symptom-relief
Needle-based acupuncture is used in some detoxification settings. However, its efficacy for illicit drug use disorders remains uncertain because prior reviews often mixed comparator types, co-interventions, or non-needle modalities. This review aimed to evaluate needle-based acupuncture monotherapy using comparator-stratified meta-analysis.
The authors searched PubMed, Embase, Web of Science, Cochrane Library, CNKI, CBM/SinoMed, trial registries, and supplementary sources from inception to September 12, 2025. The quantitative synthesis was restricted to randomized trials of manual acupuncture, electroacupuncture, or needle-insertion auricular acupuncture delivered without concomitant pharmacotherapy or psychotherapy. Although the registered protocol allowed non-randomized comparative studies, none were pooled because of insufficient comparability and a higher risk of confounding. Sensitivity analyses excluded trials with moxibustion co-treatment.
Thirteen randomized trials (n = 1,027) were included in the meta-analysis. For the prespecified primary outcome of withdrawal severity at the end of treatment, acupuncture favored blank/no-acupuncture controls [g = −2.089, 95% confidence interval (CI): −2.869 to −1.309; τ² = 0.712; I² = 82.9%], but the prediction interval (PI) crossed the null (PI: −4.306 to 0.128). Against active non-acupuncture comparators, the pooled effect was imprecise (g = −1.70, 95% CI: −5.43 to 2.02; PI: −23.49 to 20.09). Against sham acupuncture, two comparisons yielded an imprecise estimate (g = −1.45, 95% CI −9.41 to 6.51), and no PI was estimated. Among secondary outcomes, anxiety favored acupuncture over blank/no-acupuncture controls (g = −1.537, 95% CI: −2.047 to −1.026; PI: −2.939 to −0.134), whereas evidence from sham-controlled studies was less certain (g = −0.998, 95% CI: −1.744 to −0.252; PI: −2.828 to 0.832). For depression outcomes, PIs crossed the null in both blank- and sham-controlled analyses. The certainty of the evidence was low to very low.
The authors concluded that acupuncture exhibited favorable average effects on withdrawal severity, but null-crossing PIs limited confidence in the reproducibility of these effects across different settings and treatment protocols. Anxiety was interpreted as a secondary finding. No serious acupuncture-related adverse events were explicitly reported, although surveillance was often passive or insufficiently described.
The review treats acupuncture as “effective” for illicit drug disorders by highlighting short-term improvements in craving or anxiety, while the outcomes that matter for addiction – abstinence, relapse, use frequency, and retention – show no reliable benefit.
This, I think, is a classic case of presenting a negative result as a positive finding!
The review explicitly found no consistent difference between acupuncture and comparators for substance use endpoints, and the apparent positive outcomes were limited by low-quality evidence and publication bias. By foregrounding surrogate outcomes and obscuring the lack of clinically decisive effects, the paper misleads readers into perceiving acupuncture as a viable monotherapy for drug use disorders. Yet the evidence does clearly not support that conclusion.
Postherpetic neuralgia (PHN) is a refractory neuropathic pain condition with limited therapeutic options. Although electroacupuncture has demonstrated potential analgesic effects, high-quality evidence from rigorous randomized clinical trials remains limited.
This multicenter, randomized, sham-controlled clinical trial determined whether electroacupuncture reduces pain severity compared with sham electroacupuncture and evaluated its safety in patients with PHN. It took place at 7 tertiary hospitals in China and enrolled participants from October 2020 to July 2022, with the last follow-up in September 2022. Data analyses were performed from August to December 2025. Participants with PHN aged 45 to 75 years and moderate to severe pain (11-point Numeric Rating Scale [NRS-11] score ≥4) were recruited. Of 1072 patients screened, 624 were excluded. The remaining 448 participants were randomized to electroacupuncture (n = 225) or sham electroacupuncture (n = 223); 383 participants (85.49%) completed the trial. Patients received 20 sessions of electroacupuncture or sham electroacupuncture over 4 weeks, followed by a 4-week posttreatment follow-up. The primary outcome was the change in the NRS-11 scores from baseline to week 4, with responders defined as participants achieving a 30% or more reduction in NRS-11 scores.
Of 448 participants, the mean (SD) age was 63.19 (9.26) years, 233 (52.01%) were male, and 215 were female (47.99%). At week 4, the electroacupuncture group had a greater decrease in the NRS-11 scores (−1.52) than the sham electroacupuncture group (−0.99) with an adjusted mean difference of −0.53 (95% CI, −0.61 to −0.43; P < .001), and the responder rate was significantly higher in the electroacupuncture group (46.68%) than in the sham electroacupuncture group (24.28%) (adjusted risk difference, 22.40%; 95% CI, 13.02%-31.79%; P < .001). These treatment benefits persisted through a 1-month follow-up; no clinically significant adverse events were observed.
