Yesterday, I had the honour and pleasure to present to the UK press my new book entitled ‘ALTERNATIVE MEDICINE, A CRITICAL ASSESSMENT OF 150 MODALITIES’ (see also my previous post). The SCIENCE MEDIA CENTRE had invited me to do a ‘media briefing’ on the occasion of its publication. I did this by outlining the background around so-called alternative medicine (SCAM) and explaining the concept of the new book which essentially is – as its title indicates – to provide concise and critical assessments of 150 modalities.
In the course of my short presentation, I mentioned the following exotic modalities in order to show that my book goes beyond the ‘usual suspects’ of acupuncture, chiropractic, etc.:
- BERLIN WALL
- COLLOIDAL SILVER
- PALEO DIET
- URINE THERAPY
- GUA SHA
- LYMPH DRAINAGE
- SLAPPING THERAPY
- VISCERAL OSTEOPATHY
- JOHREI HEALING
- LEECH THERAPY
- NEURAL THERAPY
- ZERO BALANCE
- APPLIED KINESIOLOGY
- LIVE BLOOD ANALYSIS
- PULSE DIAGNOSIS
As it turned out, the journalists present found the BERLIN WALL remedy the most fascinating aspect of my talk. And this is clearly reflected in today’s articles covering the event:
The DAILY TELEGRAPH published an article much in the same vein, and so did THE SUN and the EXPRESS (not available on line). The only UK newspaper I have seen so far going beyond the Berlin Wall topic is THE DAILY MAIL. The paper mentions several other so-called alternative medicines (SCAMs) that consumers need to be protected from, in my view.
Interestingly, none of the articles mentioned that my new book is not an exercise in debunking. During my presentation, I made the point that several of my assessments of 150 modalities do arrive at positive conclusions for therapies that demonstrably generate more good than harm.
I also tried to point out to the journalists that SCAM includes a range of diagnostic techniques. None of them are valid which means that they present a real danger to consumers through false-positive and false-negative diagnoses. In particular the latter scenario can cost lives.
All in all, I did enjoy yesterday’s press briefing very much. I am aware of the fact that, in the realm of SCAM, the press have a most important role to play. Consumers rarely consult their doctor when deciding to use SCAM; frequently they go by what they read in the papers.
In this context, I find it noteworthy that, during the last years, the UK press have become considerably more sceptical. Not so long ago, most UK journalists used to praise SCAM like the best thing since sliced bread; today this attitude has laudably shifted towards a more rational stance. I am sure that the excellent work of the SCIENCE MEDIA CENTRE has played a crucial part in this positive development.
Before a scientific paper gets published in a journal, it is submitted to the process of peer-review. Essentially, this means that the editor sends it to 2 or 3 experts in the field asking them to review the submission. Reviewers usually do not get any reward for this, yet the task they are asked to do can be tedious, difficult and time-consuming. Therefore, most reviewers think carefully before accepting it.
My friend Timothy Caulfield was recently invited by a medical journal to review a study of homeopathy. Here is his response to the editor as posted on Twitter:
I find myself regularly in similar situations. Yet, I have never responded in this way. Here is what I normally do:
- I have a look at the journal itself. If it is one of those SCAM publications, I tend to politely reject the invitation because, in my experience, their review process is farcical and not worth the effort. All too often it has happened that I reviewed a paper that was of very poor quality and thus recommended rejecting it. Yet the editor ignored my expert opinion and published the article nevertheless. This is why, several years ago, I decided enough is enough and no longer consider investing my time is such frustrating work.
- If the journal is of decent standing, I would have a look at the submission the editor sent me. If it makes any sense at all I would consider reviewing it (obviously depending on whether I have the time and the expertise).
- If a decent journal invites me to review a nonsensical paper (I assume that was the case Timothy referred to), I find myself in the same position as my friend Timothy. But, contrary to Timothy, I normally take the trouble to write a critical review of a nonsensical submission. Why? The reason is simple: if I don’t do it, the editor will simply send it to another reviewer. Many journals allow authors to suggest reviewers of their choice. Thus, the editor might send the submission next to the person suggested by the author who most likely will write a favourable review, thus hugely increasing the chances that the paper will be published in a decent journal.
