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

quackery

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Homotoxicology is sometimes praised as the ‘best kept detox secret‘, often equated with homeopathy, and even more often not understood at all.

But what is it really?

Homotoxicology is the science of toxins and their removal from the human body. It offers a theory of disease which describes the severity and duration of an illness or disorder based on toxin-loading relative to our body’s ability to detoxify. In other words, it tells you how sick you’ll get when what stays inside progressively overwhelms our ability to get the garbage out. It explains what you can expect to see as you start removing toxins.

And yes, there is a hierarchy of toxic substances. Homotoxicology says you should remove the gentler ones first. As the body strengthens, it will be able to handle the really bad stuff (i.e., heavy metals). This explains why some people do really well on the same detox treatments that take others out at the knees.

Yes, I know!

This sounds very much like promotional BS!!!

So, what is it really, and what evidence is there to support it?

Homotoxicolgy is a therapy developed by the German physician and homeopath Hans Reckeweg. It is strongly influenced by (but not identical with) homoeopathy. Proponents of homotoxicology understand it as a modern extension of homoeopathy developed partly in response to the effects of the Industrial Revolution, which imposed chemical pollutants on the human body.

„Ich möchte einmal die Homöopathie mit der Schulmedizin verschmelzen H.-H. Reckeweg Küstermann/Auriculotherapie_2008.

According to the assumptions of homotoxicology, any human disease is the result of toxins, which originate either from within the body or from its environment. Allegedly, each disease process runs through six specific phases and is the expression of the body’s attempt to cope with these toxins. Diseases are thus viewed  as biologically useful defence mechanisms. Health, on the other hand, is the expression of the absence of toxins in our body. It seems obvious that these assumptions are not based on science and bear no relationship to accepted principles of toxicology or therapeutics. In other words, homotoxicology is not plausible.
The therapeutic strategies of homotoxicology are essentially threefold:

• prevention of further homotoxicological challenges,
• elimination of homotoxins,
• treatment of existing ‘homotoxicoses’.

Frequently used homotoxicological remedies are fixed combinations of homeopathically prepared remedies such as nosodes, suis-organ preparations and conventional drugs. All these remedies are diluted and potentised according to the rules of homoeopathy. Proponents of homotoxicology claim that they activate what Reckeweg called the ‘greater defence system’— a concerted neurological, endocrine, immunological, metabolic and connective tissue response that can give rise to symptoms and thus excretes homotoxins. Homotoxicological remedies are produced by Heel, Germany and are sold in over 60 countries. The crucial difference between homotoxicology and homoeopathy is that the latter follows the ‘like cures like’ principle, while the former does not. As this is the defining principle of homeopathy, it would be clearly wrong to assume that homotoxicology is a form of homeopathy.

Several clinical trials of homotoxicology are available. They are usually sponsored or conducted by the manufacturer. Independent research is very rare. In most major reviews, these studies are reviewed together with trials of homeopathic remedies which is obviously not correct. Our systematic review purely of studies of homotoxicology included 7 studies, all of which had major flaws. We concluded that the placebo-controlled, randomised clinical trials of homotoxicology fail to demonstrate the efficacy of this therapeutic approach.

So, I ask again: what is homotoxicology?

It is little more than homeopathic nonsense + detox nonsense + some more nonsense.

My advice is to say well clear of it.

Often referred to as “Psychological acupressure”, the emotional freedom technique (EFT) works by releasing blockages within the energy system which are the source of emotional intensity and discomfort. These blockages in our energy system, in addition to challenging us emotionally, often lead to limiting beliefs and behaviours and an inability to live life harmoniously. Resulting symptoms are either emotional and/ or physical and include lack of confidence and self esteem, feeling stuck anxious or depressed, or the emergence of compulsive and addictive behaviours. It is also now finally widely accepted that emotional disharmony is a key factor in physical symptoms and dis-ease and for this reason these techniques are being extensively used on physical issues, including chronic illness with often astounding results. As such these techniques are being accepted more and more in medical and psychiatric circles as well as in the range of psychotherapies and healing disciplines.

An EFT treatment involves the use of fingertips rather than needles to tap on the end points of energy meridians that are situated just beneath the surface of the skin. The treatment is non-invasive and works on the ethos of making change as simple and as pain free as possible.

EFT is a common sense approach that draws its power from Eastern discoveries that have been around for over 5,000 years. In fact Albert Einstein also told us back in the 1920’s that everything (including our bodies) is composed of energy. These ideas have been largely ignored by Western Healing Practices and as they are unveiled in our current times, human process is reopening itself to the forgotten truth that everything is Energy and the potential that this offers us.

END OF QUOTE

If you ask me, this sounds as though EFT combines pseudo-psychological with acupuncture-BS.

But I may be wrong.

What does the evidence tell us?

A systematic review included 14 RCTs of EFT with a total of 658 patients.  The pre-post effect size for the EFT treatment group was 1.23 (95% confidence interval, 0.82-1.64; p < 0.001), whereas the effect size for combined controls was 0.41 (95% confidence interval, 0.17-0.67; p = 0.001). Emotional freedom technique treatment demonstrated a significant decrease in anxiety scores, even when accounting for the effect size of control treatment. However, there were too few data available comparing EFT to standard-of-care treatments such as cognitive behavioural therapy, and further research is needed to establish the relative efficacy of EFT to established protocols.  Meta-analyses indicate large effect sizes for posttraumatic stress disorder, depression, and anxiety; however, treatment effects may be due to components EFT shares with other therapies.

