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

research

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Jennifer Jacobs started publishing peer-reviewed papers on homeopathy in the early 1990s. This happens to be around the same time as I did. So, we both have about 30 years of research into homeopathy behind us.

Jennifer just authored a paper entitled “Thirty Years of Homeopathic Research – Lessons Learned“. Here is its abstract:

Conducting double-blind randomized controlled trials is difficult, even in the allopathic medical system. Doing so within the paradigm of classical homeopathy is even more challenging. More than thirty years of experience in carrying out such trials has taught me much about the pitfalls to avoid as well as the factors that can lead to success. The initial steps of putting together a research protocol, securing funding, and obtaining human subjects’ approval can be daunting. After that comes developing questionnaires and surveys, hiring study personnel, and recruitment of subjects. The actual implementation of the research comes with its own set of possible missteps. Sample size determination, entry criteria, as well as type, frequency and duration of treatment are all crucial. Finally, statistical analysis must be performed to a high standard and a manuscript prepared to submit for publication. Even then there can be one or more manuscript revisions to make, based on feedback from reviewers, before a study is actually published. The entire process can take at least two years and is usually much longer.

Mistakes at any one of these steps can damage the outcome, as well as the impact of the study. With examples from my body of research, I will discuss some of the things that I wish I had done differently, as well as those that turned out to be correct. Homeopathic research is held to a much higher standard than conventional trials. Any flaws in study design, implementation, and analysis can be used by critics to negate the results. I am hopeful that the next generation of homeopathic researchers will learn from my experiences and carry on with great success.

Jennifer’s example motivated me to follow suit and contribute some very brief thoughts about my 30 years of homeopathy research and the lessons I have learnt:

  Conducting double-blind randomized controlled trials is difficult in any area of medicine. Yet these types of studies are by far the best way to find out which treatments work and which don’t. Therefore, they need doing, regardless of the obstacles they may pose.

In homeopathy, we now have a large body of such trials. Sadly, not all of them are reliable. Those that are, according to accepted criteria, tend to fail to show that homeopathy works better than a placebo. Understandably, homeopaths are disappointed with this overall result and have made numerous attempts to invalidate it.

The main problem with research into homeopathy is not the research methodology. It is well established for clinical trials and can be easily modified to fit all the demands made by individualised treatment or other pecularities that may apply to homeopathy. The main problem is the homeopath who finds it impossible to accept the truth, namely that highly diluted homeopathic remedies are pure placebos and any observed benefits of homeopathy are due to non-specific effects such as the empathetic encounter or a placebo response.

The lesson to be learned from the past is that, in medicine, even the most obsessive belief, conviction or wishful thinking will eventually have to give way to the scientific evidence. In the case of homeopathy, this process has taken an extraordinary amount of time and effort but, finally, we are almost there and the writing is on the wall for everyone to see.

Two resumes of 30 years of work, research and experience!

And what a difference between them!

Who do you think gets closer to the truth,

Jennifer or I?

I have been called just about everything during my professional life (not to mention the private one). Yesterday, a new addition arrived: a German psychologist who chose to misunderstand a re-Tweet (or is that re-X these days?), Sebastian Bartoschek, implied I am an anti-Semite.

My re-Tweet quoted without any comment by me a Holocaust survivor stating “The Nazis made me afraid to be a Jew, and the Israelis made me ashamed to be a Jew”.

My re-Tweet was meant to make people reflect critical about the horrendous atrocities that is currently happening in Gaza. However, Bartoschek decided it was anti-semitism and demanded I explain myself. As I had previously had an unpleasantly unproductive encounter over an entirely different matter with him, I did not quite see why I should comply to the wishes of this guy. What followed was a rather ridiculous triade by Bartoschek. It included him alerting DIE WELT that someone who sometimes writes for the paper propagates anti-semitism.

A third party (I don’t know who) must have suggested that this amounts to denunciation. Bartoschek replied: “If asking someone why they share anti-Semitic content is denunciation for you, then so be it.” Eventually he sent me this Tweet:

To EdzardErnst – I’ll wait until 11 a.m. tomorrow, Sunday, for a statement. After that, I’ll write about it without it.

