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

quackery

Homeopathy for depression? A previous review concluded that the evidence for the effectiveness of homeopathy in depression is limited due to lack of clinical trials of high quality. But that was 13 years ago. Perhaps the evidence has changed?

A new review aimed to assess the efficacy, effectiveness and safety of homeopathy in depression. Eighteen studies assessing homeopathy in depression were included. Two double-blind placebo-controlled trials of homeopathic medicinal products (HMPs) for depression were assessed.

  • The first trial (N = 91) with high risk of bias found HMPs were non-inferior to fluoxetine at 4 and 8 weeks.
  • The second trial (N = 133), with low risk of bias, found HMPs was comparable to fluoxetine and superior to placebo at 6 weeks.

The remaining research had unclear/high risk of bias. A non-placebo-controlled RCT found standardised treatment by homeopaths comparable to fluvoxamine; a cohort study of patients receiving treatment provided by GPs practising homeopathy reported significantly lower consumption of psychotropic drugs and improved depression; and patient-reported outcomes showed at least moderate improvement in 10 of 12 uncontrolled studies. Fourteen trials provided safety data. All adverse events were mild or moderate, and transient. No evidence suggested treatment was unsafe.

The authors concluded that limited evidence from two placebo-controlled double-blinded trials suggests HMPs might be comparable to antidepressants and superior to placebo in depression, and patients treated by homeopaths report improvement in depression. Overall, the evidence gives a potentially promising risk benefit ratio. There is a need for additional high quality studies.

I beg to differ!

What these data really show amounts to far less than the authors imply:

  • The two ‘double-blind’ trials are next to meaningless. As equivalence studies they were far too small to produce meaningful results. Any decent review should discuss this fact in full detail. Moreover, these studies cannot have been double-blind, because the typical adverse-effects of anti-depressants would have ‘de-blinded’ the trial participants. Therefore, these results are almost certainly false-positive.
  • The other studies are even less rigorous and therefore do also not allow positive conclusions.

This review was authored by known proponents of homeopathy. It is, in my view, an exercise in promotion rather than a piece of research. I very much doubt that a decent journal with a responsible peer-review system would have ever published such a biased paper – it had to appear in the infamous EUROPEAN JOURNAL OF INTEGRATIVE MEDICINE.

So what?

Who cares? No harm done!

Again, I beg to differ.

Why?

The conclusion that homeopathy has a ‘promising risk/benefit profile’ is frightfully dangerous and irresponsible. If seriously depressed patients follow it, many lives might be lost.

Yet again, we see that poor research has the potential to kill vulnerable individuals.

Chiropractic is a therapy that has been in search for an indication ever since it was invented some 120 years ago. So far, this search seems to have been unsuccessful.

Perhaps it could be promoted as a means of enhancing athletic performance?

That would be excellent news for chiropractic cash-flow!

The authors of this study wanted to analyse the acute effects of spinal manipulative therapy (SMT) on performance and autonomic modulation. A total of 37 male recreational athletes who had never received SMT were assigned to a sham (n = 19) or actual SMT group (n = 18). Study endpoints included autonomic modulation (heart rate variability), handgrip strength, jumping ability and cycling performance (8-minute time trial [TT]). Differences in custom effects between interventions were determined using magnitude-based inferences.

A significant and very likely lower value of a marker of sympathetic modulation, the stress score, was observed in response to actual compared to sham SMT (p = 0.007; effect size [ES] = -0.97). A trend towards a significant and likely lower sympathetic:parasympathetic ratio (p = 0.055; ES = -0.96) and a likely higher natural logarithm of the root-mean-square differences of successive heartbeat intervals ([LnRMSSD], p = 0.12; ES = 0.36) was also found with actual SMT. Moreover, a significantly lower mean power output was observed during the TT with actual compared with sham SMT (p = 0.035; ES = -0.28). Non-significant (p > 0.05) and unclear or likely trivial differences (ES < 0.2) were found for the rest of endpoints, including handgrip strength, heart rate during the TT, and jump loss thereafter.

A single pre-exercise SMT session induced an acute shift towards parasympathetic dominance and slightly impaired performance in recreational healthy athletes.

Ooops!

The search was unsuccessful yet again!

SMT impaired performance; this might not convince athletes to become fans of chiropractic.

What indication should the desperate chiros try next?

Any suggestions?

Acupuncture research does not have a good name; if it originates from China, even less so.

And this note in ‘ACUPUNCTURE IN MEDICINE’ is not likely to change this image:

Fang J, Keller CL, Chen L, et al. Effect of acupuncture and Chinese herbal medicine on subacute stroke outcomes: a single-centre randomised controlled trial. Acupuncture in Medicine Published online first 10 November 2017. doi: 10.1136/acupmed-2016-011167.

This article is retracted by the Editor-in-Chief on grounds of redundant publication.