Another, more recent analysis reviewed whether EFTs acupressure component was an active ingredient. Six studies of adults with diagnosed or self-identified psychological or physical symptoms were compared (n = 403), and three (n = 102) were identified. Pretest vs. posttest EFT treatment showed a large effect size, Cohen’s d = 1.28 (95% confidence interval [CI], 0.56 to 2.00) and Hedges’ g = 1.25 (95% CI, 0.54 to 1.96). Acupressure groups demonstrated moderately stronger outcomes than controls, with weighted posttreatment effect sizes of d = -0.47 (95% CI, -0.94 to 0.0) and g = -0.45 (95% CI, -0.91 to 0.0). Meta-analysis indicated that the acupressure component was an active ingredient and outcomes were not due solely to placebo, nonspecific effects of any therapy, or non-acupressure components.

From these and other reviews, one could easily get the impression that my above-mentioned suspicion is erroneous and EFT is an effective therapy. But I still do have my doubts.

Why?

These reviews conveniently forget to mention that the primary studies tend to be of poor or even very poor quality. The most common flaws include tiny sample sizes, wrong statistical approach, lack of blinding, lack of control of placebo and other nonspecific effects. Reviews of such studies thus turn out to be a confirmation of the ‘rubbish in, rubbish out’ principle: any summary of flawed studies are likely to produce a flawed result.

Until I have good quality trials to convince me otherwise, EFT is in my view:

  1. implausible and
  2. not of proven effectiveness for any condition.

The AMERICAN INSTITUTE OF HOMEOPATHY (AIH) is the oldest national medical association in the United States. The AIH’s mission is “to promote the science and art of homeopathic medicine, to safeguard the interests of the homeopathic medical profession, to improve the standards of homeopathic medical education, to educate the medical and scientific communities about the scientific basis for homeopathic medicine, and to increase public knowledge and acceptance of homeopathy as a medical specialty.”

The AIH is about to hold its annual conference. This year’s theme is “Tackling Patients with Severe Pathology”. The announcement reads as follows:

Homeopathy has been found to be effective in the great majority of patients suffering from infectious and autoimmune diseases. The limits of homeopathic treatment are encountered in the treatment of patients with Parkinson’s disease, ALS and late-stage cancers. After finding a way to treat patients with Parkinson’s disease with homeopathy, Dr. Saine began to apply this approach to cancer patients in stages III and IV. In this seminar, he will review case analysis, posology and case management for this cohort of patients.

We are fortunate to have the opportunity to learn from Dr. Saine in this seminar. He is recognized as one of the foremost homeopathic teachers and clinicians in the world, with special expertise in extremely difficult cases of severe and advanced pathology.

Who, for heaven sake, is this foremost homeopathic teachers and clinicians in the world, Dr Saine?, I asked myself after reading this (and even more so after listening to the rather spectacular video provided with the announcement). Here is what I found out about him:

Dr. Saine is a 1982 graduate of the National College of Naturopathic Medicine in Portland, Oregon. He is board-certified in homeopathy (1988) by the Homeopathic Academy of Naturopathic Physicians and has been teaching and lecturing on homeopathy since 1985. He is considered one of the world’s foremost experts on the subject of homeopathy.

And this is what non-doctor* Saine writes about medicine etc.:

The Organon of Medicine is a blueprint on how to practice medicine rationally and wisely through an integration of all the fundamental principles of medicine into a comprehensive whole. Unfortunately, to the detriment of the sick, very few homeopaths have delved, as Hahnemann did, into the practice of lifestyle medicine and the use of complementary care to homeopathy.

With rare exceptions, patients will present with a portion of their disease that ensues from an unhealthy environment or ways of living. The role of the physician is to determine in the equation of disease what is primarily due to an untuned vital force versus a causa occasionalis, as both will have to be addressed in due time.

After reading and listening to all this I am mildly shocked.

It does not seem to me that the AIH is fit for purpose. Neither am I convinced that non-doctor Saine should be let near any patient, let alone one with cancer or another severe pathology.

There should be a law protecting patients from this sort of thing!

[*in the context of healthcare, a doctor is for me someone who has studied medicine]

If you thought that Chinese herbal medicine is just for oral use, you were wrong. This article explains it all in some detail: Injections of traditional Chinese herbal medicines are also referred to as TCM injections. This approach has evolved during the last 70 years as a treatment modality that, according to the authors, parallels injections of pharmaceutical products.

The researchers from China try to provide a descriptive analysis of various aspects of TCM injections. They used the the following data sources: (1) information retrieved from website of drug registration system of China, and (2) regulatory documents, annual reports and ADR Information Bulletins issued by drug regulatory authority.

As of December 31, 2017, 134 generic names for TCM injections from 224 manufacturers were approved for sale. Only 5 of the 134 TCM injections are documented in the present version of Ch.P (2015). Most TCM injections are documented in drug standards other than Ch.P. The formulation, ingredients and routes of administration of TCM injections are more complex than conventional chemical injections. Ten TCM injections are covered by national lists of essential medicine and 58 are covered by China’s basic insurance program of 2017. Adverse drug reactions (ADR) reports related to TCM injections account for  over 50% of all ADR reports related to TCMs, and the percentages have been rising annually.

The authors concluded that making traditional medicine injectable might be a promising way to develop traditional medicines. However, many practical challenges need to be overcome by further development before a brighter future for injectable traditional medicines can reasonably be expected.

I have to admit that TCM injections frighten the hell out of me. I feel that before we inject any type of substance into patients, we ought to know as a bare minimum:

  • for what conditions, if any, they have been proven to be efficacious,
  • what adverse effects each active ingredient can cause,
  • with what other drugs they might interact,
  • how reliable the quality control for these injections is.