This is why I feel that I am blackmailed. Either I explain what I feel is too obvious to explain, or he will write about the matter in what can be expected to be a defaming way.

Well, I prefer to write about it myself by stating categorically that I am definitely not an anti-semite. What is more, I can prove it. I have since many years published numerous articles (around 30, I guess) that make my position entirely clear; to mention just three:

So, now it will be great fun to see whether Bartoschek has lost his marbles and what version of the truth he will tell in his own write-up of the story.

WATCH THIS SPACE.

 

A recent post of mine started an interesting discussion about the research of the NCCIH. Richard Rasker made the following comment:

The NCCIH was initially established as the Office for Alternative Medicine (OAM) for mostly the same reason that Edzard’s department at Exeter was founded, i.e. to study alternative modalities, and determine once and for all which ones were effective and which ones weren’t. Unfortunately, OAM and its subsequent incarnations were taken over by SCAM proponents almost right away, with its core mission changed into validating (NOT ‘studying’) SCAM modalities – a small but crucial difference that will all but guarantee that even long-obsolete and totally ineffective quackery will continue to be ‘researched’ and promoted.

So what’s the score now, after more than 30 years and well over 4 billion dollars in taxpayers’ money? How many SCAM modalities have they managed to ‘validate’, i.e. definitively proven to be effective? The answer is: none, for all intents and purposes. Even their research into herbal medicine – one of the most effective (or should I say: least ineffective) SCAMs out there – is best described as woefully lacking. Their list of herbs and plants names just 55 species of plants, and the individual descriptions are mostly to the tune of ‘a lot of research was done, but we can’t say anything definite’.

I think I can contribute meaningfully to this important comment and topic. Several years ago, my Exeter team – together with several other researches – systematically reviewed the NCCIH (formerly NCCAM)-sponsored clinical trials. Specifically, we focussed on 4 different subject areas. Here are the conclusions of our articles reporting the findings:

      1. ACUPUNCTURE

Seven RCTs had a low risk of bias. Numerous methodological shortcomings were identified. Many NCCAM-funded RCTs of acupuncture have important limitations. These findings might improve future studies of acupuncture and could be considered in the ongoing debate regarding NCCAM-funding. [Focus on Alternative and Complementary Therapies Volume 17(1) March 2012 15–21]

       2. HERBAL MEDICINE

This independent assessment revealed a plethora of serious concerns related to NCCAM studies of herbal medicine. [Perfusion 2011; 24: 89-102]

       3. ENERGY MEDICINE

In conclusion, the NCCAM-funded RCTs of energy medicine are prime examples of misguided investments into research. In our opinion, NCCAM should not be funding poor-quality studies of implausible practices. The impact of any future studies of energy medicine would be negligible or even detrimental. [Focus on Alternative and Complementary Therapies Volume 16(2) June 2011 106–109 ]

       4. CHIROPRACTIC

In conclusion, our review demonstrates that several RCTs of chiropractic have been funded by the NCCAM. It raises numerous concerns in relation to these studies; in particular, it suggests that many of these studies are seriously flawed. [https://www.ncbi.nlm.nih.gov/pubmed/21207089]

The overall conclusion that comes to my mind is this:

The NCCIH has managed to spend more money on SCAM research than any other institution in the world (in the 20 years that I ran the Exeter research unit, we spent around £2 million in total). The NCCIH has wasted precious funds on plenty of dubious studies; arguably, this is unethical. It has misappropriated its role from testing to validating SCAMs. And it has validated none.

PS

As some of the above-cited papers are not easily accessible, I offer to send copies to interested individuals on request.

A recent post of mine seems to have galvanized concerns about my image and general attitude towards so-called alternative medicine (SCAM). Here are the comments I am referring to:

Hanjo Lehmann

…you should take care of your image: not being a man who just hates anything that smells like “alternative medicine” but rather an experienced scientist and physician who sees things with appropriate skepticism.

