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

quackery

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This paper reports a survey amongst European chiropractors during early 2017. Dissemination was through an on-line platform with links to the survey being sent to all European chiropractic associations regardless of European Chiropractors’ Union (ECU) membership and additionally through the European Academy of Chiropractic (EAC). Social media via Facebook groups was also used to disseminate links to the survey.

One thousand three hundred twenty and two responses from chiropractors across Europe representing approximately 17.2% of the profession were collected. Five initial self-determined chiropractic identities were collapsed into 2 groups categorised as orthodox (79.9%) and unorthodox (20.1%); by the latter term, the investigators mean the subluxationists/vitalists.

When comparing the percentage of new patients chiropractors x-rayed, 23% of the unorthodox group x-rayed > 50% of their new patients compared to 5% in the orthodox group. Furthermore, the proportion of respondents reporting > 150 patient encounters per week in the unorthodox group were double compared to the orthodox (22 v 11%). Lastly the proportion of those respondents disagreeing or strongly disagreeing with the statement “In general, vaccinations have had a positive effect on global public health” was 57 and 4% in unorthodox and orthodox categories respectively. Logistic regression models identified male gender, seeing more than 150 patients per week, no routine differential diagnosis, and not strongly agreeing that vaccines have generally had a positive impact on health as highly predictive of unorthodox categorisation.

The authors concluded that despite limitations with generalisability in this survey, the proportion of respondents adhering to the different belief categories are remarkably similar to other studies exploring this phenomenon. In addition, and in parallel with other research, this survey suggests that key practice characteristics in contravention of national radiation guidelines or opposition to evidence based public health policy are significantly more associated with non-orthodox chiropractic paradigms.

Country

N (%) Orthodox

N (%) Unorthodox

Belgium

51 (92.7)

4 (7.3)

Germany

43 (66.2)

22 (33.8)

Ireland

31 (79.5)

8 (20.5)

Italy

23 (59.0)

16 (41.0)

Norway

132 (93.0)

10 (7.0)

Spain

34 (43.6)

44 (56.4)

Sweden

101 (82.8)

21 (17.2)

Switzerland

102 (90.3)

11 (9.7)

The Netherlands

81 (82.7)

17 (17.3)

UK

236 (80.0)

59 (20.0)

The authors do laudably question that their findings are generalisable. However, this does not mean that this limitation is not significant. With such a dismal response rate, the value of any such survey approaches zero. I think, one has to be a chiropractor to publish such valueless paper nevertheless.

If, for a minute, I disregarded the non-generalisability of these data, what I would find most remarkable here is the high proportion of subluxationists/vitalists/anti-vaccinationists amongst today’s chiropractors. Chiropractic subluxation is an obsolete theory which should have been banned to the history books a long time ago. Yet, in some European countries around half of the chiropractors would adhere to it (I speculate that the figures would be significantly higher, if the response rate had been 100%).

I would find this unacceptable.

The reason I said ‘would find it acceptable’ is that I do not accept the validity of the survey results in the first place.

Mr William Harvey Lillard was the janitor contracted to clean the Ryan Building where D. D. Palmer’s magnetic healing office was located. In 1895, he became Palmer’s very first chiropractic patient and thus entered the history books. The very foundations of chiropractic are based on this story.

[Testimony of Harvey Lillard regarding the events surrounding the first chiropractic adjustment, printed in the January 1897 issue of the Chiropractor]

To call the ‘Chiropractor’ a reliable source would probably be stretching it a bit, and there are various versions of the event, even one where BJ Palmer, DD’s son, changed significant details of the story. Nevertheless, it’s a nice story, if there ever was one. But, like many nice stories, it’s just that: a tall tale, a story that might be not based on reality. In this case, the reality getting in the way of a good story is human anatomy.

The nerve supply of the inner ear, the bit that enables us to hear, does not, like most other nerves of our body, run through the spine; it comes directly from the brain: the acoustic nerve is one of the 12 cranial nerves.

But chiropractors never let the facts get in the way of a good story! Thus they still tell it and presumably even believe it. Take this website, for instance, as an example of hundreds of similar sources:

… the very first chiropractic patient in history was named William Harvey Lillard, who experienced difficulty hearing due to compression of the nerves leading to his ears. He was treated by “the founder of chiropractic care,” David. D. Palmer, who gave Lillard spinal adjustments in order to reduce destructive nerve compressions and restore his hearing. After doing extensive research about physiology, Palmer believed that Lillard’s hearing loss was due to a misalignment that blocked the spinal nerves that controlled the inner ear (an example of vertebral subluxation). Palmer went on to successfully treat other patients and eventually trained other practitioners how to do the same.

How often have we been told that chiropractors receive a medical training that is at least as thorough as that of proper doctors? But that’s just another tall story, I guess.

Here is the abstract of a paper that makes even the most senior assessor of quackery shudder:

Objective:

The purpose of this report is to describe the manipulation under anesthesia (MUA) treatment of 6 infants with newborn torticollis with a segmental dysfunction at C1/C2.