I somehow doubt that these issues have been fully addressed in China. Therefore, I can only hope the Chinese manufacturers are not planning to export their dubious TCM injections.

By guest blogger Hans-Werner Bertelsen

Holistic ideas are booming, and they do not stop at dental medicine, where procedures and techniques that take an alleged ‘holistic’ approach are becoming more and more popular. Are these procedures and techniques effective, and do they offer a benefit over their conventional counterparts, or is it rather the providers of such procedures and techniques who benefit from a lack of knowledge and understanding in patients who seek out this so-called alternative dentistry? This paper will take a look at three topics—the concept of projections, material testing approaches, amalgam removal—that form the basis for many procedures and techniques in so-called alternative dentistry, to examine whether they offer a sound foundation for said procedures and techniques, or whether they are merely empty promises. Might they be nothing but marketing tricks?

The concept of projections suggests that conventional medicine does look closely enough at the human body, ignoring as of yet undiscovered energy lines and other mysterious linkages. Material testing approaches claim to detect harmful and allergenic components, the removal of which may be beneficial in case of systemic diseases, possibly even curing them. Beginning on July 1, 2018, the use of amalgam will be strongly restricted all throughout Europe. This easy-to-use material has received much attention for decades, as it contains a large proportion of mercury, which is known for its high neurotoxicity, and is, therefore, suspected of causing illness in the long term.

Normally, we think of projections as requiring a screen, onto which something then can be projected. Teeth, however, are also ideally suited as a dumping ground for the underlying causes of somatic and/or mental diseases, from where they can radiate out as so-called projections. Once these are identified as the true cause of disease, other potential causes such as age-related wear and tear, detrimental behaviors, or harmful eating habits can be readily ignored. This concept of projections may have particularly harmful and negative consequences in patients with tumors, as it may cause feelings of guilt, although in many cases no definite cause of tumor development can be discerned. Projected feelings of guilt, in turn, can be a negative influence on a person’s health.

The so-called “system of meridians” assigns relationship qualities to individual teeth, meaning that there are strict relationships of individual teeth to the body’s organs and individual entities. [1]

According to this system, an inflammation of the urinary bladder would be related to the number 1 teeth, the incisors. Rheumatism is linked to the number 8 teeth, the wisdom teeth. In between, there are the teeth of the ordinal numbers 2 to 7, distinguished by their locations on the left or right, in the upper or lower jaw, which offer a wealth of opportunities to assign a “guilty tooth” to clinically common physical complaints. However, this mysterious connection is postulated not only for teeth and major organs, but also for joints, vertebral levels, sensory organs, tonsils, and glands, with the relationships neatly organized in ten groups and subgroups. Multiplied by the number of teeth—eight per each of the four quadrants, 32 in total—these afford the “holistic dentist” 320 opportunities for projecting physical complaints ranging from asthma to zonulitis onto a tooth. Those who believe in this system of projections are not deterred by the fact that there is no scientific proof whatsoever for this odd thesis.

On the other hand, it is basic medical knowledge that pathogens may spread hematogenically and affect remote organs. Seeking adequate specialist counsel when dealing with rheumatic diseases, fevers of unclear etiology, or in conjunction with orthopedic joint surgeries, is, therefore, mandated by guidelines and an obvious standard in the practice of medicine. So-called alternative dentistry makes no particular mention of these general facts, but instead focuses on occult-seeming correlations in order to use a mysterious, almost conspiratorial idea of a disease to legitimize the often invasive treatment options it then recommends. Most patients will not realize that these interpretations often mistake synchronicity for causality. For example, most infections of the urinary bladder will resolve over time, regardless of whether any work was done on the upper incisors or not. However, if during the period of healing one of the incisors was treated by a dentist, it is easy enough to associate this treatment with the resolving bladder infection. From a psychological viewpoint, this constitutes a simple manipulation technique, applied to demonstrate the seemingly superior diagnostics of alternative dentistry: a simple, and easily recognized marketing strategy.

When asked what would happen to these doubtful projections in case of an autologous transplantation during which a tooth would move to another tooth’s original place in the jaw, three leading representatives of the so-called alternative dentistry answered in an evasive and even manipulative manner. [2]

There are reports of invasive therapies, conducted following dubious, often electromedical diagnostic procedures, that not only lead to high costs for the repair of the damage they caused, but also to a lasting mutilation of the patients’ jaws and dentitions. [3-6]

Another supposedly holistic school of thought that is similar to that of the system of meridians exists in some fields of dentistry regarding temporo-mandibular joint dysfunction (TMJD, TMD). These theories suggest that a disbalance in the interaction between jaw bones and masticatory muscles may be responsible for all kinds of diseases. [7]

According to the German self-appointed “TMJD Umbrella Organization” (CMD-Dachverband e. V.), TMJD is a “multifaceted disease.” The claim is that TMJD may not only cause back pain, vertigo, and tinnitus, but also sleep apnea, snoring, neck and shoulder pain, hip and knee pain, headaches, migraines, visual, mood swings, and even depression. However, there is no scientific evidence for any of these claims. [8,9]

Jens C. Türp of the University Center for Dental Medicine Basel’s Department of Oral Health & Medicine, Division Temporomandibular Disorders and Orofacial Pain, has called this standard diagnosis, offered by TMJD diagnosticians whenever a patient shows signs of nocturnal teeth grinding, “nonsense that makes your hair stand on end.”

