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

satire

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As you can imagine, I get quite a lot of ‘fan-post’. Most of the correspondence amounts to personal attacks and insults which I usually discard. But some of these ‘love-letters’ are so remarkable in one way or another that I answer them. This short email was received on 20/3/19; it belongs to the latter category:

Dr Ernst,

You have been trashing homeopathy ad nauseum for so many years based on your limited understanding of it. You seem to know little more than that the remedies are so extremely dilute as to be impossibly effective in your opinion. Everybody knows this and has to confront their initial disbelief.

Why dont you get some direct understanding of homeopathy by doing a homeopathic proving of an unknown (to you) remedy? Only once was I able to convince a skeptic to take the challenge to do a homeopathic proving. He was amazed at all the new symptoms he experienced after taking the remedy repeatedly over several days.

Please have a similar bravery in your approach to homeopathy instead of basing your thoughts purely on your speculation on the subject, grounded in little understanding and no experience of it.

THIS IS HOW I RESPONDED

Dear Mr …

thank you for this email which I would like to answer as follows.

Your lines give the impression that you might not be familiar with the concept of critical analysis. In fact, you seem to confuse my criticism of homeopathy with ‘trashing it’. I strongly recommend you read up about critical analysis. No doubt you will then realise that it is a necessary and valuable process towards generating progress in healthcare and beyond.

You assume that I have limited understanding of homeopathy. In fact, I grew up with homeopathy, practised homeopathy as a young doctor, researched the subject for more than 25 years and published several books as well as over 100 peer-reviewed scientific papers about it. All of this, I have disclosed publicly, for instance, in my memoir which might interest you.

The challenge you mention has been taken by me and others many times. It cannot convince critical thinkers and, frankly, I am surprised that you found a sceptic who was convinced by what essentially amounts to little more than a party trick. But, as you seem to like challenges, I invite you to consider taking the challenge of the INH which even offers a sizable amount of money, in case you are successful.

Your final claim that my thoughts are based purely on speculation is almost farcically wrong. The truth is that sceptics try their very best to counter-balance the mostly weird speculations of homeopaths with scientific facts. I am sure that, once you have acquired the skills of critical thinking, you will do the same.

Best of luck.

Edzard Ernst

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

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

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

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

The therapeutic claims made for the product are numerous:

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

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

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

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

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

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

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

Having the choice, I might think again.

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

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

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

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

On the one hand, I agree.

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

 

 

 

 

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

On this blog, many of us have been frightfully critical of Dana Ullman; some were even harsh and demeaning. Meanwhile, I have spent some time on-line to study the man more closely. And yes, I have changed my mind (despite all the insults he has hurled at me).

Guys, we (and the US judge who made that nasty comment about Dana) have done him wrong!

So wrong!

For instance, did you know he has written a thesis at UC Berkeley? Here is its summary:

In the Approach of this paper, this writer introduced his own Approach to the world. His subjective goals, needs, attitudes, and beliefs were presented. The subjective attitude was considered the source of his understanding himself and the universe. Then, the goals of this paper, the definitions of terms (beliefs), and the questions to be answered were discussed. To understand as much of oneself and the universe as possible was our goal, need, and scientific endeavor. Within this infinite realm, we specifically sought to understand the learning process and, in particular, to investigate why a person learns some things and not others. To help put our question into a workable framework, we introduced the concepts Approach, Method, and Content as sub-processes of the learning process.           

In our Method we chose the Behavior Psychologist as an example to help understand a person’s use of the Approach, Method, and Content in the learning process and in the way they affect what a person learns and doesn’t learn.

The Approach and Method led us into the Content – the answers to our questions.* Our answers emphasized the subjective nature of all things. We discovered a symbiotic relationship between the three sub-processes. The Approach was recognized as particularly important because it manifested into a question that predisposed limits upon the Method to study it and the Content it could find. From this disposition, we found that a person’s Approach plays a large role in determining what a person learns and doesn’t learn. Finally, we introduced some methods to better understand one’s Approach in order to help a person lead chimself to a deeper awareness of chimself and a greater comprehension of worldly phenomena. In this way, we hope we have helped chim expand the bounds of what che can learn and also helped chim understand why che doesn’t learn.

