symptom-relief
This double-blind, three-arm randomised trial evaluated the efficacy of homeopathic medication in patients with seasonal allergic rhinitis (SAR). Patients at eleven outpatient clinics and two medical centres were randomised to receive:
- (1) individualised homeopathic case taking (IHCT) and standardised homeopathic medication with Galphimia Glauca (GG),
- (2) IHCT and individualised homeopathic treatment (IHG),
- (3) IHCT and placebo (PG).
The primary outcome was disease-specific quality of life, assessed using the Rhinitis Quality of Life Questionnaire (RQLQ) after three and four weeks. Secondary outcomes included response rate (≥0.5-point change in RQLQ), rescue medication use, and total nasal and non-nasal symptom scores (TNSS, TNNSS).
Sixty-two SAR patients (mean age ± SD: 46.9 ± 14.9; 43.5% female) were recruited, approximately 25% of the planned sample size. After weeks three and four, there were no significant differences in RQLQ (p=0.244) between GG (adjusted mean, 1.2, 95% CI 0.7-1.7), IHG (1.7, 1.2-2.3), and PG (1.4, 0.8-2.0). High response rates were observed (GG: 86.4%, IHG: 66.7%, PG: 81.3%), while RM use was 21.7%, 55.6%, and 29.4%, respectively. There were no relevant differences in RM score, TNSS and TNNSS between the three groups. Eight adverse events but no serious adverse events were reported.
The authors concluded that standardised and individualised homeopathic drugs were not superior compared to placebo suggesting that treatment response was not based on study medication. The validity of the study and its conclusions are limited by the fact that the recruitment target was not achieved.
Multicentre studies like this one are useful for recruiting large numbers of patients. SAR is a common condition; the recruitment of a large sample should therefore have been fairly straight forward. So, why was this study so woefully under-powered? An average of 6 patients per centre is dismal, to put it mildly!
This leaves us with a failed study of a failed (implausible) hypothesis; its negative findings cannot be properly interpreted (other than showing the incompetence of the trialists).
Why publish such a waste of resorces at all?
Search me!
Hypothyroidism is a prevalent hormonal disorder symptoms often persist despite levothyroxine therapy. Adjunctive individualized homeopathic medicines (IHMs) may improve clinical outcomes, biochemical markers, and quality of life, robust evidence of efficacy remains limited.
The objective of this study was to evaluate the efficacy of add-on IHMs alongside standard levothyroxine therapy in the treatment of hypothyroidism in children and adults.
A 3-month, double-blind, randomized, placebo-controlled trial was conducted in a homeopathic hospital involving 64 trial subjects with hypothyroidism undergoing levothyroxine therapy. The participants received either IHMs plus levothyroxine (verum; n = 32) or placebo plus levothyroxine (control; n = 32) for 3 consecutive months. Patients, study investigators, outcome evaluators, and data entry staff were all kept blinded about the allocation concealment according to a double-blinded approach. The codes were not disclosed to the principal investigator, and unblinding occurred only in cases of clear medication-related risk, substantial benefit, or futility. The primary outcome was the Zulewski’s Clinical Scoring (ZCS); secondary outcomes included thyroid-stimulating hormone (TSH), T3, T4, and ThyroPRO-39 scores.
Both groups showed significant improvement in symptoms and thyroid indices. Between-group difference in ZCS was nonsignificant (mean diff: 0.1, 95% confidence interval [CI] −0.3–0.6, P = 0.567), but significant in T3 (mean diff: −0.2, 95% CI −0.4 to −0.1, P = 0.002), T4 (mean diff: 1.6, 95% CI 1.2–2.0, P < 0.001), and TSH (mean diff: −3.0, 95% CI −5.8 to −0.3, P = 0.033), favoring homeopathy against placebo. Quality-of-life changes were minimal, though some ThyroPRO-39 domains improved significantly with IHMs (e.g., symptoms, P < 0.001; tiredness, P = 0.012; nervousness and tension, P = 0.001; and daily activity, P = 0.001).
The authors concluded that adjunctive IHMs did not improve symptoms or quality-of-life outcomes over placebo conclusively, but revealed favorable biochemical changes, meriting further long-term studies.
I must admit: I am puzzled by this paper:
- According to the primary endpoint, the result is squarely negative.
