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

symptom-relief

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We have discussed the LIGHTNING PROCESS before:

Now, the BBC reports that it is promoted as a treatment of Long-COVID. Oonagh Cousins was offered a free place on a course run by the Lightning Process, which teaches people they can rewire their brains to stop or improve long Covid symptoms quickly. Ms Cousins, who contracted Covid in March 2020, said it “exploits” people.

Ms Cousins had reached a career goal many athletes can only dream of – being selected for the Olympics – when she developed long Covid. By the time the cancelled 2020 Olympic Games in Tokyo were rescheduled for 2021, Ms Cousins was too ill to take part. When she went public with her struggles, she was approached by the Lightning Process. It offered her a free place on a three-day course, which usually costs around £1,000.

“They were trying to suggest that I could think my way out of the symptoms, basically. And I disputed that entirely,” the former rower said. “I had a very clearly physical illness. And I felt that they were blaming my negative thought processes for why I was ill.” She added: “They tried to point out that I had depression or anxiety. And I said ‘I’m not, I’m just very sick’.

In secret recordings by the BBC, coaches can be heard telling patients that almost anyone can recover from long Covid by changing their thoughts, language and actions. Over three days on Zoom, the course taught the ritual that forms the basis of the programme. Every time you experience a symptom or negative thought, you say the word “stop”, make a choice to avoid these symptoms and then do a positive visualisation of a time you felt well. You do this while walking around a piece of paper printed with symbols – a ritual the BBC was told to do as many as 50 times a day.

In some cases the Lightning Process has encouraged participants to increase their activity levels without medical supervision, against official advice – which could make some more unwell, according to NHS guidelines. Lightning Process founder, Dr Phil Parker, who’s not a medical doctor but has a PhD in psychology of health, told us his course was “not a mindset or positive thinking approach,” but one that uses “the brain to influence physiological changes”, backed by peer-reviewed evidence. The coach on the course the BBC attended said “thoughts about your symptoms, your worry about whether it’s ever going to go – that’s what keeps the neurology going. Being in those kind of thoughts is what’s maintaining your symptoms. They’re not caused by a physical thing any more.”

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As I pointed out previously, The Lightning Process  (LP) is a therapy based on ideas from osteopathy, life coaching, and neuro-linguistic programming. LP is claimed to work by teaching people to use their brains to “stimulate health-promoting neural pathways”.

LP teaches individuals to recognize when they are stimulating or triggering unhelpful physiological responses and to avoid these, using a set of standardized questions, new language patterns, and physical movements with the aim of improving a more appropriate response to situations.

Proponents of the ‘LP’ in Norway claim that 90% of all ME patients get better after trying it. However, such claims seem to be more than questionable.

  • In the Norwegian ME association’s user survey from 2012 with 1,096 participants, 164 ME patients stated that they had tried LP. 21% of these patients experienced improvement or great improvement and 48% got worse or much worse.
  • In Norway’s National Research Center in Complementary and Alternative Medicine, NAFKAM’s survey from 2015 amongst 76 patients 8 had a positive effect and 5 got worse or much worse.
  • A survey by the Norwegian research foundation, published in the journal Psykologisk, with 660 participants, showed that 62 patients had tried LP, and 5 were very or fairly satisfied with the results.

Such figures reflect the natural history of the condition and are no evidence that the LP works.

Is there any evidence supporting the LP specifically for long COVID?

My Medline search retrieved just one single paper. Here is the abstract:

As a result of the COVID-19 pandemic, Long COVID (LC) is now prevalent in many countries. Little evidence exists regarding how this chronic condition should be treated, but guidelines suggest for most people it can be managed symptomatically in primary care. The Lightning Process is a trademarked positive psychology focused self-management programme which has shown to be effective in reducing fatigue and accompanying symptoms in other chronic conditions including Chronic Fatigue Syndrome/Myalgic Encephalomyelitis. Here we outline its novel application to two patients with LC who both reported improvements in fatigue and a range of physical and emotional symptoms post-treatment and at 3 months follow-up.