Eelco_G

Edzard preaches for his own parish and does not reach the people he would like to reach. A little more wisdom and ability to put things into perspective would earn him much more respect.

Mike Grant

Hanjo made some valid points Edzard. Perhaps you should suppress your ego?

Socrates

If you want to persuade people it’s not enough just to be right. There are times to be antagonistic and times to be more understanding. And sweeping generalisations can get people’s backs up unnecessarily.

Please allow me to take this opportunity to explain my attitude, motivation, image, etc. a little better.

After SCAM and SCAM-research had previously been a mere hobby of mine, I took the Exeter chair in ‘complementary medicine’ in 1993. Ever since, I spent my time studying the subject. Between 1993 and 2012, I headed the worldwide most productive department of SCAM research. My team published several books for healthcare professionals and well over 1 000 peer-reviewed papers on SCAM. I personally gave about 500 lectures on SCAM to all sorts of audiences all over the world. None of these books, papers, lectures, etc. are in any way dismissive of SCAM. They are, I hope, rigorously scientific.

What I am trying to point out is this: for 20 odd years I have done more that anyone else to persuade, to be understanding, to promote sound evidence, to abstain from opinion, to suppress my “ego”, to reach people interested in SCAM, to see things with “appropriate skepticism”, to be polite, to avoid stepping on anyone’s toes, to be politically correct – while conducting the best science that the circumstances allowed.

What did it get me?

Was my work acclaimed by the SCAM community?

No.

Did my research receive the funding I had been promised?

No.

Did I manage to persuade the SCAM-community to think more critically?

No.

Did even my own university show any appreciation?

No, more than once, my peers even tried to influence the nature and/or direction of my research.

In 2012, I retired from my Exeter post because Charles’ intervention had been allowed to completely destroy my department.

Was I disappointed?

Yes, the only department worldwide that independently and critically investigated SCAM had ceased to exist. This certainly is disappointing!

Was I bitter?

No, on the contrary, I had voluntarily taken the decision to retire and I soon felt relieved to no longer have anyone breathing down my neck. I was looking forward to carrying on my work, free of the pressures and irritating voices trying to tell me what outcomes were expected of me. I was delighted to be free of the tedious task to fund-raise. I was happy to be relieved of all the tedious amount of admin.

Now, more than 10 years later, my work gives me great fun every day and often laugh tears about certain aspects of SCAM. Those who think or hope that I am a bitter old fool I must disappoint bitterly.

After retiring, I wrote a series of books and started this blog. On the very first post, dated 14/10/2012, I explained my decision:

Why another blog offering critical analyses of the weird and wonderful stuff that is going on in the world of alternative medicine? The answer is simple: compared to the plethora of uncritical misinformation on this topic, the few blogs that do try to convey more reflected, sceptical views are much needed; and the more we have of them, the better.

I am telling you all this to explain that

  • I have little patience with people who feel compelled to tell me what to do.
  • For me a blog is something entirely different than a peer-reviewed paper – the former is written quickly and tends to be be light-hearted, ironic, sarcastic, provocative, exaggerated, journalistic, etc., while the latter usually is carefully worded, scientific and bone-dry.
  • With my blog, I try to create an entertaining counterbalance to the plethora of uncritical misinformation on SCAM.
  • Therefore, I am deliberately critical of SCAM.
  • I do not hate anyone or anything.
  • I am not in the slightest concerned about my image.
  • I know very well what I am doing and quite confident that, during the last 30 years, I have reflected on issues around SCAM more deeply than most.

So, to those who still are concerned about my image or my approach to SCAM I say THANKS for your advice – but no thanks. And of those who doubt my science I ask, please study my peer-reviewed papers.

PS

Of course, none of this means that I make no mistakes, or that am not frequently troubled by self-doubt. So, please do carry on criticising me and my work, but don’t assume that I worry about my image.