- Yet, the article itself is presented as though the findings were positive.
- This is because the some secondary endpoints yielded positive results.
- But how can this be?
- I find the power justification unconvincing; perhaps the study was under-powered?
- The authors report that “Neither group experienced any adverse effects.”
- How can this be?
- Even placebo therapy generates adverse effects!
- And common problems of levothyroxine therapy are palpitations, tremor, nervousness, insomnia, sweating, heat intolerance, headache, diarrhoea, weight loss, and increased appetite.
As I said, I am puzzled. Perhaps the authors’ affiliations might explain?
- Department of Materia Medica, D. N. De Homoeopathic Medical College and Hospital, Affiliated to the West Bengal University of Health Sciences, Kolkata – 700 046, West Bengal, India
- Department of Repertory, D. N. De Homoeopathic Medical College and Hospital, Affiliated to the West Bengal University of Health Sciences, Kolkata – 700 046, West Bengal, India
- Department of Homeopathy, East Bishnupur State Homoeopathic Dispensary, Chandi Daulatabad Block Primary Health Centre, Under Department of Health and Family Welfare, Govt. of West Bengal, India
Medical ethics rests on 4 core principles: autonomy, beneficence, non-maleficence, and justice, along with the crucial rule of veracity (truth-telling). In the realm of chiropractic, the most significant ethical issues/problems generally fall into the following ethical categories:
- Compromised Informed Consent & Veracity
Informed consent requires that a patient fully understands the nature, risks, benefits, and scientific backing of a treatment before proceeding.
1.1.The “Subluxation” Theory: A sizable segment of the chiropractic community still adheres to the erroneous belief that spinal “vertebral subluxations” cause a disruption in the body’s “innate intelligence,” leading to systemic disease. From an ethical standpoint, promoting an unproven, pseudo-scientific premise as medical fact violates veracity and compromises patient autonomy, as patients cannot give truly informed consent based on erroneous concepts.
1.2. Over-claiming Scope of Efficacy: While evidence might support spinal manipulation for acute lower back pain (if one were to interpret the dtat optimistically), most chiropractors claim they can treat many other illnesses, including non-musculoskeletal conditions such as asthma, allergies, infantile colic, ADHD, and high blood pressure. Marketing these services without robust clinical trial backing misleads vulnerable populations.
- Violations of Non-Maleficence
The principle of non-maleficence requires practitioners to avoid inflicting unnecessary harm or exposing patients to disproportionate risks.
2.1. Cervical Manipulation and Stroke Risk: One of the most severe ethical concerns involves high-velocity, low-amplitude (HVLA) thrusts to the upper neck, the hallmark modality of chiropractors. This procedure has been linked to vertebral artery dissection (VAD), which can cause strokes and deaths. The ethical failure is most obvious when chiropractors perform these adjustments without warning the patient of this and other adverse outcomes.
2.2. Paediatric Chiropractic: Performing spinal adjustments on infants and toddlers (whose spines are primarily cartilage and still developing) poses distinct physical risks. Because infants cannot consent and the evidence of benefit for childhood ailments is practically non-existent, this behaviour violates non-maleficence.
- Secondary Harm: Delay of Standard Medical Care
Harm does not only come from physical injury; it also comes from omitting or delaying necessary medical treatment.
3.1. Anti-Vaccine and Anti-Medicine Sentiments: A large proportion of the chiropractic profession advise patients against conventional medicine, pharmaceuticals, and vaccination. When a chiropractor discourages a patient from seeking standard medical care, they are actively contributing to potentially life-threatening delays in care.
- Violations of Beneficence and Justice
Beneficence means acting in the patient’s best interest, while justice involves the fair and equitable distribution of healthcare resources.
4.1. The “Maintenance Care” Business Model: A common predatory practice of chiropractors involves convincing patients that they require lifelong, regular spinal adjustments to “stay aligned” and prevent disease, often locked into expensive upfront contracts. Recommending continuous, costly treatments that lack clinical evidence of long-term benefit shifts the focus from patient welfare (beneficence) to practitioner financial gain.
4.2.Over-Utilization of X-rays: Some chiropractic clinics mandate full-spine X-rays for every new patient, regardless of symptoms, and repeat them frequently to “prove” alignment changes. Exposing patients to unnecessary ionizing radiation for marketing or diagnostic justification is a direct violation of both non-maleficence and the ethical use of healthcare resources.