Well, that surely convinced everyone! Except me and, of course, anyone else who can think critically.

So, I look further and find this on the company’s website:

Do you know how it feels to…

  • …be exhausted and tired no matter how much rest you get?
  • …be stuck with re-occurring pain, health symptoms and issues?
  • …get so stressed by almost everything?
  • …feel low and upset much of the time?
  • …want a better life and health but just can’t find anything that works?

If any, or all, of these sound familiar then the Lightning Process, designed by Phil Parker, PhD, could be the answer that you’re looking for.  There are lots of ways you can find out more about the suitability of the Lightning Process for you, have a look through below…

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Let me try to summarise:

  • The LP is promoted as a cure for long-Covid.
  • There is no evidence that LP is effective for it.
  • The claim is that it has been shown to work for ME.
  • There is no evidence that LP is effective for it.
  • A 3-day course costs £1 000.
  • Their website claims it is good for practically everyone.

Does anyone think that LP or its promoters are remotely serious?

I am glad to hear that the Vatican is issueing  new guidelines on supernatural phenomena. The document, compiled by the Vatican’s Dicastery for the Doctrine of the Faith, will lay out rules to assess the truthfulness of supernatural claims. Reports of such phenomena are said to have soared in recent years in an era of social media – sometimes spread through disinformation and rumour. The guidelines are likely to tighten criteria for the screening, analysis, and possible rejection of cases.

Apparitions have been reported across the centuries. Those recognised by the Church have prompted pilgrims, and popes, to visit spots where they are said to have taken place. Millions flock to Lourdes in France, for example, or Fatima in Portugal, where the Virgin Mary is alleged to have appeared to children, promising a miracle – after which crowds are said to have witnessed the sun zig-zagging through the sky. The visitation was officially recognised by the Church in 1930.

But other reports are found by church officials to be baloney. In 2016, an Italian woman began claiming regular apparitions of Jesus and Mary in a small town north of Rome after she brought back a statue from Medjugorje in Bosnia, where the Virgin Mary is also said to have appeared. Crowds prayed before the statue and received messages including warnings against same-sex marriage and abortion. It took eight years for the local bishop to debunk the story.

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Perhaps the Vatican should also have a look at faith healing*, the attempt to bring about healing through divine intervention. The Bible and other religious texts provide numerous examples of divine healing, and believers see this as a proof that faith healing is possible. There are also numerous reports of people suffering from severe diseases, including cancer and AIDS, who were allegedly healed by divine intervention.

Faith healing has no basis in science, is biologically not plausible. Some methodologically flawed studies have suggested positive effects, however, this is not confirmed by sound clinical trials. Several plausible explanations exist for the cases that have allegedly been healed by divine intervention, for instance, spontaneous remission or placebo response. Another explanation is fraud. For instance, the famous German faith healer, Peter Popoff, was exposed in 1986 for using an earpiece to receive radio messages from his wife giving him the home addresses and ailments of audience members which he purported had come from God during his faith healing rallies.

Faith healing may per se be safe, but it can nevertheless do untold indirect harm, and even fatalities are on record: “Faith healing, when added as an adjuvant or alternative aid to medical science, will not necessarily be confined to mere arguments and debates but may also give rise to series of complications, medical emergencies and even result in death.”

Alternatively, the Vatican might look at the healing potential of pilgrimages*, journeys to places considered to be sacred. The pilgrims often do this in the hope to be cured of a disease. The purpose of Christian pilgrimage was summarized by Pope Benedict XVI as follows:

To go on pilgrimage is not simply to visit a place to admire its treasures of nature, art or history. To go on pilgrimage really means to step out of ourselves in order to encounter God where he has revealed himself, where his grace has shone with particular splendour and produced rich fruits of conversion and holiness among those who believe.