Clinical Features:

Six infants aged 4 1/2 to 15 months previously diagnosed with newborn torticollis were referred to a doctor of chiropractic owing to a failure to respond adequately to previous conservative therapies. Common physical findings were limited range of motion of the upper cervical spine. Radiographs demonstrated rotational malpositions and translation of atlas on axis in all 6 infants, and 1 had a subluxation of the C1/C2 articulation.

Interventions and Outcome:

Selection was based on complexity and variety of different clinical cases qualifying for MUA. Treatment consisted of 1 mobilization and was performed in the operating room of a children’s hospital by a certified chiropractic physician with the author assisting. Along with the chiropractor and his assistant, a children’s anesthesiologist, 1 to 2 operating nurses, a children’s radiologist, and in 1 case a pediatric surgeon were present. Before the mobilization, plain radiographs of the cervico-occipital area were taken. Three infants needed further investigation by a pediatric computed tomography scan of the area because of asymmetric bony conditions on the plain radiographs. Follow-up consultations at 2, 3, 5, or 6 weeks were done. Patient records were analyzed for restriction at baseline before MUA compared with after MUA treatment for active rotation, passive rotation, and passive rotation in full flexion of the upper cervical spine. All 3 measurements showed significant differences. The long-term outcome data was collected via phone calls to the parents at 6 to 72 months. The initial clinical improvements were maintained.

Conclusion:

These 6 infants with arthrogenic newborn torticollis, who did not respond to previous conservative treatment methods, responded to MUA.

___________________________________________________________________

After reading the full text, I see many very serious problems and questions with this paper; here are 14 of the most obvious ones.

1. A congenital torticollis (that’s essentially what these kids were suffering from) has a good prognosis and does not require such invasive treatments. There is thus no plausible reason to conduct a case series of this nature.

2. A retrospective case series does not allow conclusions about therapeutic effectiveness, yet in the article the author does just that.

3. The same applies to her conclusions about the safety of the interventions.

4. It is unclear how the 6 cases were selected; it seems possible or even likely that they are, in fact, 6 cases of many more treated over a long period of time.

5. If so, this paper is hardly a ‘retrospective case series’; at best it could be called a ‘best case series’.

6. The X-rays or CT scans are unnecessary and potentially harmful.

7. The anaesthesia is potentially very harmful and unjustifiable.

8. The outcome measure is unreliable, particularly if performed by the chiropractor who has a vested interest in generating a positive result.

9. The follow-up by telephone is inadequate.

10. The range of the follow-up period (6-72 months) is unacceptable.

11. The exact way in which informed consent was obtained is unclear. In particular, we would need to know whether the parents were fully informed about the futility of the treatment and its considerable risks.

12. The chiropractor who administered the treatments is not named. Why not?

13. Similarly, it is unclear why the other healthcare professionals involved in these treatments are not named as co-authors of the paper.

14. It is unclear whether ethical approval was obtained for these treatments.

The author seems inexperienced in publishing scientific articles; the present one is poorly written and badly constructed. A Medline research reveals that she has only one other publication to her name. So, perhaps one should not be too harsh in judging her. But what about her supervisors, the journal, its reviewers, its editor and the author’s institution? The author comes from the Department of Chiropractic Medicine, Medical Faculty University, Zurich, Switzerland. On their website, they state:

The Faculty of Medicine of the University of Zurich is committed to high quality teaching and continuing research-based education of students in health care professions. Excellent and internationally recognised scientists and clinically outstanding physicians are at the Faculty of Medicine devoted to patients and public health, to teaching, to the support of young researchers and to academic medicine. The interaction between research and teaching, and their connection to clinical practice play a central role for us…

The Faculty of Medicine of the University of Zurich promotes innovative research in the basic fields of medicine, in the clinical application of knowledge, in personalised medicine, in health care, and in the translational connection between all these research areas. In addition, it encourages the cooperation between primary care and specialised health care.

It seems that, with the above paper, the UZH must have made an exception. In my view, it is a clear case of scientific misconduct and child abuse.

I am being told to educate myself and rethink the subject of NAPRAPATHY by the US naprapath Dr Charles Greer. Even though he is not very polite, he just might have a point:

Edzard, enough foolish so-called scientific, educated assesments from a trained Allopathic Physician. When asked, everything that involves Alternative Medicine in your eyesight is quackery. Fortunately, every Medically trained Allopathic Physician does not have your points of view. I have partnered with Orthopaedic Surgeons, Medical Pain Specialists, General practitioners, Thoracic Surgeons, Forensic Pathologists and Others during the course, whom appreciate the Services that Naprapaths provide. Many of my current patients are Medical Physicians. Educate yourself. Visit a Naprapath to learn first hand. I expect your outlook will certainly change.

I have to say, I am not normally bowled over by anyone who calls me an ‘allopath’ (does Greer not know that Hahnemann coined this term to denigrate his opponents? Is he perhaps also in favour of homeopathy?). But, never mind, perhaps I was indeed too harsh on naprapathy in my previous post on this subject.