“For a variety of general symptoms, it is claimed that they are caused by a TMJD: Tinnitus, ocular pressure, differences in the lengths of a person’s legs, back pain, hip pain, and knee pain, balance disorders, tingling in the fingers and many more. ‘A relationship [with TMJD] has never been proven for any of these symptoms’, says Türp. According to him, true TMJD causes problems with chewing and pain. Affected patients have difficulties opening their mouth wide or closing it fully. The “CMD-Arztsuche” (Find a TMJD Specialist) website recommends ‘a lasting correction of a person’s bite’ as treatment. This should be achieved with the help of ceramic inlays, dental crowns, and implants— all of which are expensive and unnecessary measures, in the opinion of Jens Türp. He treats his TMJD patients–almost always successfully, as he says–with occlusal splints, physiotherapy, and relaxation exercises.” (Translated from German [10])

In general, any patient should be advised, therefore, to seek a second opinion whenever confronted with a diagnosis requiring invasive treatments.

References:

1. Madsen, H. Studie zur Kieferorthopädie in der Alternativmedizin: Darstellung der Grundlagen und kritische Bewertung. Doctoral dissertation, Poliklinik für Kieferorthopädie der Universität Würzburg. Würzburg 1994

2. Schulte von Drach, M.C. Wenn Zähne fremdgehen. Süddeutsche Zeitung May 15, 2012.

3. Staehle, H.J. Der Patientin wurde das Gebiss verstümmelt. Zahnärztliche Mitteilungen 2000.

4. Dowideit, A. Wenn nach der “Störfeld-Messung” alle Backenzähne fehlen. Welt June 3, 2017.

5. Bertelsen, H.-W. Die Attraktvität “ganzheitlicher” Zahnmedizin – Teil 1: Bohren ohne Reue. skeptiker 2012, 4.

6. Bertelsen, H.-W. Die Attraktivität “ganzheitlicher” Zahnmedizin – Teil 2: Bohren ohne Reue. skeptiker 2013, 4.

7. CMD Dachverband e. V. Craniomandibuläre Dysfunktion – Ursachen & Symptome. http://www.cmd-dachverband.de/fuer-patienten/ursachen-symptome/ (May 11, 2018),

8. Wolf, T. Die richtige Hilfe bei Kieferbeschwerden. Spiegel Online July 7, 2014, 2014.

9. Türp, J.C.; Schindler, H.-J.; Antes, G. Temporomandibular disorders: Evaluation of the usefulness of a self-test questionnaire. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen 2013, 107, 285-290.

10. Albrecht, B. Teure Tricks der Zahnärzte – so schützen Sie sich vor Überbehandlung. stern February 18, 2016.

 

A few days ago, I published an article in the ‘Sueddeutsche Zeitung’ (a truly rare event, as I have never done this before) where I argued that German pharmacists should consider stopping the sale of homeopathic remedies. It violates their ethical code, I suggested.

While this discussion has been going on for a while in the UK (British pharmacists have stopped inviting me to their gatherings because I get on their nerves with banging on about this!), it is relatively novel in Germany.

After I had submitted my copy to the SZ, an article was published which is highly relevant to this subject. Here I first copy an extract of the German original, and below I try to briefly explain its content to those who do not read German.

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In vielen Apotheken werden Kunden nicht hinreichend gut zu Homöopathika beraten. Zu diesem Ergebnis kommt Professor Tilmann Betsch, an der Universität Erfurt Leiter der Professur für Sozial-, Organisations- und Wirtschaftspsychologie, der mit seinem Team 100 zufällig ausgewählte Apotheken in Stuttgart, Erfurt, Leipzig und Frankfurt auf Herz und Nieren geprüft hat. Im Mittelpunkt der Kundengespräche stand eine Beratung zu einem erkälteten Familienmitglied.

“Zum einen zeigen unsere Ergebnisse, dass im Falle eines grippalen Infektes die überwiegende Mehrzahl von ihnen zu schulmedizinischen Präparaten rät, die mit hoher Wahrscheinlichkeit zu einer Linderung der Symptome führen”, erläutert Betsch. Was die Wirkung von Homöopathika betreffe, so zeichne das Untersuchungsergebnis ein eher düsteres Bild, ergänzt er. Denn in nur fünf Prozent aller Beratungsgespräche sei gesagt worden, dass es für die Wirkung von Homöopathie keine wissenschaftlichen Belege gäbe. In 30 Prozent sei dagegen behauptet worden, die Wirkung von Homöopathie sei entweder in Studien nachgewiesen oder ergebe sich aus dem Erfahrungswissen.

“Nach den Leitlinien der Bundesapothekenkammer soll jedoch die Beurteilung der Wirksamkeit von Präparaten nach pharmakologisch-toxikologischen Kriterien erfolgen. Zumindest was die Begründung ihrer Empfehlungen betrifft, folgte die überwiegende Mehrheit der von uns befragten Apotheker diesen Leitlinien nicht”, so Betschs Fazit. Während die Empfehlungen der Apotheker in der Regel nachweislich wirksame Medikamente enthalten hätten, habe sich ihr Wissen über die Wirkung von Homöopathie mehrheitlich nicht von Laien-Meinungen unterschieden.

____________________________________________________________________________________

Professor Tilmann Betsch has conducted a study showing that German pharmacists fail their customers when advising them on homeopathy. His team went under cover as patients with flue-like symptoms to 100 randomly selected pharmacists. Only 5% of the pharmacists admitted that homeopathics have no proven efficacy, while 30% claimed homeopathics have been proven to work in studies and through experience. This behaviour, Betsch explains, violates the current guidelines for pharmacists.

