Tai chi is a meditative exercise therapy based on Traditional Chinese Medicine. On this blog, we have repeatedly discussed this so-called alternative medicine (SCAM). It involves meditative movements rooted in both Traditional Chinese Medicine and the martial arts. Tai chi was originally aimed at enhancing mental and physical health; today it has become a popular alternative therapy.
This systematic review assessed the efficiency of tai chi (TC) in different populations’ cognitive function improvement. Randomized controlled trials (RCTs) published from the beginning of coverage through October 17, 2020 in English and Chinese were retrieved from many indexing databases. Selected studies were graded according to the Cochrane Handbook for Systematic Reviews of Intervention 5.1.0. The outcome measures of cognitive function due to traditional TC intervention were obtained. Meta-analysis was conducted by using RevMan 5.4 software. We follow the PRISMA 2020 guidelines.
Thirty-three RCTs, with a total of 1808 participants, were included. The results showed that TC can progress global cognition when assessed in middle-aged as well as elderly patients suffering from cognitive and executive function impairment. The findings are as follows:
- Montreal Cognitive Assessment Scale: mean difference (MD) = 3.23, 95% CI = 1.88-4.58, p < 0.00001,
- Mini-Mental State Exam: MD = 3.69, 95% CI = 0.31-7.08, p = 0.03,
- Trail Making Test-Part B: MD = -13.69, 95% CI = -21.64 to -5.74, p = 0.0007.
The memory function of older adults assessed by the Wechsler Memory Scale was as follows: MD = 23.32, 95% CI = 17.93-28.71, p < 0.00001. The executive function of college students evaluated by E-prime software through the Flanker test was as follows: MD = -16.32, 95% CI = -22.71 to -9.94, p < 0.00001.
The authors concluded that TC might have a positive effect on the improvement of cognitive function in middle-aged and elderly people with cognitive impairment as well as older adults and college students.
These days, I easily get irritated with such conclusions. That TC might improve cognitive function is obvious. If not, there would be no reason to do a review! But does it?
This paper does not provide an answer. All it shows is that TC trials are of lousy quality and that the observed effects might well be due not to TC itself by to non-specific effects.
In so-called alternative medicine (SCAM) we have an amazing number of ‘discoveries’ which – IF TRUE – should have changed the world. Here I list of 10 of my favorites:
- Diluting and shaking a substance makes it not weaker but stronger.
Homeopaths call this process ‘potentisation’. They use it to produce highly ‘potent’ remedies that contain not a single molecule of the original substance. The assumption is that potentisation transfers energy or information. Therefore, they claim, molecules are no longer required for achieving a clinical effect.
2. A substance that causes a certain symptom in a healthy person can be used to cure that symptom when it occurs in a patient.
The ‘like cures like’ principle of homeopathy is based on the notion that the similimum provokes an artificial disease which in turn defeats the condition the patient is suffering from.
3. Subluxations of the spine are the cause of most diseases that affect us humans.
DD Palmer, the inventor of chiropractic, insisted that almost all diseases are due to subluxations. These misplaced vertebrae, he claimed, are the root cause of any disease by inhibiting the flow of the ‘innate’ which in turn caused ill health.
4. Adjusting such subluxations is the best way to restore health.
Palmer, therefore, was sure that only adjustments of these subluxations were able to restore health. All other medical interventions were useless or even dangerous, in his view. Thus Palmer opposed medicines or vaccinations.
5. An imbalance of two life forces is the cause of all illnesses.
Practitioners of TCM believe that all illnesses originate from an energetic imbalance. Harmony between the two life forces ‘yin and yang’ means health.
6. Balance can be restored by puncturing the skin at specific points.
Acupuncturists are convinced that their needling is nothing less than attacking the root cause of his or her problem. Therefore, they are convinced that acupuncture is a cure-all.
7. Our organs are represented in specific areas on the sole of our feet.
Reflexologists have maps of the sole of a foot where specific organs of the body are located. They palpate the foot and when they feel a gritty area, they conclude that the corresponding organ is in trouble.
8. Massaging these areas will positively influence the function of specific organs.
Once the diseased or endangered organ is identified, the area in question needs to be massaged until the grittiness disappears. This intervention, in turn, will have a positive influence on the organ in question.