So, let’s try again.

Just to remind you, naprapathy was developed by the chiropractor Oakley Smith who had graduated under D D Palmer in 1899. Smith was a former Iowa medical student who also had investigated Andrew Still’s osteopathy in Kirksville, before going to Palmer in Davenport. Eventually, Smith came to reject Palmer’s concept of vertebral subluxation and developed his own concept of “the connective tissue doctrine” or naprapathy.

Dr Geer published a short article explaining the nature of naprapathy:

Naprapathy- A scientific, Evidence based, integrative, Alternative form of Pain management and nutritional assessment that involves evaluation and treatment of Connective tissue abnormalities manifested in the entire human structure. This form of Therapeutic Regimen is unique specifically to the Naprapathic Profession. Doctors of Naprapathy, pronounced ( nuh-prop-a-thee) also referred to as Naprapaths or Neuromyologists, focus on the study of connective tissue and the negative factors affecting normal tissue. These factors may begin from external sources and latently produce cellular changes that in turn manifest themselves into structural impairments, such as irregular nerve function and muscular contractures, pulling its’ bony attachments out of proper alignment producing nerve irritability and impaired lymphatic drainage. These abnormalities will certainly produce a pain response as well as swelling and tissue congestion. Naprapaths, using their hands, are trained to evaluate tissue tension findings and formulate a very specific treatment regimen which produces positive results as may be evidenced in the patients we serve. Naprapaths also rely on information obtained from observation, hands on physical examination, soft tissue Palpatory assessment, orthopedic evaluation, neurological assessment linked with specific bony directional findings, blood and urinalysis laboratory findings, diet/ Nutritional assessment, Radiology test findings, and other pertinent clinical data whose information is scrutinized and developed into a individualized and specific treatment plan. The diagnostic findings and results produced reveal consistent facts and are totally irrefutable. The deductions that formulated these concepts of theory of Naprapathic Medicine are rationally believable, and have never suffered scientific contradiction. Discover Naprapathic Medicine, it works.

What interests me most here is that naprapathy is evidence-based. Did I perhaps miss something? As I cannot totally exclude this possibility, I did another Medline search. I found several trials:

1st study (2007)

Four hundred and nine patients with pain and disability in the back or neck lasting for at least 2 weeks, recruited at 2 large public companies in Sweden in 2005, were included in this randomized controlled trial. The 2 interventions were naprapathy, including spinal manipulation/mobilization, massage, and stretching (Index Group) and support and advice to stay active and how to cope with pain, according to the best scientific evidence available, provided by a physician (Control Group). Pain, disability, and perceived recovery were measured by questionnaires at baseline and after 3, 7, and 12 weeks.

RESULTS:

At 7-week and 12-week follow-ups, statistically significant differences between the groups were found in all outcomes favoring the Index Group. At 12-week follow-up, a higher proportion in the naprapathy group had improved regarding pain [risk difference (RD)=27%, 95% confidence interval (CI): 17-37], disability (RD=18%, 95% CI: 7-28), and perceived recovery (RD=44%, 95% CI: 35-53). Separate analysis of neck pain and back pain patients showed similar results.

DISCUSSION:

This trial suggests that combined manual therapy, like naprapathy, might be an alternative to consider for back and neck pain patients.

2nd study (2010)

Subjects with non-specific pain/disability in the back and/or neck lasting for at least two weeks (n = 409), recruited at public companies in Sweden, were included in this pragmatic randomized controlled trial. The two interventions compared were naprapathic manual therapy such as spinal manipulation/mobilization, massage and stretching, (Index Group), and advice to stay active and on how to cope with pain, provided by a physician (Control Group). Pain intensity, disability and health status were measured by questionnaires.

RESULTS:

89% completed the 26-week follow-up and 85% the 52-week follow-up. A higher proportion in the Index Group had a clinically important decrease in pain (risk difference (RD) = 21%, 95% CI: 10-30) and disability (RD = 11%, 95% CI: 4-22) at 26-week, as well as at 52-week follow-ups (pain: RD = 17%, 95% CI: 7-27 and disability: RD = 17%, 95% CI: 5-28). The differences between the groups in pain and disability considered over one year were statistically significant favoring naprapathy (p < or = 0.005). There were also significant differences in improvement in bodily pain and social function (subscales of SF-36 health status) favoring the Index Group.

CONCLUSIONS:

Combined manual therapy, like naprapathy, is effective in the short and in the long term, and might be considered for patients with non-specific back and/or neck pain.

3rd study (2016)

Participants were recruited among patients, ages 18-65, seeking care at the educational clinic of Naprapathögskolan – the Scandinavian College of Naprapathic Manual Medicine in Stockholm. The patients (n = 1057) were randomized to one of three treatment arms a) manual therapy (i.e. spinal manipulation, spinal mobilization, stretching and massage), b) manual therapy excluding spinal manipulation and c) manual therapy excluding stretching. The primary outcomes were minimal clinically important improvement in pain intensity and pain related disability. Treatments were provided by naprapath students in the seventh semester of eight total semesters. Generalized estimating equations and logistic regression were used to examine the association between the treatments and the outcomes.