There are only few scientific studies of pilgrimages. The purpose of this qualitative research was to explore whether pilgrims visiting Lourdes, France had transcendent experiences. The authors concluded that visiting Lourdes can have a powerful effect on a pilgrim and may include an “out of the ordinary” transcendent experience, involving a sense of relationship with the divine, or experiences of something otherworldly and intangible. There is a growing focus on Lourdes as a place with therapeutic benefits rather that cures: our analysis suggests that transcendent experiences can be central to this therapeutic effect. Such experiences can result in powerful emotional responses, which themselves may contribute to long term well-being. Our participants described a range of transcendent experiences, from the prosaic and mildly pleasant, to intense experiences that affected pilgrims’ lives. The place itself is crucially important, above all the Grotto, as a space where pilgrims perceive that the divine can break through into normal life, enabling closer connections with the divine, with nature and with the self.

Other researchers tested the effects of tap water labelled as Lourdes water versus tap water labelled as tap water found that placebos in the context of religious beliefs and practices can change the experience of emotional salience and cognitive control which is accompanied by connectivity changes in the associated brain networks. They concluded that this type of placebo can enhance emotional-somatic well-being, and can lead to changes in cognitive control/emotional salience networks of the brain.

The risks involved in pilgrimages is their often considerable costs. It is true, as the text above points out that “millions flock to Lourdes in France”. In other words, pilgrimiges are an important source of income, not least for the catholoc church.

A more important risk can be that they are used as an alternative to effective treatments. This, as we all know, can be fatal. As there is no good evidence that pilgrimiges cure diseases, their risk/benefit balance as a treatment of disease cannot be positive.

So, will the new rules of the Vatican curtail the risks on supernatural healing practises? I would not hold my breath!

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* for references see my book from where this text has been borrowed and modified.

Many forms of so-called alternative medicine (SCAM) involve touch, and touch is of critical importance: many studies have shown that it promotes mental and physical well-being.

A team of researchers conducted a pre-registered (PROSPERO: CRD42022304281) systematic review and multilevel meta-analysis encompassing 137 studies in the meta-analysis and 75 additional studies in the systematic review (n = 12,966 individuals, search via Google Scholar, PubMed and Web of Science until 1 October 2022) to identify critical factors moderating touch intervention efficacy.

Included studies always featured a touch versus no touch control intervention with diverse health outcomes as dependent variables. Risk of bias was assessed via small study, randomization, sequencing, performance and attrition bias.

The results show that touch interventions were especially effective in:

  • regulating cortisol levels (Hedges’ g = 0.78, 95% confidence interval (CI) 0.24 to 1.31),
  • increasing weight (0.65, 95% CI 0.37 to 0.94) in newborns,
  • reducing pain (0.69, 95% CI 0.48 to 0.89),
  • reducing feelings of depression (0.59, 95% CI 0.40 to 0.78),
  • reducing state (0.64, 95% CI 0.44 to 0.84) or trait anxiety (0.59, 95% CI 0.40 to 0.77) for adults.

Comparing touch interventions involving objects or robots resulted in similar physical (0.56, 95% CI 0.24 to 0.88 versus 0.51, 95% CI 0.38 to 0.64) but lower mental health benefits (0.34, 95% CI 0.19 to 0.49 versus 0.58, 95% CI 0.43 to 0.73). Adult clinical cohorts profited more strongly in mental health domains compared with healthy individuals (0.63, 95% CI 0.46 to 0.80 versus 0.37, 95% CI 0.20 to 0.55).

The authors found no difference in health benefits in adults when comparing touch applied by a familiar person or a health care professional (0.51, 95% CI 0.29 to 0.73 versus 0.50, 95% CI 0.38 to 0.61), but parental touch was more beneficial in newborns (0.69, 95% CI 0.50 to 0.88 versus 0.39, 95% CI 0.18 to 0.61). Small but significant small study bias and the impossibility to blind experimental conditions need to be considered.

The authors concluded that leveraging factors that influence touch intervention efficacy will help maximize the benefits of future interventions and focus research in this field.