On this blog, we have seen repeatedly that even top journal occasionally publish rubbish papers. Perhaps they do so because well-intentioned experts react in the way my friend Timothy did above (as he failed to tell us what journal invited him, I might be wrong).
If we want pseudoscience to disappear, we are fighting a lost battle. It will always rear its ugly head in third class journals. This is lamentable, but perhaps not so disastrous: by publishing little else than rubbish, these SCAM journals discredit themselves and will eventually be read only by pseudoscientists.
But we can do our bit to get rid of pseudoscience in decent journals. For this to happen, I think, rational thinkers need to accept invitations from such journals and do a proper review. And, of course, they can add to it a sentence or two about the futility of reviewing nonsense.
I am sure Timothy and I both want to eliminate pseudoscience as much as possible. In other words, we are in agreement about the aim, yet we differ in our approach. The question is: which is more effective?
… Many proponents of so-called alternative medicine (SCAM) are keen to point out that, while mainstream medicine may be good at treatment of diseases, particularly acute conditions, SCAM’s forte lies in the prevention of disease. Patients seem to have intuitively accepted this notion; a recent survey suggest that more than 50% of those Americans who use SCAM do so not to treat ailments but to remain healthy, i.e. to prevent disease and illness. If one looks closer at the evidence for or against SCAM’s role in disease prevention, one is stunned by the contrast of firmly held beliefs and the lack of reliable evidence to support them…
… Unfortunately the subject is more complex than normally appreciated within SCAM. Until we have convincing data, it is not possible to state with confidence that a given form of SCAM is effective in preventing a given condition. It follows
- that we now should prepare to carry out the much needed (but difficult) research related
- that we should be cautious and abstain from overstating the largely unproven role of SCAM in the prevention of disease and illness.
These lines were written by me and published exactly 20 years ago. As far as I can see, very little has changed since.
- SCAM providers continue to make big claims about disease prevention.
- Many consumers continue to believe them.
- And the evidence continues to be absent or flimsy.
It follows, I fear, that charlatans who advocate their SCAM as a means to prevent disease are dishonestly defrauding the public.
I do hope that someone disagrees with me and shows me the evidence proving me wrong!
The Society of Homeopaths (SoH) is the professional organisation of UK lay homeopaths (those with no medical training). The SoH has recently published a membership survey. Here are some of its findings:
- 89% of all respondents are female,
- 70% are between the ages of 35 and 64.
- 91% of respondents are currently in practice.
- 87% are RSHoms.
- The majority has been in practice for an average of 11 – 15 years.
- 64% identified their main place of work as their home.
- 51% work within a multidisciplinary clinic.
- 43% work in a beauty clinic.
- 85% oﬀer either telephone or video call consultations.
- Just under 50% see 5 or fewer patients each week.
- 38% are satisfied with the number of patients they are seeing.
- 80% felt conﬁdent or very conﬁdent about their future.
- 65% feel supported by the SoH.
Because this truly homeopathic survey is based on exactly 132 responses which equates to 14% of all SoH members.
If, however, we were able to conclude anything at all, it would be that the amateur researchers at the SoH cause Hahnemann to turn in his grave. Offering telephone/video consultations and working in a beauty salon would probably have annoyed the old man. But what would have definitely made him jump with fury in his Paris grave is a stupid survey like this one.
An article in the Sydney Morning Herald might be interesting to some readers. It informs us that, after more than 25 years of running, the University of Technology Sydney (UTS) intends to stop offering its degree in Traditional Chinese Medicine (TCM). A review of the Chinese Medicine Department found it should be wound up at the end of 2021 because
- it was no longer financially viable,
- did not produce enough research,
- and did not fit with the “strategic direction” of the science faculty.