9. Healing energy can be sent into our body where it stimulates the self-healing process and restores health.
Various types of energy healers are convinced that they can transmit energy that comes from a divine or other source into a patient’s body. The energy enables the body to heal itself. Thus, energy healing is a panacea and does not even require a proper diagnosis to be effective.
10. Toxins accumulate in our bodies and must be eliminated through a wide range of SCAMs.
The toxins in question can originate from within the body and/or from the outside. They accumulate and make us sick. Therefore, we need to eliminate them, and the best way to achieve this is to use this or that SCAM
I could, of course, list many more such ‘discoveries’ – SCAM is full of them. They are all quite diverse but have one important thing in common: they are false (i.e. there is no good evidence for them and they fly in the face of science).
If they were true, they would have changed the world by revolutionizing science, physics, physiology, anatomy, pathology, therapeutics, etc.
ALL THESE UGLY FACTS DESTROYING SUCH BEAUTIFUL THEORIES!
WHAT A SHAME!!!
Bloodletting therapy (BLT) has been widely used for centuries until it was discovered that it is not merely useless for almost all diseases but also potentially harmful. Yet in so-called alternative medicine (SCAM) BLT is still sometimes employed, for instance, to relieve acute gouty arthritis (AGA). This systematic review aimed to evaluate the feasibility and safety of BLT in treating AGA.
Seven databases were searched from the date of establishment to July 31, 2020, irrespective of the publication source and language. BLT included fire needle, syringe, three-edged needle, and bloodletting followed by cupping. The included articles were evaluated for bias risk by using the Cochrane risk of bias assessment tool.
Twelve studies involving 894 participants were included in the final analysis. A meta-analysis suggested that BLT was highly effective in relieving pain (MD = -1.13, 95% CI [-1.60, -0.66], P < 0.00001), with marked alterations in the total effective (RR = 1.09, 95% [1.05, 1.14], P < 0.0001) and curative rates (RR = 1.37, 95%CI [1.17, 1.59], P < 0.0001). In addition, BLT could dramatically reduce serum C-reactive protein (CRP) level (MD = -3.64, 95%CI [-6.72, -0.55], P = 0.02). Both BLT and Western medicine (WM) produced comparable decreases in uric acid (MD = -18.72, 95%CI [-38.24, 0.81], P = 0.06) and erythrocyte sedimentation rate (ESR) levels (MD = -3.01, 95%CI [-6.89, 0.86], P = 0.13). Lastly, we demonstrated that BLT was safer than WM in treating AGA (RR = 0.36, 95%CI [0.13, 0.97], P = 0.04).
The authors concluded that BLT is effective in alleviating pain and decreasing CRP level in AGA patients with a lower risk of evoking adverse reactions.
This conclusion is optimistic, to say the least. There are several reasons for this statement:
- All the primary studies came from China (and we have often discussed that such trials need to be taken with a pinch of salt).
- All the studies had major methodological flaws.
- There was considerable heterogeneity between the studies.
- The treatments employed were very different from study to study.
- Half of all studies failed to mention adverse effects and thus violate medical ethics.
In a recently published study, the willingness to be vaccinated of parents of underage children and persons without underage children was examined. The study was based on a random sample (telephone survey, n = 2014, survey between 12.11.2020 and 10.12.2020).
The results revealed that parents consistently show a lower propensity to vaccinate with a COVID-19 vaccine than respondents without minor children (54.1% vs. 71.1%). Fathers showed a more pronounced own willingness to vaccinate than mothers. Furthermore, men were more willing than women to have their own child vaccinated with a COVID-19 vaccine.
The overall sample also showed that a rejection of so-called alternative medicine (SCAM) was associated with a significantly higher willingness to be vaccinated. There was also a significant correlation between the attitude towards homeopathy and one’s own willingness to be vaccinated. If homeopathy was supported, the willingness to vaccinate was lower. This correlation between the attitude towards homeopathy and willingness to vaccinate was also evident in the sub-sample of parents. Among the parents, it was again the women who significantly more often had a positive attitude towards homeopathy than men, who more often do not think anything of it.
