I remember being a student in Munich – that was about half a century ago! – protesting against some new regulations that my University (LMU) was trying to implement. We were in the street and some placards read: “TRAUE NIEMAND UEBER 30!” (DON’T TRUST ANYONE BEYOND THE AGE OF 30!).
And now I am 75!
Do I still trust myself?
Not with everything, of course.
For instance, I would not trust myself to ski down neck-breaking slopes; nor would I trust myself to pass the medical exams again; nor to drum 3 times per week in jazz clubs.
But, generally speaking, I do manage not that badly. In particular, I think I am capable of providing (hopefully constructive) criticism and reliable information on so-called alternative medicine (SCAM), the subject that became my hobby horse in the late 1970s and subsequently my job in the early 1990s.
At my age, people often ask me about regrets.
Do I have regrets?
I used to answer this question with a straight NO.
Lately, I am realizing that this is not entirely true.
I have quite a few regrets – mostly, they are relatively trivial. But some go deeper.
Those who know my CV well often wonder “Do you not regret having left your position in Vienna?” It’s a legitimate question: in Vienna, I had a position for life, a large and well-funded department of high reputation. In Exeter, I initially had as good as nothing followed by 20 years of fighting for ever more scarce funding.
Despite all this, the positives of the last 30 years more than outweighed the negatives, in my view: I was soon able to build up a productive team of researchers; together we managed to publish some exciting and important research; and eventually, we even managed to get a reputation – depending on who you ask, a good or a bad one.
But more important for me was just being in England. I loved it! No, not the food, not the weather, but the British openness, tolerance, understatement, politeness, integrity, gentleness, and decency. Sadly, since the Brexit vote, much of this has started to slowly disappear.
Would I do it all again?
I am an incorrigible optimist convinced that the UK is presently going through a bit of a rough patch that soon will end. It’s just that, at the age of 75, I feel they better hurry up.
The birthday cake just came from Natalie Grams – thanks Natalie
About 3 years ago, I reported that the Bavarian government had decided to fund research into the question of whether the use of homeopathy would reduce the use of antibiotics (an idea that also King Charles fancies). With the help of some friends, I found further details of the project. Here are some of them:
The study on individualized homeopathic treatment to reduce the need for antibiotics in patients with recurrent urinary tract infections is a randomized, placebo-controlled, multicenter, double-blind trial. Frequent urinary tract infections (more than two infections within six months or more than three infections within twelve months) occur in up to three percent of all women during their lifetime and represent a high risk for increased antibiotic use in this population.
The current guidelines therefore also provide for therapeutic approaches without antibiotic administration under close monitoring. The approach to be investigated in the study is the administration of a homeopathic medicine individually selected for the patient for prophylaxis. The number of urinary tract infections and the need for antibiotics will be recorded and evaluated at the end of the trial period, around mid to late 2023.
The aim of the study is to find out whether patients taking homeopathics need antibiotics for the treatment of urinary tract infections less often compared to the placebo group. This could lead to a reduction in the use of antibiotics for recurrent urinary tract infections.
Project participants: Technical University of Munich, Klinikum Rechts der Isar
Project funding: 709,480.75 Euros
Project duration: January 1, 2021 to December 31, 2023
This sketch is of course not enough for providing a full evaluation of the study concept (if someone has more details, I’d be interested to learn more). From the little information given above, I feel that:
- the design of the trial might be quite rigorous,
- a fairly large sample will be required to have enough power,
- the closing date of 31/12/2023 seems optimistic (but this obviously depends on the number of centers cooperating),
- I, therefore, predict that we will have to wait a long time for the results (the pandemic and other obstacles will have delayed recruitment),
- the costs of the trial are already substantial and might increase due to delays etc.
My main criticism of the study is that:
- I see no rationale for doing such a trial,
- there is no evidence to suggest that homeopathy might prevent recurrent urinary tract infections,
- there is compelling evidence that homeopathic remedies are placebos,
- the study thus compares one placebo with another placebo (in fact, it is a classic example of what my late friend Harriet Hall would have called TOOTH FAIRY SCIENCE),
- therefore, its results will show no difference between the 2 groups (provided the trial was conducted without bias),
- if that is true, enthusiastic homeopaths will claim that the homeopathic verum was inadequate (e.g. because the homeopaths prescribing the verum did not or could not do their job properly),
- when that happens, they will therefore not stop claiming that homeopathy can reduce the over-prescribing of antibiotics;
- that means we will be exactly where we were before the trial.
