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

Prince Charles

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So-called alternative medicine (SCAM) for animals is popular. A recent survey suggested that 76% of US dog and cat owners use some form of SCAM. Another survey showed that about one quarter of all US veterinary medical schools run educational programs in SCAM. Amazon currently offers more that 4000 books on the subject.

The range of SCAMs advocated for use in animals is huge and similar to that promoted for use in humans; the most commonly employed practices seem to include acupuncture, chiropractic, energy healing, homeopathy (as discussed in the previous post) and dietary supplements. In this article, I will briefly discuss the remaining 4 categories.

ACUPUNCTURE

Acupuncture is the insertion of needles at acupuncture points on the skin for therapeutic purposes. Many acupuncturists claim that, because it is over 2 000 years old, acupuncture has ‘stood the test of time’ and its long history proves acupuncture’s efficacy and safety. However, a long history of usage proves very little and might even just demonstrate that acupuncture is based on the pre-scientific myths that dominated our ancient past.

There are many different forms of acupuncture. Acupuncture points can allegedly be stimulated not just by inserting needles (the most common way) but also with heat, electrical currents, ultrasound, pressure, bee-stings, injections, light, colour, etc. Then there is body acupuncture, ear acupuncture and even tongue acupuncture. Traditional Chinese acupuncture is based on the Taoist philosophy of the balance between two life-forces, ‘yin and yang’. In contrast, medical acupuncturists tend to cite neurophysiological theories as to how acupuncture might work; even though some of these may appear plausible, they nevertheless are mere theories and constitute no proof for acupuncture’s validity.

The therapeutic claims made for acupuncture are legion. According to the traditional view, acupuncture is useful for virtually every condition. According to ‘Western’ acupuncturists, acupuncture is effective mostly for chronic pain. Acupuncture has, for instance, been used to improve mobility in dogs with musculoskeletal pain, to relieve pain associated with cervical neurological disease in dogs, for respiratory resuscitation of new-born kittens, and for treatment of certain immune-mediated disorders in small animals.

While the use of acupuncture seems to gain popularity, the evidence fails to support this. Our systematic review of acupuncture (to the best of my knowledge the only one on the subject) in animals included 14 randomized controlled trials and 17 non-randomized controlled studies. The methodologic quality of these trials was variable but, on average, it was low. For cutaneous pain and diarrhoea, encouraging evidence emerged that might warrant further investigation. Single studies reported some positive inter-group differences for spinal cord injury, Cushing’s syndrome, lung function, hepatitis, and rumen acidosis. However, these trials require independent replication. We concluded that, overall, there is no compelling evidence to recommend or reject acupuncture for any condition in domestic animals. Some encouraging data do exist that warrant further investigation in independent rigorous trials.

Serious complications of acupuncture are on record and have repeatedly been discussed on this blog: acupuncture needles can, for instance, injure vital organs like the lungs or the heart, and they can introduce infections into the body, e. g. hepatitis. About 100 human fatalities after acupuncture have been reported in the medical literature – a figure which, due to lack of a monitoring system, may disclose just the tip of an iceberg. Information on adverse effects of acupuncture in animals is currently not available.

Given that there is no good evidence that acupuncture works in animals, the risk/benefit balance of acupuncture cannot be positive.

CHIROPRACTIC

Chiropractic was created by D D Palmer (1845-1913), an American magnetic healer who, in 1895, manipulated the neck of a deaf janitor, allegedly curing his deafness. Chiropractic was initially promoted as a cure-all by Palmer who claimed that 95% of diseases were due to subluxations of spinal joints. Subluxations became the cornerstone of chiropractic ‘philosophy’, and chiropractors who adhere to Palmer’s gospel diagnose subluxation in nearly 100% of the population – even in individuals who are completely disease and symptom-free. Yet subluxations, as understood by chiropractors, do not exist.

There is no good evidence that chiropractic spinal manipulation might be effective for animals. A review of the evidence for different forms of manual therapies for managing acute or chronic pain syndromes in horses concluded that further research is needed to assess the efficacy of specific manual therapy techniques and their contribution to multimodal protocols for managing specific somatic pain conditions in horses. For other animal species or other health conditions, the evidence is even less convincing.

In humans, spinal manipulation is associated with serious complications (regularly discussed in previous posts), usually caused by neck manipulation damaging the vertebral artery resulting in a stroke and even death. Several hundred such cases have been documented in the medical literature – but, as there is no system in place to monitor such events, the true figure is almost certainly much larger. To the best of my knowledge, similar events have not been reported in animals.

