethicists.
A much easier solution to the question ‘does the use of homeopathy reduce the use of antibiotics’ might be to not do a trial at all, but to run a simple survey. For instance, one could retrospectively assess how many antibiotics 100 homeopathic GPs have prescribed during the last year and compare this to the figure of 100 over-prescribing, ‘normal’ GPs. This type of ‘research’ is a sure winner for the homeopaths. Therefore, I predict that they will advocate this or a similarly flawed concept.
Most politicians are scientifically illiterate to such a degree that they might actually agree to finance such a survey and then confuse correlation with causation by triumphantly stating that the use of homeopathy reduces over-prescribing of antibiotics. Few, I fear, will realise that there is only one method for reducing the over-prescribing of antibiotics: remind doctors what they all learnt in medical school, namely to prescribe antibiotics only in cases where they are indicated. And for that we evidently need no homeopathy or other SCAM.