In other words, the study will turn out to be a waste of 709,480.75 Euros. To express it as I did in my previous post: the Bavarian government has gone barmy!
On 20/1/2023, I conducted multiple Medline searches aimed at generating a rough idea about which areas of so-called alternative medicine (SCAM) are currently more research active than others. I searched for:
- the topic in question
- clinical trial
- publication in 2023
Here are my findings (subject area and the number of hits):
- TCM 56
- dietary supplements 47
- acupuncture 34
- integrative medicine 27
- mindfulness 26
- herbal medicine 23
- massage 10
- aromatherapy 2
- hypnotherapy 2
- osteopathy 2
- tai chi 2
- chiropractic 1
- homeopathy 0
- iridology 0
- naturopathy 0
- Reiki 0
Several caveats must be considered, of course: The searches do not include all SCAMs. The results are not precise and most of the retrieved articles are not really clinical trials (in fact, only a minority are). The numbers are low because I deliberately did this exercise early in the year.
Yet, the findings do, I think, give an indication as to the current state of SCAM research and indicate which areas are more research active than others. To put the numbers in perspective, here are a few conventional therapies for which I searched on the same day and in the same manner:
- pharmacology 539
- physiotherapy 162
- psychiatry 239
- surgery 879
I think this makes one point fairly clear: SCAM is not an impressively research-active area. Another point stems from looking at the individual articles. TCM and acupuncture articles are almost exclusively authored by Chinese researchers. While this might not be surprising, the fact that herbal medicine is similar did amaze me; about half of the papers in this category are by Chinese authors. Essentially, this suggests that more than half of the SCAM articles currently originate from China. Considering the concerns one must have about Chinese SCAM research (see for instance here and here), do you think this finding might be worrying?
The far greater worry, I feel, is the attitude of the SCAM researchers publishing their work. Glancing at these papers I did not get the impression that many approached their subject critically, In fact, most of the papers looked to me overtly promotional and of poor quality. For instance, I did not see a single paper assessing the risks of SCAM which arguably is the most important issue in SCAM research. I admit that these concerns cannot be addressed by the above simple head count; they are best dealt with by critically analyzing individual studies – a task I regularly try to tackle on this blog
In this study, the impact of a multimodal integrative oncology pre- and intraoperative intervention on pain and anxiety among patients undergoing gynecological oncology surgery was explored.
Study participants were randomized into three groups:
- Group A received preoperative touch/relaxation techniques, followed by intraoperative acupuncture, plus standard care;
- Group B received preoperative touch/relaxation only, plus standard care;
- Group C (the control group) received standard care.
Pain and anxiety were scored before and after surgery using the Measure Yourself Concerns and Wellbeing (MYCAW) and Quality of Recovery (QOR-15) questionnaires, using Part B of the QOR to assess pain, anxiety, and other quality-of-life parameters.
A total of 99 patients participated in the study: 45 in Group A, 25 in Group B, and 29 in Group C. The three groups had similar baseline demographic and surgery-related characteristics. Postoperative QOR-Part B scores were significantly higher in the treatment groups (A and B) when compared with controls (p = .005), including for severe pain (p = .011) and anxiety (p = .007). Between-group improvement for severe pain was observed in Group A compared with controls (p = .011). Within-group improvement for QOR depression subscales was observed in only the intervention groups (p <0.0001). Compared with Group B, Group A had better improvement of MYCAW-reported concerns (p = .025).
The authors concluded that a preoperative touch/relaxation intervention may significantly reduce postoperative anxiety, possibly depression, in patients undergoing gynecological oncology surgery. The addition of intraoperative acupuncture significantly reduced severe pain when compared with controls. Further research is needed to confirm these findings and better understand the impact of intraoperative acupuncture on postoperative pain.
Regular readers of my blog know only too well what I am going to say about this study.
Imagine you have a basket full of apples and your friend has the same plus a basket full of pears. Who do you think has more fruit?
Dumb question, you say?
Just as dumb, it seems, as this study: therapy A and therapy B will always generate better outcomes than therapy B alone. But that does not mean that therapy A per se is effective. Because therapy A generates a placebo effect, it might just be that it has no effect beyond placebo. And that acupuncture can generate placebo effects has been known for a very long time; to verify this we need no RCT.