Since there is no good evidence that chiropractic spinal manipulations work in animals, the risk/benefit balance of chiropractic fails to be positive.

ENERGY HEALING

Energy healing is an umbrella term for a range of paranormal healing practices, e. g. Reiki, Therapeutic Touch, Johrei healing, faith healing. Their common denominator is the belief in an ‘energy’ that can be used for therapeutic purposes. Forms of energy healing have existed in many ancient cultures. The ‘New Age’ movement has brought about a revival of these ideas, and today ‘energy’ healing systems are amongst the most popular alternative therapies in many countries.

Energy healing relies on the esoteric belief in some form of ‘energy’ which refers to some life force such as chi in Traditional Chinese Medicine, or prana in Ayurvedic medicine. Some proponents employ terminology from quantum physics and other ‘cutting-edge’ science to give their treatments a scientific flair which, upon closer scrutiny, turns out to be little more than a veneer of pseudo-science.

Considering its implausibility, energy healing has attracted a surprisingly high level of research activity in the form of clinical trials on human patients. Generally speaking, the methodologically best trials of energy healing fail to demonstrate that it generates effects beyond placebo. There are few studies of energy healing in animals, and those that are available are frequently less than rigorous (see for instance here and here). Overall, there is no good evidence to suggest that ‘energy’ healing is effective in animals.

Even though energy healing is per se harmless, it can do untold damage, not least because it can lead to neglect of effective treatments and it undermines rationality in our societies. Its risk/benefit balance therefore fails to be positive.

DIETARY SUPPLEMENTS

Dietary supplements for veterinary use form a category of remedies that, in most countries, is a regulatory grey area. Supplements can contain all sorts of ingredients, from minerals and vitamins to plants and synthetic substances. Therefore, generalisations across all types of supplements are impossible. The therapeutic claims that are being made for supplements are numerous and often unsubstantiated. Although they are usually promoted as natural and safe, dietary supplements do not have necessarily either of these qualities. For example, in the following situations, supplements can be harmful:

  1. Combining one supplement with another supplement or with prescribed medicines
  2. Substituting supplements for prescription medicines
  3. Overdosing some supplements, such as vitamin A, vitamin D, or iron

Examples of currently most popular supplements for use in animals include chondroitin, glucosamine, probiotics, vitamins, minerals, lutein, L-carnitine, taurine, amino acids, enzymes, St John’s wort, evening primrose oil, garlic and many other herbal remedies. For many supplements taken orally, the bioavailability might be low. There is a paucity of studies testing the efficacy of dietary supplements in animals. Three recent exceptions (all of which require independent replication) are:

Dietary supplements are promoted as being free of direct risks. On closer inspection, this notion turns out to be little more than an advertising slogan. As discussed repeatedly on this blog, some supplements contain toxic materials, contaminants or adulterants and thus have the potential to do harm. A report rightly concluded that many challenges stand in the way of determining whether or not animal dietary supplements are safe and at what dosage.  Supplements considered safe in humans and other cross-species are not always safe in horses, dogs, and cats.  An adverse event reporting system is badly needed.  And finally, regulations dealing with animal dietary supplements are in disarray.  Clear and precise regulations are needed to allow only safe dietary supplements on the market.

It is impossible to generalise about the risk/benefit balance of dietary supplements; however, caution is advisable.

CONCLUSION

SCAM for animals is an important subject, not least because of the current popularity of many treatments that fall under this umbrella. For most therapies, the evidence is woefully incomplete. This means that most SCAMs are unproven. Arguably, it is unethical to use unproven medicines in routine veterinary care.

 

 

 

PS

I was invited several months ago to write this article for VETERINARY RECORD. It was submitted to peer review and subsequently I withdrew my submission. The above post is a slightly revised version of the original (in which I used the term ‘alternative medicine’ rather than ‘SCAM’) which also included a section on homeopathy (see my previous post). The reason for the decision to withdraw this article was the following comment by the managing editor of VETERINARY RECORD:  A good number of vets use these therapies and a more balanced view that still sets out their efficacy (or otherwise) would be more useful for the readership.

Ever since Samuel Hahnemann, the German physician who invented homeopathy, gave a lecture on the subject in the mid-1810s, homeopathy has been used for treating animals. Initially, veterinary medical schools tended to reject homoeopathy as implausible, and the number of veterinary homeopaths remained small. In the 1920ies, however, veterinary homoeopathy was revived in Germany, and in 1936, members of the “Studiengemeinschaft für tierärztliche Homöopathie” (Study Group for Veterinary Homoeopathy)  started to investigate homeopathy systematically.