The authors concluded that, among patients with PHN in this study, electroacupuncture provided a statistically significant reduction in pain severity, increased responder rates, and improved pain-related functional outcomes. These benefits suggest that electroacupuncture may be a useful nonpharmacological option for integrated management of PHN.
Here are a few points of concern and criticism:
- The authors state that the study was funded by the Evidence-Based Capacity Building Project for Traditional Chinese Medicine from National Administration of Traditional Chinese Medicine, the National Natural Science Foundation of China, the Natural Science Foundation of Jiangsu Province, Young Elite Scientists Sponsorship Program by China Association of Chinese Medicine, Youth Talent Project of Jiangsu Province Administration of Traditional Chinese Medicine, and Nanjing University of Chinese Medicine Double-Hundred Talent Program. Yet, they insist they had no conflict of interest.
- Acupuncture studies from China are as good as never negative. As frequently noted on this blog, the vast majority of Chinese studies seem to rely on falsified data.
- The authors imply that their study was patient-blind; yet there is no way that this is true: 1) The verum was administered to elicit ‘de-qi’, while the sham was not. 2) The electrical current in the verum group induced mild muscle twitching, while the sham group had no such experience. This means the verum patients knew the were receiving verum and thus were expecting an effective therapy. By contrast, the control group would have comprehended that they were given a placebo and were disappointed. These effects inevitably contribute to the outcome. In fact, I would agruge that they suffice in bringing them about without any contribution of a specific acupuncture effect. At the very minimum, the authors should have discussed these issues fully and critically.
- The acupuncturists of this study were also not blind. It is possible – I would argue, even likely – that they influenced patients to report or experience more positive results. Again, I would suggest that such effects suffice to generate a false-positive outcome.
- Even if there was a true effect of the verum beyond placebo, the question is, was it caused by acupuncture or the electrical current? There is a sizable body of evidence suggestion that electrotherapy might be effective for PHN!
In conclusion, the assertion that “electroacupuncture provided a statistically significant reduction in pain severity, increased responder rates, and improved pain-related functional outcomes” is uncritical, promotional and unjustified. I am once again dismayed that a reputable journal publishes such overt rubbish.
Chronic non-specific low back pain (CNSLBP) is a major cause of disability worldwide. Conventional pharmacological treatments offer limited benefits and carry potential risks, prompting interest in alternative approaches, including homeopathy. The objective of this study was to evaluate the short-term efficacy and safety of a standardised homeopathic biotherapic (Lumbar Vertebra, LM2 potency) for CNSLBP.
A randomised, double-blind, crossover, placebo-controlled clinical trial was conducted with 120 participants diagnosed with CNSLBP. Participants received both the biotherapic and placebo in two treatment phases separated by a washout period. The primary outcome was pain intensity (numeric rating scale); secondary outcomes included functional disability (Oswestry Disability Index), adverse events and use of pain medications. Data were analysed using random effects generalised linear models.
Both the biotherapic and placebo interventions led to significant within-group reductions in pain and disability (p = 0.001 and p < 0.001 respectively). However, no statistically significant differences were observed between the two interventions for either outcome (pain: p = 0.435; disability: p = 0.840). The magnitude of change in pain intensity did not reach the pre-defined minimal clinically important difference (MCID), and mean pain scores at the study endpoint remained above the inclusion threshold. Adverse events were mild and comparable across groups.
The authors concluded that no specific effect of the Lumbar Vertebra LM2 biotherapic was demonstrated. Improvements are likely due to non-specific effects such as the therapeutic environment, patient expectations and placebo response. Clinicians should consider the substantial role of non-specific responses in CNSLBP and avoid medications with unfavourable risk–benefit profiles.
One the one hand, the authors from the Department of Medicine, Federal University of São Carlos, São Carlos, Sao Paulo, the School Health Unit, Federal University of São Carlos, São Carlos, Sao Paulo, and the epartment of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil should be congratulated for publishing a squarely negative result in the journal ‘Homeopathy’ that is known for publishing even the most implausible positive findings.
On the other hand, one might criticise them: why on earth did they ever conceive the hypothesis that homeopathy in general or “Lumbar Vertebra LM2 biotherapic” in particular might be effective for CNSLBP (the study did not receive any funding or financial support, apart from the study medications donated by HN-Cristiano Pharmacy (Santana, São Paulo, Brazil), which had no role in the study design, data collection, analysis, interpretation or discussion of the results)? I have never met a homeopaths who would make such a claim, and one could easily argue that such a trial is an unethical waste of resources.