This new evidence ties in neatly with many of my previous posts on the subject of SCAM and vaccination, for instance:
- More information on homeopaths’ and anthroposophic doctors’ attitude towards vaccinations
- The anti-vaccination movement is financed by the dietary supplement industry
- The UK Society of Homeopaths, a hub of anti-vaccination activists?
- HOMEOPATHY = “the complete alternative to vaccination” ?!?!
- Are anthroposophy-enthusiasts for or against vaccinations?
- Far too many chiropractors believe that vaccinations do not have a positive effect on public health
- Andrew Wakefield, Donald Trump, SCAM, and the anti-vaccination cult
- Naturopaths’ counselling against vaccinations could be criminally negligent
- HOMEOPATHS AGAINST VACCINATION: “The decision to vaccinate and how you implement that decision is yours and yours alone”
- Use of alternative medicine is associated with low vaccination rates
- Integrative medicine physicians tend to harbour anti-vaccination views
- Vaccination: chiropractors “espouse views which aren’t evidence based”
- Faith-healing as an alternative to vaccination?
- Learning about homeopathy the hard way: the story of Aaron Rodgers
- Patients consulting chiropractors, homeopaths, or naturopaths are less likely to agree to the flu jab
- Parents’ Willingness to Vaccinate with a COVID-19 Vaccine: strongly influenced by homeopathy
- “The uncensored truth” about COVID-19 vaccines” … as told by some chiro loons
- Beliefs and behaviors of US chiropractors
- Many naturopaths, homeopaths, and chiropractors are a risk to public health
- Homeopaths (and other SCAM practitioners) are peddling dangerous myths
- Misinformation and fraudulent claims about boosting immunity during the pandemic
Collectively, this evidence tells us that:
- the effect has been shown in many different ways,
- it can therefore be assumed to be real,
- it is not confined to COVID vaccinations,
- it is not confined to one particular branch of SCAM,
- it even affects MDs (who surely should know better) dabbling in SCAM,
- it has a long history,
- it is prevalent in many, if not most countries,
- it does real harm.
So, the next time someone tells you that SCAM and SCAM practitioners have a positive influence on public health, tell them to think again.
Well-conducted systematic reviews (SRs) should in principle provide the most reliable evidence on the effectiveness of acupuncture. However, limitations on the methodological rigour of SRs may impact the trustworthiness of their conclusions. This cross-sectional study was aimed at evaluating the methodological quality of recent SRs of acupuncture.
The Cochrane Database of Systematic Reviews, MEDLINE, and EMBASE were searched for SRs focusing on manual acupuncture or electro-acupuncture published during January 2018 and March 2020. Eligible SRs needed to contain at least one meta-analysis and be published in the English language. Two independent reviewers extracted the bibliographical characteristics of the included SRs with a pre-designed questionnaire and appraised the methodological quality of the reviews with the validated AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews 2). The associations between bibliographical characteristics and methodological quality ratings were explored using Kruskal-Wallis rank tests and Spearman’s rank correlation coefficients.
A total of 106 SRs were appraised. The results were as follows:
- one (0.9%) SR was of high methodological quality,
- no review (0%) was of moderate quality,
- six (5.7%) were of low quality,
- 99 (93.4%) were of critically low quality.
Only ten (9.4%) provided an a priori protocol, only four (3.8%) conducted a comprehensive literature search, only five (4.7%) provided a list of excluded studies, and only six (5.7%) performed a meta-analysis appropriately. Cochrane SRs, updated SRs, and SRs that did not search non-English databases had relatively higher overall quality. The vast majority (87.7%) of the 106 reviews included in this analysis originated from Asia. Conflicts of interest of the review authors were declared in only 2 of the 106 reviews.
The authors concluded that the methodological quality of SRs on acupuncture is unsatisfactory. Future reviewers should improve critical methodological aspects of publishing protocols, performing comprehensive search, providing a list of excluded studies with justifications for exclusion, and conducting appropriate meta-analyses. These recommendations can be implemented via enhancing the technical competency of reviewers in SR methodology through established education approaches as well as quality gatekeeping by journal editors and reviewers. Finally, for evidence users, skills in SR critical appraisal remain to be essential as relevant evidence may not be available in pre-appraised formats.