As we have often discussed on this blog, chiropractic spinal manipulations can lead to several complications and can result in vascular injury, including traumatic dissection of the vertebral arteries with often dire consequences – see, for instance, here:

 

This recent paper is a most unusual addition to the list. It is a case report of a 43-year-old woman who was admitted to the emergency department after performing a self-chiropractic spinal manipulation. She experienced headache and vomiting and was unresponsive with severe hypertension at the time of hospital admission. Clinical computerized tomography angiography showed narrowing of the right vertebral artery but was inconclusive for dissection or thrombosis.

The patient died a short while later. At autopsy, subacute dissection of the right vertebral artery was identified along with cerebral edema and herniation. A small peripheral pulmonary thromboembolism in the right lung was also seen. Neuropathology consultation confirmed the presence of diffuse cerebral edema and acute hypoxic-ischemic changes, with multifocal acute subarachnoid and intraparenchymal hemorrhage of the brain and spinal cord.

The authors concluded that this case presents a unique circumstance of a fatal vertebral artery dissection after self-chiropractic manipulation that, to the best of our knowledge, has not been previously described in the medical literature.

Medical Acupuncture is the name of a quarterly journal published for the ‘American Academy of Medical Acupuncture’ that publishes around 60 pro-acupuncture articles every year. Its editor is Richard C. Niemtzow, M.D., Ph.D., M.P.H. Richard is a retired US Air Force colonel who was the first full-time physician acupuncturist in the US Armed Forces. He is probably best known for his invention called ‘BATTLE FIELD ACUPUNCTURE’, a form of ear-acupuncture allegedly reducing pain in emergency situations.

Medline lists 79 papers (mostly published in 3rd class journals such as ‘Medical Acupuncture’) in Niemtzow’s name. Only one of them – 21 years ago – was a clinical trial. Here it is:

Purpose: We performed a pilot trial to assess the response of lower urinary tract symptoms and prostate specific antigen (PSA) to acupuncture in a population of patients biopsy negative for prostate cancer.

Materials and methods: A total of 30 patients were randomly assigned to 1 of 3 study groups, including observation for 3 months with 6 blood samples for PSA at set intervals, 9 sessions of acupuncture in 3 months to points of the kidney-bladder distinct meridian expected to treat the prostate with 6 blood samples for PSA at set intervals and 9 sessions of acupuncture in 3 months to points not expected to treat the prostate with 6 blood samples for PSA at set intervals. The effect of acupuncture on lower urinary tract symptoms was assessed monthly using the International Prostate Symptom Score.

Results: Trend analysis (repeated measures ANOVA) revealed no significant changes in the 3-month period in the randomized arms. Statistical analysis showed p = 0.063 for the International Prostate Symptom Score, p = 0.945 for PSA and p = 0.37 for the free-to-total PSA ratio.

Conclusions: Acupuncture to the kidney-bladder distinct meridian neither relieves lower urinary tract symptoms nor impacts PSA.

Yes, an acupuncture study with a negative result!

Niemtzow has, as far as I can see, never himself conducted a study of ‘battle field acupuncture’. In fact, there only very few trials of ‘battle field acupuncture‘. The most recent (albeit lousy) study even suggest that it is less effective than electroacupuncture (EA): EA was more effective than ‘battle field auricular acupuncture’ at reducing pain severity, but both similarly improved physical and mental health scores.

This does not stop Niemtzow to continue praising acupuncture in dozens of papers, particularly his ‘battle field’ version and especially in his ‘own’ journal. The most recent example has just been published; allow me to present an excerpt to you:

In December of 2023, I had the opportunity to visit the Van Gogh Museum in Amsterdam. The only day I had for this visit was characterized by a pouring and chilling rain. This did not stop the crowds of people visiting this famous exhibition. I reminded myself that Van Gogh was a troubled spirit. He lived a short tumultuous life characterized by cutting off his left ear lobe and he spent a sojourn in an asylum. Yet, his art emerged in all its beauty and splendor to become famous in the world. Despite all his troubles, he contributed a precious collection of magnificent art. Many individuals would not have surfaced out of personal disorders to produce such a wonderful gift to society. However, history tells us that many sensational contributions originated from people embroiled in mental health illnesses.