The above article reports that a trial originally planned to be carried out at three hospitals was reduced to a single centre for reasons of cost. This is incorrect. The full three-centre trial was run and reported elsewhere (Scientific Reports 6, Article number: 25850 (2016) DOI: 10.1038/srep25850).

The Scientific Reports paper was accepted for publication prior to submission of the above paper to Acupuncture in Medicine. The third author takes responsibility for the mistake. All authors have agreed to this retraction.

The abstract of the paper in SCIENTIFIC REPORTS is here:

To determine whether integrative medicine rehabilitation (IMR) that combines conventional rehabilitation (CR) with acupuncture and Chinese herbal medicine has better effects for subacute stroke than CR alone, we conducted a multicenter randomized controlled trial that involved three hospitals in China. Three hundred sixty patients with subacute stroke were randomized into IMR and CR groups. The primary outcome was the Modified Barthel Index (MBI). The secondary outcomes were the National Institutes of Health Stroke Scale (NIHSS), the Fugl-Meyer Assessment (FMA), the mini-mental state examination (MMSE), the Montreal Cognitive Assessment (MoCA), Hamilton’s Depression Scale (HAMD), and the Self-Rating Depression Scale (SDS). All variables were evaluated at week 0 (baseline), week 4 (half-way of intervention), week 8 (after treatment) and week 20 (follow-up). In comparison with the CR group, the IMR group had significantly better improvements (P < 0.01 or P < 0.05) in all the primary and secondary outcomes. There were also significantly better changes from baseline in theses outcomes in the IMR group than in the CR group (P < 0.01). A low incidence of adverse events with mild symptoms was observed in the IMR group. We conclude that conventional rehabilitation combined with integrative medicine is safe and more effective for subacute stroke rehabilitation.

I find all this odd in several ways:

  • The publication of the ACUPUNCTURE IN MEDICINE article does not seem to have been a ‘mistake‘ but plain scientific fraud, in my view.
  • The paper in SCIENTIFIC REPORTS (SR) was published in May 2016. Therefore the reviewers and editor of AIM could and should have spotted the fraud.
  • In the SR paper, the authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. As the authors were affiliated to three different departments of acupuncture, I feel this to be debatable.

What do you think?

The ‘Schwaebische Tageblatt’ is not on my regular reading list. But this article of yesterday (16/10/2018) did catch my attention. For those who read German, I will copy it below, and for those who don’t I will provide a brief summary and comment thereafter:

Die grün-schwarze Landesregierung lässt 2019 den ersten Lehrstuhl für Naturheilkunde und Integrative Medizin in Baden-Württemberg einrichten. Lehrstuhl für Naturheilkunde und Integrative Medizin

Ihren Schwerpunkt soll die Professur im Bereich Onkologie haben. Strömungen wie Homöopathie oder Anthroposophie sollen nicht gelehrt, aber innerhalb der Lehre beleuchtet werden, sagte Ingo Autenrieth, Dekan der Medizinischen Fakultät in Tübingen am Dienstag der Deutschen Presse-Agentur. «Ideologien und alles, was nichts mit Wissenschaft zu tun hat, sortieren wir aus.»

Die Professur soll sich demnach mit Themen wie Ernährung, Probiotika und Akupunktur beschäftigten. Geplant ist laut Wissenschaftsministerium, die Lehre in Tübingen anzusiedeln; die Erforschung der komplementären Therapien soll vorwiegend am Centrum für Tumorerkrankungen des Robert-Bosch-Krankenhauses in Stuttgart stattfinden. Die Robert-Bosch-Stiftung finanziert die Professur in den ersten fünf Jahren mit insgesamt 1,84 Millionen Euro, danach soll das Land die Mittel dafür bereitstellen.

«Naturheilkunde und komplementäre Behandlungsmethoden werden von vielen Menschen ganz selbstverständlich genutzt, beispielsweise zur Ergänzung konventioneller Therapieangebote», begründete Wissenschaftsministerin Theresia Bauer (Grüne) das Engagement. Sogenannte sanfte oder natürliche Methoden könnten schwere Krankheiten wie etwa Krebs alleine nicht heilen, heißt es in einer Mitteilung des Ministeriums. Wissenschaftliche Ergebnisse zeigten aber, dass sie häufig zu Therapieerfolgen beitragen könnten, da sie den Patienten helfen, schulmedizinische Therapien gut zu überstehen – etwa die schweren Nebenwirkungen von Chemotherapien mindern.

Im Gegensatz zur Schulmedizin gebe es bisher aber kaum kontrollierte klinische Studien zur Wirksamkeit solcher Therapien, ergänzte Ingo Autenrieth. Ihre Erforschung am neuen Lehrstuhl solle Patienten Sicherheit bringen und ermöglichen, dass die gesetzlichen Krankenkassen die Kosten dafür übernehmen.

Hersteller alternativer Arzneimittel loben den Schritt der Politik. «Baden-Württemberg nimmt damit eine Vorreiterrolle in Deutschland und in Europa ein», heißt es beim Unternehmen Wala Heilmittel GmbH in Bad Boll. Die Landesregierung trage mit der Entscheidung dem Wunsch vieler Patienten und Ärzte nach umfassenden Behandlungskonzepten Rechnung.