It seems obvious to me that these findings are relevant to several SCAMs, e.g.:

  • acupuncture,
  • Alexander technique,
  • applied kinesiology,
  • aromatherapy,
  • Bowen technique,
  • chiropractic,
  • craniosacral therapy,
  • cupping,
  • Dorn method,
  • Feldenkrais method,
  • gua sha,
  • kinesiology taping,
  • lymph drainage,
  • massage in all its variations,
  • naprapathy,
  • osteopathy,
  • rebirthing,
  • reflexology,
  • Rolfing,
  • shiatsu,
  • slapping therapy,
  • therapeutic touch.

This also means that the effects of these SCAMs will be at least to some extend non-specific, i.e. not related to the treatment per se but to touch. Finally, it means that clinical trials testing these SCAMs need to be designed such that the touch element is adequately accounted for.

This randomized controlled, pretest-post-test intervention study examined the effect of distance reiki on state test anxiety and test performance.
First-year nursing students (n = 71) were randomized into two groups. One week before the examination,

  • the intervention group participants received reiki remotely for 20 minutes for 4 consecutive days,
  • the control group participants received no intervention.
The intervention group had lower posttest cognitive and psychosocial subscale scores than pretest scores (p > .05). The control group had a significantly higher mean posttest physiological subscale score than pretest score (p < .05). Final grade point averages were not significantly different between the intervention and control groups (p > .05). One quarter of the intervention group participants noted reiki reduced their stress and helped them perform better on the examination.The authors concluded that Reiki is a safe and easy-to-practice method to help students cope with test anxiety.What a conclusion!What a study!

A controlled clinical trial has the purpose of comparing outcomes of two or more treatments. Therefore, intra-group changes are utterly irrelevant. The only thing of interest is the comparison between the intervention and control groups. In the present study, this did not show a significant difference. In other words, distant Reiki had no effect.

This means that the bit in the conclusion telling us that Reiki helps students cope with test anxiety is quite simply not true.

This leaves us with the first part of the conclusion: Reiki is a safe and easy-to-practice method. This may well be true – yet it is meaningless. Apart from the fact that the study was not aimed at assessing safety or ease of practice, the statement is true for far too many things to be meaningful, e.g.:

  • Not having Reiki (the control group) is a safe and easy-to-practice method.
  • Going for a walk is a safe and easy-to-practice method.
  • Cooking a plate of spagetti is a safe and easy-to-practice method.
  • Having a nap is a safe and easy-to-practice method.
  • Reading a book is a safe and easy-to-practice method.

(I think you get my gist)

To make the irony complete, let me tell you that this trial was published in Journal of Nursing Education. On the website, the journal states: The Journal of Nursing Education is a monthly, peer-reviewed journal publishing original articles and new ideas for nurse educators in various types and levels of nursing programs for over 60 years. The Journal enhances the teaching-learning process, promotes curriculum development, and stimulates creative innovation and research in nursing education.

I suggest that the journal urgently embarks on a program of educating its editors, reviewers, contributors and readers about science, pseudoscience, minimal standards, scientific rigor, and medical ethics.

 

 

In the realm of so-called alternative medicine (SCAM), dental amalgam is a big topic. Therefore, we have discussed it several times before, e.g.:

This study evaluated the changes of health complaints after removal of amalgam restorations in patients with health complaints attributed to dental amalgam fillings.

Patients with medically unexplained physical symptoms (MUPS) attributed to dental amalgam (Amalgam cohort) had all their amalgam fillings removed. The participants indicated an intensity of 11 local and 12 general health complaints on numeric rating scales before the treatment and at follow-up after 1 and 5 years.

The comparison groups comprising

  1. a group of healthy individuals
  2. a group of patients with MUPS without symptom attribution to dental amalgam

did not have their amalgam restorations removed.