Medical Acupuncture published more than 13 years ago the acupuncture ‘‘diagnosis’’ of Vincent Van Gogh. The article, which is worth rereading, discussed the Five-Element pattern associated with the artist’s hallucinations, alcoholism, severe depression, insomnia, anxiety, dizziness, headaches, nightmares, etc. The author, Vera Kaikobad, LAc, stated: ‘‘It is poignant to realize that a few needles in the hands of a skilled acupuncturist may have spared this great artist such torment and perhaps saved his life.’’ Feasibly, in 2024 we should not only examine our patients for their physical complaints; we should venture into their mental health status as well. A back or neck pain is important, but so is anxiety, insomnia, etc. In promoting mental health, we may assist many patients who are perhaps capable of contributing to the well-being of the world. It is our responsibility as acupuncturists not to think of our patients as a neck or back pain, etc.; instead, we must see them as whole persons having spiritual and physical needs that must be addressed.

I feel that, overall, this remarkable effort justifies Niemtzow’s admission to my ALTERNATIVE MEDICINE HALL OF FAME.

WELCOME, RICHARD!

And let me introduce you to the rest of the 24 laureates:

  1. Helmut Kiene (anthroposophical medicine)
  2. Helge Franke (osteopathy, Germany)
  3. Tery Oleson (acupressure , US)
  4. Jorge Vas (acupuncture, Spain)
  5. Wane Jonas (homeopathy, US)
  6. Harald Walach (various SCAMs, Germany)
  7. Andreas Michalsen ( various SCAMs, Germany)
  8. Jennifer Jacobs (homeopath, US)
  9. Jenise Pellow (homeopath, South Africa)
  10. Adrian White (acupuncturist, UK)
  11. Michael Frass (homeopath, Austria)
  12. Jens Behnke (research officer, Germany)
  13. John Weeks (editor of JCAM, US)
  14. Deepak Chopra (entrepreneur, US)
  15. Cheryl Hawk (chiropractor, US)
  16. David Peters (osteopathy, homeopathy, UK)
  17. Nicola Robinson (TCM, UK)
  18. Peter Fisher (homeopathy, UK)
  19. Simon Mills (herbal medicine, UK)
  20. Gustav Dobos (various SCAMs, Germany)
  21. Claudia Witt (homeopathy, Germany/Switzerland)
  22. George Lewith (acupuncture, UK)
  23. John Licciardone (osteopathy, US)

If I had a £ for each time I was asked during the last few days whether King Charles is going to treat his cancer with homeopathy, I would have my pockets full of cash. The question seems reasonable because he has been singing the praise of homeopathy for decades. But, as I have pointed out previously, he is unlikely to use homeopathy or any other unproven cancer cure; on the contrary he will certainly receive the most effective therapies available today.

In any case, the homeopathic treatment of cancer is currently a most popular topic. As if on command, an article appeared on my screen that promises to address the subject:

“Homoeopathy and Cancer – An Alternative Approach towards the path of Healing”

Here is the abstract of this remarkable paper:

Homoeopathy is a holistic system of medicine rooted on the principle of “Similia Similibus Curentur”. It has gained attention for its potential therapeutic benefits. It offers a holistic approach that addresses both the physical symptoms and emotional well-being of individuals. While this alternative approach of healing has been explored in various health contexts, a notable gap remains in understanding its application in the realm of cancer care. This review seeks to fill this void by exploring the broader landscape of homoeopathy’s principles and applications. Through a critical examination of existing research and evidence, it aims to offer valuable insights into the potential role of homoeopathy as a complementary approach in cancer care and symptomatic relief. This review underscores the need for further research and a more nuanced understanding of homoeopathy’s place in healthcare, particularly in the context of cancer patients and their well-being.