RESULTS:

At 12 weeks follow-up, 64% had a minimal clinically important improvement in pain intensity and 42% in pain related disability. The corresponding chances to be improved at the 52 weeks follow-up were 58% and 40% respectively. No systematic differences in effect when excluding spinal manipulation and stretching respectively from the treatment were found over 1 year follow-up, concerning minimal clinically important improvement in pain intensity (p = 0.41) and pain related disability (p = 0.85) and perceived recovery (p = 0.98). Neither were there disparities in effect when male and female patients were analyzed separately.

CONCLUSION:

The effect of manual therapy for male and female patients seeking care for neck and/or back pain at an educational clinic is similar regardless if spinal manipulation or if stretching is excluded from the treatment option.

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I don’t know about you, but I don’t call this ‘evidence-based’ – especially as all the three trials come from the same research group (no, not Greer; he seems to have not published at all on naprapathy). Dr Greer does clearly not agree with my assessment; on his website, he advertises treating the following conditions:

Anxiety
Back Disorders
Back Pain
Cervical Radiculopathy
Cervical Spondylolisthesis
Cervical Sprain
Cervicogenic Headache
Chronic Headache
Chronic Neck Pain
Cluster Headache
Cough Headache
Depressive Disorders
Fibromyalgia
Headache
Hip Arthritis
Hip Injury
Hip Muscle Strain
Hip Pain
Hip Sprain
Joint Clicking
Joint Pain
Joint Stiffness
Joint Swelling
Knee Injuries
Knee Ligament Injuries
Knee Sprain
Knee Tendinitis
Lower Back Injuries
Lumbar Herniated Disc
Lumbar Radiculopathy
Lumbar Spinal Stenosis
Lumbar Sprain
Muscle Diseases
Musculoskeletal Pain
Neck Pain
Sciatica (Not Due to Disc Displacement)
Sciatica (Not Due to Disc Displacement)
Shoulder Disorders
Shoulder Injuries
Shoulder Pain
Sports Injuries
Sports Injuries of the Knee
Stress
Tendonitis
Tennis Elbow (Lateral Epicondylitis)
Thoracic Disc Disorders
Thoracic Outlet Syndrome
Toe Injuries

Odd, I’d say! Did all this change my mind about naprapathy? Not really.

But nobody – except perhaps Dr Greer – can say I did not try.

And what light does this throw on Dr Greer and his professionalism? Since he seems to be already quite mad at me, I better let you answer this question.

Chiropractic may be nonsense, but it nevertheless earns chiros very good money. Chiropractors tend to treat their patients for unnecessarily long periods of time. This, of course, costs money, and even if the treatment in question ever was indicated (which, according to the best evidence, is more than doubtful), this phenomenon would significantly inflate healthcare expenditureIt was reported that over 80% of the money that the US Medicare paid to chiropractors in 2013 went for medically unnecessary procedures. The federal insurance program for senior citizens thus spent roughly $359 million on unnecessary chiropractic care that year.

Such expenditure may not benefit patients, but it surely benefits the chiropractors. A recent article in Forbes informed us that, according to the US Bureau of Labor Statistics’ Occupational Outlook Handbook, the employment of chiropractors is expected to grow 12% from 2016 to 2026, faster than the average for all occupations.

According to the latest data from the Bureau Occupational Employment Statistics, as of 2017, the average income of an US chiropractor amounts to US $ 85,870. However, chiropractors’ salaries aren’t this high in every US state. The lowest average income (US$ 45 000) per year is in the state of Wyoming.

Below you’ll find a breakdown of where chiropractors’ incomes are the highest.

1 Rhode Island $147,900
2 Tennessee $122,620
3 Connecticut $113,130
4 Alaska $106,600
5 Colorado $99,350
6 New Hampshire $99,330
7 Nevada $99,140
8 Delaware $97,650
9 Massachusetts $96,110
10 Maryland $95,190

 

These are tidy sums indeed – remember, they merely depict the averages. Individual chiropractors will earn substantially more than the average, of course. And there are hundreds of websites, books, etc. to teach chiros how to maximise their cash-flow. Some of the most popular ‘tricks of the chiro trade’ include:

  • maintenance therapy,
  • treatment of children,
  • making unsupported therapeutic claims,
  • disregarding the risks of spinal manipulation,
  • selling useless dietary supplements.

Considering the sums of money that are at stake, I am beginning to understand why chiropractors tend to get so nervous, often even furious and aggressive, when I point out that they might be causing more harm than good to their patients.

Its the money, stupid!

 

We have discussed various forms of healing before – see, for instance, here, here and here. Of all the implausible SCAMs, healing takes the biscuit. Here is a healing-paper that fascinated me.

The aim of the study was to report epidemiologic data on ‘biofield healers’ (all types of energy healers) in radiation therapy patients, and to assess the possible objective and subjective benefits.