As I have so often pointed out, the A+B versus B study design never generates a negative finding.
This is, I fear, precisely the reason why this design is so popular in so-called alternative medicine (SCAM)! It enables promoters of SCAM (who are not as dumb as the studies they conduct) to pretend they are scientists testing their therapies in rigorous RCTs.
The most disappointing thing about all this is perhaps that more and more top journals play along with this scheme to mislead the public!
Brillia for Children is probably the most amazing homeopathic quackery I have ever encountered:
Uses: Enhance clarity, improve concentration of attention, reduce feelings of anxiety & stress, excitability, irritability and hyperactivity to improve attention, focus and mood regulation.
Active Ingredient: Lapine S-100 immune globulin mixture of homeopathic dilutions 12C, 30C and 50C.
Brillia is a unique combination of antibody science and homeopathic formulation. The active ingredient of Brillia is antibodies to the brain-specific S100 protein (S100B). This protein is an important regulator of many different intracellular and extracellular brain processes, e.g. various enzymes activities, calcium homeostasis, communication between neurons, etc. Since almost all mental and neurological diseases as well as temporal stress-induced conditions are accompanied by disturbance of the above-mentioned processes, especially communication between neurons, the normalization of these processes is considered to be a prospective way to treat people with such undesirable conditions. Brillia is an antibody conjugated to the S100B protein and does not alter the concentration of the S100B protein in the bloodstream. Brillia’s efficacy stems from its ability to regulate the activity of the S100B protein and does not alter its concentration. In order for a protein to have an effect in the body, it needs to bind to its target, such as an enzyme. Proteins have very specific conformations that ensure that only the correct protein binds to the correct target molecule. Once the protein correctly orients itself into the active site of the target molecule, this is when the protein causes an effect in the body. When Brillia binds to the S100B protein, the overall shape of the protein is altered, hindering its ability to bind to its target molecule and thereby controlling its activity in the body. In short, Brillia stops the S100B protein from acting in the body by changing its shape, consequently regulating levels of anxiety and hyperactivity.
Inactive Ingredients: Lactose monohydrate, magnesium stearate, microcrystalline cellulose. Does not contain artiﬁcial colors or artificial ﬂavors.
Food Allergy Warning: This product contains lactose. Brillia is gluten free and nut free.
About active ingredients, the website tells us this:
Let’s start off with the active ingredient, registered with the FDA as Lapine S-100B immune globulin. Now we know this name can be intimidating, so we are going to break it down for you. Working backwards, “immune globulin” is just the “sciency” way of saying “antibody”, and don’t worry, we will get into what an antibody actually is in just a second. Next, “S-100B” is the name of the protein the antibody is designed to recognize in the body. Lastly, “Lapine” is just a descriptor of the origin of the antibody, just like the millions of other antibodies used each and every day in laboratories all across the world.
So, what exactly is an antibody? Antibodies are a naturally occurring protein and component of our immune system that are individually programmed to target a very specific protein, in the case of Brillia, the S-100B protein. It is important to understand that antibodies are one of the most specific and targeted molecules in our bodies, resulting in zero off-target effects — meaning that antibodies specifically look for and attach to their target only. This is why Brillia has no harmful side effects, because it only interacts with the S-100B protein. Not only does Brillia have absolutely zero side effects, it also has no contraindications with any other medications or supplements your child may be taking. This is due to Brillia’s extremely high level of target specificity, meaning that Brillia is so well targeted to the S-100B protein, it won’t even think about touching anything else in the body, including any other drugs or supplements.
Now that we know more about the active ingredient, let’s talk about its target, the S-100B protein.
The S-100B protein is a naturally occurring protein and is most prevalent in the brain. It is an important regulator of many processes such as regulating calcium levels and helping neurons communicate, but in our case, we care about how it influences the symptoms we mentioned earlier, such as anxiety and hyperactivity.
Given that S-100B protein influences these symptoms, it is quite intuitive that when the S-100B protein doesn’t do its job properly, these symptoms become more prevalent, and this is exactly what happens in those who suffer from anxiety, hyperactivity, stress and lack of focus.
