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

pseudo-science

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When I first saw this press-release, I thought it was a hoax. After all, it came from a most dubious homeopathic source. Then I read it again and was no longer sure.

What do you think?

Here it is in full:

Santa Clara, Cuba, April 3,2020 (Prensa Latina) The homeopathic medicine Prevengho-VIR began to be administered as a measure to confront the Covid-19 in this province of central Cuba.

Dr. Mirtha Rosa Hernandez, head of the Department of the Elderly in Villa Clara, reported that the supply of the preparation began in the Grandparents’ Homes and Elderly Homes of the territory, which has 184,000 people over 60 years old, 23.9 percent of the local universe. The medicine is administered by doctors and nurses of the basic working group where the Grandparents’ Homes and Nursing Homes are located in the 13 municipalities of this province.

This homeopathic medicine comes in a 10-milliliter bottle, and the daily dosage is 5 drops, thrice a day; while on the tenth day a reactivation of the initial dose is performed. It is aimed at preventing the respiratory diseases in this risk group, in addition to other medical conditions, such as dengue.

In the upcoming days it will be extended to the Maternal Homes. It is administered by the doctors and the nurses from the basic work group of the senior homes.

She said, that besides avoiding the new coronavirus the formula is also aimed at preventing respiratory diseases in this risk group, in addition to others such as dengue fever.

This medicine can also be administered to children under 10 years old, pregnant women, nursing mothers, and patients with liver disorders.

Combination Medicine
Anas berberiae 200
Baptisia tinctora 200
Bascilinum 30
Pyrogenum 200
Eupetorium perf 200
Influezinum 200
Arsenicum Album 200

As I said, I was not sure whether this was for real. Is it possible that even officials are so stupid, brainwashed or gullible to go for homeopathy in such a serious situation?

In an attempt to find out, I did a little search and quickly found that the story has been reported by multiple media. This, for instance, is what the Miami Herald reported:

As scientists around the world speed up clinical trials to find a cure or vaccine for the coronavirus, the Cuban government will begin distributing a homeopathic remedy to the elderly and other vulnerable people to “prevent” the spread of the disease, a top health official said.

Dr. Francisco Durán, national director of Epidemiology at the Ministry of Public Health, said in a press conference on Sunday that “sublingual drops” of the compound PrevengHo-Vir “prevent different diseases such as influenza, the common cold, dengue, and emerging viral infections such as this one.”

On Monday, Durán tried to correct his statements and said that the product “does not prevent contagion” but rather “increases resistance, the body’s defenses against a certain virus.”

Several state media outlets reported that PrevengHo-Vir is already being used in various Cuban provinces to treat the elderly and other groups vulnerable to the coronavirus. There is no internet record of PrevengHo-Vir, other than press reports about the announcement of its distribution in Cuba.

So, it’s not a hoax!

In this case, let me try to predict what will happen next:

  • When the pandemic is over, the Cubans will publish mortality rates achieved with their homeopathic prevention [A].
  • They will compare them to data from a cohort that did not receive the homeopathic treatment [B].
  • Neither of the data-sets will be transparent and nobody will be able to check its reliability.
  • The comparison will yield a significant difference in favour of homeopathy.
  • The Cubans will use this to market their remedy.
  • The world of homeopathy will use it as a proof that homeopathy is effective (it wouldn’t be the first time).

Nothing wrong with that, some will say. Others who understand research methodology will, however, point out that these data are less than convincing.

In such case/control studies, one large group of patients [A] is compared to another group [B]. Group A has been treated homeopathically, while group B received no homeopathy. Any difference in outcome between A and B might be due to a range of circumstances that are unrelated to the homeopathic treatment, for instance:

  • group A might have been less ill than group B,
  • group A might have been better nourished,
  • group A might have benefited from better hygiene,
  • group A might have received better care,
  • group B might have received treatments that made the situation not better but worse,
  • the researchers might have prettified the data to make group A look better.

Such concerns are not totally unfounded; after all, Cuba seems to have a long history of making irresponsible claims for their homeopathic products.