This study was conducted to determine the effect of Reiki performed on children with leukemia between the ages of 5-7 years on pain, vital signs, oxygen saturation, and quality of life. It was a double-blind, pre-test-post-test randomized controlled experimental study. The research sample consisted of 66 children with leukemia aged 5-7 years who were hospitalized in pediatric oncology wards of a university hospital between December 2020 and November 2021. The balanced block randomization method was used for randomization. The data were collected using Information Form, Wong-Baker FACES Pain Scale (W-BPS), Vital Signs Follow-up Form, The Pediatric Quality of Life Inventory (PedsQL) 3.0 Cancer Module. Reiki was performed to the Reiki group for 20-30 min once per day, for 3 consecutive days and pseudo-Reiki was applied to the pseudo-Reiki group by an independent nurse during the same application period.
There was no statistically significant difference in vital signs (heart rate, respiratory rate, body temperature) and SpO2 values among the groups (p > 0.05). However, both children’s and mothers’ evaluations on days 1, 2, and 3 after the intervention showed that pain scores in the Reiki group were significantly lower than in the pseudo-Reiki and control groups (p < 0.001), and quality of life was significantly higher (child:p < 0.001; mother:p < 0.01) compared to the pseudo-Reiki and control groups.
The authors concluded that Reiki did not affect the vital signs of the children but was effective in reducing pain and increasing the quality of life compared with the pseudo Reiki and control groups. It is recommended that Reiki therapy be used in addition to medical treatment to reduce pain and improve quality of life in children with leukemia aged 5-7 years.
The whole point of having a control group receiving pseudo-Reiki is to control for placebo effects. For this purpose, it is necessary to fool the patients well and make sure that they are unable to tell Reiki from pseudo-Reiki. I would guess – I have no aceess to the full paper – that this was not the case in this study. If I am correct, the positive outcome is likely to be due to expectation of a positive healing effect and unrelated to any specific effect of Reiki.
In any case, it is irresponsible nonsense to recommend Reiki – or any therapy – on the basis of just one positive study. For that one would need several independent confirmations with high quality studies that firmly establish a cause effect relationship. The current study does not fall into that category, and I am not aware of a single trial that does.
Insomnia is a prevalent disorder that is associated with substantial impairment. Homeopathy has been proposed as a complementary treatment for insomnia, but its clinical effects remain uncertain.
This systematic review assessed the efficacy, effectiveness, and safety of homeopathic treatments for insomnia. Prospective comparative studies evaluating any homeopathic preparation for insomnia were included. Searches in MEDLINE, EMBASE, seven additional databases, and three trial registries were conducted through August 2025. Risk of bias, intervention complexity, model validity, and pragmatism were assessed using respectively RoB 2, ROBINS-I, iCAT, MVHT, and RITES. Data were synthesized using random-effects meta-analyses, and certainty of evidence was evaluated using GRADE.
Eight randomized controlled trials (RCTs; n = 364 participants) and four non-randomized studies (NRSIs; n = 517) met the inclusion criteria. In adults, sleep quality (MD = −2.6 points; 95% CI −5.5 to 2.6; low certainty) and insomnia severity (MD = −3.2; 95% CI −5.68 to −0.72, moderate certainty) were reported in one RCT each. For total sleep time, the pooled MD of three RCTs was 0.65 hours (95% CI −0.9 to 2.2; low certainty). In children, one open-label RCT suggested a difference in insomnia severity, but certainty of evidence was very low. Adverse events were rarely reported, resulting in low certainty evidence.
The authors concluded that the current evidence is mainly limited by imprecision and risk of bias. The available evidence does not allow firm conclusions regarding the effects of homeopathy for insomnia. High-quality, replicated trials with systematic adverse event monitoring are needed.
15 years ago, I published a similar review entitled “Homeopathy for insomnia and sleep-related disorders: a systematic review of randomised controlled trials” (Focus on Alternative and Complementary Therapies Volume 16(3) September 2011 195–199)). Here is its abstract:
The aim of this review was the critical evaluation of evidence for the effectiveness of homeopathy for insomnia and sleep-related disorders. A search of MEDLINE, AMED, CINAHL, EMBASE and Cochrane Central Register was conducted to find RCTs using any form of homeopathy for the treatment of insomnia or sleep-related disorders. Data were extracted according to predefined criteria; risk of bias was assessed using Cochrane criteria. Six randomised, placebo-controlled trials met the inclusion criteria. Two studies used individualised homeopathy, and four used standardised homeopathic treatment. All studies had significant flaws; small sample size was the most prevalent limitation. The results of one study suggested that homeopathic remedies were superior to placebo; however, five trials found no significant differences between homeopathy and placebo for any of the main outcomes. Evidence from RCTs does not show homeopathy to be an effective treatment for insomnia and sleep-related disorders.