If I am not mistaken, this piece of research is not just brilliant, it also earned Dana the master’s degree in public health that he likes to mention so often.

Amongst the many informative sources that I found, his own website tells it best, I think. Here is an excerpt:

Dana Ullman, MPH, CCH, (MPH = Masters in Public Health, U.C. Berkeley;  CCH = Certified in Classical Homeopathy) has authored 10 books on homeopathy and is one of America’s leading advocates for homeopathy, and he has authored chapters on homeopathic medicine in three medical textbooks. He has served on advisory boards of alternative medicine institutes at Harvard and Columbia (you can learn more about him at this link; see About Dana Ullman, MPH, CCH).

Dana Ullman, MPH, CCH, provides phone and email consultation OR he can provide a personalized referral to leading homeopaths in North America (and often in many other countries in the world). There is a $45 fee for a 10-minute conversation, and there is a $40 additional fee for each 10 minute. Call or email to make an appointment for this conversation, or if you want, everything can be done online. You will need to provide us with a Visa, MasterCard, American Express, or Discover cards for payment….or payment can be made via PayPal to email@homeopathic.com.  Dana is also able to accept “Wellness Cards” and from “Health Savings Accounts” (credit cards sometimes given to employees for “health services”).

Generally, a homeopath seeks to prescribe a “homeopathic constitutional medicine” that will strengthen a person’s overall level of health.  This consultation delves into a person’s family history, his/her own health history, and the totality of physical and psychological symptoms and characteristics.  In most cases, this first consultation takes one-hour, costing $245.00, though people with a complex health condition may require more time.  Follow-ups are usually 10 minutes to 40 minutes (or $45 to $165), with follow-ups vary depending upon the complexity of a person’s health…and some follow-ups will require more than 40 minutes.

Dana Ullman provides personalized and individualized homeopathic treatment for people with a wide variety of acute and chronic health problems.  He regularly treats infants and children with either physical or psychological challenges, from chronic ear infections to various ADD/ADHD or autistic spectrum problems (Dana’s book on Homeopathic Medicines for Children and Infants was published in 1991).  Dana also treats people with a wide variety of pain syndromes, including people with fibromyalgia and arthritic disorders, shingles or sciatica, and headaches (Dana co-authored a chapter in a leading conventional medical textbook on pain management, called “Weiner’s Pain Management”).  Dana also treats people in various stages of cancer (Dana was the lead author written with three medical doctor a chapter on homeopathy and cancer care in a textbook published by Oxford University Press called “Integrative Oncology”).  Dana provide “adjunctive health care” that is in addition to whatever other health or medical care the person is receiving (many of his patients use an integration of conventional and homeopathic medicines).

Dana Ullman provides homeopathic treatment via phone, Skype, and in our Berkeley office! You will need to phone or email us (email@homeopathic.com) to set-up an appointment. Please clarify if you prefer an in-office or on-telephone or Skype appointment.

Also, if you have questions about homeopathy, specific homeopathic medicines, the care that you have received from a homeopath, how to best learn homeopathy, what homeopathic research exists, or many other subjects in this field, you may benefit from a personal consultation with Dana Ullman, MPH, CCH. Call or email us to set up a phone appointment. An email conversation is also possible, but this tends to require more time than an interactive discussion.

You might frown upon telephone consultations. But stop being so sceptical, Dana is sacrificing his precious time to help as many patients as he can – even those with AIDS, autism or cancer. Does that not deserve some respect?

And look at his many achievements: 10 own books! 3 chapters is medical textbooks! What, you ask which textbooks? Here they are:

  1. Homeopathic Medicine: Principles and Research, in Complementary and Alternative Veterinary Medicine: Principles and Practice, edited by Allen M. Schoen, DVM, and Susan G. Wynn, DVM, PhD, New York: Mosby, 1998.
  2. Homeopathy (co-authored with Michael Loes, MD), in Weiner’s Pain Management: A Practical Guide for Clinicians, edited by M. V. Boswell and B. E. Cole, 7th edition, New York: Taylor and Francis, 2006.
  3. Homeopathy for Primary and Adjunctive Cancer Therapy (co-authored with Menacham Oberbaum, MD, Iris Bell, MD, PhD, and Shepherd Roee Singer, MD), in Integrative Oncology, edited by Andrew Weil, MD and Donald Abrams, MD, published in March, 2009, by Oxford University Press.