In the Amalgam cohort, mean symptom intensity was lower for all 23 health complaints at follow-up at 1 year compared to baseline. Statistically significant changes were observed for specific health complaints with effect sizes between 0.36 and 0.68. At the 5-year follow-up, the intensity of symptoms remained consistently lower compared to before the amalgam removal. In the comparison groups, no significant changes of intensity of symptoms of health complaints were observed.

The authors concluded that, after removal of all amalgam restorations, both local and general health complaints were reduced. Since blinding of the treatment was not possible, specific and non-specific treatment effects cannot be separated.

This is an interesting study with a particularly long follow-up. Unfortunately, due to the study’s design, its results tell us very little about causality. The results are perfectly consistent with two entirely different explanations:

  1. Amalgam was the cause of MUPS and therefore removal of amalgam cured the problem permanently.
  2. Amalgam was not the cause of MUPS but the knowledge that the evil substance had finally been removed sufficed for MUPS to disappear.

It is to the credit of the authors that they consider both options.

A word of caution: amalgam removal can lead to a spike in Hg levels in the body!

This study aims to appraise the utility, accuracy, and quality of information available on YouTube on acupuncture for chronic pain treatment. Using search terms such as “acupuncture for chronic pain” and “acupuncture pain relief”, the top 54 videos by view count were selected. Videos were included if they were:

  • > 1 minute duration,
  • contained audio in English,
  • had > 7000 views,
  • related to acupuncture.

Each video was categorised as either:

  • useful,
  • misleading,
  • or neither.

Another primary outcome of interest was the quality and reliability of each video using validated instruments, including the modified DISCERN (mDISCERN) tool and the Global Quality Scale (GQS). The means were calculated for the video production characteristics, production sources, and mDISCERN and GQS scores. Continuous and categorical outcomes were compared using Student’s t-test and chi-square test, respectively.

The results show that, of the 54 videos,

  • 57.4% were categorized as useful,
  • 14.8% were misleading,
  • and 27.8% were neither.

Useful videos had a mean GQS and mDISCERN score of 3.77± 0.67 and 3.48± 0.63, respectively, while misleading videos had mean GQS and mDISCERN score of 2.50± 0.53 and 2.38± 0.52, respectively. 41.8% of the useful videos were produced by a healthcare institution while none of the misleading videos were produced by a healthcare institution. However, 87.5% of the misleading videos were produced by health media compared to only 25.8% of useful videos from health media.

The authors concluded that their analysis of the highest viewed acupuncture videos for chronic pain reveals only about half provide useful information, indicating a significant misinformation challenge for viewers. This underscores the urgent need for more high-quality, unbiased videos from healthcare institutions and physicians on complementary health practices like acupuncture.

This new analysis confirms what we and others have shown numerous times before: information about so-called alternative medicine (SCAM), which is abundantly available on the Internet, needs to be taken with a healthy pinch of salt. Whenever we studied the issue, our conclusions were even less optimistic than those of the present authors. In fact, most of the time we concluded that following such advice is a risk factor to our health.

In the previous two parts of this series (see here and here), we discussed the following SCAM diagnoses:

  • adrenal fatigue,
  • candidiasis hypersensitivity,
  • chronic intoxications,
  • chronic Lyme disease,
  • electromagnetic hypersensitivity,
  • homosexuality.

Today, I will add three further fake diagnoses to the list.

Leaky gut syndrome

Leaky gut syndrome is allegedly caused by the passage of harmful substances from the gut wall into the body. SCAM proponents claim it is the origin of many conditions, including multiple sclerosis and autism. However, there is no evidence to show that these claims are true. SCAM practitioners nevertheless recommend many types of SCAM to treat the non-existing entity, e.g. SCAM diets, supplements, etc. It goes without saying that none of them have been shown to be effective.

Multiple chemical sensitivity

Multiple chemical sensitivity is allegedly caused by a hypersensitivity to commonly used chemicals. The symptoms are vague such as headache, dizziness, fatigue. Even those who believe that the condition exist are unable to offer a generally accepted definition of the syndrome.