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I am delighted with these findings; they confirm my arguments perfectly.

Since, in Germany, homeopathics are sold only in pharmacies, German pharmacists have a pivotal role here. They are ethically bound to inform their customers based on the current best evidence. So, in my day-dreams, I imagine a dialogue between a customer and an ethical pharmacist:

CUSTOMER: I have a flu, is there a homeopathic remedy against it?

PHARMACIST: Yes, there is.

CUSTOMER: Can I have it please?

PHARMACIST: If you insist; but I must warn you: it has been shown not to work, and there is absolutely nothing in it that could possibly work.

CUSTOMER: What? Why do you sell it then?

PHARMACIST: Because some people like it.

CUSTOMER: Even though it does not work?

PHARMACIST: Yes.

CUSTOMER: Is it expensive?

PHARMACIST: Yes.

CUSTOMER: And some people still buy it?

PHARMACIST: Yes.

CUSTOMER: Well, not I! I am not a fool. But thank you for your honest information. Can I have something else that alleviates my symptoms?

PHARMACIST: With pleasure!

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The fate of homeopathy in Germany is largely in the hands of pharmacists, it seems.

But, is it in good, ethical hands? Is there hope that progress can be made?

We will see – so far, I have heard of just one!!! pharmacy that has stopped displaying homeopathics on its shelves.

Doctor Jens Wurster is no stranger to this blog; previously I discussed his claim that he has treated more than 1000 cancer patients homeopathically and we could even cure or considerably ameliorate the quality of life for several years in some, advanced and metastasizing cases. So far, his claims were based not on evidence published in peer-reviewed journals (I cannot find a single Medline-listed paper by this man); but now Wurster has published an article in a German Journal (Wurster J. Zusatznutzen der Homöopathie … Deutsche Zeitschrift für Onkologie 2018; 50: 85–91; not Medline-listed, I am afraid). The paper is in German, but it has an English abstract; here it is:

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All over the world, oncology patients receive homeopathic treatment concomitant to conventional treatments, such as chemotherapy and radiation treatment, in order to reduce the side effects of these therapies. It has been shown that cancer patients, who are receiving homeopathic treatment in addition to conventional therapies, have a higher quality of life and a longer survival rate. Studies in cancer cell research have shown the direct effects of highly potentized homeopathic medicines on tumor cell lines. Tumor inhibiting properties of homeopathic medicines have been proven in vivo as well as in vitro. Research projects into complementary medicine (CAMbrella) and research into personalized immunotherapies as well as additive homeopathy open the door to the future of integrative oncology.

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In the article, Wurster states that he has 20 years of experience in treating cancer with homeopathy as an add-on to conventional care, and that he can confirm homeopathy’s effectiveness. He claims that ‘very many’ patients have thus benefitted by experiencing less side-effects of conventional treatments. And he offers two case-reports to illustrate this.

[Nach 20 Jahren klinischer Erfahrung in der Clinica St. Croce im Tessin mit der Behandlung onkologischer Patienten mithilfe der Homöopathie können wir deutlich den Zusatznutzen der Homöopathie in der Onkologie bestätigen [1]. So gelang es unserem Ärzteteam in den zurückliegenden Jahren bei sehr vielen Patienten, durch gezielten Einsatz homöopathischer Mittel die Nebenwirkungen von Chemotherapien oder Bestrahlungen erfolgreich zu reduzieren [1]. Wie dabei Schulmedizin und Homöopathie in der Praxis zusammenwirken, zeigt folgendes Beispiel. ([1] Wurster J. Die homöopathische Behandlung und Heilung von Krebs und metastasierten Tumoren. Norderstedt: Books on Demand; 2015)]

The two case-reports lack detail and are less than convincing, in my view. Both patients have had conventional therapies and Wurster claims that his homeopathic remedies reduced their side-effects. There is no way of verifying this claim, and the improvements might have occurred also without homeopathy.

In the discussion section of his paper, Wurster then elaborates that oncologists throughout Europe are now realising the potential of homeopathy. In support he mentions paediatric oncologists in Klagenfurt who managed to spare pain-killers by giving homeopathics. Similarly, at the Inselspital in Bern, they are offering homeopathic consultations to complement conventional treatments.

[Inzwischen haben auch einige Onkologen erkannt, wie eine gezielt eingesetzte homöopathische Behandlung die Nebenwirkungen von Chemotherapien oder Bestrahlungen reduzieren kann. Wir arbeiten inzwischen mit einigen Onkologen aus ganz Europa zusammen, die den Zusatznutzen der Homöopathie in der Onkologie erlebt haben. In der Kinderonkologie in Klagenfurt beispielsweise konnten mithilfe der Homöopathie Schmerzmittel bei den Kindern eingespart werden. Auch am Inselspital Bern werden zusätzliche homöopathische Konsile in der Kinderonkologie angeboten, um die konventionelle Behandlung begleiten zu können [8].]

At this point, Wurster inserts his reference number 8. As several of his references are either books or websites, this reference to an article in a top journal seems interesting. Here is its abstract:

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BACKGROUND:

Though complementary and alternative medicine (CAM) are frequently used by children and adolescents with cancer, there is little information on how and why they use it. This study examined prevalence and methods of CAM, the therapists who applied it, reasons for and against using CAM and its perceived effectiveness. Parent-perceived communication was also evaluated. Parents were asked if medical staff provided information on CAM to patients, if parents reported use of CAM to physicians, and what attitude they thought physicians had toward CAM.