On this blog, I have often complained about the lack of critical input and the poor quality of systematic reviews of so-called alternative medicine (SCAM), particularly of acupuncture, and especially of Chinese reviews, and even more especially Chinese reviews of (mostly) Chinese studies. This new paper is a valuable confirmation of this fast-growing deficit.
One does not need to be a prophet to predict that this pollution of the literature with complete rubbish will have detrimental effects. Because poor reviews almost always draw an over-optimistic picture of the value of acupuncture, this phenomenon must seriously mislead the public. The end result will be that the public believes acupuncture to be effective.
I cannot help thinking that this is, in fact, the intended aim of the authors of such poor, false-positive reviews. Moreover, a glance at the subject areas of the reviews in the list below gives the impression that China is heavily promoting the idea that acupuncture is a panacea. Yet there is good evidence to show that acupuncture is little more than placebo therapy.
In my last post, I have reported that I am an author of many of the frequently-cited systematic acupuncture reviews. You might thus assume that I am a significant part of this pollution by rubbish reviews. This would, however, be an entirely wrong conclusion. The above analysis covers a period when my unit had already been closed, and I am thus not responsible for a single of the papers included in the above analysis.
List of included systematic reviews
|ID||Included systematic reviews|
|1||Acupuncture for primary insomnia: An updated systematic review of randomized controlled trials|
|2||Efficacy and safety of acupuncture for essential hypertension: A meta-analysis|
|3||Acupuncture for the treatment of sudden sensorineural hearing loss: A systematic review and meta-analysis: Acupuncture for SSNHL|
|4||Effectiveness of Acupuncturing at the Sphenopalatine Ganglion Acupoint Alone for Treatment of Allergic Rhinitis: A Systematic Review and Meta-Analysis|
|5||Acupuncture and clomiphene citrate for anovulatory infertility: a systematic review and meta-analysis|
|6||Acupuncture for primary trigeminal neuralgia: A systematic review and PRISMA-compliant meta-analysis|
|7||Acupuncture as an adjunctive treatment for angina due to coronary artery disease: A meta-analysis|
|8||Conventional treatments plus acupuncture for asthma in adults and adolescent: A systematic review and meta-analysis|
|9||Optimizing acupuncture treatment for dry eye syndrome: A systematic review|
|10||Acupuncture using pattern-identification for the treatment of insomnia disorder: a systematic review and meta-analysis of randomized controlled trials|
|11||Efficacy and Safety of Auricular Acupuncture for Cognitive Impairment and Dementia: A Systematic Review|
|12||Acupuncture for cognitive impairment in vascular dementia, alzheimer’s disease and mild cognitive impairment: A systematic review and meta-analysis|
|13||Effectiveness of pharmacopuncture for cervical spondylosis: A systematic review and meta-analysis|
|14||Acupuncture combined with swallowing training for poststroke dysphagia: a meta-analysis of randomised controlled trials|
|15||Scalp acupuncture treatment for children’s autism spectrum disorders: A systematic review and meta-analysis|
|16||Acupuncture for Post-stroke Shoulder-Hand Syndrome: A systematic review and meta-analysis|
|17||Systematic review of acupuncture for the treatment of alcohol withdrawal syndrome|
|18||Acupuncture for hip osteoarthritis|
|19||Clinical Benefits of Acupuncture for the Reduction of Hormone Therapy-Related Side Effects in Breast Cancer Patients: A Systematic Review|
|20||Combination therapy of scalp electro-acupuncture and medication for the treatment of Parkinson’s disease: A systematic review and meta-analysis|
|21||Acupuncture for migraine: A systematic review and meta-analysis|
|22||Acupuncture to Promote Recovery of Disorder of Consciousness after Traumatic Brain Injury: A Systematic Review and Meta-Analysis|
|23||Acupuncture Compared with Intramuscular Injection of Neostigmine for Postpartum Urinary Retention: A Systematic Review and Meta-Analysis of Randomized Controlled Trials|
|24||Acupuncture for the relief of hot flashes in breast cancer patients: A systematic review and meta-analysis of randomized controlled trials and observational studies|
|25||Effectiveness and Safety of Acupuncture for Perimenopausal Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials|
|26||Acupuncture plus Chinese Herbal Medicine for Irritable Bowel Syndrome with Diarrhea: A Systematic Review and Meta-Analysis|