The findings of the two reviews are remarkably similar. For the following reasons, I find this notable:
- One would have hoped that 15 years are a long enough time for clarifying the issue, particularly as insomnia is not an unimportant condition for homeopathy.
- The new review is authored by well-known proponents. It seems unexpected that they (almost) go as far as admitting that the evidence for homeopathy as a treatment for insomnia is not positive.
- We have here, I think, a textbook example of how proponents of homeopathy prettify results that do not confirm their belief.
SO FAR, SO GOOD.
But now consider this: There are two further reviews of the same subject!
The first is entitled “Homoeopathy for insomnia: A meta-analysis of clinical evidence – Journal of Integrated Standardized Homoeopathy“. Here is its abstract:
Objectives: Insomnia is a prevalent sleep disorder characterised by challenges in initiating, maintaining or achieving restorative sleep, resulting in compromised daytime functionality. Traditional therapeutic modalities frequently encompass pharmacological treatments, which may have adverse effects and potential for dependency. Numerous patients pursue alternative methodologies, such as homoeopathy, which is attributed to its personalised, holistic and non-invasive treatment framework. This thorough examination assesses the effectiveness of homoeopathy in promoting better sleep quality and overall wellness in people with insomnia by analysing randomised controlled trials (RCTs).
Material and Methods: This meta-analysis sought to ascertain whether homoeopathy induces a statistically significant enhancement in the management of insomnia, concentrating on aspects of sleep quality, duration and general well-being. All RCTs addressing insomnia treated with homoeopathic interventions were included in this review. All studies were meticulously documented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three evaluators independently reviewed and compiled the literature, extracting comprehensive details regarding participants, study designs, therapeutic interventions and follow-up pertaining to homoeopathic treatment. The primary outcome of the investigation was disease assessment based on sleep diary scores, with an additional outcome being the enhancement of quality of life.
Results: The analysis revealed that homoeopathic remedies exhibited statistically significant improvement over placebo in the management of insomnia. The overall pooled effect size, standardised mean difference (random), was −0.60, standard error (random) was 0.42 and confidence interval (random) at 95% ranged from −0.93 to −0.26. The risk of bias was assessed for all studies.
Conclusion: This meta-analysis shows that homoeopathic remedies are effective in treating insomnia, but more studies are required for accuracy.
The last review is entitled “Effectiveness of Homeopathic Interventions for Insomnia and Sleep Disorders: A Systematic Review and Meta-Analysis“. Here is its abstract:
Insomnia is a common sleep disorder, and many individuals seek alternative treatments like homeopathy. However, evidence for its effectiveness remains controversial. This systematic review and meta-analysis evaluated the effectiveness of homeopathic interventions for insomnia and sleep-wake disorders. A comprehensive search of PubMed, MEDLINE, CINAHL, and the Cochrane Library was conducted for studies published between 2010 and 2025. We included randomized controlled trials (RCTs) and non-randomized studies involving adults (≥18 years) with primary insomnia receiving any homeopathic intervention compared to placebo, no treatment, or active care. Primary outcomes included validated sleep quality measures (e.g., Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI). Four reviewers independently performed study selection, data extraction, and risk of bias assessment using RoB 2.0 and ROBINS-I. A random-effects meta-analysis was conducted for controlled trials, and a narrative synthesis for non-randomized studies. Certainty of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). The search yielded 1304 records; 12 studies (nine RCTs and three non-randomized) met inclusion criteria. Meta-analysis showed a large, statistically significant positive effect of homeopathy on sleep outcomes (SMD = 0.81, 95% CI [0.24, 1.38], p = 0.0055), with substantial heterogeneity (I² = 86.04%) and publication bias (Egger’s test, p = 0.0079). Most studies had high or critical risk of bias, and overall certainty was low. Homeopathic interventions showed a large positive effect on sleep outcomes, but due to high bias, heterogeneity, and publication bias, evidence remains low-certainty and insufficient to support effectiveness. High-quality RCTs are needed.
What should we make of this?
We now have two reviews concluding that there is no good evidence and two implying that homeopathy is effective for insomnia! This clearly demonstrates how easy it is to mislead the public with seemingly rigorous reviews.
I must say, I pity all the interested lay people who are trying to make sense of this mess.
How can they arrive at the best available, most reliable evidence?
We have here, I think, another textbook example; one of how important it is to run reality checks. But surely, we cannot possible ask of a lay person to understand why the last two reviews are badly misleading. What we need is an accessible tool for differentiating the science from the pseudoscience, the reliable from the unreliable.