STUDY DESIGN:

All childhood cancer patients treated at the University Children‘s Hospital Bern between 2002-2011 were retrospectively surveyed about their use of CAM.

RESULTS:

Data was collected from 133 patients (response rate: 52%). Of those, 53% had used CAM (mostly classical homeopathy) and 25% of patients received information about CAM from medical staff. Those diagnosed more recently were more likely to be informed about CAM options. The most frequent reason for choosing CAM was that parents thought it would improve the patient’s general condition. The most frequent reason for not using CAM was lack of information. Of those who used CAM, 87% perceived positive effects.

CONCLUSIONS:

Since many pediatric oncology patients use CAM, patients’ needs should be addressed by open communication between families, treating oncologists and CAM therapists, which will allow parents to make informed and safe choices about using CAM.

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Any hope that this paper might back up the statements made by Wurster is thus disappointed.

Altogether, this Wurster-paper contains no reliable evidence. The only clinical trial it seems to rely on is the one by Prof Frass which we have discussed previously here and here. The Frass-study is odd in several ways and, before we can take its results seriously, we need to see an independent replication of its findings. In this context, it is noteworthy that my own 2006 systematic review concluded that there is insufficient evidence to support clinical efficacy of homeopathic therapy in cancer care. In view of all this, I feel that the new Wurster-paper provides no reliable evidence and no reason to change my now somewhat dated conclusion of 2006. Moreover, I would insist that those who claim otherwise are unethical and behave irresponsible.

And finally, I need to reiterate what I stated in my previous post: the Wurster-paper indicates that something is amiss with medical publishing. How can it be that, in 2018, the ‘Deutsche Zeitschrift für Onkologie’ (or any other medical journal for that matter) can be so bar of critical thinking to publish such dangerously misleading nonsense? The editors of this journal (Univ.-Prof. Dr. med. Arndt Büssing, Witten/Herdecke; Dr. med. Peter Holzhauer, Bad Trissl und München) and its editorial board members (L. Auerbach, Wien; C. Bahne Bahnson, Kiel; J. Büntzel, Nordhausen; B. Freimüller-Kreutzer, Heidelberg; H.R. Maurer, Berlin; A. Mayr, Starnberg; R. Moss, New York; T. Ostermann, Witten/Herdecke; K. Prasad, Denver; G. Pulverer, Köln; H. Renner, Nürnberg; C.P. Siegers, Lübeck; W. Schmidt, Greifswald; G. Uhlenbruck, Köln; B. Wolf, München; K.S. Zänker, Witten/Herdecke) should ask themselves whether they are taking their moral obligations seriously enough, or whether their behaviour is not a violation of their most fundamental ethical duties.

In our book ‘MORE HARM THAN GOOD‘ we allude to such problems as follows: …Spurious results are frequently paraded by CAM advocates in support of implausible treatments… the more poorly conceived and executed a research project is, the more likely it is to produce false-positive results. These results then may lead to repetitive cycles of unproductive work to explain what was found—often to simply disprove the erroneous results. This is an unfortunate feature of various fields of scientific research, but it has particularly serious implications in medical research. Moreover, researchers who practice and behave as advocates of CAM may unintentionally or deliberately distort or exaggerate weak findings. Invalid CAM research claims tend not to be put to rest; instead they are repeatedly recycled…

And:

The CAM practitioner who promotes untruths has either failed to enlighten themselves as to the facts—this being a central requirement of professional ethics— or has chosen to deliberately deceive patients. Either of these reasons for promulgating falsehoods amounts to a serious breach in terms of virtue ethics. According to almost all forms of ethical theory, the truth-violating nature of CAM renders it immoral in both theory and practice.

The damage that can result from such violations of medical ethics is not merely a matter for the ‘ivory towers of academia’, it can virtually be a matter of life and death.

Please bear with me and have a look at the three short statements quoted below:

1 Reiki

… a Reiki practitioner channels this pure ‘chi’, the ‘ki’ in Reiki, or energy through her hands to the recipient, enhancing and stimulating the individual’s natural ability to restore a sense of wellbeing. It is instrumental in lowering stress levels, and therefore may equip the recipient with increased resources to deal with the physical as well as the emotional, mental and spiritual problems raised by his/her condition. It is completely natural and safe, and can be used alongside conventional medicine as well as other complementary therapies or self-help techniques.

It has been documented that patients receiving chemotherapy have commented on feeling less distress and discomfort when Reiki is part of their care plan. Besides feeling more energy, hope and tranquillity, some patients have felt that the side-effects of chemotherapy were easier to cope with. Reiki has been shown to reduce anxiety and depression, to raise energy levels in tired and apathetic patients. It is of great value in degenerative disease for the very reasons that pain and anxiety can be reduced.

The treatment is gentle, supportive and non-invasive, the patient always remains clothed. Even though the origins of reiki are spiritual in nature, Reiki imposes no set of beliefs. It can be used by people of different cultural backgrounds and faith, or none at all. This makes it particularly suitable in medical settings. Predicting who would or would not like to receive Reiki is impossible.

2 Emmett

EMMETT is a gentle soft tissue release technique developed by Australian remedial therapist Ross Emmett. It involves the therapist using light finger pressure at specific locations on the body to elicit a relaxation response within the area of concern.

Cancer impacts people in different ways throughout the journey of diagnosis, treatment and recovery. Many have found the EMMETT Technique to be very beneficial in a number of ways. Although pressure therapy isn’t new (e.g. acupressure and trigger point therapy are already well known), the amount of pressure required with EMMETT is much lighter and the placement of the pressure is unique to EMMETT Therapy.