Today, veterinary homeopathy is popular not least because of the general boom in so-called alternative medicine (SCAM). Prince Charles is just one of many prominent advocates who claims to treat animals with homeopathy. In many countries, veterinary homeopaths have their own professional organisations, while elsewhere veterinarians are banned from practicing homeopathy. In the UK, only veterinarians are currently allowed to use homeopathy on animals (but ironically, anyone regardless of background can use it on human patients).

Considering the implausibility of its assumptions, it seems unlikely that homeopathic remedies can be anything other than placebos. Yet homeopaths and their followers regularly produce clinical trials that seem to suggest efficacy. Today, there are about 500 controlled clinical trials of homeopathy (mostly on humans), and it is no surprise that, purely by chance, some of them show positive results. To avoid being misled by random findings, cherry-picking, or flawed science, we ought to critically evaluate the totality of the available evidence. In other words, we should rely not on single studies but on systematic reviews of all reliable trials.

A 2015 systematic review by ardent homeopaths tested the hypothesis that the outcome of veterinary homeopathic treatments is distinguishable from placebos. A total of 15 trials could be included, but only two comprised reliable evidence without overt vested interest. The authors concluded that there is “very limited evidence that clinical intervention in animals using homeopathic medicines is distinguishable from corresponding intervention using placebos.”

A more recent systematic review compared the efficacy of homeopathy to that of antibiotics in cattle, pigs and poultry. A total number of 52 trials were included of which 28 were in favour of homeopathy and 22 showed no effect. No study had been independently replicated. The authors concluded that “the use of homeopathy cannot claim to have sufficient prognostic validity where efficacy is concerned.”

Discussing this somewhat unclear and contradictory findings of trials of homeopathy for animals, Lee et al concluded that “…it is overwhelmingly likely that small effects observed in the RCTs and systematic reviews are the result of residual bias in the trials.” To this, I might add that ‘publication bias’, i. e. the phenomenon that negative trials often remain unpublished, might be the reason why systematic reviews of homeopathy are never entirely negative.

In recent years, several scientific bodies have assessed the evidence on homeopathy and published statements about it. Here are the key passages from some of these ‘official verdicts’:

 “The principles of homeopathy contradict known chemical, physical and biological laws and persuasive scientific trials proving its effectiveness are not available”

Russian Academy of Sciences, Russia

Homeopathy should not be used to treat health conditions that are chronic, serious, or could become serious. People who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness.

National Health and Medical Research Council, Australia

“These products are not supported by scientific evidence.”

Health Canada, Canada

“Homeopathic remedies don’t meet the criteria of evidence-based medicine.”

Hungarian Academy of Sciences, Hungary

“The incorporation of anthroposophical and homeopathic products in the Swedish directive on medicinal products would run counter to several of the fundamental principles regarding medicinal products and evidence-based medicine.”

Swedish Academy of Sciences, Sweden

There is little evidence to support homeopathy as an effective treatment for any specific condition

National Centre for Complementary and Integrative Health, USA

There is no good-quality evidence that homeopathy is effective as a treatment for any health condition

National Health Service, UK

Homeopathic remedies perform no better than placebos, and the principles on which homeopathy is based are “scientifically implausible”

House of Commons Science and Technology Committee, UK

“Homeopathy has not definitively proven its efficacy in any specific indication or clinical situation.”

Ministry of Health, Spain

“… homeopathy should be treated as one of the unscientific methods of the so called ‘alternative medicine’, which proposes worthless products without scientifically proven efficacy.”

National Medical Council, Poland

“… there is no valid empirical proof of the efficacy of homeopathy beyond the placebo effect.”

Federaal Kenniscentrum voor de Gezondheidszorg, Belgium

As they are usually far too dilute to contain anything, homeopathic remedies are generally harmless, provided they are produced according to good manufacturing practice (which is not always the case). Unfortunately, however, this harmlessness does not necessarily apply to homeopathy in general. When employed to replace an effective therapy, even the most innocent but ineffective treatment can become life-threatening. Since homeopaths recommend their remedies for even the most serious conditions, this is by no means a theoretical consideration. I have therefore often stated that HOMEOPATHICS MIGHT BE HARMLESS, BUT HOMEOPATHS CERTAINLY ARE NOT.

It follows that an independent risk/benefit analysis of homeopathy fails to arrive at a positive conclusion. In other words, homeopathy has not been shown to generate more good than harm. In turn, this means that homeopathy has no place in veterinary (or human) evidence-based medicine.

