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

quackery

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“Working well for him…” That was the response to my tweet yesterday about cupping for Olympic swimmers. I had tweeted this picture showing one swimmer’s cupping marks (similar signs currently are currently being displayed by several competitors in Tokyo).

I had added to the tweet my post from 2018 which failed to show that cupping is an effective means of improving athletic performance.

The response ‘WORKING WELL FOR HIM..’ irritated me (not that it has the slightest importance) and made me think how prone we all are to find causal relationships where there are, in fact, none (which might have more importance). I feel that we must, as intelligent humans, do more to fight this reflex.

In 2008, just before Simon Singh and I published ‘TRICK OT TREATMENT?‘, I broke my left shoulder. It was stupid, painful, unpleasant, and most annoying. Yet, it coincided with a very nice publishing success: our book received plenty of praise and was translated into about 20 languages.

So, should we recommend to all authors who are about to publish a book that they break their left shoulder? I think we can probably agree that this would be absurd.

But why do many people who see the cupping-marked Olympic athletes think that cupping is WORKING WELL FOR THEM? I know, it is tempting to think that they know best, and they must have tested it, etc. But why not rather consult the evidence? Why not rather question the plausibility of cupping as a means to improve performance? Why not rather consider that athletes do all sorts of weird, irrational things that make them feel a little more secure?

Frankly, the evidence that breaking your arm makes you publish a decent book is just as sound as the evidence that cupping improves the speed of swimmers. My advice, therefore, is to resist quick thinking where slow thinking including asking probing questions and consulting the evidence is indicated.

 

 

Ever wondered what homeopathy truly is?

Who better to ask than Boiron?

On their website, Boiron (the largest manufacturer of homeopthics) explains:

Homeopathy is a therapeutic method that uses natural substances to relieve symptoms. It derives from the Greek words homeo, meaning “similar,” and pathos, meaning “suffering” (such as the pathology of a disease). Homeopathy operates on a “like cures like” principle that has been used empirically for more than 200 years and continues to be confirmed in pharmacological research and clinical studies.

What this means is a person suffering from symptoms can be treated by microdoses of a substance capable of producing similar symptoms in a healthy person. It is said that homeopathic medicines stimulate the body’s physiological reactions that restore health. This is accomplished with a very low risk of side effects due to the use of microdoses.

Homeopathy in Action

An example of how homeopathic medicines work is the similarity of symptoms between allergies and chopping onions. When you cut into an onion, your eyes will water and your nose runs. If similar symptoms appear after contact with pollen or a pet, the homeopathic medicine most appropriate to treat these symptoms is made from a tiny amount of onion. Instead of masking symptoms, the medicine sends the body a signal to help it rebalance and heal.

The Benefits of Homeopathy and You

A natural choice. The active ingredients in homeopathic medicines are made from diluted extracts of plants, animals, minerals, or other raw substances found in nature.

For everyday use. Similar to other over-the-counter (OTC) medicines, homeopathic medicines can be used to relieve symptoms of a wide range of common health conditions such as allergies, coughs, colds, flu, stress, arthritis pain, muscle pain, and teething.

Safe and reliable. Homeopathy has been used for more than 200 years, building a remarkable safety record and generating a great body of knowledge. Homeopathic medicines do not mask symptoms, are not contraindicated with pre-existing conditions, and are not known to interact with other medications or supplements, making them one of the safest choices for self-treatment.

Rigorous standards. Homeopathic medicines are manufactured according to the highest standards, complying with U.S. Food and Drug Administration regulations and the Homeopathic Pharmacopoeia of the United States (HPUS).

More choices and preferences. Homeopathic medicines are available in a variety of dosage forms such as gels, ointments, creams, syrups, eye drops, tablets, and suppositories.

_________________________

Are you pleased with this explanation?

No?

One must not be too harsh with Boiron and forgive them their errors; a powerful conflict of interest might have clouded their views. Therefore, I shall now take the liberty to edit and update their text ever so slightly.