Many cancer patients undergo surgery and experience post-surgery tightness and tension around the surgery site in the scar tissue and further afield through the connective tissue or fascia as the body heals. They experience restricted range of movement that may be painful too. Mastectomy patients as an example will usually experience pain or tenderness, swelling around the surgery site, limited arm or shoulder movement, and even numbness in the chest or upper arm. Here’s where EMMETT can assist.  With gentle pressure to specific points, many women have received relief from the pain, reduced swelling and much improved range of movement.  There are multiple EMMETT points that are used to help these women and that give the therapist a range of options depending on the patient’s specific concern.

Many cancer patients also experience fatigue, increased risk of infection, nausea, appetite changes and constipation as common side effects of chemotherapy.  These symptoms can also be greatly supported with a designated sequence where the EMMETT Therapist gently stimulates areas all around the body for an overall effect.  Patients report reduction in swelling, feelings of lightness, increased energy, more robust emotional well-being, less pain and feeling better generally within themselves.

3 Daoyin Tao

The theory behind this massage lies in traditional Chinese medicine, so covers yin and yang, five elements and Chinese face reading from a health perspective.  It enables the emotional elements behind disease to be explored. For example, the Chinese will say that grief is held in the Lung, anger in the liver, and fear in the kidney.

For this half hour massage there is no need for the patient to remove clothes, so it is a lovely way of receiving a massage where body image may be an issue, or where lines and feeds are in place, making removal of clothes difficult. This massage therapy can be given not only in a clinic, but also on the day unit, on hospital wards and even in an intensive care unit.

In working the meridian system the therapist is able to work the whole body, reaching areas other than the contact zone. Patients have commented that this deeply relaxing and soothing massage is; “one of the best massages I have ever had”. It has been proven to be beneficial with problems of; sleep, headaches, anxiety, watery eyes, shoulder and neck tension, sinusitis and panic attacks, jaw tension, fear, emotional trauma/distress.

END OF QUOTES

__________________________________________________________________________

Where do you think these statements come from?

They sound as though they come from a profoundly uncritical source, such as a commercial organisation trying to persuade customers to use some dodgy treatments, don’t they?

Wrong!

They come from the NHS! To be precise, they come from the NHS NATURAL HEALTH SCHOOL in Harrowgate, a service that offers a range of free complementary therapy treatments to patients and their relatives who are affected by a cancer diagnosis and are either receiving their cancer treatment at Harrogate or live in the Harrogate and Rural District.

This NHS school offers alternative treatments to cancer patients and claim that they know from experience, that when Complementary Therapies are integrated into patient care we are able to deliver safe, high quality care which fulfils the needs of even the most complex of patients.

In addition, they also run courses for alternative practitioners. Their reflexology course, for instance, covers all of the following:

  • Explore the history and origins of Reflexology
  • Explore the use of various mediums used in treatment including waxes, balms, powders and oils
  • Explore the philosophy of holism and its role within western bio medicine
  • Reading the feet/hands and mapping the reflex points
  • Relevant anatomy, physiology and pathology
  • Managing a wide range of conditions
  • Legal implications
  • Cautions and contraindications
  • Assessment and client care
  • Practical reflexology skills and routines
  • Treatment planning

I imagine that the initiators of the school are full of the very best, altruistic intentions. I therefore have considerable difficulties in criticising them. Yet, I do strongly feel that the NHS should be based on good evidence; and that much of the school’s offerings seems to be the exact opposite. In fact, the NHS-label is being abused for giving undeserved credibility to outright quackery, in my view.

I am sure the people behind this initiative only want to help desperate patients. I also suspect that most patients are very appreciative of their service. But let me put it bluntly: we do not need to make patients believe in mystical life forces, meridians and magical energies; if nothing else, this undermines rational thought (and we could do with a bit more of that at present). There are plenty of evidence-based approaches which, when applied with compassion and empathy, will improve the well-being of these patients without all the nonsense and quackery in which the NHS NATURAL HEALTH SCHOOL seems to specialise.

It is bad enough, I believe, that such nonsense is currently popular and increasingly politically correct, but let’s keep/make the NHS evidence-based, please!

I stumbled over an article entitled ‘The myths of homeopathy: Resounding answers‘. I thought it was great fun, so much so, that I copied it below – not just once but twice. The second time I took the liberty of replacing the little porkies told by homeopaths with the truth.

THE ORIGINAL

Homeopathic medicines are not placebos! Little “pellets” of sugar cannot have an effect!

Of course, the sugar in homeopathic pellets doesn’t have any effect. This is why we also have tablets and drops that contain homeopathic active substances.

The sugar is simply a medium for these active substances. The important element is what has been added to the sugar – the active ingredient!

As homeopathic remedies have very slow action, they cannot be used to treat acute illnesses!

This is incorrect. You can successfully use homeopathy in acute circumstances such as infections, fevers and colds.

Homeopathy seems to be a kind of magic!

Homeopathy is not magic! Homeopathy is a field of medicine that has the capacity to heal, but if course, it has its limits, just like any other medicine, including conventional medicine.

To give you a clear example – it’s unlikely that homeopathy will replace a surgical intervention.

During homeopathic treatment you have to follow a strict diet!

Well, it’s not such a bad thing…but of course, you need to eat healthily and avoid smoking, drinking alcohol and coffee.

In some cases you can’t eat onion or garlic as they contain sulphur, which is a homeopathic remedy in itself. All of these things have little to do with a strict diet.

Diabetes sufferers can’t use homeopathic remedies!