The ‘Dunning Kruger Effect‘ (DuKE) has been discussed here before. The DuKE means that, the less you know, the less able you are to recognize how little you know, and the less likely you are to recognize your limitations. Consequently, your confidence in yourself is inflated and you believe you are more competent than your opponent. Expressed differently:

  • Incompetence prevents the recognition of incompetence.
  • Too stupid to doubt.

A recent paper brilliantly shows the DuKE in action; here is its abstract

There is widespread agreement among scientists that genetically modified foods are safe to consume and have the potential to provide substantial benefits to humankind. However, many people still harbour concerns about them or oppose their use. In a nationally representative sample of US adults, we find that as extremity of opposition to and concern about genetically modified foods increases, objective knowledge about science and genetics decreases, but perceived understanding of genetically modified foods increases. Extreme opponents know the least, but think they know the most. Moreover, the relationship between self-assessed and objective knowledge shifts from positive to negative at high levels of opposition. Similar results were obtained in a parallel study with representative samples from the United States, France and Germany, and in a study testing attitudes about a medical application of genetic engineering technology (gene therapy). This pattern did not emerge, however, for attitudes and beliefs about climate change.

As I have stated before, I suspect the DuKE can explain much of what is going on in the realm of SCAM (so-called alternative medicine). So much so that I am tempted to re-write part of the above abstract as follows:

As extremity of belief in SCAM increases, objective knowledge about science and medicine decreases. In parallel, perceived understanding of science and medicine increases. Extreme believers in SCAM know the least, but think they know the most. Moreover, the relationship between self-assessed and objective knowledge shifts from positive to negative at high levels of SCAM-belief.

Yes, yes, I know. You are absolutely correct: this is little more than speculation! And I also realise, of course, that not everyone can have a full understanding of SCAM, medicine and science; however, if someone has a strong interest in (plus a strong opinion of) these matters, it would be advisable to read up about at least the most basic facts.

In case you disapprove, please do have a look at some of the recent comments on this blog or assess what some of the most famous proponents of SCAM tell the public, and I am confident that you will begin to suspect that my speculation might be not that far off the mark.

Today is Charles’ 70th birthday! On previous occasions, I have published a detailed review of Charles’ outstanding achievements in the realm of alternative medicine. For his 70th, I feel that something else is required. How about a personal birthday card?

HAPPY BIRTHDAY YOUR ROYAL HIGHNESS!

I know, it is not easy to become 70, but you must look on the bright side: you are reasonably healthy, you are not exactly a poor man, and you even managed to change the rules and marry the woman you have always loved. What else could you wish for?

Yes, I know, your big idea of ‘Integrated Medicine’ is not doing all that brilliantly. Your book ‘Harmony‘ was viciously ridiculed, and the ‘best of both worlds’ turns out to be a bit of a strange idea. The thing is that, in healthcare, there is only one real world: the world of reality, facts and evidence. The other is the unreal world of fantasy, wishful thinking and mysticism.

We all know you love homeopathy. After listening to Laurence van der Post in your younger days, it would have been lovely for you, had the notion of a remedy based on a mystical vital force been true. It would have avoided all the complexities of reality. But now, at the age of 70, you must have realised that make belief is a poor substitute for fact.

It has become all but impossible to ignore the truth about homeopathy. Only last year, the European Academies Science Advisory Council concluded that “the claims for homeopathy are implausible and inconsistent with established scientific concepts” and that “there are no known diseases for which there is robust, reproducible evidence that homeopathy is effective beyond the placebo effect”. Such brutal realism must be painful. And now the NHS decided to ditch homeopathy completely. All your homeopathic spider memos for nothing!

Yes, it is tough to grow old. But perhaps it is not too late. You could try to forget about van der Post and all your other ill-advised ‘advisers’. Instead, you could gather a few young, energetic, bright scientists and let them inspire you with the beauty and excitement of reality and science. You could still become a force for real progress in healthcare.

Think about it and keep looking on the bright side.

Many happy returns

Edzard Ernst

 

For years, Margaret McCartney, a GP from Scotland, wrote a weekly column in the BMJ. It was invariably well-worth reading. Recently, she regrettably ended it by publishing her last article entitled  A summary of four and a half years of columns in one column. In it, she makes 36 short points. They are all poignant, but the one that made me think most (probably because it is relevant to my work and this blog) reads as follows:

Many people seek to make money from those who don’t understand science. Doctors should call out bollocksology when they see it.