Unfortunately, such a tool does not exist. But there are a few indicators:
- Is the journal that published the review reputable?
- Are the authors affiliated to reputable institutions?
- Do the authors have a history of critical analysis or one of uncritical promotion?
- Do they explain clearly and provide the essential details of their work?
These are issues that lay people might be able to check relatively easily. The above 4 reviews demonstrate that using them does not always provided an entirely clear cut-off. However, it might give some valuable pointers into the right direction.
Zack Polanski the current Leader of the Green Party of England and Wales, previously worked as a professional “cognitive hypnotherapist”.
My own assessment of hypnotherapy states that is the use of a trance-like state (hypnosis) for therapeutic purposes. It can be traced back to ancient cultures, but more recently Anton Mesmer (1734–1815) introduced hypnotherapy into medicine. Initially Mesmer was highly successful—until a Royal Commission investigated his method of ‘animal magnetism’ and concluded its effects were entirely due to imagination. Hypnotherapy induces in many but not all individuals a state of deep relaxation that is potentially helpful in a range of conditions. Today, there are different schools of hypnotherapy, e.g. Ericksonian hypnotherapy, cognitive behavioural hypnotherapy, curative hypnotherapy. Various different healthcare professionals practise hypnotherapy, including doctors, dentists, psychologists and nurses. Hypnotherapy is used to treat many conditions or symptoms, from pain and stress to irritable bowel syndrome and drug dependency. The evidence from clinical trials is mixed. Most systematic reviews emphasise the often poor-quality of the primary studies, e.g.:
“Hypnosis reduces pain intensity and anxiety ratings in adults undergoing burn wound care. However, because of the limitations discussed, clinical recommendations are still premature.”
“Due to exploratory designs and high risk of bias, the effectiveness of hypnosis or hypnotherapy in stress reduction remains still unclear.”
“There are still only a relatively small number of studies assessing the use of hypnosis for labour and childbirth. Hypnosis may reduce the overall use of analgesia during labour, but not epidural use. No clear differences were found between women in the hypnosis group and those in the control groups for satisfaction with pain relief, sense of coping with labour or spontaneous vaginal birth. Not enough evidence currently exists regarding satisfaction with pain relief or sense of coping with labour and we would encourage any future research to prioritise the measurement of these outcomes. The evidence for the main comparison was assessed using GRADE as being of low quality for all the primary outcomes with downgrading decisions due to concerns regarding inconsistency of the evidence, limitations in design and imprecision.”
“We have not shown that hypnotherapy has a greater effect on six month quit rates than other interventions or no treatment. The effects of hypnotherapy on smoking cessation claimed by uncontrolled studies were not confirmed by analysis of randomised controlled trials.”
“Current research concerning the efficacy of hypnosis to relieve insomnia is lacking in key methodological elements”
Contrary to what is often claimed, hypnotherapy is not entirely free of adverse effects. It has been associated with the ‘false memory syndrome’ where unpleasant recollections that have never occurred are implanted into the patient’s brain. Hypnotherapy should not be used by patients who suffer from psychoses or personality disorders.
Polanski’s practice was based at a clinic on Harley Street, a London district renowned for private healthcare. His work focused on personal development, confidence building, and body-image issues. Polanski’s hypnotherapy career became a subject of public scrutiny due to a 2013 report by The Sun newspaper, in which it was claimed that during a consultation, Polanski offered to use hypnosis to facilitate breast enlargement. While Polanski later stated the piece was a “misleading” representation of his methods and intended as an experiment in internal self-image, recent investigative reporting has cast doubt on his subsequent narrative.
Although Polanski has frequently asserted that he apologized for the article “the day after” its publication in a BBC radio interview. This claim is, however, contested. In a 2013 interview with BBC Radio Humberside, Polanski reportedly discussed the technique and stated that “the evidence is growing” regarding its efficacy. Independent analysis of the clinical evidence-base for hypnotherapy fails to find good evidence regarding physical outcomes. Similarly, the evidence regarding the efficacy of hypnotherapy for personal development and confidence building is at best varied, with outcomes often depending on the specific application and individual context. My own assessment does not arrive at a positive conclusion.
Polanski has claimed he was misrepresented in the Sun article. Yet, he also wrote in a 2019 blog post that he did not believe the journalist had done a “bad job” or misrepresented him. In that same post, he noted that the coverage led to numerous inquiries from men seeking similar hypnotic treatments for other physical augmentations, all of which he stated he declined.
The “breast enlargement” claim has been frequently cited by political opponents and the media to question Polanski’s judgment and credibility. The story has resurfaced repeatedly during his political campaigns, including through confrontations from members of the public and intense scrutiny during his time as leader.