Auch hoffen die Unternehmen, dass Licht in die oft kritische Debatte um Homöopathie gebracht wird. «Wir sehen mit Erstaunen und Befremden, dass eine bewährte Therapierichtung wie die Homöopathie, die Teil der Vielfalt des therapeutischen Angebots in Deutschland ist, diskreditiert werden soll», sagte ein Sprecher des Herstellers Weleda AG mit Sitz in Schwäbisch Gmünd der Deutschen Presse-Agentur. Deshalb begrüße man den Lehrstuhl: «Es ist gut, dass Forschung und Lehre ausgebaut werden, da eine Mehrheit der Bevölkerung Komplementärmedizin wünscht und nachfragt. Es braucht Ärzte, die in diesen Bereichen auch universitär ausgebildet werden.»

Laut Koalitionsvertrag will Baden-Württemberg künftig eine Vorreiterrolle in der Erforschung der Komplementärmedizin einnehmen. Bisher gab es im Südwesten mit dem Akademischen Zentrum für Komplementäre und Integrative Medizin (AZKIM) zwar einen Verbund der Unikliniken Tübingen, Freiburg, Ulm und Heidelberg, aber keinen eigenen Lehrstuhl. Bundesweit existieren nach Angaben der Hufelandgesellschaft, dem Dachverband der Ärztegesellschaften für Naturheilkunde und Komplementärmedizin, Lehrstühle für Naturheilkunde noch an den Universitäten Duisburg-Essen, Rostock und Witten/Herdecke sowie drei Stiftungsprofessuren an der Berliner Charité.

END OF QUOTE

And here is my English summary:

The black/green government of Baden-Wuerttemberg has decided to create a ‘chair of naturopathy and integrated medicine’ at the university of Tuebingen in 2019. The chair will focus in the area of oncology. Treatments such as homeopathy and anthroposophical medicine will not be taught but merely mentioned in lectures. Ideologies and everything that is not science will be omitted.

The chair will thus deal with nutrition, acupuncture and probiotics. The teaching activities will be in the medical faculty at Tuebingen, while the research will be located at the Robert-Bosch Hospital in Stuttgart. The funds for the first 5 years – 1.84 million Euro – will come from the Robert-Bosch Foundation; thereafter they will be provided by the government of the county.

So-called gentle or natural therapies cannot cure serious diseases on their own, but as adjuvant treatments they can be helful, for instance, in alleviating the adverse effects of chemotherapy. There are only few studies on this, and the new chair will increase patient safety and facilitate the reimbursement of these treatments by health insurances.

Local anthroposophy manufacturers like Wala welcomed the move stating it would be in accordance with the wishes of many patients and doctors. They also hope that the move will bring light in the current critical debate about homeopathy. A spokesperson of Weleda added that they ‘note with surprise that time-tested therapies like homeopathy are being discredited. Therefore, it is laudable that research and education in this realm will be extended. The majority of the public want complementary medicine and need doctors who are also university-trained.’

Baden-Wurttemberg aims for a leading role in researching complementary medicine. Thus far, chairs of complementary medicine existed only at the universities of Duisburg-Essen, Rostock und Witten/Herdecke as well as three professorships at the Charité in Berlin.

END OF MY SUMMARY

As I have occupied a chair of complementary medicine for 19 years, I am tempted to add a few points here.

  • In principle, a new chair can be a good thing.
  • The name of the chair is odd, to say the least.
  • As the dean of the Tuebingen medical school pointed out, it has to be based on science. But how do they define science?
  • Where exactly does the sponsor, the Robert-Bosch Stiftung, stand on alternative medicine. Do they have a track-record of being impractical and scientific?
  • In order to prevent this becoming a unrealistic prospect, it is essential that the new chair needs to fall into the hands of a scientist with a proven track record of critical thinking.
  • Rigorous scientist with a proven track record of critical thinking are very rare in the realm of alternative medicine.
  • The ridiculous comments by Wala and Weleda, both local firms with considerable local influence, sound ominous and let me suspect that proponents of alternative medicine aim to exert their influence on the new chair.
  • The above-voiced notion that the new chair is to facilitate the reimbursement of alternative treatments by the health insurances seems even more ominous. Proper research has to be objective and could, depending on its findings, have the opposite effect. To direct it in this way seems to determine its results before the research has started.
  • I miss a firm commitment to medical ethics, to the principles of EBM, and to protecting the independence of the new chair.

Thus, I do harbour significant anxieties about this new chair. It is in danger of becoming a chair of promoting pseudoscience. I hope the dean of the Tuebingen medical school might read these lines.

I herewith offer him all the help I can muster in keeping pseudoscience out of this initiative, in defining the remit of the chair and, crucially, in finding the right individual for doing the job.

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.

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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.

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