On this blog, I have often discussed people who make money from consumers and patients who are unable to detect the quackery they are being sold. No doubt, the most famous case of me doing this was when, in 2009, I criticised Prince Charles and his ‘Dodgy Originals Detox Tincture’. It made many headlines; the BBC, for instance, reported:

Edzard Ernst, the UK’s first professor of complementary medicine, said the Duchy Originals detox tincture was based on “outright quackery”.

There was no scientific evidence to show that detox products work, he said.

Duchy Originals says the product is a “natural aid to digestion and supports the body’s elimination processes”.

But Professor Ernst of Peninsula Medical School said Prince Charles and his advisers appeared to be deliberately ignoring science, preferring “to rely on ‘make-believe’ and superstition”.

He added: “Prince Charles thus financially exploits a gullible public in a time of financial hardship.”

Marketed as Duchy Herbals’ Detox Tincture, the artichoke and dandelion mix is described as “a food supplement to help eliminate toxins and aid digestion”.

It costs £10 for a 50ml bottle…

At the time, I got a right blocking from my dean, Prof John Tooke, for my audacity. As far as I could see, there was almost no support from the UK medical profession. Since then, the exploitation of the public by quacks has not diminished; on the contrary, I have the feeling that it is thriving. And are doctors calling out bollocksology left right and centre? No, they are not!

Of course, some do occasionally raise their voices (and some do it even regularly). But mostly, it is the group of non-medical sceptics who open their mouths and try their best to prevent harm. Yet, I wholly agree with my friend Margret: doctors have a responsibility and must do more.

And why don’t they?

I think, there are several reasons for their inactivity:

  • doctors are frightfully busy,
  • doctors often don’t know how much bollocksology is out there,
  • doctors don’t (want to) see how dangerous much of this bollocksology is,
  • doctors fail to realise that it would be their ethical responsibility to speak out against bollocksology,
  • some doctors do not seem to understand science either,
  • some doctors are active bollocksologists themselves,
  • some doctors simply don’t care.

This clearly is a depressing state of affairs! But, at the same time, it also is a cheerful occasion for me to thank all those doctors who are the laudable exceptions, who do care, who do think critically, who see their ethical responsibility, and who do something about the never-ending flood of bollocksology endangering their patients’ health and wealth.

When NHS England announced several months ago that they plan to stop the reimbursement of homeopathy, UK homeopaths were understandably upset and decided to launch a legal challenge to this decision. Yesterday, the result of this challenge has been published in a NHS press-release:

START OF QUOTE

NHS chief Simon Stevens has today welcomed the High Court’s decisive rejection of a legal challenge by the British Homeopathic Association to overturn plans to no longer routinely fund homeopathy on the NHS.

As part of action to clamp down on waste, over the last two years NHS England has taken action to curb prescriptions for medicines that can be bought over the counter or are of low value.

At the end of last year NHS England published guidance to curb prescriptions for 18 ineffective, unsafe or low clinical priority treatments, such as coproxamol, some dietary supplements, herbal treatments and homeopathy, saving up to £141 million a year. Earlier this year NHS England published a further list of 35 minor, short-term conditions for which over the counter medicines should not routinely be prescribed, saving around a further £100 million a year.

Savings form a key building block of the NHS’s 10 point efficiency plan contained in the Next Steps on the NHS Five Year Forward View, published in March 2017.

NHS chief, Simon Stevens said: “There is no robust evidence to support homeopathy which is at best a placebo and a misuse of scarce NHS funds.

“So we strongly welcome the High Court’s clear cut decision to kick out this costly and spurious legal challenge.”

Guidance on items which should not be routinely prescribed in primary care is available on the NHS England website.

END OF QUOTE

The reaction of UK homeopaths was as swift and deluded as it was predictable. The British Homeopathy Association, for instance, commented thus:

… The charity’s main claims against NHS England were that the consultation misrepresented homeopathy and therefore was unfair; and a report used in the consultation to inform the public was so complicated it would deter rather than encourage people to respond. Although the judge found there were sufficient grounds for a judicial review, after four days of lengthy legal arguments he dismissed the claims. Margaret Wyllie, BHA Chair, said the case highlighted how health bosses were unfairly manipulating the consultation process and making decisions about healthcare services without genuine patient engagement. “That NHS England attracted fewer than 3,000 responses from patients to a national consultation that ran for three months highlights its failure to genuinely engage with the public on important decisions about healthcare provision. Although 18 medicines were under review the only negative statement in NHS England’s press release promoting its public consultation was about homeopathy. The statement was so prejudicial it was widely reported in the media that the decision to deny patients homeopathic medicines had already been taken. How the judge failed to recognise that this was a deliberate attempt by NHS England to unfairly influence the public is astonishing,” said Mrs Wyllie.