Polanski maintains that his background in hypnotherapy provides him with unique insights into mental health and communication, which he views as assets in his political role. I would add that, for many of the conditions for which it is promoted, hypnotherapy is not an evidence-based treatment.
Polanski has expressed regret for the “distraction” the story has caused his party, even as critics continue to challenge the consistency of his account regarding the original 2013 events.
When a top journal like PNAS (Procedings of the Nationsl Academy of Science) publishes an article entitled “What’s the science behind acupuncture?“, I must take notice. Here is my take on the (sadly disappointing) effort:
My very short summary of the paper (I do encourange my readers to read it in full)
The article starts from the premise that acupuncture is proven to work, an assumption that – as we will see in a minute – is not based on sound evidence. It describes the evolution of acupuncture from a traditional practice rooted in ancient concepts like “qi” and “meridians” to a modern medical treatment increasingly validated by science. It argues that practitioners like Min Chen are today able to provide evidence-based explanations for their work. While early clinical trials were plagued by the “sham” acupuncture paradox, the text argues that more recent, rigorous studies and technological projects are bridging the gap between Eastern philosophy and evidence-based medicine, suggesting that acupuncture’s effects are physiological realities rather than mere placebo.
My concerns of the paper
The article attempts to bridge the gap between Traditional Chinese Medicine (TCM) and conventional medicine suggesting that several anatomical discoveries “correspond” to ancient meridians. This, however, is a post hoc ergo propter hoc fallacy. Finding a morphological structure (e.g. fascia) and claiming it represents the meridian system ignores that meridians were conceptualized as functional energetic conduits, not anatomical vessels. Citing an 80% overlap between acupoints and connective tissue planes lacks specificity. Given the ubiquity of connective tissue in the human frame, any randomized point on the body would likely “overlap” with a tissue plane, rendering the “meridian” map a possible exercise in pattern-seeking rather than anatomical discovery.
The paper acknowledges the “most puzzling” finding that sham acupuncture often produces results comparable to “true” acupuncture. This, it would seem to me, invalidates the foundational TCM theory of specific “acupoints” and “meridians” is invalidated. Yet, the article suggests that sham acupuncture is “not a true placebo” because it also triggers biological pathways. If needling anywhere produces an effect, acupuncture is merely a generalized, non-specific neuro-modulatory stimulus.
The article quotes Chen on “harmonizing organ functions” and “regulating qi” as well as researchers referring to “fibroblast activation” and “vagus nerve stimulation”. The author seems to consider both to be true; yet they seem mutually exclusive. Translating metaphysical concepts into physical phenomena does not “validate” the original theory but merely replaces it.
The article employs the opioid crisis to justify the rise of acupuncture. Yes, the need for non-pharmacological pain management is urgent, but clinical necessity does not equate to scientific validity. The text quotes the “lasting benefits” observed in some meta-analyses without discussing the often fatal flaws in these papers. Furthermore, it fails to cite the substantial body of evidence suggesting that acupuncture is not effective. Moreover, it hardly mentions the small effect sizes and hence limited clinical usefulness found in the positive studies.
The final section of the paper essentially rebrands acupuncture as “bioelectronic medicine”. If its mechanism of action is purely the electrical stimulation of the vagus nerve or the release of endogenous opioids, then the TCM concepts are all but superfluous. If a cheap and wearable TENS unit is more or less equivalent, the “meridian” and “qi” myths are obsolete.
In summary, the paper reads, I fear, only marginally better than a Chinese government promotional text – most disappointing for an article published in a journal of high standing. It attempts to preserve the cultural prestige of TCM while stripping it of its internal logic in order to make it compatible with science. For acupuncture to gain a true “scientific footing”, research must, in my view, move beyond finding “tantalizing” correlations. It should address fundamental problems, e.g.:
- As long as we have no convincing proof that acupuncture works beyond placebo, discussions about its mechanisms are futile.
- If qi, acupoints and meridians are illusions and irrelevant for the clinical outcome, then the science is not validating acupuncture but merely re-discovering a well-known non-specific form of peripheral nerve stimulation.
Tonsillitis is a common condition predominantly affecting children and adolescents, presenting as acute, recurrent, or chronic infection. This review evaluated the effectiveness of homeopathy for clinical improvement and recurrence prevention across all tonsillitis presentations.