The SCAMs recommended include:

  • Nutritional supplements
  • Digestive aids
  • Hormone balancing
  • Detoxification
  • Desensitization
  • Eliminating occult infections
  • Oxygen
  • Immune stimulation

Naturally, none of them is supported by sound evidence.

Neurasthenia

In 1869, physician George Miller Beard developed a diagnostic profile for a mental disorder that appeared to be common in the US. Neurasthenia was allegedly characterised by migraines, fatigue, depression, and digestive problems.

The cure, according to Beard, was to flee the city – because it was the stresses of city life that caused the condition. Women were encouraged to rest, while men were asked to engage in outdoor activities. By the early 20th century, this mental disorder had become a status symbol, and it soon spread to other parts of the world. But this pandemic was short-lived: by 1930, neurasthenia had virtually disappeared from conventional medicine.

In SCAM, however, neurasthenia is still a well-establisged money earner. SCAM practitioners do not hesitate to recomment virually every SCAM under the sun for it. They all have one thing in common: they do not work.

 

The BBC stands for reliable information, at least that’s what I used to believe. After reading a recent article published on the BBC website, I have my doubts, however. See for yourself; here are a few excerpts:

On a holiday to Kerala on India’s south-western Malabar Coast, Shilpa Iyer decided to visit Kotakkal, a town that became famous after the establishment of Arya Vaidya Sala, Kerala’s best-known centre for the practice of Ayurveda, in 1902. Seven days later, she left the historical treatment centre after completeing panchakarma, a cleansing and rejuvenating programme for the body, mind and consciousness.

“There was nothing really wrong, but I was always busy with the demands of modern life and plagued with continual aches and pains. So, I decided to focus on my own health,” Iyer says.

Panchakarma, a holistic Ayurvedic therapy, involves a series of detoxifying procedures. It integrates herbal medicines, cleansing therapies, personalised diet plans and wellness activities to eliminate the root cause of disease, revive and rejuvenate the body, and ensure health and longevity.

Iyer says she left “feeling lighter, healthier and better than ever before”. She isn’t the only one who signed up for an Ayurvedic treatment in Kerala; the holistic system of medicine is a way of life in this coastal paradise.

… Ayurveda translates to “knowledge of life” and originated in India more than 3,000 years ago. It is based on the ideology that health and wellness depend on a delicate balance between the mind, body, spirit and environment, and places great emphasis on preventive strategies rather than curative ones. The ancient system of medicine is centred on the idea of universal interconnectedness between prakriti (the body’s constitution) and doshas (life forces). Varied combinations of the five elements — aakash (sky), jal (water), prithvi (earth), agni (fire) and vayu (air) – create the three doshas.

Kerala Tourism Ayurveda places great emphasis on preventive strategies rather than curative ones (Credit: Kerala Tourism)

Dr Gaurang Paneri, an Ayurveda practitioner, explains every person has the three doshas, vatapitta and kapha, in varying strength and magnitude. “The predominant dosha determines their prakriti. Diseases arise when doshas are affected because of an external or internal stimulus (typically linked to eating habits, lifestyle or physical exercise). Ayurveda works to ensure harmony between the three,” he says…

The small state has more than 100 Ayurvedic government-run hospitals, 800 Ayurvedic pharmaceutical factories and 800 Ayurvedic medicine dispensaries. As many as 120 holiday resorts and private wellness centres offer specialised treatments such as kasti vvasti, an oil-based treatment for back pain and inflammation in the lumbosacral region; elakkizhi, a treatment with heated herbal poultices to tackles aches, pains and muskoskeletal trauma; njavara kizhi, a massage therapy for arthritis or chronic musculoskeletal discomfort; and shirodhara, a restorative therapy to ease stress and anxiety and that involves pouring warm, medicated oil over the forehead.