Not impressed?

In this case, you suffer from closed-mindedness and denialism.

You might need help!

Phone Dana, he will prescribe a cure (and ameliorate his income).

 

 

[*I have noticed that, in the past, some of my readers seem to have difficulties in detecting satire; for them I should disclose: THIS POST IS PURE SATIRE!]

One would be hard-pressed to find a form of so-called alternative medicine (SCAM) that is not being promoted for back pain: chiropractic, osteopathy, reflexology, naturopathy, homeopathy … you name it. Intriguingly, they all seem to generate similarly good – a realist would say bad – results. Faced with this large but largely ineffective options, one can hardly be surprised that enterprising innovators look for their own solutions. And few are more enterprising then this patient from Ireland who decided to devise his very own and highly unusual back pain therapy.

The 33 year old male with a history of back problems was seen complaining of severe, sudden onset lower back pain. He reported lifting a heavy steel object 3 days prior and his symptoms had progressed ever since. A physical exam of revealed an erythematous papule with a central focus on the medial aspect of his right upper limb.

The patient disclosed that he had – independent of any medical advice – intravenously injected his own semen as an innovative method to alleviate his back pain (a truly naturopathic approach, if there ever was one!). He also revealed that he had previously injected one monthly “dose” of semen for 18 consecutive months using a hypodermic needle purchased online.

On this occasion, the patient had tried to inject three “doses” of semen intra-vascularly and intra-muscularly. The erythema extended medially along his upper limb over the course of the following 24 hours.

It became indurated around the injection site where he had failed multiple attempts at injecting the semen thus causing an extravasation of his sperm into the soft tissues. Blood tests demonstrated a C-reactive protein of 150mg/L and white cell count of 13×109/L. The patient was immediately commenced on intravenous antimicrobial treatment after seeking advice regarding appropriate cover. A radiograph of the limb was obtained to exclude retained foreign body and it demonstrated a subcutaneous emphysema.

This patient’s back pain improved over the course of his inpatient stay. He opted to discharge himself without availing of an incision and drainage of the local collection.

Remarkable!

For me, the most fascinating aspect of this story is the fact that the patient had previously treated himself 18 (!) times before this little mishap occurred.

Why?, one may well ask. The answer has, I think, been provided by legions of proponents of diverse forms of SCAM: BECAUSE IT WORKED! PEOPLE ARE NOT STUPID; THEY DON’T CONTINUE TREATMENTS, IF THEY DON’T WORK.

So, either intravenous semen injections are an effective way to control back pain – in which case, I recommend that NICE look into it – or…

THERE IS SOMETHING BADLY WRONG WITH THE FAVOURITE ARGUMENT OF SCAM-ENTHUSIASTS, IT WORKED FOR ME AND THEREFORE IT IS EFFECTIVE AND SAFE.

(I know which explanation I favour)

Once again, I am indebted to the German homeopathy lobbyist, Jens Behnke (research officer at the Karl and Veronica Carstens-Foundation); this time for alerting me via a tweet to the existence of the ‘Institute for Scientific Homeopathy’ run by Dr K Lenger. Anyone who combines the terms ‘scientific’ and ‘homeopathy’ has my full attention.

The institution seems to be small (too small to have its own website); in fact, it seems to have just one member: Dr Karin Lenger. But size is not everything! Lenger has achieved something extraordinary: she has answered the questions that have puzzled many of us for a long time; she has found the ‘modus operandi’ of homeopathy by discovering that:

  • Homeopathy is a regulation therapy that acts (and reacts) as per the principle of resonance to deal hypo- and hyper-functions of pathological pathways.
  • As per resonance principle, the fundamental principles of homeopathy have the same frequencies so that the resonance principle can work.
  • Pathological pathways are cured by using their highly potentized substrates, inhibitors, and enzymes.
  • The efficacy of homeopathy now has a scientific base and is completely explained by applying biochemical and biophysical laws.

Progress at last!

If that is not noteworthy, what is?

But there is more!