The UTS’s Chinese medicine clinic, which offers acupuncture and herbal treatments, would also close. Students who don’t finish by the end of 2021 will either move to another health course, or transfer to another university (Chinese medicine is also offered by the University of Western Sydney, RMIT in Melbourne, and several private colleges).
TCM “is a historical tradition that pre-dated the scientific era,” said the president of Friends of Science, Associate Professor Ken Harvey. “There’s nothing wrong with looking at that using modern scientific techniques. The problem is people don’t, they tend to teach it like it’s an established fact. If I was a scientifically-orientated vice chancellor I would worry about having a course in my university that didn’t have much of a research profile in traditional Chinese medicine.”
But a spokesman for the University of Technology Sydney said the debate over the scientific validity of Chinese medicine had nothing to do with the decision, and was “in no way a reflection of an institutional bias against complementary health care”. Personally, I find this statement surprising. Should the scientific validity of a subject not be a prime concern of any university?
In this context, may I suggest that the UTS might also have a critical look at their ‘AUSTRALIAN RESEARCH CENTRE IN COMPLEMENTARY AND INTEGRATIVE MEDICINE‘. They call themselves ‘the first centre worldwide dedicated to public health and health services research on complementary and integrative medicine’. Judging from the centre director’s publications, this means publishing one useless survey after another.
Cupping is a so-called alternative medicine (SCAM) that has existed in several ancient cultures. It recently became popular when US Olympic athletes displayed cupping marks on their bodies, and it was claimed that cupping is used for enhancing their physical performance. There are two distinct forms: dry and wet cupping.
Wet cupping involves scarring the skin with a sharp instrument and then applying a cup with a vacuum to suck blood from the wound. It can thus be seen (and was traditionally used) as a form of blood-letting. Wet cupping is being recommended by enthusiasts for a wide range of conditions. But does it work?
This study compared the effects of wet-cupping therapy with conventional therapy on persistent nonspecific low back pain (PNSLBP). In this randomized clinical trial, 180 participants with the mean age of 45±10 years old, who had been suffering from PNSLBP were randomly assigned to wet-cupping or conventional treatment. The wet-cupping group was treated with two separate sessions (4 weeks in total) on the inter-scapular and sacrum area. In the conventional treatment group, patients were conservatively treated using rest (6 weeks) and oral medications (3 weeks). The primary and the secondary outcome were the quantity of disability using Oswestry Disability Index (ODI), and pain intensity using Visual Analogue Scale (VAS), respectively.
The results show that there was no significant difference in demographic characteristics (age, gender, and body mass index) between the two groups. Therapeutic effect of wet-cupping therapy was comparable to conventional treatment in the 1st month follow-up visits. The functional outcomes of wet-cupping at the 3rd and 6th month visits were significantly superior compared to the conventional treatment group. The final ODI scores in the wet-cupping and conventional groups were 16.7 ± 5.7 and 22.3 ± 4.5, respectively (P<0.01).
The authors concluded that wet-cupping may be a proper method to decrease PNSLBP without any conventional treatment. The therapeutic effects of wet-cupping can be longer lasting than conventional therapy.
Perhaps the authors were joking? In any case, their conclusions cannot be taken seriously. Why? There are several reasons, but the most obvious ones are:
- There was no adequate control of the presumably substantial placebo effects of wet cupping.
- The control group received a treatment that is known to be ineffective or even detrimental.
For people with acute low back pain, advice to rest in bed is less effective than advice to stay active. Thus comparing wet cupping to a control group treated with bed rest is bound to generate a false-positive outcome for wet cupping.
My final point is perhaps the most important: wet cupping can lead to serious complication, and I therefore do not recommend it to anyone – other than masochists, perhaps.