For a more detailed account of the ethical problems in so-called alternative medicine, please see our book on this very subject.
The IGeL-Monitor is a German information portal that reviews self-pay medical services offered in doctors’ offices. It summarizes the likely benefit and harm of these services in plain language so patients can make more informed decisions. It is run by the “Medizinischer Dienst Bund” and uses evidence-based assessments rather than advertising or provider opinion.
The IGeL‑Monitor has recently focussed on osteopathy for non‑specific low back pain and judged the evidence as “unclear” stating that the current evidence does not reliably show a benefit, nor does it demonstrate meaningful harm. The reassessment pooled evidence from ten randomised clinical trials including about 1,160 participants. While some trials suggested small improvements in pain or function, the overall certainty of these findings was low due to methodological weaknesses in the primary studies. The reviewers therefore concluded that there is no convincing, high‑quality proof that osteopathic manual therapy provides a clinically relevant advantage over sham or usual care.
A further concern highlighted in the assessment is publication bias: positive trials may be preferentially published. This phenomenon that exaggerates apparent benefits.
No clear pattern of harm from osteopathic treatment was identified. Adverse events were inconsistently and inadequately recorded in the trials. This fact not only limits the confidence about safety, but is also a clear breach of medical ethics.
The IGeL‑Monitor reiterates its previous (2018) position: with current data one cannot reliably endorse osteopathy as an effective out‑of‑pocket intervention for non‑specific low back pain, nor can one identify significant risk. Hence the label “unclear.” For patients considering osteopathy as a self‑paid service, the IGeL‑Monitor recommends being informed about the uncertain benefit and the weak evidence base when weighing potential costs against likely outcomes.
The new assessment is in agreement with much that I have been saying on this blog. I nevertheless would like to add one important point: back pain is the one condition for which the evidence is relatively sound. There are many other conditions for which osteopathy is being relentlessly promoted as an effective therapy with even less or no reliable evidence at all.
I must admit that, in recent months, I neglected my ALTERNATIVE MEDICINE HALL OF FAME. As my regular readers will know, this is an assembly of extraordinary researchers – extraordinary in the sense that they all have been busy studying so-called alternative medicine (SCAM) without ever managing to publish a single negative result.
At present, the ALTERNATIVE MEDICINE HALL OF FAME includes the following 27 men and women:
- Miek Jong (homeopathy, Norway)
- Josef M Schmid (homeopathy, Germany)
- Meinhard Simon (homeopathy, Germany)
- Richard C. Niemtzow (acupuncture, US)
- Helmut Kiene (anthroposophical medicine, Germany)
- Helge Franke (osteopathy, Germany)
- Tery Oleson (acupressure , US)
- Jorge Vas (acupuncture, Spain)
- Wane Jonas (homeopathy, US)
- Harald Walach (various SCAMs, Germany)
- Andreas Michalsen ( various SCAMs, Germany)
- Jennifer Jacobs (homeopath, US)
- Jenise Pellow (homeopath, South Africa)
- Adrian White (acupuncturist, UK)
- Michael Frass (homeopath, Austria)
- Jens Behnke (research officer, Germany)
- John Weeks (editor of JCAM, US)
- Deepak Chopra (entrepreneur, US)
- Cheryl Hawk (chiropractor, US)
- David Peters (osteopathy, homeopathy, UK)
- Nicola Robinson (TCM, UK)
- Peter Fisher (homeopathy, UK)
- Simon Mills (herbal medicine, UK)
- Gustav Dobos (various SCAMs, Germany)
- Claudia Witt (homeopathy, Germany/Switzerland)
- George Lewith (acupuncture, UK)
- John Licciardone (osteopathy, US)
Today, an article by Stephanie Benz published in L’Express caught my attention. It mentions a man who might well qualify as a candidate for my illustre assembly. As it is in French, let me summarise it for you.
The article focusses on the bixarre actions of Professor Julien Nizard. He is the vice-dean of Nantes University’s medical school, who stands accused of abusing his academic standing to promote SCAM, while suppressing scientific critique. Serving as an institutional shield for pseudo-sciences, Nizard uses his leadership at the university and within the Collège Universitaire de Médecine Intégrative et Thérapies Complémentaires (CUMIC) to introduce SCAM into official medical training.