Most treatment centres offer therapies and treatments for a range of health issues, including immunity, mental health, anxiety, pain management, weight loss, skin and health care, sleep issues, psoriasis, eczema, eye care, arthritis, sciatica, gastric problems and paralysis. The treatments typically include dietary changes, herbal medicines, massage therapies, poultices, meditation and breath exercises…

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I find such advertisements disguised as journalism disturbing:

  • No mention that the treatments in question lack conclusive evidence of effectiveness.
  • Not a word about the fact that many can be outright dangerous.
  • No mention of the often exorbitant fees visitors are asked to pay.

Please do better next time you report about health matters, BBC!

This systematic review and meta-analysis investigated the effectiveness and safety of manual therapy (MT) interventions compared to oral or topical pain medications in the management of neck pain.
The investigators searched from inception to March 2023, in Cochrane Central Register of Controller Trials (CENTRAL), MEDLINE, EMBASE, Allied and Complementary Medicine (AMED) and Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCO) for randomized controlled trials that examined the effect of manual therapy interventions for neck pain when compared to oral or topical medication in adults with self-reported neck pain, irrespective of radicular findings, specific cause, and associated cervicogenic headaches. Trials with usual care arms were also included if they prescribed medication as part of the usual care and they did not include a manual therapy component. The authors used the Cochrane Risk of Bias 2 tool to assess the potential risk of bias in the included studies, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach to grade the quality of the evidence.

Nine trials  with a total of 779 participants were included in the meta-analysis.

  • low certainty of evidence was found that MT interventions may be more effective than oral pain medication in pain reduction in the short-term (Standardized Mean Difference: -0.39; 95% CI -0.66 to -0.11; 8 trials, 676 participants),
  • moderate certainty of evidence was found that MT interventions may be more effective than oral pain medication in pain reduction in the long-term (Standardized Mean Difference: −0.36; 95% CI −0.55 to −0.17; 6 trials, 567 participants),
  • low certainty evidence that the risk of adverse events may be lower for patients who received MT compared to the ones that received oral pain medication (Risk Ratio: 0.59; 95% CI 0.43 to 0.79; 5 trials, 426 participants).

The authors conluded that MT may be more effective for people with neck pain in both short and long-term with a better safety profile regarding adverse events when compared to patients receiving oral pain medications. However, we advise caution when interpreting our safety results due to the different level of reporting strategies in place for MT and medication-induced adverse events. Future MT trials should create and adhere to strict reporting strategies with regards to adverse events to help gain a better understanding on the nature of potential MT-induced adverse events and to ensure patient safety.

Let’s have a look at the primary studies. Here they are with their conclusions (and, where appropriate, my comments in capital letters):