The current debate about homeopathy is intense and often emotional. Yet, many people who discuss the loudest seem not even to know what homeopathy is; others are unaware that there is not one but many forms of homeopathy. The following passages from my book are an attempt to define some of them:
Agrohomeopathy is a somewhat exotic fringe area of homeopathy. It is the term describing the use of homeopathic remedies to treat gardens and crops. Its proponents claim that it is an effective, chemical free, non-toxic method of growing plants. They also believe that agrohomeopathy renders plants resistant to disease by strengthening them ‘from the inside out’. Agrohomeopathy, they say, can even treat a trauma retained in the ‘biological memory’ of the plant resulting from conditions such as forced hybridization, moving to places outside their natural habitats, or exaggerated fertilization. There is no evidence, however, that any of these assumptions are correct.
Classical homeopathy is the term used to describe the type of homeopathy that adheres to the principles, instructions and methods published by Hahnemann. As Hahnemann’s texts are by no means free of contradictions, classical homeopathy is not a well-defined concept. As it is practised today, it incorporates ideas that originate not from Hahnemann but also from other prominent homeopaths, such as Kent. Thus some might use the term ‘classical homeopathy’ to denote the highly individualised prescribing of Hahnemann and to contrast it with the symptom-orientated prescribing of ‘clinical homeopathy’. Others might employ it to differentiate those homeopaths who would practise no method other than homeopathy from those who regularly combine homeopathy with conventional medicine. Others again might take it to mean unicist homeopathy administering one single remedy at a time, the way Hahnemann mostly did.
Clinical Homeopathy While ‘classical homeopathy’ relies on individualised prescribing according to the ‘like cures like’ principle and selects the optimal remedy for each patient based on the findings from provings, clinical homeopathy resembles more the way drugs are prescribed in conventional medicine; it selects the appropriate remedy according to the condition of the patient, while largely disregarding the ‘like cure like’ principle. However, clinical and classical homeopathy are not mutually exclusive; in fact, there is considerable overlap between the two approaches, and they are often used in parallel by the same clinician. In other words, if the symptoms of a patient reveal a very clear indication for a certain homeopathic remedy, clinical homeopathy is used even by classical homeopaths. For instance, Arnica is considered a clear indication for cuts and bruised; so is Coffea for insomnia, Drosera for cough, Opium for constipation etc., and these remedies would be employed regularly by classical homeopaths. Clinical homeopathy is also used by many non-homeopaths as well as by consumers when they self-prescribe. It does not require an understanding any of the principles of homeopathy nor its fine details. Moreover, clinical homeopathy is also the predominant approach in veterinary homeopathy.
Complex homeopathy is the use of preparations which contain more than one homeopathic remedy. Even though it is not in line with Hahnemann’s teachings, complex homeopathy is currently highly popular and commercially successful. Homeopathic combination remedies can be bought over the counter and usually contain a range of different remedies which, according to the concepts of clinical homeopathy, are most likely to cure a given condition.
Homeo-prophylaxis Some homeopaths advise their patients against immunisations and instead recommend homeopathic immunisations or ‘homeo-prophylaxis’. This normally entails the oral administration of homeopathic remedies, called nosodes. Such remedies are potentised remedies based on pathogenic material like bodily fluids or pus. There is no evidence that homeopathic immunisations are effective. After conventional immunisations, patients develop immunity against the infection in question which can be monitored by measuring the immune response to the intervention. No such evidence exists for homeopathic immunisations. Despite this lack of evidence, some homeopaths – particularly those without medical training – continue to recommend homeopathic immunisations. A recent US conference on the topic was advertised with the slogan ‘homeo-prophylaxis is a gentle, non-toxic alternative’. Such promotion constitutes a serious risk for public health: once rates for conventional immunisations fall below a certain threshold, the population would lose its herd immunity, subsequently even those individuals who were immunised are at risk of acquiring the infection.
Homotoxicology is a method inspired by homeopathy which was developed by Hans Heinrich Reckeweg (1905 – 1985). He believed that all or most illness is caused by an overload of toxins in the body. The toxins originate, according to Reckeweg, both from the environment and from the malfunction of physiological processes within the body. His treatment consists mainly in applying homeopathic remedies which usually consist of combinations of single remedies, because health cannot be achieved without ridding the body of toxins. The largest manufacturer and promoter of remedies used in homotoxicology is the German firm Heel.