I am sure you are as impressed as I am and keen to learn more. In the article itself, the authors offer some brand-new, cutting-edge science to back up their views:

According to Samuel Hahnemann, “When a person is ill, it is originally merely the spirit-like, autonomic life force (life principle), which is always there in the organism, that is mistuned by the dynamic effect of a morbific agent inimical to life.Only the life principle, tuned incorrectly to such an anomalyis capable of causing irregular functions the body. Cancer may initially be treated as a one-sided disease because the expanded pathology weakens the Vital Force. According to Hahnemann, “Diseases that seem to have just a few symptoms are called one-sided because only one or two prominent symptoms are indicated. This makes these diseases, which primarily fall under the category of chronic diseases, harder to cure. According to Arthur Hill Grimmer, the biggest challenge in treating advanced cancer cases is getting therapeutic individualization of symptoms. Even with all the typical symptoms, it is quite difficult to create a potent homoeopathic prescription. Burnett considered both the characteristic aspects of the patient as well as the ‘action’ or‘organ affinity’ of the remedy he prescribed.

Eventually, the authors (who are affiliated with prestigeous institutions: Rajasthan Ayurved University, Jodhpur; Swasthya Kalyan Homoeopathic Medical College & Research Centre, Jaipur) arrive at the following conclusion:

In the scientific literature, homoeopathy’s use in the treatment of cancer is still largely unexplored. Pioneers have offered intriguing perspectives on disease origins and treatment challenges. The miasmatic perspective offers a distinctive approach that emphasises individualised strategies based on symptoms and characteristics. Some studies suggest an improvement in quality of life of the individuals suffering from cancer. In the dynamic landscape of cancer treatment, more studies are warranted to enhance the scope of holistic, patient-centered care through homoeopathy.

Yes, homeopathy is a joke. This paper (and the many similar publications out there) could thus be intensely funny – except for the fact that these charlatans are playing with the lives of many vulnerable and desperate patients. I sincerely hope Charles manages to stay well clear of homeopathy and its irresponsible practitioners which clearly is one precondition for making a full recovery.

I have to admit that I came across the ‘ARCIM’ (Academic Research in Complementary and Integrative Medicine) Institute only yesterday when writing the post about Buteyko. Naturally, the institution interested me, and I tried to find out more about it. As pointed out previously, the aim of the ARCIM research institute, founded in 2010, is to research complementary and integrative medicine, in particular anthroposophic medicine, on a scientific basis according to rigorous scientific standards established by the Equator Network criteria (http://www.equator-network.org/).

On the ARCIM’s website we furthermore learn that:

  • ARCIM exists since 2010.
  • Consists of a team of 8 co-workers.
  • Its director is the physician Jan Vagedes.
  • Who have published a sizable amount of papers.
  • Is funded by the following sponsors: Federal Ministry of Education and Research (BMBF), Mahle-Foundation (Mahle Stiftung), Software AG (Software AG), DAMUS-DONATA e.V.
  • Is located in the buildings of the ‘Filderclinic’.

This begs, I think, several questions:

Why is the Federal Ministry of Education and Research sponsoring the ARCIM?

As anthroposophical medicine is based on concepts that fly in the face of science, this seems a legitimate question. Sadly, I have no answer to it.

What is the ‘Filderclinic’?

The Filderklinik in Filderstadt-Bonlanden is one of six anthroposophically orientated hospitals in Germany. It is operated by the non-profit organisation Filderklinik gGmbH. The main founders of the Filderklinik, which has existed since 1975, were Hermann and Ernst Mahle, the founders of the Mahle Group. The Mahle-Stiftung GmbH is the main shareholder and also the largest sponsor of Filderklinik gGmbH. The hospital employs around 915 staff and has 300 beds.

Who is Jan Vagedes?

Jan Vagedes is a specialist for paediatrics and adolescent medicine, neonatology and a doctor for anthroposophic medicine. He studied in and graduated from the LMU in Munich (my alma mater) in 1997. He is the Founder and Scientific Director of the ARCIM Institute, a research associate at the University Children’s Hospital Tübingen, and Head of paediatrics and adolescent medicine at the Filderclinic.