Homeopathy is an obsolete method that used all sorts of substances in the misguided hope to relieve symptoms. The word derives from the Greek words homeo, meaning “similar,” and pathos, meaning “suffering” (such as the pathology of a disease). Homeopathy was alleged to operate on a “like cures like” principle that had been used empirically for more than 200 years but was refuted by pharmacological research, clinical studies and more.

What it suggested was that a person suffering from symptoms might be treated by the absence of a substance capable of producing similar symptoms in a healthy person. It was said that homeopathic medicines stimulate the body’s physiological reactions that restore health. These assumptions proved to be erroneous.

Homeopathy in Action

An example of how homeopathic medicines were supposed to work is the similarity of symptoms between allergies and chopping onions. When you cut into an onion, your eyes will water and your nose runs. If similar symptoms appear after contact with pollen or a pet, the homeopathic medicine most appropriate to treat these symptoms was assumed to be made with the memory of an onion. These ideas were never proven and had no basis in science.

The Alleged Benefits of Homeopathy

A natural choice. The active ingredients in homeopathic medicines were often made from diluted extracts of plants, animals, minerals, or other raw substances found in nature. The appeal to nature is, however, misleading: firstly the typical remedy did not contain anything; secondly, some remedies were made from synthetic substances (e. g. Berlin wall) or no substances (e. g. X-ray).

For everyday use. Similar to other over-the-counter (OTC) medicines, homeopathic medicines were promoted to relieve symptoms of a wide range of common health conditions such as allergies, coughs, colds, flu, stress, arthritis pain, muscle pain, and teething. These claims could never be verified and are therefore bogus.

Safe and reliable. Homeopathy had been used for more than 200 years. During all these years, no reliable safety record or body of knowledge had been forthcoming. Homeopathic medicines do not mask symptoms, are not contraindicated with pre-existing conditions, and are not known to interact with other medications or supplements. In fact, they have no effects whatsoever beyond placebo.

Rigorous standards. Homeopathic medicines were said to be manufactured according to the highest standards, complying with U.S. Food and Drug Administration regulations and the Homeopathic Pharmacopoeia of the United States (HPUS). This guaranteed that they were devoid of any active ingredient and made them pure placebos.

More choices and preferences. Homeopathic medicines were available in a variety of dosage forms such as gels, ointments, creams, syrups, eye drops, tablets, and suppositories. This means they offered a range of placebos to chose from.

In case, Boiron feels like adopting my updated, evidence-based version of their text, I am sure we can come to an agreement based on an adequate fee.

These days, I live in France (some of my time) and I am often baffled by the number of osteopaths and the high level of acceptance of osteopathy in this country. The public seems to believe everything osteopaths claim and even most doctors have long given up to object to the idiocies they proclaim.

The website of the Institute of Osteopathy in Renne is but one of many examples. The Institute informed us as follows (my translation):

In addition to back pain, the osteopath can act on functional disorders of the digestive, neurological, cardiovascular systems or conditions related to ear, nose and throat. Osteopaths can promote recovery in athletes, relieve migraines, musculoskeletal disorders such as tendonitis, or treat sleep disorders. Less known for its preventive aspect, osteopathy also helps maintain good health. It can be effective even when everything is going well because it will prevent the appearance of pain. Osteopathy is, in fact, a manual medicine that allows the rebalancing of the major systems of the body, whatever the age of the patient and his problems. The osteopath looks for the root cause of your complaint in order to develop a curative and preventive treatment.

Who are osteopathic consultations for?

Osteopathic consultations at the Institute of Osteopathy of Rennes-Bretagne are intended for the following types of patients and pathologies

BABY / CHILD

GERD (gastric reflux), plagiocephaly (cranial deformities), recurrent ENT disorders (sinusitis, ear infections…), digestive, sleep and behavioural disorders, motor delay, following a difficult birth…

ADULT

Prevention, comfort treatment of osteoarthritis, musculoskeletal pain, functional abdominal pain, digestive disorders, headaches, dizziness, postural deficiency, facial pains…

PREGNANT WOMAN

Musculoskeletal pain (lumbago, back pain), digestive disorders, preparation for childbirth, post-partum check-up.