Today is the official publication date of my new book ‘DON’T BELIEVE WHAT YOU THINK‘. It is essentially a crash course in critical thinking. To give you a flavour, here is an excerpt from its preface:

… So-called alternative medicine (SCAM) is a complex and controversial subject. Many people pretend to be experts in SCAM, but few know even the basic facts about it. Many consumers talk about SCAM, but few can be bothered to look behind the smokescreen of misleading claims. Many feel emotionally attached to SCAM, but few manage to think rationally about it. Many religiously believe in SCAM, but few show concern about the evidence. Many are desperate for help, but few seem to mind getting ripped off…

Enthusiasts of SCAM tend to hope for less side-effects, symptom relief, a cure of their condition, improvements in quality of life, and protection from illness. Such high expectations are usually based on misinformation, often even on outright lies. The disappointing truth is that not many SCAMs are truly effective in treating or preventing disease, and that none is totally harmless. In fact, the dangers of SCAM are multi-fold and potentially serious:

  • harm due to adverse effects such as toxicity of an herbal remedy, stroke after chiropractic manipulation, pneumothorax after acupuncture (see chapter 3.2);
  • harm caused by bogus diagnostic techniques (see chapter 4.4);
  • harm of using materials from endangered species (see chapter 3.15);
  • harm through incompetent advice by SCAM providers (see chapter 4.5);
  • harm due to using SCAM instead of an effective therapy for serious conditions (see chapter 4.5);
  • harm due to the high costs of SCAM (see chapter 3.8);
  • harm due to SCAM undermining evidence-based medicine (see chapter 5.4);
  • harm caused by inhibiting medical progress and research (see chapter 5.1).

In this book, I address these issues in detail and explain how consumers get manipulated into believing things that are evidently wrong. Using plenty of real-life examples, I outline how the constant flow of misinformation, coupled with motivated ignorance, motivated reasoning, and cognitive bias can produce a form of wishful thinking that is detached from reality. In the interest of my readers’ health, I aim to correct some of these false beliefs and fallacious thought processes.

My book consists of 35 concise essays each of which addresses one commonly held belief about SCAM. The essays can be read as stand-alone articles; occasionally, this necessitates a degree of repetition which, however, is minimal. The text avoids technical jargon and is therefore easy to follow. For those who want to dig deeper into the scientific evidence, links are provided to numerous papers that might prove to be helpful. A glossary is added at the end to explain some terms that might be unfamiliar.

This book is meant to stimulate critical thinking not just about SCAM, but also in a more general way. Science deniers employ similar techniques no matter whether they focus on health, climate change, evolution or other subjects. Exposing their techniques for what they are is thus important.

  • They ignore the scientific consensus.
  • They cherry-pick their evidence.
  • They rely on poor quality studies, opinion and anecdotes.
  • They invent conspiracy theories.
  • They defame their opponents.
  • They point out that science has been wrong before.
  • They say, ‘science does not know everything’.

Critical thinking is the best, perhaps even the only protection we have from being fooled and, crucially, from fooling ourselves. If my book enables you to question nonsense, call out untruths, correct falsehoods, ridicule stupidity, and disclose fake news, it surely was worth the effort.

 

Guest post by Kevin Smith

A family member of my household has been aghast to receive in the post yesterday a letter suggesting that, if they develop symptoms of coronavirus, they should take homeopathic remedies.

If this had been from some quack pharmacy doing a random mailshot, it would have been bad enough. But, astonishingly, it has come from the NHS! The letter is not on headed notepaper and is unsigned (it is in the format of a ‘factsheet’), thus is doesn’t contain the sender’s address; however, the envelope’s address label displays both my family member’s NHS number and the name of their GP practice. Moreover, the franking refers to a PO Box number that is owned by the NHS teaching hospital in our area. So it has certainly come from the NHS.

I believe that the family member who received it has been targeted because, in the past, a GP referral had been made for them to consult an NHS homeopath at this hospital.

Yes, very sadly, homeopaths have managed to exist within the NHS in the local area. I had assumed that, with the NHS recently cracking down on homeopathy, such quacks would have been excised – but this looks not to be the case, given the sending of this letter.

Here’s the text of the letter. Read it and see if you are as astonished – indeed as enraged – as I certainly am, and as is the family member to whom it was sent.

Guidance on Coronavirus (updated)

Prevention:

Daily probiotics, Regular handwashing, Stat dose of Covid-19 nosode 200c if it becomes available, Vit C & Zinc supplementation

Stress avoidance (Constitutional homeopathic prescribing & lifestyle)

Avoid incidental paracetamol use (ie no symptomatics for stress headaches etc)

Contact:

Add Ecchinacea, tincture 5 drops in water, twice daily, for no more than 4 consecutive days

Prodromal (ie before symptoms emerge):

Avoidance of incidental paracetamol use.

Stop work. Rest. Isolation. (+ Gelsemium 2 hourly, and/or Covid-19 nosode if it becomes available)

If you develop symptoms of Coronavirus: then avoid Paracetamol, Ibuprofen or Aspirin and take one of the following every hour, sucked in the mouth:

Camphora 30c (tablets or pillules) chills, cough, changeable fever

Bryonia 30c (tablets or pillules) fever, painful dry cough

Arsenicum album 30c (tablets or pillules) washed out feeling, chilliness, restless or agitated

Veratrum album 30c (diarrhoea, chills and fatigue)

Bryonia and Camphora are the most commonly indicated for Covid-19 from experience so far. Order them directly from one of the UK Homeopathic Pharmacies listed.