He has no ‘habilitation’ (PhD and in Germany precondition for a professorship). Medline currently lists 42 articles in his name most of which are in 3rd class journals. His first Medline-listed article is dated 2012. As the ARCIM was established in 2010, this means that, when he was appointed as its ‘scientific director’, he had exactly zero published science to his name.

Why did he get the job?

I have absolutely no idea?

(If you know more than I do, I’d be grateful to hear about it.)

 

 

The Buteyko techniques (known in Russia as ‘Voluntary Elimination of Deep Breathing’) are treatments to control respiration developed by the Russian Konstantin Buteyko (1923–2003). Inspired by the methods of respiratory control in yoga, the original Buteyko technique was specifically aimed at easing the symptoms of respiratory conditions, particularly asthma. Konstantin Buteyko postulated that there is a connection between hyperventilation and asthma and that it should be possible to reduce asthma symptoms by deliberate breath control.

The Eucapnic Buteyko method is an adaptation of Buteyko’s original technique which was first introduced in Australia and is now used worldwide. It includes the same focus on ventilation control, but the approach has been re-designed with the aim of achieving better patient-compliance. Both treatments and further variations depend crucially on the cooperation of the patient who has to attend long sessions of learning the technique and must follow the somewhat tedious programme rigorously.

A Cochrane review of Buteyko and similar breathing techniques concluded that “there is no credible evidence regarding the effectiveness of breathing exercises for the clinical symptoms of dysfunctional breathing/hyperventilation syndrome. It is currently unknown whether these interventions offer any added value in this patient group or whether specific types of breathing exercise demonstrate superiority over others.”

Now, a new study adds to this knowledge. This randomized clinical trial included two groups (n = 30 each) of patients with asthma. They received either:

  • Buteyko breathing technique (BBT) together with usual therapy (UT)
  • or UT alone over a period of 3 months.

The primary outcome comprised the voluntary control pause (CP) after 3 months, secondary outcomes an additional breathhold parameter, forced expiratory volume in 1 s (FEV1), capnovolumetry, exhaled nitric oxide (FeNO), Asthma Control Questionnaire (ACQ) and Nijmegen Questionnaire (NQ), and the use of medication (β2-agonists; inhaled corticosteroids, ICS).

CP showed significant time-by-group interaction [F(1,58.09) = 28.70, p < 0.001] as well as main effects for study group [F(1,58.27) = 5.91, p = 0.018] and time [F(1,58.36) = 17.67, p < 0.001]. ACQ and NQ scores were significantly (p < 0.05 each) improved with BBT. This was associated with reductions in the use of β2-agonists and ICS (p < 0.05 each) by about 20% each. None of these effects occurred in the UT group. While FEV1 and the slopes of the capnovolumetric expiratory phases 2 and 3 did not significantly change, the capnovolumetric threshold volume at tidal breathing increased (p < 0.05) with BBT by about 10 mL or 10%, compared to baseline, suggesting a larger volume of the central airways. No significant changes were seen for FeNO.

The authors concluded that BBT was clinically effective, as indicated by the fact that the improvement in symptom scores and the small increase in bronchial volume occurred despite the significant reduction of respiratory pharmacotherapy. As the self-controlled Buteyko breathing therapy was well-accepted by the participants, it could be considered as supporting tool in asthma therapy being worth of wider attention in clinical practice.

I disagree with this conclusion and think it ought to be changed to:

BBT or a placebo effect was clinically effective.

The reason is that, as many readers have heard me say before, the infamous A+B versus B design does not control for placebo effects and thus is guaranteed to produce a positive result.

The research was conducted by an international team evidently led by the relatively new ARCIM Institute which claims on its website:

The acronym ARCIM stands for Academic Research in Complementary and Integrative Medicine.

The bridging between different treatment and research approaches, disciplines and ways of thinking achieved by the research work of the ARCIM Institute can be symbolized by our logo’s bridge arch. ARCIM integrates this bridge-building metaphor within its name since the Latin term “arcus” means “arch” or “bridge.”