COMPANY

Prevention and treatment of MSDs (musculoskeletal disorders) linked to workstation ergonomics, stress, pain due to repetitive movements, poor posture at work, etc.

ADOLESCENT

Scoliosis, prevention of certain pathologies linked to growth, fatigue, stress, follow-up of orthodontic treatment.

SPORTSMAN

Musculoskeletal pain, tendonitis, osteopathic preparation for competition, osteopathic assessment according to the sport practised, repetitive injury.

In case you are not familiar with the evidence for osteopathy, let me tell you that as good as none of the many claims made in the above text is supported by anything that even resembles sound evidence.

So, how can we explain that, in France, osteopathy is allowed to thrive in a virtually evidence-free space?

In France, osteopathy started developing in the 1950s. In 2002, osteopathy received legislative recognition in France, and today, it is booming; between 2016 and 2018, 3589 osteopaths were trained in France. Osteopaths can be DO doctors, DO physiotherapists, DO nurses, DO midwives, DO chiropodists, or even DO dentists.

Thus, in 2018, and out of a total of 29,612 professionals practising osteopathy, there were 17,897 osteopaths DO and 11,715 DO health professionals. The number of professionals using the title of osteopath has roughly tripled in 8 years (11608 in 2010 for 29612 in 2018). There are currently around 30 osteopathic schools in France. About 3 out of 5 French people now consult osteopaths.

But this does not answer my question why, in France, osteopathy is allowed to thrive in a virtually evidence-free space! To be honest, I do not know its answer.

Perhaps someone else does?

If so, please enlighten me.

 

 

The UK Society of Homeopaths (the organization of the UK non-medically trained homeopaths) has featured on this blog many times, e.g.:

Now, the Society has released the following statement:

The Society of Homeopaths (the Society) has taken part in the Accredited Registers Programme run by the Professional Standards Authority (the Authority) since 2014. This accreditation has provided additional assurance to our members and their patients of the professional standards that we have promoted and maintained for over 40 years.

Public protection, patient safety and patient choice are paramount and built into all the Society’s processes and governance. Accountability is ensured through a balance of representation by practitioners and independent members on the Board as well as on the Society’s professional standards and education committees.

Since July 2020 the Society and its members have put tremendous effort into addressing the concerns of the Authority and following the suspension of our accreditation in January 2021, we said we would take time to consider both the Authority’s report and our own position. This has since been superseded by the Authority’s review of its own accreditation scheme and fee structure in the light of the proposed withdrawal of its government funding.

After a number of consultations with the Authority, it has become clear to the Society that the new fee structure for the Accredited Registers Programme disadvantages smaller organisations in favour of larger bodies, and the fee increase proposed by the Authority to the Society, aside from lacking clarity for the future, effectively prices us out of the scheme. Further changes to the Authority’s standards and criteria are also still to be confirmed. The Board has therefore made the decision to withdraw from the Authority’s voluntary accreditation scheme.

We will continue to strengthen our 43-year tradition of being the most highly valued and professional organisation for homeopaths in the UK. The Society’s mission remains to ensure that patients receive the highest standards of care from our trusted members.

 

I wonder from which organization the Society of Homeopaths might now obtain an accreditation.

Is there an ‘Unprofessional Standards Authority’?

If not, might they create one?

Watch this space!

On FACEBOOK I recently found this advertisement posted by ‘LifeCell Health’

Guys, weight loss starts at our gut. The reishi mushroom targets this key area of the body and promotes weight loss in a unique way, by changing our gut bacteria to digest food in a manner that improves weight loss and can even prevent weight gain. By combining 3 of the most researched mycological species on the planet, LifeCell Myco+ delivers a blend of weight loss mushrooms like no other: Improve gut health, speed up weight loss, enhance immune function, natural energy and more with our blend of Reishi, Turkey Tail, and Shiitake mushrooms. Each mushroom has been the subject of several in-vivo studies proving their efficacy when it comes to weight loss.

🍄Why Mushrooms Work.
✔️Reishi: Prevents weight gain by altering bacteria inside the digestive system
✔️Shiitake: Helps the body develop less fat by nourishing good gut bacteria.
✔️Turkey Tail: Reduces inflammation and helps prevent weight gain.