A retrospective study was conducted in a French cancer institute. All consecutive breast or prostate cancer patients undergoing a curative radiotherapy during 2015 were screened (n = 806). Healer consultation procedure, frequency, and remuneration were collected. Patient’s self-evaluation of healer’s impact on treatment tolerance was reported. Tolerance (fatigue, pain) was assessed through visual analogic scale (0 to 10). Analgesic consumption was evaluated.

A total of 500 patients were included (350 women and 150 men), and 256 patients (51.2%) consulted a healer during their radiation treatment, with a majority of women (58%, p < 0.01). Most patients had weekly (n = 209, 41.8%) or daily (n = 84, 16.8%) appointments with their healer. Regarding the self-reported tolerance, > 80% of the patients described a “good” or “very good” impact of the healer on their treatment. Healers were mainly voluntary (75.8%). Regarding the clinical efficacy, no difference was observed in prostate and in breast cancer patients (toxicity, antalgic consumption, pain).

The authors concluded that this study reveals that the majority of patients treated by radiotherapy consults a healer and reports a benefit on subjective tolerance, without objective tolerance amelioration.

The authors admit that their investigation has several limitations:

  1. Among the 806 screened patients, only 500 were finally included. These patients more likely report their subjective benefit on biofield healing, and could overestimate benefits in the healer group.
  2. Practices were highly variable from a healer to another.
  3. Toxicities evaluation might have been biased due to retrospective analysis based on medical patient record.

But what does this study really show?

I think, it demonstrates that:

  1. Healing is frightfully popular in France. I use the term deliberately, because this level of irrationality does, in fact, frighten me.
  2. Healing does not seem to alter the natural history of cancer.

And what about the fact that 84% of the patients reported a good or very good impact of the biofield healer on their tolerance to radiotherapy? Does this prove or even suggest that healing has positive effects? I think not! This result is to be expected. Imagine a retrospective study of patients who chose to eat a hamburger. Would we not expext that a similar percentage might claim that eating it did them good?

I rest my case.

 

 

My friend Roger, the homeopath, alerted me to the ‘Self-Controlled Energo Neuro Adaptive Regulation‘ (SCENAR). He uses it in his practice and explains:

The scenar uses biofeedback; by stimulating the nervous system, it is able to teach the body to heal itself. The device sends out a series of signals through the skin and measures the response. Each signal is only sent out when a change, in response to the previous signal, is recorded in the electrical properties of the skin. Visible responses include reddening of the skin, numbness, stickiness (the device will have the feeling of being magnetically dragged), a change in the numerical readout and an increase in the electronic clattering of the device.

The C-fibres, which comprise 85% of all nerves in the body, react most readily to the electro-stimulation and are responsible for the production of neuropeptides and other regulatory peptides. A TENS unit will only stimulate the A & B-fibres for temporary relief.

The body can get accustomed to a stable pathological state, which may have been caused by injury, disease or toxicity. The Scenar catalyses the process to produce regulatory peptides for the body to use where necessary, by stimulation of C-fibres  . It is these neuropeptides that in turn reestablish the body’s natural physiological state and are responsible for the healing process. As these peptides last up to several hours, the healing process will continue long after the treatment is over. The large quantity of neuropeptides and C-fibres in the Central Nervous System can also result in the treatment on one area aiding with other general regulatory processes, like chemical imbalances, correcting sleeplessness, appetite and behavioral problems.

Sounds like science fiction?

Or perhaps more like BS?

But, as always, the proof of the pudding is in the eating. Roger explains:

What conditions can Scenar treat?
In the UK, the devices are licensed by the British Standards Institute for pain relief only. Likewise the FDA has approved the Scenar for pain relief. However, because of the nature of the device, viz., stimulating the nervous system, the Russian experience is that Scenar affects all the body systems in a curative manner.

The Russian experience suggests that it can be effective for a very broad range of diseases, including diseases of the digestive, cardio-vascular, respiratory, musculo-skeletal, urinary, reproductive and nervous systems. It is also useful for managing ENT diseases, eye diseases, skin conditions and dental problems. It has also been found beneficial in burns, fractures, insect bites, allergic reactions, diseases of the blood and disorders involving immune mechanisms; endocrine, nutritional and metabolic disorders; stress and mental depression, etc.

It is known to give real relief from many types of pain. It does so because it stimulates the body to heal the underlying disease causing the pain!

Another SCENAR therapist is much more specific. He tells us that SCENAR is effective for:

  • Sports and other injuries
  • Musculoskeletal problems
  • Issues with circulation
  • Respiratory diseases
  • Digestive disorders
  • Certain infections
  • Immune dysfunctions

Perhaps I was a bit hasty; perhaps the SCENAR does work after all. It is certainly offered by many therapists like Roger. They cannot all be charlatans, or can they?