7 grammes / 8 grammes = 60 tablets or pillules

14 grammes / 15 grammes = 120 tablets or pillules

That’s the front page of the letter. Overleaf, it lists 11 homeopathic suppliers (across the UK), complete with contact details.

Additionally, the letter was accompanied by a pink slip, containing the following text:

If you find that you need to use any of the treatments outlined here, it is very important that you provide detailed feedback to us, so that we can adapt and improve our advice to others if necessary. Email (feedback only) [email protected]

What to make of this communication? Remember, this was from the NHS! What to do about it? COMMENTS WELCOME!

During the last 30 years, I must have read a few thousand studies of so-called alternative medicine (SCAM). Some made me angry because of their methodological flaws or wrong conclusions. A few impressed me. Many made me giggle. But none has ever caused me to laugh out so long as this one entitled ‘A STUDY ON THE PROPHYLACTIC EFFICACY OF HOMOEOPATHIC PREVENTIVE’.

Here is its abstract:

Homoeopathy has established its supremacy in the control of infectious viral diseases. The widespread acclaim in this regard is now supported by this study. The study was conducted in the Chikungunya fever hit areas of Kerala. The genus epidemicus was selected after detailed analysis of the first cases of Chikungunya. This preventive medicine was widely distributed in the disease prevalent areas. A survey was conducted for the evaluation of prophylactic efficacy. The study showed a very high significant effect of Homeopathic medicine in the prevention of Chikungunya fever.

You are, of course, correct to defend the Indian authors: it is unfair to judge a study purely on its abstract. So, let’s have a look at the rest. After a lengthy introduction, the heart of the full paper discloses the amazing details of the study.

Here I present the unabridged text of the study; the only part I have omitted is the introduction:

Aims and Objectives

1. To assess the efficacy of Homoeopathic medicine in the prevention of Chikungunya.
2. To determine the magnitude of incidence, clinical features, mortality , social & economic impact of the Chikungunya epidemic.

Conclusion

The Homoeopathic preventive medicine distributed for Chikungunya epidemic was highly effective.

THAT’S ALL!

As so often in the realm of so-called alternative medicine (SCAM), the Australians are setting an example. The Australian Health Practitioner Regulation Agency (Ahpra) is the national organisation responsible for implementing the National Registration and Accreditation Scheme (the National Scheme) across Australia. Yesterday, the Ahpra have issued an important press-release. Here is an excerpt:

… While the vast majority of health practitioners are responding professionally to the COVID-19 emergency and focusing on providing safe care, Ahpra and National Boards are seeing some examples of false and misleading advertising on COVID-19.

During these challenging times, it is vital that health practitioners only provide information about COVID-19 that is scientifically accurate and from authoritative sources, such as a state, territory or Commonwealth health department or the World Health Organization (WHO). According to these authoritative sources, there is currently no cure or evidence-based treatment or therapy which prevents infection by COVID-19 and work is currently underway on a vaccine.

Other than sharing health information from authoritative sources, registered health practitioners should not make advertising claims on preventing or protecting patients and health consumers from contracting COVID-19 or accelerating recovery from COVID-19. To do so involves risk to public safety and may be unlawful advertising. For example, we are seeing some advertising claims that spinal adjustment/manipulation, acupuncture and some products confer or boost immunity or enhance recovery from COVID-19 when there is no acceptable evidence in support.

Advertisers must be able to provide acceptable evidence of any claims made about treatments that benefit patients/health consumers. We will consider taking action against anyone found to be making false or misleading claims about COVID-19 in advertising. If the advertiser is a registered health practitioner, breaching advertising obligations is also a professional conduct matter which may result in disciplinary action, especially where advertising is clearly false, misleading or exploitative. There are also significant penalties for false and misleading advertising claims about therapeutic products under the Therapeutic Goods Act 1989.

Patients and health consumers should treat any advertising claims about COVID-19 cautiously and check authoritative sources for health information about COVID-19, such as state, territory and Commonwealth health departments.

As always, patients and health consumers should ask their practitioner for information to support any advertising claims before making decisions about treatment. Patients and health consumers should receive accurate and truthful messages so they can make the right choices about their health.