The aim of the ARCIM research institute, founded in 2010, is to research complementary and integrative medicine, in particular anthroposophic medicine, on a scientific basis according to rigorous scientific standards established by the Equator Network criteria (http://www.equator-network.org/).
______________________
“rigorous scientific standards”?
… … …
You could have fooled me!

An alarming story of research fraud in the area of so-called alternative medicine (SCAM) is unfolding: Bharat B. Aggarwal, the Indian-American biochemist who worked at MD Anderson Cancer Center, focused his research on curcumin, a compound found in turmeric, and authored more than 125 Medline-listed articles about it. They reported that curcumin had therapeutic potential for a variety of diseases, including various cancers, Alzheimer’s disease and, more recently, COVID-19.

The last of these papers, entitled “Curcumin, inflammation, and neurological disorders: How are they linked?”, was publiched only a few months ago. Here is its abstract:

Background: Despite the extensive research in recent years, the current treatment modalities for neurological disorders are suboptimal. Curcumin, a polyphenol found in Curcuma genus, has been shown to mitigate the pathophysiology and clinical sequalae involved in neuroinflammation and neurodegenerative diseases.

Methods: We searched PubMed database for relevant publications on curcumin and its uses in treating neurological diseases. We also reviewed relevant clinical trials which appeared on searching PubMed database using ‘Curcumin and clinical trials’.

Results: This review details the pleiotropic immunomodulatory functions and neuroprotective properties of curcumin, its derivatives and formulations in various preclinical and clinical investigations. The effects of curcumin on neurodegenerative diseases such as Alzheimer’s disease (AD), amyotrophic lateral sclerosis (ALS), brain tumors, epilepsy, Huntington’s disorder (HD), ischemia, Parkinson’s disease (PD), multiple sclerosis (MS), and traumatic brain injury (TBI) with a major focus on associated signalling pathways have been thoroughly discussed.

Conclusion: This review demonstrates curcumin can suppress spinal neuroinflammation by modulating diverse astroglia mediated cascades, ensuring the treatment of neurological disorders.

  The Anderson Cancer Center initially appeared to approve of Aggarwal’s work. However, in 2012, following concerns about image manipulation raised by pseudonymous sleuth Juuichi Jigen, MD Anderson Cancer Center launched a research fraud probe against Aggarwal which eventually led to 30 of Aggarwal’s articles being retracted. Moreover, PubPeer commenters have noted irregularities in many publications beyond the 30 that have already been retracted. Aggarwal thus retired from M.D. Anderson in 2015.

Curcumin doesn’t work well as a therapeutic agent for any disease – see, for instance, the summary from Nelson et al. 2017:

“[No] form of curcumin, or its closely related analogues, appears to possess the properties required for a good drug candidate (chemical stability, high water solubility, potent and selective target activity, high bioavailability, broad tissue distribution, stable metabolism, and low toxicity). The in vitro interference properties of curcumin do, however, offer many traps that can trick unprepared researchers into misinterpreting the results of their investigations.”

Despite curcumin’s apparent lack of therapeutic promise, the volume of research produced on curcumin grows each year.  More than 2,000 studies involving the compound are now published annually. Many of these studies bear signs of fraud and involvement of paper mills. As of 2020, the United States National Institutes of Health (NIH) has spent more than 150 million USD funding projects related to curcumin.

Graphs describing the volume of curcumin research from various sources. Data collected from PubMed and NIH RePORTER. Data may be incomplete in recent years.

This proliferation of research has fueled curcumin’s popularity as a dietary supplement. It is estimated that the global market for curcumin as a supplement is around 30 million USD in 2020.

The damage done by this epic fraud is huge and far-reaching. Hundreds of millions of taxpayer dollars, countless hours spent toiling by junior scientists, thousands of laboratory animals sacrificed, thousands of cancer patients enrolled in clinical trials for ineffective treatments, and countless people who have eschewed effective cancer treatment in favor of curcumin, were encouraged by research steeped in lies.

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