This website, for instance, explains that Lenger Karin Dr.rer.nat., pursued Diploma in Biochem, studied Biochemistry at the Universities of Tubingen and Cologne. Her research topics revolved around enzymatic gene regulation, cancer research, enzymatic mechanisms of steroid hormones at the Medical University of Lubeck. In 1987 she became a Lecturer for Homeopathy at DHU ((Deutsche Homöopathie Union = German Homeopathy Union). Since 1995 she worked as a Homeopathic Practitioner and developed the “biochemical homeopathy” by using highly potentized substrates of pathological enzymes for her patients. She detected magnetic photons in high homeopathic potencies by two magnetic resonance methods and developed a model of physical and biochemical function of homeopathy.

Karin Lenger detected magnetic photons in highly diluted and potentized homeopathic remedies. Since the living body is an electromagnetic wavepackage (Einstein), the homeopathic law of Similars (Hahnemann 1755-1843) can be expressed as: the frequencies of the patient must match the frequencies of the remedies. Homeopathy is a regulation therapy curing hypo and hyperfunction of a pathological pathway by resonance: highly potentized substrates, inhibitors, enzymes, receptors of the distinct pathological pathways cure according to biochemical rules: A homeopathic symptom picture is obtained by poisoning a volunteer with a toxin. Simultaneously he develops psychological symptoms, the toxicological pathway and e.g. frequencies I-V. The highly potentized toxin has the frequencies I-V. The patient has symptoms as if he was poisoned by the toxin: during his illness he developed the toxicological pathway, frequencies I-V and psychological symptoms. The potentized toxin cures simultaneously the patient’s frequencies by resonance, his pathological pathway and the psychological symptoms. A stitch of honey bee, apis mellifica, causes a red oedema; a patient developing a red oedema at the finger-joint by rheumatism is cured by highly potentized Apis mellifica. Paralyses caused by a lack of the neurotransmitter acetylcholine bound to the acetylcholine-receptor at the post-synapsis can be healed by using these potentized remedies: the venom of cobra, Naja tripudians containing the receptor’s irreversible inhibitor cobrotoxin, the reversible inhibitor Atropine and Acetylcholine, daily applied. The availability of acetylcholine is maintained by glycolysis and fatty acid oxidation. This can be supported by giving these remedies: Lecithin, Lipasum, Glycerinum, Glucosum and Coenzyme A.

And in case, you are not yet fully convinced, a recent publication is bound to ball you over. Here is its abstract, if you need more, the link allows you to read the full paper as well:

Homeopathy, a holistic therapy, is believed to cure only acute symptoms of a beginning illness according to the Laws of Similars; but not deep, bleeding, septic wounds. The homeopaths refuse to heal according to special medical indications. Based on Lenger’s detection of magnetic photons in homeopathic remedies a biochemical and biophysical model of homeopathic healing was developed Biochemical, pathological pathways can be treated by their highly potentized substrates and inhibitors. Three groups of patients with moderate, severe and septic wounds had been successfully treated with the suitable remedies depending on the biochemical pathological state.

___________________________________________________________

Do I sense a Nobel Prize in the offing?

Surely!

Lenger’s clinical trial is baffling. But much more impressive are the ‘magnetic photons’ and the reference to Einstein. This is even more significant, if we consider what the genius (Einstein, not Lenger!) is reported to have said about homeopathy:  Einstein reflected for a little while and then said: “If one were to lock up 10 very clever people in a room and told them they were only allowed out once they had come up with the most stupid idea conceivable, they would soon come up with homeopathy.”

The notion that ‘chiropractic adds years to your life’ is often touted, particularly of course by chiropractors (in case you doubt it, please do a quick google search). It is logical to assume that chiropractors themselves are the best informed about what they perceive as the health benefits of chiropractic care. Chiropractors would therefore be most likely to receive some level of this ‘life-prolonging’ chiropractic care on a long-term basis. If that is so, then chiropractors themselves should demonstrate longer life spans than the general population.

Sounds logical?

Perhaps, but is the theory supported by evidence?

Back in 2004, a chiropractor, Lon Morgan,  courageously tried to test the theory and published an interesting paper about it.

He used two separate data sources to examine the mortality rates of chiropractors. One source used obituary notices from past issues of Dynamic Chiropractic from 1990 to mid-2003. The second source used biographies from Who Was Who in Chiropractic – A Necrology covering a ten year period from 1969-1979. The two sources yielded a mean age at death for chiropractors of 73.4 and 74.2 years respectively. The mean ages at death of chiropractors is below the national average of 76.9 years; it also is below the average age at death of their medical doctor counterparts which, at the time, was 81.5.