A team of scientists searched nine databases and four trial registries for randomised controlled trials (RCTs) and non-randomised controlled trials (nRCTs) involving patients of all ages with diagnosed tonsillitis. Studies examining individualised homeopathy (IH) and non-individualised homeopathy (non-IH) were included, compared with an inactive or active control group. Primary outcomes were clinical improvement (symptoms and signs) and recurrence. Secondary outcomes were antibiotic consumption, healthcare utilisation, quality of life, costs, and adverse events. Data extraction, Risk of Bias assessment, and certainty of evidence evaluation (GRADE) followed established methodology.
Five RCTs compared homeopathy with placebo (n=4) or standard care (n=1): one used IH, one used both IH and non-IH, and three used non-IH. Two RCTs examined acute tonsillitis, two examined recurrent tonsillitis, and one examined chronic tonsillitis. Three trials enrolled children, one enrolled adults, and one enrolled a mixed population. Sample sizes ranged from 30 to 256. Substantial heterogeneity across populations, interventions, and outcomes precluded meta-analysis. Individual RCTs showed that, in acute tonsillitis, non-IH achieved short-term symptom improvement. In recurrent tonsillitis, both IH and non-IH were associated with reduced infection recurrence, lower antibiotic consumption, and improved quality of life, with the strongest evidence for a standardised non-IH complex (SilAtro-5-90). In chronic tonsillitis, IH showed delayed but consistent improvements in symptoms, recurrence, healthcare utilisation, and quality of life by 2–3 months, with early outcomes favouring placebo. The certainty of evidence for all outcomes was low. No serious adverse events were reported.
The authors concluded that the evidence from individual trials suggests that both individualised and non-individualised homeopathy may benefit clinical improvement, reduce infection recurrence, reduce antibiotic use, and enhance quality of life in tonsillitis, with no safety concerns reported. However, substantial heterogeneity across studies and methodological limitations restrict the ability to draw definitive conclusions about homeopathy’s effectiveness in patients with tonsillitis. Further well-designed, adequately-powered trials with standardised outcomes and consistent methodological approaches are needed to strengthen the evidence base and enable more robust conclusions.
My critical evaluation of this paper is impeded by the fact that two of its authors were once members of my own team. On the one hand, this might assure me that their review is of a high standard, on the other hand it hinders me to voice harsh criticism. Fortunately, they include their own valid criticism of their project:
One study was a pilot study and therefore not appropriately powered [36] and one was published by a single researcher not following a formal publication protocol or underwent a formal peer-review process [34]. One study used an add-on design [31] which is a recognised methodology in clinical research, not unique to homeopathy, and their limitations regarding attribution of effect are well understood and acknowledged. We do acknowledge the possibility of publication bias and the limitations of a small evidence base. We also note there are issues arising from numerous outcomes, subscales, and repeated time-point analyses, which substantially increases the likelihood of false-positive findings.
Further variability was introduced by unclear definitions of some secondary outcomes and by differences in definitions across studies. Two of the five studies reported on their funding body. One did not receive funding [37] and Palm et al., 2017 [31] was sponsored by Deutsche Homoopathie-Union, DHU-Arzneimittel GmbH & Co. Germany.
They also are open about the funding of their work:
Existing funds held by Homeopathy Research Institute (HRI) – donated by Manchester Homeopathic Clinic Charitable Trust – were donated to University of Bristol to conduct the systematic review. The funders had no involvement in the study design; in the collection, analysis and interpretation of the data; in the writing of the report; and in the decision to submit the paper for publication.
So, what should we make of their effort? Let me just state this:
If I had to advise them on how to improve their review substantially, I would have suggested they re-phrase their conclusion. I am sure that something like this would have been much more adequate:
Most of the included trials were positive yet, because of substantial heterogeneity and methodological limitations of the primary studies, the evidence collectively fails to show that individualised or non-individualised homeopathy are effective treatments for tonsillitis.
- IHMPs (verum; n = 67),
- or identical-looking placebos (control; n = 67)
Both treatments were administered alongside standard concomitant care including sitz baths, pelvic floor exercises, and dietary advice.
- Department of Repertory, D. N. De Homoeopathic Medical College and Hospital, Government of West Bengal, Kolkata, India.
- East Bishnupur State Homoeopathic Dispensary, Chandi Daulatabad Block Primary Health Centre, under Department of Health & Family Welfare, Government of West Bengal, Parganas, India.
- Department of Pathology & Microbiology, D. N. De Homoeopathic Medical College and Hospital, Government of West Bengal, Kolkata, India.
- Department of Organon of Medicine and Homoeopathic Philosophy, D. N. De Homoeopathic Medical College and Hospital, Government of West Bengal, Kolkata, India.
- Department of Materia Medica, D. N. De Homoeopathic Medical College and Hospital, Government of West Bengal, Kolkata, India.