The article explicitly notes Nizard’s defense, instruction, or validation of several SCAM practices, including:
- Acupuncture
- Hypnosis / Hypnotherapy
- Osteopathy
- Socio-aesthetic care (often used as part of supportive cancer care)
- Auriculotherapy (ear acupuncture)
- Various other “soft medicines” and non-medicinal interventions (INMs) lacking robust, peer-reviewed clinical proof.
To shield his SCAM programs from internal dissent, Nizard has allegedly turned to unusual administrative and legal pressures against critical faculty members and advocates of evidence-based medicine, like the Collectif No Fakemed. His tactics are said to include:
- Legal Threats and Institutional Action: Nizard has reportedly threatened to drag critical colleagues before the National Order of Physicians (CNOM) or pursue defamation lawsuits to silence them.
- Professional Hostility: Internal whistleblowers and professors attempting to uphold strict evidence-based standards report facing a hostile work environment, administrative stonewalling, and explicit professional pressure meant to damage their academic standing if they publicly oppose his pseudo-scientific initiatives.
- Political Manipulation: He uses behind-the-scenes lobbying at the ministerial level to bypass traditional university peer-review processes, relying on political influence to institutionalize practices that fail to meet baseline clinical research standards.
The article motivated me to look up Julien Nizard in order to find out what papers he has published in the realm of SCAM. The result is impressive. I found 7 abstracts of his SCAM-related papers listed on Medline.
Recent guidelines for managing fibromyalgia highlight the importance of a graded-care approach, tailoring treatment to predominant symptoms, and appropriately integrating nonpharmacological treatments and complementary medicine (CM). Many fibromyalgia patients turn to nonpharmacological treatment and CM for various reasons, including concerns about medication side effects and persistent symptoms despite pharmacological treatment. In addition, these approaches are sometimes mistakenly, but often, perceived as natural and, therefore, widely accepted as well-tolerated with minimal risks. However, as with many patients using CM, fibromyalgia patients frequently engage in these practices without informing their physicians, often because of fear of a negative reaction. This can occur in contexts that lack adequate safeguards, such as treatment by noncertified practitioners, undocumented practices, excessive costs, or unsafe environments. In this narrative review, we first provide updated definitions of these practices, discuss their potential benefits and associated risks, and explore the challenges in their evaluation. We then summarize key findings from the literature before proposing a structured approach for discussing these practices with fibromyalgia patients. This includes assessing their prior experiences, expectations, and motivations for long-term adherence. We also offer guidance on selecting qualified practitioners and ensuring a sufficiently safe treatment environment. Finally, we highlight essential “red flags” that pain specialists and health care providers should discuss with patients, emphasizing the need for caution or even discontinuation of certain practices when these warning signs are present.
The majority of nurses have a favourable opinion of complementary therapies. This makes it easier to identify the therapies used by patients. Being trained in and practising a complementary therapy strengthens the nursing skills and helps to give it new meaning. Nurses must play an active part in the ongoing structuring of integrative medicine in France.
Neuropsychiatric disorders are one of the frequent complications of neurocognitive disease, and have an impact on the quality of life of patients and caregivers. Non-phamacologic interventions are recommended as first-line treatment. The Snoezelen method is a multisensory stimulation method based on the assumption that acting on sensoriality can improve neuropsychiatric symptoms and thus quality of life, but its level of evidence is controversial. To explore this, we performed a systematic literature review of randomized controlled articles focusing on the use of the Snoezelen method in patients with cognitive disorders. Eighteen studies were included. The clinical outcomes studied were multiple (behavior, mood, cognition, functional capacities and biomedical parameters). When the Snoezelen method was compared to the “standard activities” group, it appears to be effective on short-term behavior. This was more negligible when the method was compared to others non-pharmacological interventions. Although the Snoezelen method could be effective on mood, cognition, and functional abilities, its level of evidence remains low. Furthers mixed studies (quantitative and qualitative) would be an interesting approach to delve into this topic in the most holistic way by integrating the patients, the caregivers and the cost of the method.