|27||Electroacupuncture as an adjunctive therapy for motor dysfunction in acute stroke survivors: A systematic review and meta-analyses|
|28||Acupuncture for Acute Pancreatitis: A Systematic Review and Meta-analysis|
|29||Acupuncture for chronic fatigue syndrome: a systematic review and meta-analysis|
|30||Compare the efficacy of acupuncture with drugs in the treatment of Bell’s palsy: A systematic review and meta-analysis of RCTs|
|31||The effectiveness and safety of acupuncture for the treatment of myasthenia gravis: a systematic review and meta-analysis of randomized controlled trials|
|32||Acupuncture therapy for fibromyalgia: A systematic review and meta-analysis of randomized controlled trials|
|33||The effectiveness of acupuncture therapy in patients with post-stroke depression: An updated meta-analysis of randomized controlled trials|
|34||Fire needling for herpes zoster: A systematic review and meta-analysis of randomized clinical trials|
|35||Comparison between the Effects of Acupuncture Relative to Other Controls on Irritable Bowel Syndrome: A Meta-Analysis|
|36||Manual Acupuncture for Optic Atrophy: A Systematic Review and Meta-Analysis|
|37||Effect of warm needling therapy and acupuncture in the treatment of peripheral facial paralysis: A systematic review and meta-analysis|
|38||The Effect of Acupuncture in Breast Cancer-Related Lymphoedema (BCRL): A Systematic Review and Meta-Analysis|
|39||The Efficacy of Acupuncture in Chemotherapy-Induced Peripheral Neuropathy: Systematic Review and Meta-Analysis|
|40||The maintenance effect of acupuncture on breast cancer-related menopause symptoms: a systematic review|
|41||The effectiveness of acupuncture in the management of persistent regional myofascial head and neck pain: A systematic review and meta-analysis|
|42||Acupuncture for the Treatment of Adults with Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis|
|43||The effectiveness of superficial versus deep dry needling or acupuncture for reducing pain and disability in individuals with spine-related painful conditions: a systematic review with meta-analysis|
|44||Effects of dry needling trigger point therapy in the shoulder region on patients with upper extremity pain and dysfunction: a systematic review with meta-analysis|
|45||Is dry needling effective for low back pain?: A systematic review and PRISMA-compliant meta-analysis|
|46||The effectiveness and safety of acupuncture for patients with atopic eczema: a systematic review and meta-analysis|
|47||Comparing verum and sham acupuncture in fibromyalgia syndrome: a systematic review and meta-analysis|
|48||Acupuncture for symptomatic gastroparesis|
|49||The Efficacy and Safety of Acupuncture for the Treatment of Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis|
|50||Acupuncture Versus Sham-acupuncture: A Meta-analysis on Evidence for Non-immediate Effects of Acupuncture in Musculoskeletal Disorders|
|51||Acupuncture Treatment for Post-Stroke Dysphagia: An Update Meta-Analysis of Randomized Controlled Trials|
|52||Effectiveness of Acupuncture Used for the Management of Postpartum Depression: A Systematic Review and Meta-Analysis|
|53||Clinical effects and safety of electroacupuncture for the treatment of post-stroke depression: a systematic review and meta-analysis of randomised controlled trials|
|54||Placebo effect of acupuncture on insomnia: a systematic review and meta-analysis|
|55||Acupuncture for Chronic Pain-Related Insomnia: A Systematic Review and Meta-Analysis|
|56||Evidence for Dry Needling in the Management of Myofascial Trigger Points Associated With Low Back Pain: A Systematic Review and Meta-Analysis|
|57||Warm needle acupuncture in primary osteoporosis management: a systematic review and meta-analysis|
|58||Acupuncture for overactive bladder in adults: a systematic review and meta-analysis|
|59||Traditional acupuncture for menopausal hot flashes: A systematic review and meta-analysis of randomized controlled trials|
|60||The effectiveness of acupuncture for osteoporosis: A systematic review and meta-analysis|
|61||Long-term effects of acupuncture for chronic prostatitis/chronic pelvic pain syndrome: Systematic review and single-Arm meta-Analyses|
|62||Does acupuncture the day of embryo transfer affect the clinical pregnancy rate? Systematic review and meta-analysis|
|63||Acupuncture treatments for infantile colic: a systematic review and individual patient data meta-analysis of blinding test validated randomised controlled trials|
|64||Acupuncture performed around the time of embryo transfer: a systematic review and meta-analysis|
|65||Is Acupuncture Effective for Improving Insulin Resistance? A Systematic Review and Meta-analysis|