Time to do a proper Medline search and find out about the clinical trials that have been done with the SCENAR. Disappointingly, I only found three relevant papers; here they are:

Study No 1

A new technique of low-frequency modulated electric current therapy, SCENAR therapy, was used in treatment of 103 patients with duodenal ulcer (DU). The influence of SCENAR therapy on the main clinical and functional indices of a DU relapse was studied. It was shown that SCENAR therapy, which influences disturbed mechanisms of adaptive regulation and self-regulation, led to positive changes in most of the parameters under study. Addition of SCENAR therapy to the complex conventional pharmacotherapy fastened ulcer healing, increased the effectiveness of Helicobacter pylori eradication, and improved the condition of the gastroduodenal mucosa.

Study No 2

Administration of artrofoon in combination with SCENAR therapy to patients with localized suppurative peritonitis in the postoperative period considerably reduced plasma MDA level, stabilized ceruloplasmin activity, and increased catalase activity in erythrocytes compared to the corresponding parameters in patients receiving standard treatment in combination with SCENAR therapy.

Study No 3

The author recommends a self-control energoneuroadaptive regulator (SCENAR) as effective in the treatment of neurogenic dysfunction of the bladder in children with nocturnal enuresis. This regulator operates according to the principles of Chinese medicine and may be used in sanatoria and at home by the children’s parents specially trained by physiotherapist.

_____________________________________________________________________

While the quantity of the ‘studies’ is lamentable, their quality seems quite simply unacceptable.

We are thus left with two possibilities: either the SCENAR is more or less what its proponents promise and the science has for some strange reason not caught up with this reality; or the reality is that SCENAR is a bogus treatment used by charlatans who exploit the gullible public.

I know which possibility I favour – how about you?

Actually, the article is not entitled ‘Explaining Homeopathy with Quantum Bollocks’, it has the title ‘Explaining Homeopathy with Quantum Electrodynamics’. Its two Italian authors have prestigious affiliations in the world of quantum physics:

  • Independent Researcher
  • Homeopathic Clinic, Bassano del Grappa

What they write must therefore be authorative and important. Let’s have a look; here is the abstract:

Every living organism is an open system operating far from thermodynamic equilibrium and exchanging energy, matter and information with an external environment. These exchanges are performed through non-linear interactions of billions of different biological components, at different levels, from the quantum to the macro-dimensional. The concept of quantum coherence is an inherent property of living cells, used for long-range interactions such as synchronization of cell division processes. There is support from recent advances in quantum biology, which demonstrate that coherence, as a state of order of matter coupled with electromagnetic (EM) fields, is one of the key quantum phenomena supporting life dynamics. Coherent phenomena are well explained by quantum field theory (QFT), a well-established theoretical framework in quantum physics. Water is essential for life, being the medium used by living organisms to carry out various biochemical reactions and playing a fundamental role in coherent phenomena.

Quantum electrodynamics (QED), which is the relativistic QFT of electrodynamics, deals with the interactions between EM fields and matter. QED provides theoretical models and experimental frameworks for the emergence and dynamics of coherent structures, even in living organisms. This article provides a model of multi-level coherence for living organisms in which fractal phase oscillations of water are able to link and regulate a biochemical reaction. A mathematical approach, based on the eigenfunctions of Laplace operator in hyper-structures, is explored as a valuable framework to simulate and explain the oneness dynamics of multi-level coherence in life. The preparation process of a homeopathic medicine is analyzed according to QED principles, thus providing a scientific explanation for the theoretical model of “information transfer” from the substance to the water solution. A subsequent step explores the action of a homeopathic medicine in a living organism according to QED principles and the phase-space attractor’s dynamics.

According to the developed model, all levels of a living organism organelles, cells, tissues, organs, organ systems, whole organism-are characterized by their own specific wave functions, whose phases are perfectly orchestrated in a multi-level coherence oneness. When this multi-level coherence is broken, a disease emerges. An example shows how a homeopathic medicine can bring back a patient from a disease state to a healthy one. In particular, by adopting QED, it is argued that in the preparation of homeopathic medicines, the progressive dilution/succussion processes create the conditions for the emergence of coherence domains (CDs) in the aqueous solution. Those domains code the original substance information (in terms of phase oscillations) and therefore they can transfer said information (by phase resonance) to the multi-level coherent structures of the living organism.

We encourage that QED principles and explanations become embodied in the fundamental teachings of the homeopathic method, thus providing the homeopath with a firm grounding in the practice of rational medicine. Systematic efforts in this direction should include multiple disciplines, such as quantum physics, quantum biology, conventional and homeopathic medicine and psychology.

I hope you agree that this is remarkable, perhaps even unique. The only similar paper I can remember is the one by my good friend Lionel Milgrom which concluded that quantum field theory demonstrates that quantum properties can be physical without being observable. Thus, an underlying similarity in discourse could exist between homeopathy and quantum theory which could be useful for modelling the homeopathic process. This preliminary investigation also suggested that key elements of previous quantum models of the homeopathic process, may become unified within this new QFT-type approach.

As far as I can see, the two authors of the new paper (published in the journal ‘Homeopathy‘) have just revolutionised our understanding of:

  • quantum physics,
  • human physiology,
  • pathophysiology,
  • therapeutics,
  • homeopathy.

Not a mean feast, you must admit.