Background: Low Back Pain (LBP) is the leading cause of disability worldwide, 90% of which is nonspecific. Manual therapy is one of the recommended treatment modalities. However, reported outcomes may be variable. This review aims to identify their scope in the context of the development of a Core Outcome Set (COS), which is defined as « an agreed standardised set of outcomes that should be measured and reported, as a minimum, in all clinical trials in specific areas of health or health care ».
Methods: A scoping review with risk of bias assessment of randomised controlled trials (RCTs) of manual therapy for nonspecific LBP was conducted using MEDLINE, CENTRAL, PEDro, WebOfScience and ClinicalTrials.gov, from 2010 up to August 2024. Manual therapy was considered the use, alone or in combination, of manipulations (high velocity, low amplitude), mobilisations (low-grade velocity, small-to-large amplitude) or soft tissue relaxation (especially massage, trigger points, muscle contractions).
Results: Out of 3929 articles, 147 RCTs and 74 protocols were included. Two main outcomes emerged: pain intensity (assessed by numerical rating scale or visual analogue scale) and disability (mostly assessed by Rolland-Morris Disability Questionnaire or Oswestry Disability Index). Range of motion is the most frequent clinical outcome assessed. Psychological factors such as fear-avoidance beliefs, kinesiophobia and catastrophising, and healthcare consumption, particularly medication, are also frequent. Most of the outcomes were patient-reported outcomes.
Conclusion: Consistent with a previous COS on nonspecific low back pain, manual therapy appears to address the same outcomes. Clinical trials in manual therapy should focus on using the existing COS by measuring pain intensity using a numerical rating scale, disability using the ODI 2.1a or the 24-item RMDQ, health-related quality of life using the SF-12 or the 10-item PROMIS. Additionally, due to the gap between clinical research and pain experience, trials should consider conducting subgroup analyses to identify effects on outcomes related to gender or age, paying particular attention to health inequalities by carrying out analyses based on socioeconomic status, as these factors are well known to significantly impact pain experience and access to care.
Background: Deep brain stimulation (DBS) is an effective technique to treat patients with advanced Parkinson’s disease. The surgical procedure of DBS implantation is generally performed under local anesthesia due to the need for intraoperative clinical testing. However, this procedure is long (5-7 h on average) and, therefore, the objective that the patient remains co-operative and tolerates the intervention well is a real challenge.
Objective: To evaluate the additional benefit of electroacupuncture (EA) performed intraoperatively to improve the comfort of parkinsonian patients during surgical DBS implantation.
Methods: This single-center randomized study compared two groups of patients. In the first group, DBS implantation was performed under local anesthesia alone, while the second group received EA in addition. The patients were evaluated preoperatively, during the different stages of the surgery, and 2 days after surgery, using the 9-item Edmonton Symptom Assessment System (ESAS), including a total sum score and physical and emotional subscores.
Results: The data of nine patients were analyzed in each group. Although pain and tiredness increased in both groups after placement of the stereotactic frame, the ESAS item “lack of appetite”, as well as the ESAS total score and physical subscore increased after completion of the first burr hole until the end of the surgical procedure in the control group only. ESAS total score and physical subscore were significantly higher at the end of the intervention in the control group compared to the EA group. After the surgical intervention (D2), anxiety and ESAS emotional subscore were improved in both groups, but the feeling of wellbeing improved in the EA group only. Finally, one patient developed delirium during the intervention and none in the EA group.
Discussion: This study shows that intraoperative electroacupuncture significantly improves the tolerance of DBS surgery in parkinsonian patients. This easy-to-perform procedure could be fruitfully added in clinical practice.
Background: It is currently considered that around 30% of chronic pain patients are totally refractory to medical treatment. Among patients who remain responsive to medical treatment, it is estimated that between 20% and 50% are likely to discontinue treatment due to severe side effects. Given these therapeutic difficulties, a significant number of patients turn to complementary therapies.
Objective: The LineQuartz® is a medical device that combines 3 complementary therapies, namely, music therapy, light therapy, and chromotherapy. We propose to evaluate its effectiveness in chronic pain patients.