|66||Efficacy of acupuncture in the management of post-apoplectic aphasia: A systematic review and meta-analysis of randomized controlled trials|
|67||Acupuncture for lumbar disc herniation: a systematic review and meta-analysis|
|68||Traditional Chinese acupuncture and postpartum depression: A systematic review and meta-analysis|
|69||Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis|
|70||Acupuncture Therapy for Functional Effects and Quality of Life in COPD Patients: A Systematic Review and Meta-Analysis|
|71||Electroacupuncture for Reflex Sympathetic Dystrophy after Stroke: A Meta-Analysis|
|72||The Effect of Patient Characteristics on Acupuncture Treatment Outcomes|
|73||The efficacy and safety of acupuncture in women with primary dysmenorrhea: A systematic review and meta-analysis|
|74||Role of acupuncture in the treatment of insulin resistance: A systematic review and meta-analysis|
|75||Appropriateness of sham or placebo acupuncture for randomized controlled trials of acupuncture for nonspecific low back pain: A systematic review and meta-analysis|
|76||Evidence of efficacy of acupuncture in the management of low back pain: a systematic review and meta-analysis of randomised placebo- or sham-controlled trials|
|77||The effects of acupuncture on pregnancy outcomes of in vitro fertilization: A systematic review and meta-analysis|
|78||Acupuncture for migraine without aura: a systematic review and meta-analysis|
|79||Acupuncture for acute stroke|
|80||Acupuncture at Tiaokou (ST38) for Shoulder Adhesive Capsulitis: What Strengths Does It Have? A Systematic Review and Meta-Analysis of Randomized Controlled Trials|
|81||Acupuncture for hypertension|
|82||The effect of acupuncture on Bell’s palsy: An overall and cumulative meta-analysis of randomized controlled trials|
|83||Effects of acupuncture on cancer-related fatigue: a meta-analysis|
|84||Acupuncture for adults with overactive bladder|
|85||Electroacupuncture for Postoperative Urinary Retention: A Systematic Review and Meta-Analysis|
|86||Meta-Analysis of Electroacupuncture in Cardiac Anesthesia and Intensive Care|
|87||Acupuncture therapy improves health-related quality of life in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis|
|88||The effect of acupuncture on the quality of life in patients with migraine: A systematic review and meta-analysis|
|89||Cognitive improvement effects of electro-acupuncture for the treatment of MCI compared with Western medications: A systematic review and Meta-analysis 11 Medical and Health Sciences 1103 Clinical Sciences|
|90||Oriental herbal medicine and moxibustion for polycystic ovary syndrome: A meta-analysis|
|91||The Effect of Acupuncture and Moxibustion on Heart Function in Heart Failure Patients: A Systematic Review and Meta-Analysis|
|92||Acupuncture therapy for the treatment of stable angina pectoris: An updated meta-analysis of randomized controlled trials|
|93||Traditional manual acupuncture combined with rehabilitation therapy for shoulder hand syndrome after stroke within the Chinese healthcare system: a systematic review and meta-analysis|
|94||Effects of moxibustion on pain behaviors in patients with rheumatoid arthritis: A meta-analysis|
|95||Acupuncture Treatment for Chronic Pelvic Pain in Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials|
|96||The effectiveness of dry needling for patients with orofacial pain associated with temporomandibular dysfunction: a systematic review and meta-analysis|
|97||Acupuncture for postherpetic neuralgia systematic review and meta-analysis|
|98||Acupoint selection for the treatment of dry eye: A systematic review and meta-analysis of randomized controlled trials|
|99||Warm-needle moxibustion for spasticity after stroke: A systematic review of randomized controlled trials|
|100||Acupuncture for menstrual migraine: a systematic review|
|101||The efficacy of acupuncture for stable angina pectoris: A systematic review and meta-analysis|
|102||Acupuncture and weight loss in Asians: A PRISMA-compliant systematic review and meta-analysis|
|103||Effects of Acupuncture on Breast Cancer-Related lymphoedema: A Systematic Review and Meta-Analysis|
|104||Acupuncture for infertile women without undergoing assisted reproductive techniques (ART): A systematic review and meta-analysis|
|105||Moxibustion for alleviating side effects of chemotherapy or radiotherapy in people with cancer|
|106||Acupuncture for stable angina pectoris: A systematic review and meta-analysis|
It was only when I came across this recent paper that I realized that, apparently, I am THE WORLD CHAMPION in acupuncture reviews. The aim of this paper was to analyze the 100 most-cited systematic reviews or meta-analyses in the field of acupuncture research.