So, what makes the S-100B protein, for a lack of a better term, mess up? The answer is quite simple, when the S-100B protein is overproduced or overactive, its activity becomes unnecessarily high, making it capable of causing these symptoms.
The firm even has something vaguely resembling evidence: a study that “shows that over the course of 12 weeks, Brillia had a significantly better effect on the severity of anxiety over those that did not take Brillia, therefore proving Brillia’s efficacy.” They show some actual results but the methods or source of the study are not disclosed. On Medline, I could not find it either. Therefore, I asked the firm to send it to me. This is the answer I got:
“Our studies were conducted in Europe and then published on our website. Please click here to view the full details found on our site.”
So, they have a study that they commissioned in Europe; it was done by researchers unnamed. The firm then put some data of it on their website. In other words:
- we don’t know who was responsible for the study;
- we cannot evaluate how rigorous it was;
- it has never been peer-reviewed;
- it is now being used for promotional purposes.
Personally, I don’t find this acceptable. In my view, this does not provide a legitimation to make far-reaching claims about the remedy. Until I have evidence to the contrary, I thus deem it safe to conclude that Brillia has no effect other than enriching the manufacturer.
Yesterday, Harriet’s many friends received the sad news of her unexpected death on 11 January. Harriet was not just a good and loyal friend, she was a tirelessly working, determined, and effective skeptic. Her work focussed on so-called alternative medicine (SCAM), and thus the two of us were on the same wavelength.
Harriet’s husband, Kirk, posted this short note about her death on social media:
I know Harriet’s work was followed and admired by many of you. It is with great sadness that I must tell you my beloved wife passed away quietly and unexpectedly in her sleep last night. At this moment, she would probably simply ask you to have a kind thought for her, be kind to each other and continue to support her belief in the truth.
I feel that, without intending to, Kirk described Harriet’s character very well. She was a quiet and kind person. Yet she inspired many, and her influence was considerable. Harriet Hall had been the founding member of skeptic organizations, author of books and countless articles, recipient of awards, author of many brilliant lectures, and much more.
Harriet and I have met in person only 2 or 3 times. But we did keep in contact and exchanged many emails. Most generously, she published reviews of most of my books and was often immeasurably supportive of my work.
Harriet Hall will be remembered by skeptics around the world for her quiet enthusiasm, her kindness, and her honesty. I will always remember her for coining an absolutely perfect term for the pseudo-research that plagues the field of SCAM:
TOOTH FAIRY SCIENCE
I lost a friend; the world lost a great skeptic.
We will all miss you, Harriet!
It is hardly surprising that I receive plenty of complaints about the things I publish. After all, so-called alternative medicine (SCAM) is dominated by emotions and not by rationality. When I was still in post at Exeter, my peers received complaints about me all the time. Now that I write articles for several newspapers and journals (not to mention this blog), the flow of complaints to the editors is continuing nicely. Consequently, I am in a good position to offer a beginner’s guide to complaining to everyone who is fed up with me and my work.
Foremost, such a complaint must have a clear structure. Here is one that I advise considering:
- Your objection
- Ad hominem
Allow me to take you through these headings one by one.
The recipient of your complaint (e.g. a newspaper editor) needs to know why you are addressing him or her. This means you ought to clearly state your aim at the outset. Something like “I am writing to you to complain about an article recently published in your paper” would probably suffice. But you probably find it hard to be concise – and who could blame you: you are fuming with anger and overflowing with emotion.
I am sure the recipient of your complaint will understand that you have to use a few colorful sentences to introduce the subject properly. If you feel like elaborating that you have been a reader of the paper since 1972, or that you slept badly last night, or that your last dinner was indigestible, or why you are opposed to COVID vaccinations – by all means, please go ahead. The editor will be delighted to receive a little background and can thus empathize with your concerns.
Despite these efforts, there is always the danger that the editor reading your complaint does not take you seriously. This must be avoided at all costs. Therefore, you must make sure he/she understands how important you truly are. As your complaint is healthcare-related, it is helpful to stress your unique standing in this area. Do not worry if you have not studied medicine, are not a scientist, or understand buggar all about anything. The least you must do is to state that you have years of experience in health. Such phraseology is non-commital – after all, you probably have been ill once or twice – and it makes it clear that you know what you are talking about.