So, one might be tempted to conclude that ‘chiropractic substracts years from your life’. I know, this would be not very scientific – but it would probably be more evidence-based than the marketing gimmick of so many chiropractors trying to promote their trade by saying: ‘chiropractic adds years to your life’!

In any case, Morgan, the author of the paper, concluded that this paper assumes chiropractors should, more than any other group, be able to demonstrate the health and longevity benefits of chiropractic care. The chiropractic mortality data presented in this study, while limited, do not support the notion that chiropractic care “Adds Years to Life …”, and it fact shows male chiropractors have shorter life spans than their medical doctor counterparts and even the general male population. Further study is recommended to discover what factors might contribute to lowered chiropractic longevity.

Another beautiful theory killed by an ugly fact!

The ‘Dunning Kruger Effect‘ (DuKE) has been discussed here before. The DuKE means that, the less you know, the less able you are to recognize how little you know, and the less likely you are to recognize your limitations. Consequently, your confidence in yourself is inflated and you believe you are more competent than your opponent. Expressed differently:

  • Incompetence prevents the recognition of incompetence.
  • Too stupid to doubt.

A recent paper brilliantly shows the DuKE in action; here is its abstract

There is widespread agreement among scientists that genetically modified foods are safe to consume and have the potential to provide substantial benefits to humankind. However, many people still harbour concerns about them or oppose their use. In a nationally representative sample of US adults, we find that as extremity of opposition to and concern about genetically modified foods increases, objective knowledge about science and genetics decreases, but perceived understanding of genetically modified foods increases. Extreme opponents know the least, but think they know the most. Moreover, the relationship between self-assessed and objective knowledge shifts from positive to negative at high levels of opposition. Similar results were obtained in a parallel study with representative samples from the United States, France and Germany, and in a study testing attitudes about a medical application of genetic engineering technology (gene therapy). This pattern did not emerge, however, for attitudes and beliefs about climate change.

As I have stated before, I suspect the DuKE can explain much of what is going on in the realm of SCAM (so-called alternative medicine). So much so that I am tempted to re-write part of the above abstract as follows:

As extremity of belief in SCAM increases, objective knowledge about science and medicine decreases. In parallel, perceived understanding of science and medicine increases. Extreme believers in SCAM know the least, but think they know the most. Moreover, the relationship between self-assessed and objective knowledge shifts from positive to negative at high levels of SCAM-belief.

Yes, yes, I know. You are absolutely correct: this is little more than speculation! And I also realise, of course, that not everyone can have a full understanding of SCAM, medicine and science; however, if someone has a strong interest in (plus a strong opinion of) these matters, it would be advisable to read up about at least the most basic facts.

In case you disapprove, please do have a look at some of the recent comments on this blog or assess what some of the most famous proponents of SCAM tell the public, and I am confident that you will begin to suspect that my speculation might be not that far off the mark.

The German Association of Medical Homeopaths (Deutscher Zentralverein homöopathischer Ärzte (DZVhÄ)) have recently published an article where, amongst other things, they lecture us about evidence-based medicine (EBM). If you feel that this might be a bit like an elephant teaching Fred Astaire how to step-dance, you could have a point. Here is their relevant paragraph:

… das Konzept der modernen Evidenzbasierte Medizin nach Sackett [stützt sich] auf drei Säulen: auf die klinischen Erfahrung der Ärzte, auf die Werte und Wünsche des Patienten und auf den aktuellen Stand der klinischen Forschung. Homöopathische Ärzte wehren sich gegen einen verengten Evidenzbegriff der Kritiker, der Evidenz allein auf die Säule der klinischen Forschung bzw. ausschließlich auf RCT verengen möchte und die anderen beiden Säulen ausblendet. Experten schätzen, dass bei einer solchen Auffassung von EbM rund 70 Prozent aller Leistungen der GKV nicht evidenzbasiert sei. Nötiger als eine Homöopathie-Debatte hat die deutsche Ärzteschaft aus unserer Sicht eine klare Verständigung darüber, welcher Evidenzbegriff nun gilt.