Alternatively – and I am genuinely uncertain here – the journal ‘Homeopathy’ has just fallen victim of a hilarious spoof.

Please, do tell me which is the case.

This paper notes that, according to the World Naturopathic Federation (WNF), the naturopathic profession is based on two fundamental philosophies of medicine (vitalism and holism) and seven principles of practice (healing power of nature; treat the whole person; treat the cause; first, do no harm; doctor as teacher; health promotion and disease prevention; and wellness). The philosophy, theory, and principles are translated to clinical practice through a range of therapeutic modalities. The WNF has identified seven core modalities: (1) clinical nutrition and diet modification/counselling; (2) applied nutrition (use of dietary supplements, traditional medicines, and natural health care products); (3) herbal medicine; (4) lifestyle counselling; (5) hydrotherapy; (6) homeopathy, including complex homeopathy; and (7) physical modalities (based on the treatment modalities taught and allowed in each jurisdiction, including yoga, naturopathic manipulation, and muscle release techniques).

The ‘scoping’ review was to summarize the current state of the research evidence for whole-system, multi-modality naturopathic medicine. Studies were included, if they met the following criteria:

  • Controlled clinical trials, longitudinal cohort studies, observational trials, or case series involving five or more cases presented in any language
  • Human studies
  • Multi-modality treatment administered by a naturopath (naturopathic clinician, naturopathic physician) as an intervention
  • Non-English language studies in which an English title and abstract provided sufficient information to determine effectiveness
  • Case series in which five or more individual cases were pooled and authors provided a summative discussion of the cases in the context of naturopathic medicine
  • All human research evaluating the effectiveness of naturopathic medicine, where two or more naturopathic modalities are delivered by naturopathic clinicians, were included in the review.
  • Case studies of five or more cases were included.

Thirty-three published studies with a total of 9859 patients met inclusion criteria (11 US; 4 Canadian; 6 German; 7 Indian; 3 Australian; 1 UK; and 1 Japanese) across a range of mainly chronic clinical conditions. A majority of the included studies were observational cohort studies (12 prospective and 8 retrospective), with 11 clinical trials and 2 case series. The studies predominantly showed evidence for the efficacy of naturopathic medicine for the conditions and settings in which they were based. Overall, these studies show naturopathic treatment results in a clinically significant benefit for treatment of hypertension, reduction in metabolic syndrome parameters, and improved cardiac outcomes post-surgery.

The authors concluded that to date, research in whole-system, multi-modality naturopathic medicine shows that it is effective for treating cardiovascular disease, musculoskeletal pain, type 2 diabetes, polycystic ovary syndrome, depression, anxiety, and a range of complex chronic conditions. Overall, these studies show naturopathic treatment results in a clinically significant benefit for treatment of hypertension, reduction in metabolic syndrome parameters, and improved cardiac outcomes post-surgery.

Where to start?

There are many issues here to choose from:

  • The definition of naturopathy used in this review may be the one of the WHF, but it has little resemblance to the one used elsewhere. German naturopathic doctors, for instance, would not consider homeopathy to be a naturopathic treatment. They would also not, like the WNF does, subscribe to the long-obsolete humoral  theory of disease. The only German professional organisation that is a member of the WNF is thus not one of naturopathic doctors but one of Heilpraktiker (the notorious German lay-practitioner created by the Nazis during the Third Reich).
  • A review that includes observational studies and even case series, while drawing far-reaching conclusions on therapeutic effectiveness is, in my view, little more than embarrassing pseudo-science. Such studies are unable to differentiate between specific and non-specific therapeutic effects and therefore can tell us nothing about the effectiveness of a treatment.
  • A review on a subject such as naturopathy (an approach which, after all, originated in Europe) that excludes studies not published in English (and without an English abstract providing sufficient information to determine effectiveness) is likely to be incomplete.
  • The authors call their review a ‘scoping review’; they nevertheless draw conclusions not about the scope but the effectiveness of naturopathy.
  • Many of the studies included in this review do, in fact, not comply with the inclusion criteria set by the review-authors.
  • The review does not assess or even comment on the risks of naturopathic treatments.
  • Several of the included studies are not investigations of naturopathy but of approaches that squarely fall under the umbrella of integrative or alternative medicine.
  • Of the 33 studies included, only 5 were RCTs, and none of these was free of major limitations.
  • None of the RCTs have been independently replicated.
  • There is a remarkable absence of negative trials suggestion a strong influence of bias.
  • The review lacks any trace of critical thinking.
  • The authors are affiliated to institutions of naturopathy but declare no conflicts of interest.
  • No funding source was named but it seems that it was supported by the WNF; their primary goal is to promote and advance the naturopathic profession.
  • The review appeared in the notorious Journal of Complementary and Alternative Medicine.

Prof Dwyer, the founding president of the Australian ‘Friends of Science in Medicine’, said the study damaged Southern Cross University’s reputation. “At the heart of this is the credibility of Southern Cross University,” he said. “There’s been a stand-off between SCU and the rest of the scientific community in Australia for a number of years and there have been challenges to whether they are really upholding the highest standards of evidence-based medicine.” Professor Dwyer also raised questions about the university’s credibility late last year when it accepted a $10 million donation from vitamin company Blackmore’s to establish a National Centre for Naturopathic Medicine.