The Web of Science Core Collection was used to retrieve lists of 100 most-cited systematic reviews or meta-analyses in the field of acupuncture research. Two authors screened literature, extracted data, and analyzed the results.
The citation number of the 100 most-cited systematic reviews or meta-analyses varied from 65 to 577; they were published between 1989 and 2018. Fourteen authors published more than 1 study as the corresponding author and 10 authors published more than 1 study as the first author.
In terms of the corresponding authors, Edzard Ernst and Linde Klaus published the most systematic reviews/meta-analyses (n = 7). The USA published most of the systematic reviews or meta-analyses (n = 24), followed by England (n = 23) and China (n = 14). Most institutions with more than 1 study were from England (4/13). The institutions with the largest numbers of most-cited systematic reviews or meta-analyses were the Technical University of Munich in Germany, the University of Maryland School of Medicine in the USA (n = 8), the Universities of Exeter and Plymouth in England (n = 6), and the University of Exeter in England (n = 6). The journal with the largest number of most-cited systematic reviews or meta-analyses was the Cochrane Database of Systematic Reviews (n = 20), followed by Pain (n = 6). The majority of the 100 most-cited reviews are on pain or pain-related conditions. Only 4 of them focus on safety issues, and all of these are by my team.
The authors concluded that the 100 most-cited systematic reviews or meta-analyses in the acupuncture research field are mostly from high impact factor journals and developed countries. It will help researchers follow research hot spots, broaden their research scope, expand their academic horizons, and explore new research ideas, thereby improving the quality of acupuncture research.
The authors show that, both in the list of corresponding as well as first authors, I am in place number one! Not only that, they furthermore reveal that my department is also in place number 1 (as Universities of Exeter and Plymouth in England (n = 6), and the University of Exeter in England (n = 6) both refer to my unit [in the 19 years it existed the Exeter medical school changed affiliation twice]). This is remarkable, particularly because acupuncture was only one of several research foci of my team (the other 3 being herbal medicine, homeopathy, and spinal manipulation), and my department was closed almost 10 years ago.
When I write about acupuncture these days (mostly on this blog), I often get the impression that the true believers in this therapy don’t especially like what I have to say. I, therefore, fear that the concept of me being the WORLD CHAMPION of acupuncture reviews might cause some degree of displeasure to them.
What can I say?
The non-specific effects constitute part of the overall effect of acupuncture. It is unclear whether responders and non-responders of acupuncture experience non-specific effects differently. This analysis aimed to compare their experiences in a nested qualitative study embedded in an acupuncture trial on functional dyspepsia.
Purposive sampling was used to capture the experience of responders (n=15) and non-responders (n=15) to acupuncture via individual in-depth interviews. Design and analysis followed a framework analysis approach, with reference to an existing model on acupuncture non-specific effects. Themes emerging outside of this model were purposefully explored.
The findings suggest that responders had a more trusting relationship with the acupuncturist in response to their expression of empathy. In turn, they were more actively engaged in lifestyle modifications and dietary advice offered by acupuncturists. Non-responders were not satisfied with the level of reassurance regarding acupuncture safety. They were also expecting more peer support from fellow participants, regarded that as an empowerment process for initiating and sustaining lifestyle changes.
The authors concluded that our results highlighted key differences in acupuncture non-specific effect components experienced by responders and non-responders. Positive non-specific effects contributing to overall benefits could be enhanced by emphasizing on empathy expression from acupuncturists, trust-building, offering appropriate explanations on safety, and organizing patient support groups. Further research on the relative importance of each component is warranted.