Methods: Between October 2021 and October 2022, 44 patients aged between 23 and 85 years (mean: 55.4 years) were included in a prospective study. All patients had background pain intensity greater than 4/10 on the Numerical Pain Scale (NS). Treatment consisted of 4 half-hour sessions, divided into one session per week for 3 weeks (21 days). Patients were assessed by the Brief Pain Inventory (BPI) and the Hospital Anxiety and Depression scale (HAD) the day before starting treatment (Day 0) and the day after the end of treatment (Day 22).
Results: Apart from the BPI item, “relationship with others,” all items improved significantly (p < 0.050). Background pain intensity (NS) and frequency of painful attacks improved very significantly (p < 0.001). The HAD anxiety subscore was also significantly improved (p < 0.001). Discussion. This open pilot study supports the idea that LineQuartz® has a place among complementary therapies dedicated to the treatment of chronic pain. However, these results need to be confirmed by a controlled study.
Context: In addition to curative care, supportive care is beneficial in managing the anxiety symptoms common in patients in sterile hematology unit. We hypothesize that personal massage can help the patient, particularly in this isolated setting where physical contact is extremely limited. The main objective of this study was to show that anxiety could be reduced after a touch-massage® performed by a nurse trained in this therapy.
Methods: A single-center, randomized, unblinded controlled study in the sterile hematology unit of a French university hospital, validated by an ethics committee. The patients, aged between 18 and 65 years old, and suffering from a serious and progressive hematological pathology, were hospitalized in sterile hematology unit for a minimum of three weeks, patients were randomized into either a group receiving 15-minute touch-massage® sessions or a control group receiving an equivalent amount of quiet time once a week for three weeks. In the treated group, anxiety was assessed before and after each touch-massage® session, using the State-Trait Anxiety Inventory questionnaire with subscale state (STAI-State). In the control group, anxiety was assessed before and after a 15-minute quiet period. For each patient, the difference in the STAI-State score before and after each session (or period) was calculated, the primary endpoint was based on the average of these three differences. Each patient completed the Rosenberg Self-Esteem Questionnaire before the first session and after the last session.
Results: Sixty-two patients were randomized. Touch-massage® significantly decreased patient anxiety: a mean decrease in STAI-State scale score of 10.6 [7.65-13.54] was obtained for the massage group (p ≤ 0.001) compared with the control group. The improvement in self-esteem score was not significant.
Conclusion: This study provides convincing evidence for integrating touch-massage® in the treatment of patients in sterile hematology unit.
_________________________
Are you as impressed as I am?
Not only has this vice-dean of a medical school shown how to properly defend SCAM by innovative means including legal threats, he has also found the time to publish 7 Medline-listed papers on various forms of SCAM! I am even more impressed that someone with so little valid SCAM research can become such an ardent “defender of the indefensible”. But what impresses me most is this: in all his publications, I cannot find a single negative result, nor a word of SCAM-related criticism.
This, by Jove, is a remarkable achievement!
I hope you all agree that it deserves inclusion into my ALTERNATIVE MEDICINE HALL OF FAME.
Bienvenue Julien!
A recent paper entitled “Research Ethics and Integrity and the Different Forms of Misconduct: Applications and Challenges in Traditional, Complementary, and Integrative Medicine Research” caught my eye. As the subject is close to my heart and often covered on this blog, I studied it carefully. Here is the abstract:
Research ethics and integrity are foundational to the credibility, safety, and societal trust of scientific inquiry. As the use of traditional, complementary, and integrative medicine (TCIM) grows globally, concerns about research misconduct (including fabrication, falsification, and plagiarism) have become increasingly salient. With up to 80% of populations in certain countries utilizing TCIM, the field’s expansion underscores the need for rigorous, ethically grounded evidence to guide practice and policy. However, around 470 TCIM-related articles have been retracted to date, as indicated on the Retraction Watch database, which may be due to ethical or non-ethical concerns. This educational article critically examines the state of ethics and integrity in TCIM research, drawing on case studies of misconduct and highlighting the broader consequences for patient safety, scientific credibility, and healthcare integration. In addition, the educational article explores emerging ethical dilemmas posed by artificial intelligence (AI), including risks of automated fabrication, falsification, plagiarism, and opacity in research reporting. To strengthen ethical conduct, we propose strategies spanning four domains: 1) improving education and fostering interdisciplinary collaboration to enhance research literacy, 2) embedding open science practices to promote transparency and reproducibility, 3) leveraging meta-research to monitor and advance research quality, and 4) developing policies and safeguards for responsible AI use. Upholding high ethical standards in TCIM research is essential not only to ensure reliable evidence but also to protect patients, sustain public trust, and enable meaningful integration of TCIM within evidence-based healthcare systems.