Isopathy is the use of potentised remedies which are derived from the causative agent of the disease that is being treated. It thus does not follow the supreme law of homeopathy; instead of ‘like cures like’, instead it postulates that identical cures identical. An example of isopathy is the use of potentised grass pollen to treat patients suffering from hay fever. Some of the methodologically best trials that generated a positive result were done using isopathy; they therefore did not test homeopathy and its principal assumption, the ‘like cures like’ theory. They are nevertheless regularly used by proponents of homeopathy to argue that homeopathy is effective.
Pluralist homeopathy is a variation of Hahnemann’s original concepts. It allows or even encourages the use of more than one homeopathic remedy to treat a patient at one time. The remedies may cover different aspects of the patient’s illness. Hahnemann was very clear in his instructions that normally one patient should get only one single remedy at one time.
Purist homeopathy A purist homeopath is a clinician who adheres strictly to the instructions of Hahnemann. Since the early days of homeopathy, homeopaths were divided by this issue: some purists believe that any deviation from Hahnemann’s dictum is a travesty that renders homeopathy ineffective, while others are convinced that clinicians have an ethical responsibility to incorporate new medical knowledge into their practice. An editorial in the British Homeopathic Journal of 1944, for instance, stated that ‘to shut one’s eyes to the discoveries of chemotherapy…is…foolishness. The ‘pure’ homeopath so called is a crank living in his own little cell. The complete physician is he who endeavours to know all, and knowing all, to choose what is best for the patient.’
Unicist Homeopathy School of homeopathy that insists on following Hahnemann’s dictum of using only one single remedy for one patient at any one time. See also pluralist homeopathy.
One would be forgiven for being confused in view of this plethora of variations. Is there anything these treatments have in common?, you may well ask. The answer is yes:
THEY ALL ARE BIOLOGICALLY IMPLAUSIBLE AND NOT SUPPORTED BY GOOD EVIDENCE OF EFFECTIVENESS.
George Vithoulkas, has been mentioned on this blog repeatedly. He is a lay homeopath – one that has no medical background – and has, over the years, become an undisputed hero within the world of homeopathy. Yet, Vithoulkas’ contribution to homeopathy research is perilously close to zero. Judging from a recent article in which he outlines the rules of rigorous research, his understanding of research methodology is even closer to zero. Here is a crucial excerpt from this paper intercepted by a few comment from me in brackets and bold print.
Which are [the] homoeopathic principles to be respected [in clinical trials and meta-analyses]?
1. Homoeopathy does not treat diseases, but only diseased individuals. Therefore, every case may need a different remedy although the individuals may be suffering from the same pathology. This rule was violated by almost all the trials in most meta-analyses. (This statement is demonstrably false; there even has been a meta-analysis of 32 trials that respect this demand)
2. In the homoeopathic treatment of serious chronic pathology, if the remedy is correct usually a strong initial aggravation takes place [14–16]. Such an aggravation may last from a few hours to a few weeks and even then we may have a syndrome-shift and not the therapeutic results expected. If the measurements take place in the aggravation period, the outcome will be classified negative. (Homeopathic aggravations exist only in the mind of homeopaths; our systematic review failed to find proof for their existence.)
This factor was also ignored in most trials . At least sufficient time should be given in the design of the trial, in order to account for the aggravation period. The contrary happened in a recent study , where the aggravation period was evaluated as a negative sign and the homoeopathic group was pronounced worse than the placebo . (There are plenty of trials where the follow-up period is long enough to account for this [non-existing] phenomenon.)
3. In severe chronic conditions, the homoeopath may need to correctly prescribe a series of remedies before the improvement is apparent. Such a second or third prescription should take place only after evaluating the effects of the previous remedies . Again, this rule has also been ignored in most studies. (Again, this is demonstrably wrong; there are many trials where the homeopath was able to adjust his/her prescription according to the clinical response of the patient.)