  1. For participants with acute and subacute neck pain, spinal manipulative therapy (SMT) was more effective than medication in both the short and long term. However, a few instructional sessions of home exercise with (HEA) resulted in similar outcomes at most time points. EXERCISE WAS AS EFFECTIVE AS SMT
  2.  Oral ibuprofen (OI) pharmacologic treatment may reduce pain intensity and disability with respect to neural mobilization (MNNM and CLG) in patients with CP during six weeks. Nevertheless, the non-existence of between-groups ROM differences and possible OI adverse effects should be considered. MEDICATION WAS BETTER THAN MT
  3. It appears that both treatment strategies (usual care + MT vs usual care) can have equivalent positive influences on headache complaints. Additional studies with larger study populations are needed to draw firm conclusions. Recommendations to increase patient inflow in primary care trials, such as the use of an extended network of participating physicians and of clinical alert software applications, are discussed. MT DOES NOT IMPROVE OUTCOMES
  4. The consistency of the results provides, in spite of several discussed shortcomings of this pilot study, evidence that in patients with chronic spinal pain syndromes spinal manipulation, if not contraindicated, results in greater improvement than acupuncture and medicine. THIS IS A PILOT STUDY, A TRIAL TESTING FEASIBILITY, NOT EFFECTIVENESS
  5. The consistency of the results provides, despite some discussed shortcomings of this study, evidence that in patients with chronic spinal pain, manipulation, if not contraindicated, results in greater short-term improvement than acupuncture or medication. However, the data do not strongly support the use of only manipulation, only acupuncture, or only nonsteroidal antiinflammatory drugs for the treatment of chronic spinal pain. The results from this exploratory study need confirmation from future larger studies.
  6. In daily practice, manual therapy is a favorable treatment option for patients with neck pain compared with physical therapy or continued care by a general practitioner.
  7. Short-term results (at 7 weeks) have shown that MT speeded recovery compared with GP care and, to a lesser extent, also compared with PT. In the long-term, GP treatment and PT caught up with MT, and differences between the three treatment groups decreased and lost statistical significance at the 13-week and 52-week follow-up. MT IS NOT SUPERIOR [SAME TRIAL AS No 6]
  8. In this randomized clinical trial, for patients with chronic neck pain, Chuna manual therapy was more effective than usual care in terms of pain and functional recovery at 5 weeks and 1 year after randomization. These results support the need to consider recommending manual therapies as primary care treatments for chronic neck pain.
  9. In patients with chronic spinal pain syndromes, spinal manipulation, if not contraindicated, may be the only treatment modality of the assessed regimens that provides broad and significant long-term benefit. SAME TRIAL AS No 5
  10. An impairment-based manual physical therapy and exercise (MTE) program resulted in clinically and statistically significant short- and long-term improvements in pain, disability, and patient-perceived recovery in patients with mechanical neck pain when compared to a program comprising advice, a mobility exercise, and subtherapeutic ultrasound. THIS STUDY DID NOT TEST MT ALONE AND SHOULD NOT HAVE BEEN INCLUDED

I cannot bring myself to characterising this as an overall positive result for MT; anyone who can is guilty of wishful thinking, in my view. The small differences in favor of MT that (some of) the trials report have little to do with the effectiveness of MT itself. They are almost certainly due to the fact that none of these studies were placebo-controlled and double blind (even though this would clearly be possible). In contrast to popping a pill, MT involves extra attention, physical touch, empathy, etc. These factors easily suffice to bring about the small differences that some studies report.

It follows that the main conclusion of the authors of the review should be modified:

There is no compelling evidence to show that MT is more effective for people with neck pain in both short and long-term when compared to patients receiving oral pain medications.

 

Acute tonsillitis, which includes tonsillopharyngitis, is a common condition, particularly in childhood. It is mostly caused by a viral infection. Symptomatic treatment is of high importance. But which treatment is effective and which isn’t?

For this expert consensus, 53 physicians from Germany, Spain, Netherlands, Switzerland, Austria, and Hungary with at least one year of experience in anthroposophic paediatric medicine were invited to participate in an online Delphi process. The process comprised 5 survey rounds starting with open-ended questions and ending with final statements, which need 75% agreement of experts to reach consensus. Expert answers were evaluated by two independent reviewers using MAXQDA and Excel.

Response rate was between 28% and 45%. The developed recommendation included 15 subtopics. These covered clinical, diagnostic, therapeutic and psychosocial aspects of acute tonsillitis. Six subtopics achieved a high consensus (>90%) and nine subtopics achieved consensus (75-90%). The panel felt that AM was an adequate therapy for acute tonsillitis.

The authors of this paper concluded that the clinical recommendation for acute tonsillitis in children aims to simplify everyday patient care and provide decision-making support when considering and prescribing anthroposophic therapies. Moreover, the recommendation makes AM more transparent for physicians, parents, and maybe political stakeholders as well.

I found it hard to decide whether to cry or to laugh while reading this paper.

Experience in anthroposophic paediatric medicine does not make anyone an expert in anything other than BS.

Expert consensus and clinical guidelines are not conducted by assembling a few people who all are in favour of a certain therapy while ignoring the scientific evidence.

AM for acute tonsillitis in children is nonsense, whatever these pseudo-experts claim.

Imagine we run a Delphi process with a few long-standing members of ‘the flat earth society’ and ask them to tell us about the shape of the earth …

…I rest my case.

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