My conclusion of naturopathy, as defined by the WNF, is that it is an obsolete form of quackery steeped in concepts of vitalism that should be abandoned sooner rather than later. And my conclusion about the new review agrees with Prof Dwyer’s judgement: it is an embarrassment to all concerned.

“Most of the supplement market is bogus,” Paul Clayton*, a nutritional scientist, told the Observer. “It’s not a good model when you have businesses selling products they don’t understand and cannot be proven to be effective in clinical trials. It has encouraged the development of a lot of products that have no other value than placebo – not to knock placebo, but I want more than hype and hope.” So, Dr Clayton took a job advising Lyma, a product which is currently being promoted as “the world’s first super supplement” at £199 for a one-month’s supply.

Lyma is a dietary supplement that contains a multitude of ingredients all of which are well known and available in many other supplements costing only a fraction of Lyma. The ingredients include:

  • kreatinin,
  • turmeric,
  • Ashwagandha,
  • citicoline,
  • lycopene,
  • vitamin D3.

Apparently, these ingredients are manufactured in special (and patented) ways to optimise their bioavailabity. According to the website, the ingredients of LYMA have all been clinically trialled with proven efficacy at levels provided within the LYMA supplement… Unless the ingredient has been clinically trialled, and peer reviewed there may be limited (if any) benefit to the body. LYMA’s revolutionary formulation is the most advanced and proven super supplement in the world, bringing together eight outstanding ingredients – seven of which are patented – to support health, wellbeing and beauty. Each ingredient has been selected for its efficacy, purity, quality, bioavailability, stability and ultimately, on the results of clinical studies.

The therapeutic claims made for the product are numerous:

  • it will improve your hair, skin and nails (80% improvement in skin smoothness, 30% increase in skin moisture, 17% increase in skin elasticity, 12% reduction in wrinkle depth, 47% increase in hair strength & 35% decrease in hair loss)
  • it will support energy levels in both the body and the brain (increase in brain membrane turnover by 26% and increase brain energy by 14%),
  • it will improve cognitive function,
  • it will enhance endurance (cardiorespiratory endurance increased by 13% compared to a placebo),
  • it will improve quality of life,
  • it will improve sleep (reducing insomnia by 70%),
  • it will improve immunity,
  • it will reduce inflammation,
  • it will improve your memory,
  • it will improve osteoporosis (reduce risk of osteoporosis by 37%).

These claims are backed up by 197 clinical trials, we are being told.

If true, this would be truly sensational – but is it true?

I asked the Lyma firm for the 197 original studies, and they very kindly sent me dozens papers which all referred to the single ingredients listed above. I emailed again and asked whether there are any studies of Lyma with all its ingredients in one supplement. Then I was told that they are ‘looking into a trial on the final Lyma formula‘.

I take this to mean that not a single trial of Lyma has been conducted. In this case, how do we be sure the mixture works? How can we know that the 197 studies have not been cherry-picked? How can we be sure that there are no interactions between the active constituents?

The response from Lyma quoted the above-mentioned Dr Paul Clayton stating this: “In regard to LYMA, clinical trials at this stage are not necessary. The whole point of LYMA is that each ingredient has already been extensively trialled, and validated. They have selected the best of the best ingredients, and amalgamated them; to enable consumers to take them all in a convenient format. You can quite easily go out and purchase all the ingredients separately. They aren’t easy to find, and it would mean swallowing up to 12 tablets and capsules a day; but the choice is always yours.”

It’s kind, to leave the choice to us, rather than forcing us to spend £199 each month on the world’s first super-supplement. Very kind indeed!

Having the choice, I might think again.

I might even assemble the world’s maximally evidence-based, extra super-supplement myself, one that is supported by many more than 197 peer-reviewed papers. To not directly compete with Lyma, I could use entirely different ingredients. Perhaps I should take the following five:

  • Vitamin C (it has over 61 000 Medline listed articles to its name),
  • Vitanin E (it has over 42 000 Medline listed articles to its name),
  • Collagen (it has over 210 000 Medline listed articles to its name),
  • Coffee (it has over 14 000 Medline listed articles to its name),
  • Aloe vera (it has over 3 000 Medline listed articles to its name).

I could then claim that my extra super-supplement is supported by some 300 000 scientific articles plus 1 000 clinical studies (I am confident I could cherry-pick 1 000 positive trials from the 300 000 papers). Consequently, I would not just charge £199 but £999 for a month’s supply.

But this would be wrong, misleading, even bogus!!!, I hear you object.

On the one hand, I agree.

On the other hand, as Paul Clayton rightly pointed out: Most of the supplement market is bogus.

 

 

 

 

*If my memory serves me right, I met Paul many years ago when he was a consultant for Boots (if my memory fails me, I might need to order some Lyma).

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