Many of my posts during the last weeks have dealt with this problem. The sad truth is that charlatans of all types are trying to exploit the fear of consumers during the current crisis for making a fast buck. This is despicable, unethical, unprofessional and possibly criminal.I do hope that the authorities of other countries follow the Australian example.

The ‘Corona-Virus Quackery Club’ (CVQC) is getting positively crowded. You may remember, its members include:

Today we are admitting the herbalists. The reason is obvious: many of them have jumped on the corona band-wagon by trying to improve their cash-flow on the back of the pandemic-related anxiety of consumers. If you go on the Internet you will find many examples, I am sure. I have chosen this website for explaining the situation.

Herbs That Can Stop Coronavirus Reproduction

CoV multiplies fast in the lungs and the stomach and intestines. The more virus, the sicker you get. The herbs are in their scientific names and common names.

    1. Cibotium barometz – golden chicken fern or woolly fern grows in China and Southeast Asia.

      Cibotium Barometz

    2. Gentiana scabra – known as Korean gentian or Japanese gentian seen in the United States and Japan.

      Japanese Gentian

    3. Dioscorea batatas or Chinese Yam grows in China and East Asia

      Chinese Yam

    4. Cassia tora or Foetid cassia, The Sickle Senna, Wild Senna – grows in India and Central America

      Cassia Tora

    5. Taxillus Chinensis – Mulberry Mistletoe

Lectin Plants that Have Anti Coronavirus Properties

Plant Lectins with Antiviral activity Against Coronavirus

From the table above, all have anti coronavirus activity except for garlic. One plant that is effective but not listed is Stinging nettle.

Yes, very nice pictures – but sadly utterly unreliable messages. My advice is that, in case you have concerns about corona (or any other health problem for that matter), please do not ask a herbalist.

WELCOME TO THE CVQC, HERBALISTS!

[If you do not like black humour or sarcasm, please do NOT read this post!!!]

Donald Trump just announced that, at Easter, he wants to see churches packed, his way of saying the lock-down is over because it is damaging the economy. Many others have put forward similar arguments and have pointed out that caring for the vulnerable, sick, old, etc. creates an economic burden that might eventually kill more people than it saves (see for instance ‘Economic crash could cost more lives than coronavirus, study warns‘).

Many people have also argued that homeopathy is unjustly vilified because it is truly a wholesome and safe medicine that should be used routinely. The notion here is that, alright, the evidence is not brilliant, but 200 years of experience and millions of fans cannot be ignored.

I have been wondering whether these two lines of thinking could not be profitably combined. Here is my suggestion based on the following two axioms.

  1. The economy is important for all our well-being.
  2. Homeopaths have a point in that the value of experience must not be ignored.

What follows is surprisingly simple: in view of the over-riding importance of the economy, let’s prioritise it over health. As it would look bad to deny those poor corona victims all forms of healthcare, let’s treat them homeopathically. This would make lots of people happy:

  • those who think the economy must take precedent,
  • those who fear the huge costs of saving corona patients (homeopathy is very cheap),
  • those who argued for decades that we never gave homeopathy a fighting chance to show its worth.

There is a downside, of course. There would be a most lamentable mortality rate. But, to paraphrase Dominic Cummings, if a few oldies have to snuff it, so be it!

Once we get used to this innovative approach – I suggest we call it integrative medicine – we might even consider adopting it for other critical situations. When we realise, for instance, that the pension pots are empty, we could officially declare that homeopathy is the ideal medicine for anybody over 60.

What do you think?

 

I have often stated jokingly that ‘HOMEOPATHY IS INCURABLE’; well, I was wrong! There seems to be a treatment that works quite reliably.

It’s called humour.

The Brits have been the pioneers in this field. One of the best examples is this classic by Mitchell and Webb.

 

In my view, it marked a turning point in UK homeopathy. After it’s enormous success, even the NHS re-considered its previously positive stance on homeopathy.

Now, a brilliant French comedian, Jeremy Ferrari, is having a similar success with his homeopathy-show in France. And it too marks the turning point where homeopathy is starting to be phased out from reimbursement in France.

So, are comedians the ones that bring consumers to reason when it comes to absurdities such as homeopathy? Or are comedians gifted at picking up the Zeitgeist and thus merely the ones who hammer the last nail into the coffin of homeopathy?

I think it is probably a bit of both.

But, whatever it is, these guys are brilliant! They achieve more good with their work than others writing clever articles in the Lancet and other medical journals. One good laugh seems to be more efficacious that pages of critical analysis.

If my blog has in the past stimulated some of these comedians to do their ingenious work – and I happen to know it has – I am both delighted and proud.

So far, our ‘Corona-Virus Quackery Club’ (CVQC) boasts the following membership:

It is time now, I think, to admit some supplement peddlers.