Now it is time to state what you actually object to and why. This might not be as easy as it sounds. Most people who complain about my work are unable to pinpoint what exactly it is that they don’t like. They never dispute a concrete fact or finding I presented but they disagree with my stance in general terms. Therefore, they cannot define a precise error or misinterpretation in my text. In such cases, it might be best to claim that you have read several or all of my articles and you are scandalized by my general attitude, ignorance, or malice. You might add that my articles systematically defame SCAMs that:
- have clearly stood the test of time,
- are used by millions,
- are holistic,
- have cured your goldfish, etc.
Do never include any actual data in your complaint. This can only expose you to criticism; and that’s the last thing you want to achieve.
The less specific material you complain about, the more important it is to display true conviction by going on a personal attack. I can highly recommend the ad hominem principle for this purpose. Go for it!
In a previous post, I listed some ideas that might help you here. You could claim that:
- I am not qualified
- I only speak tosh
- I do not understand science
- I never did any ‘real’ research
- Exeter Uni fired me
- I have been caught red-handed (not quite sure at what)
- I am on BIG PHARMA’s payroll
- I faked my research papers
Feel free to come up with your own ideas; use your imagination. I am sure the editor who reads your inspired lines will thank you for it.
Now that you have thoroughly dealt with me (Prof Ernst) as a person, you need to generalize in order to lend more relevance and impact to your complaint. You could point out, for example, that not just I but all scientists or skeptics are corrupt, ignorant, etc. Or you might explain that, in any case, science is over-rated and cannot be trusted. Such enlightened remarks are important because they put things into perspective and show that you are well-informed.
To end your letter, it is advisable to ensure that the editor who is trying to make sense of your complaint cannot dismiss it easily. For this purpose, I find it helpful to add a few actual threats. The editor needs to know that he would disregard your concerns at his own peril.
For instance, you could state that, if this paper/journal in question should dare to ever again publish a single line of Ernst’s writings, you will never again buy this publication. If you want to sound alarmingly dangerous, add that you will tell all your friends to do likewise. And if you wish to scare the hell out of the poor editor, tell him/her that you will file a report with the ombudsman.
I have tried!
But at present, it is simply not possible to escape the revelations and accusations by Harry Windsor.
So, eventually, I gave in and had a look at the therapy he often refers to. He claims that he is deeply traumatized by what he had to go through and, to help him survive the ordeal, Harry has been reported to use EMDR.
Eye Movement Desensitization and Reprocessing (EMDR) is a fringe psychotherapy that was developed to alleviate the distress associated with traumatic memories. It is supposed to facilitate the accessing and processing of traumatic memories and other adverse life experiences with a view of bringing these to an adaptive resolution. The claim is that, after successful treatment with EMDR therapy, affective distress is relieved, negative beliefs are reformulated, and physiological arousal is reduced.
During EMDR therapy the patient must attend to emotionally disturbing material in brief sequential doses while simultaneously focusing on an external stimulus. Therapist-directed lateral eye movements are commonly used as external stimulus but a variety of other stimuli including hand-tapping and audio stimulation can also be employed.
Francine Shapiro, the psychologist who invented EMDR claims to have serendipitously discovered this technique by experiencing spontaneous saccadic eye movements in response to disturbing thoughts during a walk in the woods. Yet, as GM Rosen explains, this explanation is difficult to accept because normal saccadic eye movements appear to be physiologically undetectable and are typically triggered by external stimuli.
Shapiro hypothesizes that EMDR therapy facilitates the access to the traumatic memory network, so that information processing is enhanced, with new associations forged between the traumatic memory and more adaptive memories or information. These new associations are alleged to result in complete information processing, new learning, elimination of emotional distress, and development of cognitive insights.
EMDR therapy uses a three-pronged protocol:
- (1) the past events that have laid the groundwork for dysfunction are processed, forging new associative links with adaptive information;
- (2) the current circumstances that elicit distress are targeted, and internal and external triggers are desensitized;
- (3) imaginal templates of future events are incorporated, to assist the client in acquiring the skills needed for adaptive functioning.
The question I ask myself is, of course: Does EMDR work?
The evidence is mixed and generally flimsy. A systematic review showed that “limitations to the current evidence exist, and much current evidence relies on small sample sizes and provides limited follow-up data”.