This is not true. The amount of sugar in the pellets is negligible. These homeopathic pellets could even be taken on a daily basis. The foods we eat contain much more sugar, even those that are especially for diabetics.

MY CORRECTED VERSION

Homeopathic medicines are not placebos! Little “pellets” of sugar cannot have an effect!

Of course, the sugar in homeopathic pellets doesn’t have any effect. And the drops added also contain no active substances.

In other words, there is no active ingredient!

As homeopathic remedies have very slow action, they cannot be used to treat acute illnesses!

This is correct. You cannot successfully use homeopathy in acute circumstances such as infections, fevers and colds. In fact, you cannot use it to cure any condition, chronic or acute.

Homeopathy seems to be a kind of magic!

Homeopathy is not magic! It relies on the placebo and other non-specific effects, and that is no magic.

During homeopathic treatment you have to follow a strict diet!

Hahnemann gave very clear instructions to avoid a whole range of things while taking homeopathic remedies – otherwise, they don’t work, he claimed. This is as wrong as everything else Hahnemann said about homeopathy: these remedies don’t work whatever you do.

Diabetes sufferers can’t use homeopathic remedies!

This is not true. The amount of sugar in the pellets is negligible. These homeopathic pellets could even be taken on a daily basis. The foods we eat contain much more sugar, even those that are especially for diabetics. But that does, of course, not mean that diabetics ought to take homeopathic remedies. There is no reason why they should; these remedies are pure placebos.

__________________________________________________________________________

Few people reading these lines will be surprised that the ‘resounding answers’ turn out to be resounding lies. And what I above called ‘great fun’, turns out to be a serious deception.

The fascinating thing here is, I think, the way homeopaths try to mislead the public: one seemingly innocent untruth about the ‘active substance’ is used as the basis for an entire house of cards. It tumbles at the slightest attempt to provide the facts. Sadly, many consumers do not know the facts and are therefore prone to fall victim of these resounding lies.

There is perhaps not a law against such lies, but there certainly are moral and ethical principles that must not be violated:

TELLING LIES OF THIS NATURE IS UNETHICAL AND ENDANGERS THE HEALTH OF THOSE WHO DO NOT KNOW THE FACTS.

Homeopaths are not generally known for the reliability of their recommendations. This advice by the UK Society of Homeopaths (SoH) was emailed to me a few days ago (how on earth did they know I was on holiday?). It is just too weird and wonderful – I cannot resist the temptation of showing it to you:

START OF QUOTE

Off on holiday? Whether you’re going abroad or ‘staycationing’, keep these remedies handy to tackle a range of minor ailments. We suggest 30c potencies for all remedies, using every 30- 90 minutes, two or three times depending on the severity of the condition. Always seek medical help for anything more than a minor injury or illness.

Aconite Great for shock, such as from fright, bad news or after having a fall. Also good for the onset of fever after exposure to acute cold, wind or heat.

Apis For bee or wasp stings and any allergic reaction which causes rapid swelling, redness and pain and where the affected area is puffy, white or rosy, feels hot and is better for cold compresses.

Arnica The classic remedy for trauma, injury and bruising. The typical arnica patient will tell you that they are fine but may well be confused or in shock. Also useful for fractures, strains after exertion such as lifting heavy objects and the early stages of a black eye and for jetlag.

Arsenicum This is a great remedy for food poisoning, especially from meat. The person will be very anxious and not easily pacified. The pains are often burning. Vomiting and diarrhoea accompanied by chills, exhaustion, and restless.

Belladonna Great for heatstroke or exhaustion, along with appropriate cooling and rehydration therapy, and for acute fevers or inflammations, which come on suddenly and lead to throbbing pain, redness and swelling. The skin is hot and red and the face flushed but, at the same time, the person can feel chilly and want to be covered.

Ledum This is the first remedy to think of with puncture wounds and for bites and stings which fester. Good for twisted or sprained joints, especially ankles.

Nux Vomica The main remedy for hangover or indigestion from over-eating but also useful for food poisoning in which there is constant retching.

Urtica urens Very useful for skin conditions such as urticaria with raised lumps like nettle rash and great for ‘prickly heat. Urtica can be used for minor burns and scalds as well where pains are stinging, like nettle rash, but not too sore to touch.

END OF QUOTE

I find the list and particularly the comments most revealing. To me, they suggest that homeopathy just do not have a cue. They recommend nonsense for conditions they know nothing about. They do not seem to know what real shock or food poisoning or heat stroke are. They do not seem to appreciate that they can be life-threatening problems. And by stating “Always seek medical help for anything more than a minor injury or illness”, they clearly admit that they are merely jokers of no significance whatsoever.

For what it’s worth, I here give my evidence-based view on the remedies listed:

Aconite No evidence to justify the claims mentioned above.

Apis No evidence to justify the claims mentioned above.

Arnica Some evidence to show that Arnica does not work.

Arsenicum No evidence to justify the claims mentioned above.

Belladonna No evidence to justify the claims mentioned above.

Ledum No evidence to justify the claims mentioned above.

Nux Vomica No evidence to justify the claims mentioned above.

Urtica urens No evidence to justify the claims mentioned above.

Oh, I almost forgot: the SoH is the organisation of ‘professional’ homeopaths in the UK (professional meaning they have no medical training). On their website, they state: “High standards are the cornerstone of the Society of Homeopaths. So we were delighted that our register was accredited by the Professional Standards Authority for Health and Social Care (PSA)  in 2014… This accreditation demonstrates our commitment to high professional standards, to enhancing safety and delivering a better service.”

One does wonder whether killing gullible holidaymakers via bad advice counts as high standards.

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