For those who cannot understand the full splendour of their argument because of the language problem, I translate as literally as I can:

… the concept of the modern EBM according to Sackett is based on three pillars: on the clinical experience of the doctors, on the values and wishes of the patient and on the current state of the clinical research. Homeopaths defend themselves against the narrowed understanding of ‘evidence’ of the critics which aims at narrowing evidence solely to the pillar of the clinical research or exclusively to RCT, while eliminating the other two pillars. Experts estimate that, with such an view of EBM, about 70% of all treatments reimbursed by our health insurances would not be evidence-based. We feel that we more urgently need a clear understanding which evidence definition applies than a debate about homeopathy.

END OF MY TRANSLATION

So, where is the hilarity in this?

I don’t know about you, but I find the following things worth a giggle:

  1. ‘narrowed understanding of evidence’ – this is a classical strawman; non-homeopaths tend to apply Sackett’s definition which states that ‘evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical experience with the best available external clinical evidence from systematic research‘;
  2. as we see, Sackett’s definition is quite different from the one cited by the homeopaths;
  3. the three pillars cited by the homeopaths are those subsequently developed for Evidence Based Practice (EBP) and include: A) patient values, B) clinical expertise and C) external best evidence;
  4. as we see, these three pillars are also not quite the same as those suggested by the homeopaths;
  5. non-homeopaths do certainly not aim at eliminating the ‘other two pillars’;
  6. current best evidence clearly includes much more than just RCTs – to mention RCTs in this context therefore suggests that the ones guilty of narrowing anything might, in fact, be the homeopaths;
  7. even if it were true that 70% of reimbursable treatments are not evidence-based, this would hardly be a good reason to employ homeopathic remedies of which 100% are not even remotely evidence-based;
  8. unbeknown to the German homeopaths, the discussion about a valid definition of EBM has been intense, is as old as EBM itself, and would by now probably fill a mid-size library;
  9. this discussion does, however, in no way abolish the need to bring the debate about homeopathy to the only evidence-based conclusion possible, namely the discontinuation of reimbursement of this and all other bogus therapies.

In conclusion, I do thank the German homeopaths for being such regular contributors to fun and hilarity. I shall miss them, once they have fully understood EBM and are thus compelled to stop prescribing placebos.

The 2018 World Federation of Chiropractic ACC Education Conference was held on 24-27 October in London. It resulted in several consensus statements developed by the attendees. I happen to know this from a short report that has just been published; it can be found here.

Of the 10 points made in this consensus, I find only the following noteworthy:

“Chiropractic education programs have an ethical obligation to support an evidence-based teaching and learning environment.”

Perhaps it is me – English is not my first language – but I find the phraseology used in this sentence strangely complicated and confusing. I have been a teacher of medical students for most of my life, but I am not sure what an ‘evidence-based teaching and learning environment’ is. I know what ‘evidence-based’ means, of course. However, what exactly is:

  • a teaching environment?
  • a learning environment?
  • and how does ‘evidence-based’ apply to either of the two?

Is there evidence that some environments are better suited than others for teaching?

Is there evidence that some environments are better suited than others for learning?

I suppose the answer must be YES!

The environment, i. e. the space and conditions in which teaching and learning happen should, for instance, be/include:

  • quiet,
  • not cramped,
  • not too cold,
  • not too hot,
  • equipped with ergometric chairs and desks,
  • well-lit,
  • there should be visual aids,
  • access to computers,
  • a library,
  • good mentoring and support,
  • etc.

So, the consensus of the education conference wanted to optimise the environmental conditions of teaching and learning for chiropractic lecturers and students? Most laudable, I must say!

But still, it seems like a missed opportunity for an ‘Education Conference’ not to have stated something about the content of teaching and learning. Personally, I find it a pity that they did not state: Chiropractic education programs have an ethical obligation to be evidence-based.

Or is that what they really wanted to say?

Naaahh … come to think of it … they cannot possibly make such a demand.

Why?

Because, in this case, they would have to teach students not to become chiropractors.