What might be particularly interesting in relation to Harry Windsor is that EMDR techniques have been associated with memory-undermining effects and may undermine the accuracy of memory, which can be risky if patients, later on, serve as witnesses in legal proceedings.
Personally, I think that Harry’s outbursts lend support to the hypothesis that EMDR is not effective. In the interest of the royal family, we should perhaps see whether so-called alternative medicine (SCAM) does offer an effective treatment against navel gazing?
It has been reported that a German consumer association, the ‘Verbraucherzentrale NRW’, has first cautioned the manufacturer MEDICE Arzneimittel Pütter GmbH & Co. and then sued them for misleading advertising statements. The advertisement in question gave the wrong impression that their homeopathic remedy MEDITONSIN would:
- for certain generate a health improvement,
- have no side effects,
- be superior to “chemical-synthetic drugs”.
The study used by the manufacturer in support of such claims was not convincing according to the Regional Court of Dortmund. The results of a “large-scale study with more than 1,000 patients” presented a pie chart indicating that 90% of the patients were satisfied or very satisfied with the effect of Meditonsin. However, this was only based on a “pharmacy-based observational study” with little scientific validity, as pointed out by the consumer association. Despite the lack of evidence, the manufacturer claimed that their study “once again impressively confirms the good efficacy and tolerability of Meditonsin® Drops”. The Regional Court of Dortmund disagreed with the manufacturer and agreed with the reasoning of the consumer association.
“It is not permitted to advertise with statements that give the false impression that a successful treatment can be expected with certainty, as suggested by the advertising for Meditonsin Drops,” emphasizes Gesa Schölgens, head of “Faktencheck Gesundheitswerbung,” a joint project of the consumer centers of North Rhine-Westphalia and Rhineland-Palatinate. According to German law, this is prohibited. In addition, the Regional Court of Dortmund considered consumers to be misled by the advertising because the false impression was created that no harmful side effects are to be expected when Meditonsin Drops are taken. The package insert of the drug lists several side effects, according to which there could even be an initial worsening of symptoms after taking the drug.
The claim of advantages of the “natural remedy” represented by the manufacturer in comparison with “chemical-synthetic medicaments, which merely suppress the symptoms”, was also deemed to be inadmissible. Such comparative advertising is inadmissible.
This ruling is, I think, interesting in several ways. The marketing claims of so-called alternative medicine (SCAM) products seem all too often not within the limits of the laws. One can therefore hope that this case might inspire many more legal cases against the inadmissible advertising of SCAMs.
You, the readers of this blog, have spoken!
The WORST PAPER OF 2022 competition has concluded with a fairly clear winner.
To fill in those new to all this: over the last year, I selected articles that struck me as being of particularly poor quality. I then published them with my comments on this blog. In this way, we ended up with 10 papers, and you had the chance to nominate the one that, in your view, stood out as the worst. Votes came in via comments to my last post about the competition and via emails directly to me. A simple count identified the winner.
It is PAUL VARNAS, DC, a graduate of the National College of Chiropractic, US. He is the author of several books and has taught nutrition at the National University of Health Sciences. His award-winning paper is entitled “What is the goal of science? ‘Scientific’ has been co-opted, but science is on the side of chiropractic“. In my view, it is a worthy winner of the award (the runner-up was entry No 10). Here are a few memorable quotes directly from Paul’s article:
- Most of what chiropractors do in natural health care is scientific; it just has not been proven in a laboratory at the level we would like.
- In many ways we are more scientific than traditional medicine because we keep an open mind and study our observations.
- Traditional medicine fails to be scientific because it ignores clinical observations out of hand.
- When you think about it, in natural health care we are much better at utilizing the scientific process than traditional medicine.
But I am surely doing Paul an injustice. To appreciate his article, please read his article in full.
I am especially pleased that this award goes to a chiropractor who informs us about the value of science and research. The two research questions that undoubtedly need answering more urgently than any other in the realm of chiropractic relate to the therapeutic effectiveness and risks of chiropractic. I just had a quick look in Medline and found an almost complete absence of research from 2022 into these two issues. This, I believe, makes the award for the WORST PAPER OF 2022 all the more meaningful.
Yesterday, I wrote to Paul informing him about the good news (as yet, no reply). Once he provides me with a postal address, I will send him a copy of my recent book on chiropractic as his well-earned prize. I have also invited him to contribute a guest post to this blog. Watch this space!