That sounded interesting, I thought, and I investigated a bit further. On the website of the firm, I found this text:

By combining 3 of the most researched mycological species on the planet, LifeCell Myco+ delivers an organic wellness formula unlike any other. Improve gut health, speed up weight loss, enhance immune function, natural energy and more with our blend of Reishi, Turkey Tail, and Shiitake mushrooms.

Keeping a healthy balance of beneficial bacteria in your gut is critical for maintaining a strong immune system. Your gut bacteria interact with immune cells and directly impact your immune response. Turkey tail mushrooms contain prebiotics, which help nourish these helpful bacteria. An 8-week study in 24 healthy people found that consuming 3,600 mg of PSP extracted from turkey tail mushrooms per day led to beneficial changes in gut bacteria and suppressed the growth of the possibly problematic E. coli and Shigella bacteria.

Next, I conducted a few Medline searches but was unable to find any trial data suggesting that any of the three mushrooms or their combination might reduce body weight. So, I wrote to the company:

Dear Madam/Sir

I am intrigued by your product MYCO +. Would you be kind enough to send me the studies showing that it can reduce body weight?

Many thanks

Edzard Ernst

What followed was a bizarre correspondence with several layers of administrators in the firm. They all said that I should discuss this with the next higher person. So, I asked myself up the hierarchy of LiveCell. The last email I received was this one:

Good morning Edzark,

Thank you for your email and I hope you are enjoying your day.

It is great to hear that you are interested in our LifeCell Myco.  I have forwarded your request for additional information and once received I will be sure to forward the information to you.

What do I conclude from this experience?

Apart from being unable to get my name right, the people responsible at ‘LifeCell Health’ seem also not able to send me the evidence I asked for. This, I fear, means that there is no such evidence which means the claims are unsubstantiated. Scientifically, this might amount to misconduct; legally, it could be fraudulent.

But I am, of course, no lawyer and therefore leave it to others to address the legal issues.

 

PS

If anyone happens to know of some evidence, please let me know and I will correct my post accordingly.

 

I have often warned that, even if chiropractic manipulations were harmless (which they are clearly not), this would not necessarily apply to those who administer them, the chiropractors. They can do harm via interfering or advising against conventional interventions (the best-research example is immunization) or by treating conditions that they are not competent to tackle (like ear infections), or giving advice that endangers the health of the patient.

Italian authors reported the case of a 67-year-old woman, who had been suffering from low back pain due to herniated discs, decided to undergo chiropractic treatment. According to the chiropractor’s prescription, the patient drank about 8 liters of water in a day. During the afternoon, she developed headaches, nausea, vomiting, and fatigue, for which reason she consulted the chiropractor, who reassured the patient and suggested continuing the treatment in order to purify the body. The next day, following the intake of another 6 liters of water, the patient developed sudden water retention, loss of consciousness, and tonic-clonic seizures; for this reason, she was admitted to the Intensive Care Unit with a coma from electrolyte alterations.

The diagnosis of water intoxication was stated based on the history reported by the family members; according to the clinical findings, the hydro-electrolytic alterations were adequately corrected, allowing the disease resolution. Once resolved the intoxication, the patient underwent surgery to treat a shoulder dislocation and a humerus fracture which occurred due to a fall consequent to the tonic-clonic seizures.

The Judicial Authority thus ordered a medico-legal evaluation of the chiropractor’s behavior in order to identify any professional liability issue.

The Italian authors commented that this case is peculiar since it shows the dangerous implications for the patients’ health and safety deriving from the prescription of a large quantity of water intake, without any control by the chiropractor, and thus underestimating the risks of such a practice, as evidenced by the suggestion to continue the water intake aiming to detoxify the body from pharmacological substances. As a consequence, the patient developed a severe form of hyponatremia, leading to life-threatening complications that could have been otherwise avoided.

The medico-legal evaluation of the case led to the admission of professional liability of the chiropractor, who
thus had to pay the damages to the patient.

It is, of course, tempting to argue that the patient was not very clever to follow this ridiculous advice (and that the chiropractor was outright stupid to give it). One might even go further and argue that most patients trusting chiros are not all that smart … one could … but it is far from me to do so.