How come?

Many dietary supplement merchants seem to feel that the current pandemic is an excellent opportunity to flog their useless wares to the anxious public.

“COVID-19

In order to support increasing worldwide demand for the LYMA supplement, we would like to inform new and existing customers that we have sufficient stock in place to ensure uninterrupted supply.”

This was the text of an email I received recently. It linked to a website that informed me of the following:

We continue to work with our scientific network and global supply chain to bring you the latest scientific developments as they arise.

Dr. Paul Clayton, PhD – Director of Science, LYMA

“Covid-19 is causing an enormous amount of illness and disruption. This is due to its high transmission rates, long incubation period, and the substantial numbers of people – 15 to 20% of those infected – who become ill enough to require hospitalisation. This last aspect is concerning as no health care system in the world has sufficient resources to cope with such an influx of seriously ill patients.

At the time of writing there are no specific treatments available. The only advice given is to avoid crowds, wash the hands frequently, and not touch the face. Some authorities recommend face masks and gloves; and we are increasingly being recommended to shelter in place.

But there may be more we can do to protect ourselves. Dysnutrition is common, due to our over-consumption of ultra-processed foods with little nutritional value. Supplements have a role to play in improving general nutritional status and general immunity. But we can take that further.

LYMA. The ultimate supplement.

Chronic stress reduces immuno-competence and makes us more vulnerable to infection. Adaptogens such as KSM-66 Ashwagandha in LYMA have the ability to alleviate the damaging effects of stress and have been shown to improve immunity. So have the Wellmune 1-3, 1-6 beta glucans in LYMA, with many hundreds of studies showing that these natural compounds increase resistance to infection.

These are just two elements that may improve our chances in the difficult times ahead.”
Dr. Paul Clayton, PhD – Director of Science, LYMA

In case the name ‘LYMA’ rings a bell: yes, we have previously discussed the ‘the world’s first super supplement’ and the many claims made for it. We even had the pleasure of an interesting exchange with the above-pictured Dr Paul Clayton in the comments section of that post. Given the above, I am more than happy to welcome him, his LYMA team, and all other supplement peddlers who try to make a fast buck in the present crisis to the CVQC.

WELCOME GUYS!

The objective of this analysis was to evaluate the impact of chiropractic utilization upon use of prescription opioids among patients with spinal pain. The researchers employed a retrospective cohort design for analysis of health claims data from three contiguous US states for the years 2012-2017.

They included adults aged 18-84 years enrolled in a health plan and with office visits to a primary care physician or chiropractor for spinal pain. Two cohorts of subjects were thus identified:

  1. patients who received both primary care and chiropractic care,
  2. Patients who received primary care but not chiropractic care.

The total number of subjects was 101,221. Overall, between 1.55 and 2.03 times more nonrecipients of chiropractic care filled an opioid prescription, as compared with recipients.

The authors concluded that patients with spinal pain who saw a chiropractor had half the risk of filling an opioid prescription. Among those who saw a chiropractor within 30 days of diagnosis, the reduction in risk was greater as compared with those with their first visit after the acute phase.

Similar findings have been reported before and we have discussed them on this blog (see here, here and here). As before, one has to ask: WHAT DO THEY ACTUALLY MEAN?

The short answer is NOTHING MUCH! And certainly not what many chiros make of them.

They do not suggest that chiropractic care is a substitute for opioids in the management of spinal pain.

Why?

There are several reasons. Perhaps the most important ones are that such analyses lack any clinical outcome data, and that comparing one mistake (opioid-overuse) whith what might be another (chiropractic care) is a wrong apporoach. Imagine a scenario where half to the patients had received, in addition to their usual care, the services of:

  • a paranormal healer,
  • a crystal therapist,
  • a shaman,
  • or a homeopath.

Nobody would be surprised to see a very similar result, particularly if all of these practitioners were in the habit of discouraging their patients from using conventional drugs. Or imagine a scenario where half of all patients suffering from spinal pain are entered into an environment where they receive no treatment at all. Who would not expect that this regimen does not dramatically reduce the risk of filling an opioid prescription? But would that indicate that zero treatment is a good solution for managing spinal pain?

The thing is this:

  • If you want to reduce opioid use, you need to prescribe less opioids (for instance, by re-educating doctors to do as they have been told in med school and curb over-prescribing).
  • If you discourage patients to use opioids (as many other healthcare professionals would), many will not use opioids.
  • If you want to know whether chiropractic is effective in managing spinal pain, you need to conduct a well-designed clinical trial.

Or, to put it simply:

CORRELATION IS NOT CAUSATION!

 

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