Slowly, I seem to be turning into a masochist! Yes, I sometimes read publications like ‘HOMEOPATHY 360’. It carries articles that are enragingly ill-informed. But in my defence, I might say that some are truly funny. Here is the abstract of one that I found outstanding in that category:

The article explains about Gangrene and its associated amputations which is a clinically challenging condition, but Homeopathy offers therapy options. The case presented herein, details about how the Homeopathic treatment helped in the prevention of amputation of a body part. Homeopathy stimulates the body’s ability to heal through its immune mechanisms; consequently, it achieves wound healing and establishes circulation to the gangrenous part. Instead of focusing on the local phenomena of gangrene pathology, treatment focuses on the general indications of the immune system, stressing the important role of the immune system as a whole. The aim was to show, through case reports, that Homeopathic therapy can treat gangrene thus preventing amputation of the gangrenous part, and hence has a strong substitution for consideration in treating gangrene.

The paper itself offers no less than 13 different homeopathic treatments for gangrene:

  1. Arsenicum album– Medicine for senile gangrene;gangrene accompanied by foetid diarrhoea; ulcers extremely painful with elevated edges, better by warmth and aggravation from cold; great weakness and emaciation.
  2. Bromium – Hospital gangrene; cancerous ulcers on face; stony hard swelling of glands of lower jaw and throat.
  3. Carbo vegetabilis – Senile and humid gangrene in the persons who are cachectic in appearance; great exhaustion of vital powers; marked prostration; foul smell of secretions; indolent ulcers, burning pain; tendency to gangrene of the margins; varicose ulcers.
  4. Bothrops– Gangrene; swollen, livid, cold with hemorrhagic infiltration; malignant erysipelas.
  5. Echinacea– Enlarged lymphatics; old tibial ulcers; gangrene; recurrent boils; carbuncles.
  6. Lachesis– Gangrenous ulcers; gangrene after injury; bluish or black looking blisters; vesicles appearing here and there, violent itching and burning; swelling and inflammation of the parts; itching pain and painful spots appearing after rubbing.
  7. Crotalus Horridus– Gangrene, skin separated from muscles by a foetid fluid; traumatic gangrene; old scars open again.
  8. Secale cornatum– Pustules on the arms and legs, with tendency to gangrene; in cachectic, scrawny females with rough skin; skin shriveled, numb; mottled dusky-blue tinge; blue color of skin; dry gangrene, developing slowly; varicose ulcers; boils, small, painful with green contents; skin feels too cold to touch yet covering is not tolerated. Great aversion to heat;formication under skin.
  9. Anthracinum– Gangrene; cellular tissues swollen and oedematous; gangrenous parotitis; septicemia; ulceration, and sloughing and intolerable burning.
  10. Cantharis – Tendency to gangrene; vesicular eruptions; burns, scalds, with burning and itching; erysipelas, vesicular type, with marked restlessness.
  11. Mercurius– Gangrene of the lips, cheeks and gums; inflammation and swelling of the glands of neck; pains aggravated by hot or cold applications.
  12. Sulphuric acid– Traumatic gangrene; haemorrhages from wounds; dark pustules; blue spots like suggillations; bedsores.
  13. Phosphoric acid– Medicine for senile gangrene. Gunpowder, calendula are also best medicines.

But the best of all must be the article’s conclusion: “Homeopathy is the best medicine for gangrene.

I know, there are many people who will not be able to find this funny, particularly patients who suffer from gangrene and are offered homeopathy as a cure. This could easily kill the person – not just kill, but kill very painfully. Gangrene is the death of tissue in part of the body, says the naïve little caption. What it does not say is that it is in all likelihood also the death of the patient who is treated purely with homeopathy.

And what about the notion that homeopathy stimulates the body’s ability to heal through its immune mechanisms?

Or the assumption that it might establish circulation to the gangrenous part?

Or the claim that through case reports one can show the effectiveness of an intervention?

Or the notion that any of the 13 homeopathic remedies have a place in the treatment of gangrene?

ALL OF THIS IS TOTALLY BONKERS!

Not only that, it is highly dangerous!

Since many years, I am trying my best to warn people of charlatans who promise bogus cures. Sadly it does not seem to stop the charlatans. This makes me feel rather helpless at times. And it is in those moments that I decide to look at from a different angle. That’s when I try to see the funny side of quacks who defy everything we know about healthcare and just keep on lying to themselves and their victims.

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