Chinese researchers evaluated the effect of Chinese medicine (CM) on survival time and quality of life (QoL) in patients with small-cell lung cancer (SCLC). They conducted an exploratory and prospective clinical observation. Patients diagnosed with SCLC receiving CM treatment as an add-on to conventional cancer therapies were included and followed up every 3 months. The primary outcome was overall survival (OS), and the secondary outcomes were progression-free survival (PFS) and QoL.

A total of 136 patients including 65 limited-stage SCLC (LS-SCLC) patients and 71 extensive-stage SCLC (ES-SCLC) patients were analyzed. The median OS of ES-SCLC patients was 17.27 months, and the median OS of LS-SCLC was 40.07 months. The survival time was 16.27 months for SCLC patients with brain metastasis, 9.83 months for liver metastasis, 13.43 months for bone metastasis, and 18.13 months for lung metastasis. Advanced age, pleural fluid, liver, and brain metastasis were risk factors, while longer CM treatment duration was a protective factor. QoL assessment indicated that after 6 months of CM treatment, scores increased in function domains and decreased in symptom domains.

The authors concluded that CM treatment might help prolong OS of SCLC patients. Moreover, CM treatment brought the trend of symptom amelioration and QoL improvement. These results provide preliminary evidence for applying CM in SCLC multi-disciplinary treatment.

Sorry, but these results provide NO evidence for applying CM in SCLC multi-disciplinary treatment! Even if the findings were a bit better than those reported for SCLC in the literature – and I am not sure they are – it is simply not possible to say with any degree of certainty what effect the CM had. For that, we would obviously need a proper control group.

The study was supported by the National Natural Science Foundation of China (No. 81673797), and Beijing Municipal Natural Science Foundation (No. 7182142). In my view, this paper is an example for showing how the relentless promotion of dubious Traditional Chinese Medicine by Chinese officials might cost lives.

I feel that it is time to do something about it.

But what precisely?

Any ideas anyone?

 

Prof Harald Walach has had a few rough weeks. First, he published his paper suggesting that Covid vaccinations do more harm than good which was subsequently retracted as flawed, if not fraudulent. Next, he published a paper showing that children are put in danger when wearing face masks suggesting that “decision-makers weigh the hard evidence produced by these experimental measurements accordingly, which suggest that children should not be forced to wear face masks.” Now, the journal put out the following announcement about it:

The Research Letter, “Experimental Assessment of Carbon Dioxide Content in Inhaled Air With or Without Face Masks in Healthy Children: A Randomized Clinical Trial,” by Harald Walach, PhD, and colleagues published online in JAMA Pediatrics on June 30, 2021,1 is hereby retracted.

Following publication, numerous scientific issues were raised regarding the study methodology, including concerns about the applicability of the device used for assessment of carbon dioxide levels in this study setting, and whether the measurements obtained accurately represented carbon dioxide content in inhaled air, as well as issues related to the validity of the study conclusions. In their invited responses to these and other concerns, the authors did not provide sufficiently convincing evidence to resolve these issues, as determined by editorial evaluation and additional scientific review. Given fundamental concerns about the study methodology, uncertainty regarding the validity of the findings and conclusions, and the potential public health implications, the editors have retracted this Research Letter.

To make things even worse, Walach’s University fired him because of his fraudulent anti-vax research. Poznan University of Medical Sciences tweeted on 6 July:

We wish to emphasize that the claims included in dr Harald Walach’s recent article in @Vaccines_MDPI do not represent the position of @PUMS_tweets . We find that the article lacked scientific diligence and proper methodology. Dr. Walach’s affiliation with PUMS was now terminated. Throughout the pandemic PUMS has actively promoted vaccination programs, offering scientific expertise in the media, broadcasting seminars, and reported on progress of the vaccination program. We consider vaccinations as the paramount tool in the global fight against the pandemic. We consider vaccinations as the paramount tool in the global fight against the #pandemic. Over 85% of our own academic community has already been vaccinated with support and encouragement from the University.