In The Telegraph, Wyllie is quoted saying: It appears NHS England can fail to engage with patients properly on removing services and get away with it. That is not good enough, for it is important to remember that the real losers in this case are the patients who are now being refused a treatment on which they have come to depend.”

One can only marvel at the lack of insight and self-criticism. I should to add that the BHA is a charity; with this court case, they have wasted significant amounts of public money for their own, hopelessly misguided interests. To me, this indicates that they no longer deserve a charitable status.

Personally, I had very little doubt that the court would decide as it did. The evidence was simply overwhelming and indisputable. In the written judgement, the judge stated that “I am satisfied that NHSE was rigorous in the discharge of the duty to have “due regard” to relevant matters, and that it was entitled, on the evidence before it, to conclude that the Guidance would not have an adverse impact on the statutory equality objectives, but rather, as the Analysis found, “would [enable] patients to have access to the most effective medications to achieve the best outcomes”.

 

In all this, the open questions, in my view, were whether

  1. Prince Charles, the prime defender of quackery in the UK, would intervene,
  2. and whether his intervention might change anything.

So, did he try to intervene?

I do not know. It could be that, after all the hoo-ha about his spider memos, he now is a little more cautions about meddling in health politics. It could also be that, as he is getting ready to become king, he wants to keep a low profile about his more bizarre ideas. Lastly, it could be that his opinion does not weigh as heavily as I had feared.

In any case, The High Court ruling is most welcome and unquestionably just, progressive, and long-overdue. I applaud all who have worked hard to bring it about, and am sure that (most of) my readers agree.

“This utter hokum is symptomatic of the crass stupidity of the vacuous classes before the lumpen mob rebelled and chopped off their useless heads. Where, oh where, is our mob?”

No, I am not calling for a British re-run of the French revolution. This is a comment that made me chuckle. I found it under an article in the SUNDAY TIMES. As it is about acupuncture, I thought I mention it here and show you a few experts:

_________________________________________________________________________________

… Prince Harry and Meghan Markle had regular appointments with an acupuncturist in the lead-up to their wedding. They were treated by Ross Barr, acupuncturist to the stars, who has been described as “divertingly handsome” by many of his enthusiastic fans and whose treatments have been lauded as “better than Botox”. Beauty experts say his appointments “go faster than Glastonbury tickets”.

Barr, whose treatments deal with anything from infertility to hair loss and relationship problems, is understood to have been regularly treating the couple since Meghan moved to London last year. The treatments are said to have been so successful that Barr and his wife, the actress Eva Birthistle, were invited to the wedding alongside celebrities including Oprah Winfrey, who had acupuncture live on her television show…

Harry, 33, has spoken of his struggles with anxiety and depression after the death of his mother, Diana, Princess of Wales in 1997. In an interview with The Sunday Times in 2016 he also admitted “my body . . . has basically been ruined over the last 10 years of army service”. His father, the Prince of Wales, is renowned for championing alternative and complementary therapies such as homeopathy and acupuncture…

It is thought Harry was keen to try acupuncture as part of a recent health drive to prepare for his wedding. He is reported to have reduced his alcohol consumption and is now regularly seen exercising at the exclusive KX gym in Chelsea, west London. Meghan, 36, is likely to be a fan of Barr’s “anti-wrinkle acupressure facial”, which aims to smooth fine lines and may have contributed to the American former actress’s radiant complexion on her wedding day…

Both Kensington Palace and Barr declined to comment yesterday.

_________________________________________________________________________________

Well, let me offer a few comments then:

  1. The article is recklessly promotional and, in my view, very poor journalism.
  2. It does not even include the usual attempt at ‘balance’ where an expert warns at the end of the article that acupuncture is unscientific rubbish.
  3. There is no good evidence that acupuncture works for any of the conditions mentioned in the article.
  4. Critical thinking, journalistic ethics, or objective analysis do not seem to be the forte of the author of this regrettable drivel.

Yes, I know … this is not very important. It is merely a little innocent story about some VIPs for gullible consumers.

Innocent?

Perhaps!

But misleading the public about healthcare can also be seen as short-sighted, counter-productive, unethical, and stupid.