- Department of Organon of Medicine and Homoeopathic Philosophy, National Institute of Homoeopathy, Ministry of AYUSH, Government of India, Salt Lake, Kolkata, India.
- Department of Community Medicine, D. N. De Homoeopathic Medical College and Hospital, Government of West Bengal, Tangra, India.
This list does not inspire me with confidence that this study is reliable.
Next I looked around for further trials of homeopathy for hemorrhoids – and I found another study by the same authors published 2 years earlier in the same dodgy journal:
Objectives: To investigate the efficacy and safety of individualized homeopathic medicines (IHMs) in treating hemorrhoids compared with placebo. Design: This is a double-blind, randomized (1:1), two parallel arms, placebo-controlled trial. Setting: The trial was conducted at the surgery outpatient department of the State National Homoeopathic Medical College and Hospital, Lucknow, Uttar Pradesh, India. Subjects: Patients were 140 women and men, aged between 18 and 65 years, with a diagnosis of primary hemorrhoids grades I-III for at least 3 months. Excluded were the patients with grade IV hemorrhoids, anal fissure, and fistula, hypertrophic anal papillae, inflammatory bowel disease, coagulation disorders, rectal malignancies, obstructed portal circulation, patients requiring immediate surgical intervention, and vulnerable samples. Interventions: Patients were randomized to Group 1 (n = 70; IHMs plus concomitant care; verum) and Group 2 (n = 70; placebos plus concomitant care; control). Outcome measures: Primary-the anorectal symptom severity and quality-of-life (ARSSQoL) questionnaire, and secondary-the EuroQol 5-dimensions 5-levels (EQ-5D-5L) questionnaire and EQ visual analogue scale (VAS); all of them were measured at baseline, and every month, up to 3 months. Results: Out of the 140 randomized patients, 122 were protocol compliant. Intention-to-treat sample (n = 140) was analyzed. The level of significance was set at p < 0.05 two tailed. Statistically significant between-group differences were elicited in the ARSSQoL total (Mann-Whitney U [MWU]: 1227.0, p < 0.001) and EQ-5D-5L VAS (MWU: 1228.0, p = 0.001) favoring homeopathy against placebos. Sulfur was the most frequently prescribed medicine. No harm or serious adverse events were reported from either of the groups. Conclusions: IHMs demonstrated superior results over placebo in the short-term treatment of hemorrhoids of grades I-III. The findings are promising, but need to be substantiated by further phase 3 trials.
Are we to believe that the authors were able to pull off 2 large almost identical studies within just 2 years?
Pull the other one!
This review was aimed at analyzing the scientific evidence on Reiki intervention as a nursing care strategy for people with cancer. For this purpose, the researchers searched six databases, including primary studies, in Portuguese, Spanish and/or English, about the evidence on the use of Reiki intervention as a care strategy for cancer patients, totaling five publications.
The included studies suggest potential benefits of Reiki intervention, such as pain relief, reduction of physical symptoms (fatigue and insomnia) and improvement in emotional aspects, such as anxiety and stress. However, the results are still limited in terms of methodological robustness and generalizability.
The Brazilian authors concluded that, although the findings indicate beneficial effects of Reiki in people with oncological diseases, there is a limited production of clinical trials aimed at the application of this therapy in clinical nursing practice. Reiki can be considered a complementary strategy in nursing care, as long as it is integrated into an individualized therapeutic plan. It is recommended that studies with greater methodological rigor be carried out to evaluate the effectiveness of Reiki applied by oncology nurses.
The authors explain that “Reiki is a practice that uses the laying on of hands and symbols to channel universal life energy to recharge, realign and rebalance the human energy field. Its objective is to undo energetic blockages that compromise the flow of vital energy, and maintain harmony between the body, mind and spirit.” With just 2 sentences, the authors inply that Reiki has a sound scientific basis which they do not question in their paper at all. Yet phenomena such as live energy, regarging, realigning and rebalancing human energy fields, energetic blockages in the human body, flow of vital energy could not be less scientific. In fact, they are pure fantasy and have no basis in reality.
The authors also explain that 20 % (n=1) of the included studies were qualitative, 20 % (n=1) were quasi-experimental, 20 % (n=1) were reports of professional experience, and 40 % (n=2) consisted of randomized clinical trials (RCTs). On closer scrutiny, none of the RCTs was sufficiently rigorous to allow firm, positive conclusions. In other words, there is no good evidence and the conclusion that Reiki is beneficial for cancer patients is nonsense.
The authors note that, in 2017, with the publication of Ordinance No. 849, of March 27, Reiki was officially included in the Brazilian public health network. In view of the above mentioned lack of plausibility combined with a lack of effectiveness, this inclusion seems wholly irresponsible.