4. As the prognosis of a chronic condition and the length of time after which any amelioration set in may differ from one to another case , the treatment and the study-design respectively should take into consideration the length of time the disease was active and also the severity of the case. (This would mean that conditions that have a short history, like post-operative ileus, bruising after injury, common cold, etc. should respond well after merely a short treatment with homeopathics. As this is not so, Vithoulkas’ argument seems to be invalid.)
5. In our experience, Homeopathy has its best results in the beginning stages of chronic diseases, where it might be possible to prevent the further development of the chronic state and this is its most important contribution. Examples of pathologies to be included in such RCTs trials are ulcerative colitis, sinusitis, asthma, allergic conditions, eczema, gangrene rheumatoid arthritis as long as they are within the first six months of their appearance. (Why then is there a lack of evidence that any of the named conditions respond to homeopathy?)
In conclusion, three points should be taken into consideration relating to trials that attempt to evaluate the effectiveness of homoeopathy.
First, it is imperative that from the point of view of homoeopathy, the above-mentioned principles should be discussed with expert homoeopaths before researchers undertake the design of any homoeopathic protocol. (I am not aware of any trial where this was NOT done!)
Second, it would be helpful if medical journals invited more knowledgeable peer-reviewers who understand the principles of homoeopathy. (I am not aware of any trial where this was NOT done!)
Third, there is a need for at least one standardized protocol for clinical trials that will respect not only the state-of-the-art parameters from conventional medicine but also the homoeopathic principles . (Any standardised protocol would be severely criticised; a good study protocol must always take account of the specific research question and therefore cannot be standardised.)
Fourth, experience so far has shown that the therapeutic results in homeopathy vary according to the expertise of the practitioner. Therefore, if the objective is to validate the homeopathic therapeutic modality, the organizers of the trial have to pick the best possible prescribers existing in the field. (I am not aware of any trial where this was NOT done!)
Only when these points are transposed and put into practice, the trials will be respected and accepted by both homoeopathic practitioners and conventional medicine and can be eligible for meta-analysis.
I suspect what the ‘GREAT VITHOULKAS’ really wanted to express are ‘THE TWO ESSENTIAL PRINCIPLES OF HOMEOPATHY RESEARCH’:
- A well-designed study of homeopathy can always be recognised by its positive result.
- Any trial that fails to yield a positive finding is, by definition, wrongly designed.
In Switzerland, so-called alternative medicine (SCAM) is officially recognised within the healthcare system and mainly practised in conjunction with conventional medicine. So far no research has been published into the attitude towards, training in and offer of SCAM among paediatricians in Switzerland. This survey addresses this gap by investigating these topics with an online survey of paediatricians in Switzerland.
It employed a 19-item, self-reporting questionnaire among all ordinary and junior members of the Swiss Society of Paediatrics (SSP). A comparison of the study sample with the population of all paediatricians registered with the Swiss Medical Association (FMH) allowed an assessment of the survey’s representativeness. The data analysis was performed on the overall group level as well as for predefined subgroups (e.g. sex, age, language, workplace and professional experience).
A total of 1890 paediatricians were approached and 640, from all parts of Switzerland, responded to the survey (response rate 34%). Two thirds of respondents were female, were aged between 35 and 55 years, trained as paediatric generalist and worked in a practice. Apart from young paediatricians in training, the study sample was representative of all Swiss paediatricians.
According to the authors’ statistics, the results suggest that
- 23% had attended training in SCAM, most frequently in phytotherapy, homeopathy, acupuncture/traditional Chinese medicine (TCM) and anthroposophic medicine
- 8% had a federal certificate in one or more SCAM methods.
- 44% did not routinely ask their patients about their use of SCAM.
- 84% did not offer SCAM.
- 65% were interested in SCAM courses and training.
- 16% provided SCAM services to their patients.
- 97% were asked by patients/parents about SCAM therapies.
- More than half of the responding paediatricians use SCAM for themselves or their families.
- 42% were willing to contribute to paediatric SCAM research.