Once upon a time, the University of Exeter prided itself of having the ‘1st chair in complementary medicine’ in the country. That was in 1993, when I was appointed to that position. I then recruited a team of motivated researchers, and we soon managed to become the world’s leading research group in our field. Together, we published more papers on alternative medicine in the peer reviewed medical literature than any other team before or since, and we managed to get an international reputation for high-quality critical assessments of alternative medicine. Unfortunately, not all people were happy; some even seemed to be distinctly unhappy because few of our findings were as they had hoped.

In 2012/13, I retired under circumstances that, I am afraid, were not to the credit or integrity of my peers (the full and rather sad story has been told in my memoir). Since then, I have the status of Emeritus Professor; in that role, I give occasional lectures, publish about one book per year, run this blog, and generally enjoy life. There is not much that can bother me these days…

…at least, this is what I thought until I saw this announcement by Exeter University.

It informed me that the University of Exeter has decided to “offer a range of complementary therapies at a discounted rate to Staff at both Streatham and St Lukes Campus.”

Treatments are not cheap but members will receive the following reductions:

  • 60 minutes + treatments £5.00 discount
  • 45 minute treatments £4.00 discount
  • 30 minute treatments £3.00 discount.

You want to know which therapies precisely are on offer?

Here is a selection of the treatments they are providing:

  • Hot Stone Back Massage
  • Reflexology
  • Pregnancy Massage
  • Indian Head Massage
  • Acupressure points
  • Yoga movements
  • Somatic movements
  • Chi  Qong
  • Nutrition based Ayurvedic system of health
  • Tai Yoga massage

Impressive?

Yes, most impressive – particularly as none of the therapies listed above are supported by anything that looks remotely like good evidence!

So, has my University gone raving mad?

Have they joined the legion of charlatans promoting nonsense?

Do they perhaps want to score even more brownie-points with HRH, the Prince of Wales?

One would assume so … but wait … they added a disclaimer to their announcement:

Whilst the University is pleased to welcome complementary practitioners to the campus and support greater access to a range of wellbeing services, we are not in a position to actively condone the effectiveness of such treatments. However, Reed Mews Wellbeing Centre wants to promote choice and encourage individuals to make informed decisions regarding the management of their health needs.

AHHH – I AM SO PLEASED – THAT’S ALRIGHT THEN!

Gosh, we in the UK needed that boost of jingoism (at least, if you are white, non-Jewish and equipped with a British passport)! But it’s all very well to rejoice at the news that we have a new little Windsor. With all the joy and celebration, we must not forget that the blue-blooded infant might be in considerable danger!

I am sure that chiropractors know what I am talking about.

KISS (Kinematic Imbalance due to Suboccipital Strain) is a term being used to describe a possible causal relation between imbalance in the upper neck joints in infants and symptoms like postural asymmetry, development of asymmetric motion patterns, hip problems, sleeping and eating disorders. Chiropractors are particularly fond of KISS. It is a problem that chiropractors tend to diagnose in new-borns.

This website explains further:

The kinematic imbalances brought on by the suboccipital strain at birth give rise to a concept in which symptoms and signs associated with the cervical spine manifest themselves into two easily recognizable clinical presentations. The leading characteristic is a fixed lateroflexion [called KISS I] or fixed retroflexion [KISS II]. KISS I may be associated with torticollis, asymmetry of the skull, C–scoliosis of the neck and trunk, asymmetry of the gluteal area and of the limbs, and retardation of the motor development of one side. KISS II, on the other hand, displays hyperextension during sleep, occipital flattening that may be asymmetrical, hunching of the shoulders, fixed supination of the arms, orofacial muscular hypotonia, failure to lift the trunk from a ventral position, and difficulty in breast feeding on one side. [34] The leading trademarks of both KISS I and KISS II are illustrated in Figure 1. [31]

In essence, these birth experiences lay the groundwork for rationalizing the wisdom of providing chiropractic healthcare to the pediatric population…

END OF QUOTE

KISS must, of course, be treated with chiropractic spinal manipulation: the manual adjustment is the most common, followed by an instrument adjustment. This removes the neurological stress, re-balances the muscles and normal head position.  Usually a dramatic change can be seen directly after the appropriate adjustment has been given…

Don’t frown! We all know that we can trust our chiropractors.

Evidence?

Do you have to insist on being a spoil-sport?

Alright, alright, the evidence tells a different story. A systematic review concluded that, given the absence of evidence of beneficial effects of spinal manipulation in infants and in view of its potential risks, manual therapy, chiropractic and osteopathy should not be used in infants with the KISS-syndrome, except within the context of randomised double-blind controlled trials.