As I said, this is truly unlucky …

.. or perhaps not?

Come to think of it, it is lucky when pseudo-science and fraud are called out. It means that the self-cleaning mechanisms of science are working and we are protected from the harm done by charlatans.

Two chiropractors conducted a retrospective review of publicly available data from the California Board of Chiropractic Examiners. Their aim was to determine categories of offense, experience, and gender of disciplined doctors of chiropractic (DC) in California and compare them with disciplined medical physicians in California.

Retrospective reviews of publicly available data from the California Board of Chiropractic Examiners.

The DC disciplinary categories, in descending order, were

  • fraud (44%),
  • sexual boundary issues (22%),
  • other offences (13%),
  • abuse of alcohol or drugs (10%),
  • negligence or incompetence (6%),
  • poor supervision (2%),
  • mental impairment (.3%).

The authors concluded that the professions differ in the major reasons for disciplinary actions. Two thirds (67%) of the doctors of chiropractic were disciplined for fraud and sexual boundary issues, compared with 59% for negligence and substance misuse for medical physicians. Additional study in each profession may reveal methods to identify causes and possible intervention for those who are at high risk.

The two authors of this paper should be congratulated for their courage to publish such a review. These figures seem shocking. But I think that in reality some of them might be far higher. Take the important matter of competence, for instance. If you consider it competent that chiropractors treat conditions other than back pain, you might arrive at the above-mentioned figure of 6%. If you consider this as incompetent, as I do, the figure might be one order of magnitude higher (for more on unprofessional conduct by chiropractors see here).

The abstract of the paper does not provide comparisons to the data related to the medical profession. Here they are; relative to doctors, chiropractors are:

  • 2x more likely to be involved in malpractice,
  • 9x more likely to be practising fraud,
  • 2x more likely to transgress sexual boundaries.

The frequency of fraud is particularly striking. Come to think of it, however, it is not all that amazing. I have said it before: chiropractic is in my view mostly about money.

It has been reported that B.C.’s chiropractors are deeply divided about the future of their profession, disagreeing on everything from false advertising to the use of routine X-rays.

Chiropractors attending an extraordinary general meeting of the College of Chiropractors of B.C. were split nearly down the middle on a series of non-binding resolutions addressing actions the College has taken in recent years. By the narrowest of margins, with at most 54% support, the members voted in favor of the college’s moves to limit the use of diagnostic X-rays and ban claims that aren’t supported by scientific evidence. The question that remains is who represents the bulk of the profession in B.C. — chiropractors advocating for what they describe as evidence-based practice targeting the musculoskeletal system, or “vitalists” who argue that chiropractic treatment can help with everything from immunity to brain function.

The modernizers see it as “a deliberate attempt to take over the college by a small group of chiropractors with no respect or knowledge of regulation … funded by organizations out of the province and out of the country,” Victoria chiropractor Clark Konczak told the virtual meeting.

At issue was a series of policies the college introduced in the wake of what Konczak called “the smoothie episode.” He was referring to a video posted on Facebook in 2017 by the then-vice chair of the college’s board, Avtar Jassal, in which he falsely suggested fruit smoothies are better than vaccines at preventing the flu.

Earlier this year, the college introduced amendments that bar chiropractors from performing routine and repeat X-rays, saying radiography is only scientifically supported when there are red flags that something is seriously wrong. The policy change on X-rays was the flashpoint in the long-simmering tension within the profession. A group of chiropractors has filed a petition in B.C. Supreme Court, alleging the college is preventing them from providing “safe, ethical, and effective care to their patients.” Their legal action has backing from national and international vitalistic organizations. During the recent meeting, a group of chiropractors argued unsuccessfully for the new X-ray policy to be tossed. Some suggested that chiropractors who don’t perform X-rays as a matter of routine are actually harming their patients. Another extraordinary general meeting has been called for July 20 to vote on resolutions calling for the removal of four college board members.

As I have often pointed out, chiropractic is all about money. The ‘chiro-wars’ have been going on for quite a while now, and they are by no means confined to B. C. or Canada. In a nutshell, they suggest to me that a significant proportion of chiropractors prefer money to progress.

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