The authors concluded that in a representative sample of paediatricians in Switzerland, the overall attitude towards SCAM was positive, emphasised by great interest in SCAM training, willingness to contribute to SCAM research and, in particular, by the high rate of paediatricians using SCAM for themselves and their families. However, given the strong demand for SCAM for children, the rate of paediatricians offering SCAM is rather low, despite the official recognition of SCAM in Switzerland. Among the various reasons for this, insufficient knowledge and institutional barriers deserve special attention. The paediatricians’ great interest in SCAM training and support for SCAM research offer key elements for the future development of complementary and integrative medicine for children in Switzerland.
SCAM suffers from acute survey mania. I am anxiously waiting for a survey of SCAM use in left-handed, diabetic policemen in retirement from Devon. But every other variation of the theme has been exploited. And why not? It provides the authors with a most welcome addition to their publication list. And, of course, it lends itself very nicely to SCAM-promotion. Sadly, there is not much else that such surveys offer.
Except perhaps for an opportunity to do an alternative evaluation of their results. Here is an assessment the devil’s advocate in me proposes. Based on the reasonable assumption that those 34% of paediatricians who responded did so because they had an interest in SCAM, and the 64% who did not reply couldn’t care less, it is tempting to do an analysis of the entire population of Swiss paediatricians. Here are my findings:
- Hardly anyone had attended training in SCAM.
- Hardly anyone had a federal certificate in one or more SCAM methods.
- Very few did not routinely ask their patients about their use of SCAM.
- Hardly anyone offered SCAM.
- Very few were interested in SCAM courses and training.
- Hardly anyone provided SCAM services to their patients.
- Quite a few were asked by patients/parents about SCAM therapies.
- Very few paediatricians use SCAM for themselves or their families.
- Few were willing to contribute to paediatric SCAM research.
These results might be closer to the truth but they have one very important drawback: they do not lend themselves to drawing the SCAM-promotional conclusions formulated by the authors.
Oh Yes, reality can be a painful thing!
A team from Israel conducted a pragmatic trial to evaluate the impact of So-called Alternative Medicine (SCAM) treatments on postoperative symptoms. Patients ≥ 18 years referred to SCAM treatments by surgical medical staff were allocated to standard of care with SCAM treatment (SCAM group) or without SCAM. Referral criteria were patient preference and practitioner availability. SCAM treatments included Acupuncture, Reflexology, or Guided Imagery. The primary outcome variable was the change from baseline in symptom severity, measured by Visual Analogue Scale (VAS).
A total of 1127 patients were enrolled, 916 undergoing 1214 SCAM treatments and 211 controls. Socio-demographic characteristics were similar in both groups. Patients in the SCAM group had more severe baseline symptoms. Symptom reduction was greater in the SCAM group compared with controls. No significant adverse events were reported with any of the CAM therapies.
The authors concluded that SCAM treatments provide additional relief to Standard Of Care (SOC) for perioperative symptoms. Larger randomized control trial studies with longer follow-ups are needed to confirm these benefits.
Imagine a situation where postoperative patients are being asked “do you want merely our standard care or do you prefer having a lot of extra care, fuss and attention? Few would opt for the former – perhaps just 211 out of a total of 1127, as in the trial above. Now imagine being one of those patients receiving a lot of extra care and attention; would you not feel better, and would your symptoms not improve faster?
I am sure you have long guessed where I am heading. The infamous A+B versus B design has been discussed often enough on this blog. Researchers using it can be certain that they will generate a positive result for their beloved SCAM – even if the SCAM itself is utterly ineffective. The extra care and attention plus the raised expectation will do the trick. If the researchers want to make extra sure that their bogus treatments come out of this study smelling of roses, they can – like our Israeli investigators – omit to randomise patients to the two groups and let them chose according to their preference.
To cut a long story short: this study had zero chance to yield a negative result.
- As such it was not a test but a promotion of SCAM.
- As such it was not science but pseudo science.
- As such it was not ethical but unethical.
WHEN WILL WE FINALLY STOP PUBLISHING SUCH MISLEADING NONSENSE?