And this means I now must worry for a slightly different reason: we all know that the new baby was born into a very special family – a family that seems to embrace every quackery available! I can just see the baby’s grandfather recruiting a whole range of anti-vaccinationists, tree-huggers, spoon-benders, homeopaths, faith healers and chiropractors to look after the new-born.

By Jove, one does worry about one’s Royals!

The UK ‘COLLEGE OF MEDICINE’ has recently (and very quietly) renamed itself; it now is THE COLLEGE OF MEDICINE AND INTEGRATED HEALTH (COMIH). This takes it closer to its original intentions of being the successor of the PRINCE OF WALES FOUNDATION FOR INTEGRATED MEDICINE (PWFIM), the organisation that had to be shut down amidst charges of fraud and money-laundering. Originally, the name of COMIH was to be COLLEGE OF INTEGRATED HEALTH (as opposed to disintegrated health?, I asked myself at the time).

Under the leadership of Dr Michael Dixon, OBE (who also led the PWFIM into its demise), the COMIH pursues all sots of activities. One of them seems to be publishing ‘cutting-edge’ articles.

A recent and superb example is on the fascinating subject of ‘holistic dentistry‘:

START OF QUOTE

Professor Sonia Williams … explores how integrated oral health needs to consider the whole body, not just the dentition…

Complementary and alternative approaches can also be considered as complementary to ‘mainstream’ care, with varying levels of evidence cited for their benefit.

Dental hypnosis (British Society of Medical and Dental Hypnosis) can help support patients including those with dental phobia or help to reduce pain experience during treatment.

Acupuncture in dentistry (British Society of Dental Acupuncture) can, for instance, assist with pain relief and allay the tendency to vomit during dental care.  There is also a British Homeopathic Dental Association.

For the UK Faculty of General Dental Practitioners, holistic dentistry refers to strengthening the link between general and oral health.

For some others, the term also represents an ‘alternative’ form of dentistry, which may concern itself with the avoidance and elimination of ‘toxic’ filling materials, perceived potential harm from fluoride and root canal treatments and with treating dental malocclusion to put patients back in ‘balance’.

In the USA, there is a Holistic Dental Association, while in the UK, there is the British Society for Mercury-free Dentistry. Unfortunately the evidence base for many of these procedures is weak.

Nevertheless, pressure to avoid mercury in dental restorative materials is becoming mainstream.

In summary, integrated health and care in dentistry can mean different things to different people. The weight of evidence supports the contention that the mouth is an integral part of the body and that attention to the one without taking account of the other can have adverse consequences.

END OF QUOTE

Do I get this right? ‘Holistic dentistry’ in the UK means the recognition that my mouth belongs to my body, and the adoption of a few dubious treatments with w ‘weak’ evidence base?

Well, isn’t this just great? I had no idea that my mouth belongs to my body. And clearly the non-holistic dentists in the UK are oblivious to this fact as well. I am sooooooo glad we got this cleared up.

Thanks COMIH!!!

And what about the alternative treatments used by holistic dentists?

The British Society of Medical and Dental Hypnosis (Scotland) inform us on their website that a trained medical and dental hypnotherapists can help you to deal with a large variety of challenges that you face in your everyday life e.g.

Asthma Migraines
Anxiety & Stress Smoking Cessation
Dental Problems Insomnia
Weight Problems Psychosexual Disorders
Depression Pain Management
Irritable Bowel  And many other conditions

I hasten to add that, for most of these conditions, the evidence fails to support the claims.

The British Society of Dental Acupuncture claim on their website that the typical conditions that may be helped by acupuncture are:

  • TMJ (jaw joint) problems
  • Facial pain
  • Muscle spasm in the head and neck
  • Stress headaches & Migraine
  • Rhinitis & sinusitis
  • Gagging
  • Dry mouth problems
  • Post-operative pain
  • Dental anxiety

I hasten to add that, for most of these conditions, the evidence fails to support the claims.

The British Homeopathic Dental Association claim on their website that studies have shown improved bone healing around implants with Symphytum and reduced discomfort and improved healing time with ulcers and beneficial in oral lichen planus.

I hasten to add that none of these claims are not supported by sound evidence.

The COMIH article is entitled “The mouth reflects whole body health – but what does integrated care mean for dentists?’ So, what does it mean? Judging from this article, it means an amalgam (pun intended) of platitudes, bogus claims and outright nonsense.

Pity that they did not change their name to College of Medicine and Integrated Care – I could have abbreviated it as COMIC!

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