The full conclusions of the authors are as follows: “With the increasing global use of TCIM therapies, it is crucial for TCIM researchers to uphold high ethical standards to ensure the feasibility, validity, efficacy and safety of TCIM interventions. TCIM research challenges such as heterogeneity, complexity, and lack of standardization practices, alongside issues with research training and funding, create both transformative opportunities and ethical dilemmas that require reflection. Addressing these challenges requires a firm commitment to enhancing research ethics and integrity in TCIM. This commitment must be translated into action through multifaceted strategies: improving research and ethics literacy, fostering open science practices, and ensuring the transparency, integrity, and reproducibility of TCIM research. Strengthening ethical and research practices will not only support its continued development as a discipline but also maximize its potential to contribute to global health.”
I find it most commendable that this subject has finally been addressed by a group of researchers, most of who are known advocates of so-called alternative medicine (SCAM). I hope that this is proves to be a step in the right direction for the fileld of SCAM.
Yet, I fear that it is a small or even tiny step. The reason for my fear is that several important issues related to research ethics and integrity in SCAM are let untouched by the authors. In my view, the one of the most important amongst them is the SCAM researcher him/herself. As often discussed on this blog, SCAM research is unique amongst all areas of medical research for being populated by individuals who have a strong ideological bias in favour of SCAM.
These (pseudo)scientists tend to abuse science by trying to prove that their beliefs are correct. Rather than trying to falsify their hypotheses, they would bend over backwards to show that their favourite SCAM is effective. I tried to demontrate this clearly by establishing my ALTERNATIVE MEDICINE HALL OF FAME on this blog.
As to the many other omissions of important ethical concerns from the above paper, I recommend having a look at our book “More Harm than Good?: The Moral Maze of Complementary and Alternative Medicine“. It offers a much more complete review of the ethical issues involved in SCAM research (amusingly, it was not cited in the paper above).
Breast cancer and its treatments affect patients’ physical, psychological, and emotional well-being. Practices such as Reiki are used to support symptom management, particularly during chemotherapy. This systematic review aims to evaluate the effects of Reiki practice on improving symptoms in breast cancer patients within the framework of Martha E. Rogers’ “Science of Unitary Human Beings.”
The research was conducted as a systematic review in accordance with the PRISMA 2020 guidelines. A comprehensive literature search was performed in the PubMed, Web of Science, CINAHL (EBSCOhost), Google Scholar, and DergiPark databases, with the search updated through May 2026 prior to the final analysis. Randomized controlled trials, experimental studies, and quasi-experimental studies investigating Reiki interventions in breast cancer patients were included. Methodological quality and risk of bias were independently assessed by two researchers using Joanna Briggs Institute (JBI) critical appraisal tools and the Cochrane Risk of Bias Tool.
Four studies meeting the inclusion criteria included a total of 339 participants. The included studies suggested that Reiki practice may reduce fatigue and improve overall comfort and well-being. Some studies also reported improvements in quality of life, comfort, mental well-being, and mood.
The authors concluded that Reiki appeared to be a safe and well-tolerated complementary intervention in the included studies. Reiki practice may contribute to symptom management, improve quality of life, and support psychological well-being in breast cancer patients. However, due to the limited number of studies, small sample sizes, and methodological differences, larger, well-designed randomized controlled trials are needed.
This is a weird review, if there ever was one!
- It certainly did not follow the PRISMA guidelines.
- It evaluated the effects of Reiki practice on improving symptoms in breast cancer patients; much clearer can one not display a pro-Reiki bias!
- It included non-randomised trials.
- None of the included studies were of sufficiently good quality.
But the weirdest aspect must be the conclusion of the abstract: it aknowledges the fact that the primary studies were rubbish and nevertheless praises the multiple alleged benefits of Reiki. If the evidence is unconvincing due to many flaws of the primary data, the only adequate conclusion should read something like this:
Because of serious flaws of the included studies, the evidence that Reiki affects the symptoms of breast cancer patients fails to be positive.
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.