I doubt that this tiny study lends itself to drawing any firm conclusions. However, what they seem to imply and what the authors (proponents of acupuncture) ignore totally is the following: acupuncture responders are those people who respond to the context of the treatment situation. Thus their positive result is not due to the specific effects of acupuncture itself but to non-specific effects. In other words, acupuncture operates predominantly or entirely via non-specific effects. Or, to put it bluntly: this analysis confirms what we have discussed many times before (see for instance here, here, and here), namely that
acupuncture is a placebo therapy.
Gua sha, sometimes referred to as “scraping”, “spooning” or “coining”, is a traditional Chinese treatment that has also been adopted in several other Asian countries. It has long been popular in Vietnam and is now also becoming
well-known in the West. The treatment consists of scraping the skin with a smooth edge placed against the pre-oiled skin surface, pressed down firmly, and then moved downwards along muscles or meridians, the assumed ‘energy’ channels of traditional Chinese medicine. According to its proponents, gua sha stimulates the flow of the vital energy ‘chi’ and releases unhealthy bodily matter from blood stasis within sored, tired, stiff or injured areas.
Gua sha is a traditional healing technique that aims to create petechiae on the skin for a believed therapeutic benefit. Natural healings are mostly based on repeated observations and anecdotal information. Hypothetical model for healing does not always fit the modern understanding. Yet, the mechanisms underlying Gua Sha have not been empirically established. Contemporary scientific research can now explain some events of traditional therapies that were once a mystery. It is assumed that Gua Sha therapy can serve as a mechanical signal to enhance the immune surveillance function of the skin during the natural resolving of the petechiae, through which scraping may result in therapeutic benefits. The current review, without judging the past hypothetical model, attempts to interpret the experience of the ancient healings in terms of contemporary views and concepts.
The authors conclude that this narrative review draws up a survey of scientific sources on an ancient healing, scraping therapy. It is hypothesized that the skin, the nervous system and immune system interact with one another to generate a cascade of physiological responses to the scraping, through which scraping may result in therapeutic benefits. Within the scope and limitations of this review, only a brief overview could be given of the potential relationship between the observed outcomes and scraping therapy. Implementing effective traditional healings within health systems will require appropriate knowledge translations and future prospective studies.
And they add the following ket points:
- The observed therapeutic effects following scraping therapy may be a physiological response to the minor bruising.
- Scraping is assumed to be a mechanical signal to elicit the immune function of the skin.
- Through natural resolving of the scraping marks (petechiae) a cascade of physiological responses are generated.
- Counterirritation and placebo effect can also contribute to positive effects for symptom relief.
I think that this paper is a good example for highlighting a common misunderstanding in so-called alternative medicine (SCAM): the confusion about how and whether any given therapy might work.
It is in my view utterly irrelevant, to consider or investigate the mechanisms of action of a SCAM that has not been proven to be an effective treatment of a disease or symptom. Such an approach can only lead to confusion about the value of the SCAM in question. In the present case, it makes gua sha look almost like a reasonable therapy, and consumers who read the paper might conclude that gua sha is worth trying.
A deliberately exaggerated example might make this clearer: If I fall down the staircase, a multitude of physiological effects of the fall could easily be verified on my body. Yet, nobody would claim that throwing patients down the stairs is of therapeutic value. Likewise, the forceful scratching of the skin is bound to have all sorts of physiological effects. These are, however, totally irrelevant until someone has shown that the procedure also has therapeutic value.
To put it bluntly: who cares how a SCAM works when it is unproven that it works?
Muscular dystrophies are a rare, severe, and genetically inherited disorders characterized by progressive loss of muscle fibers, leading to muscle weakness. The current treatment includes the use of steroids to slow muscle deterioration by dampening the inflammatory response. Chinese herbal medicine (CHM) has been offered as adjunctive therapy in Taiwan’s medical healthcare plan, making it possible to track CHM usage in patients with muscular dystrophies. This investigation explored the long-term effects of CHM use on the overall mortality of patients with muscular dystrophies.
A total of 581 patients with muscular dystrophies were identified from the database of Registry for Catastrophic Illness Patients in Taiwan. Among them, 80 and 201 patients were CHM users and non-CHM users, respectively. Compared to non-CHM users, there were more female patients, more comorbidities, including chronic pulmonary disease and peptic ulcer disease in the CHM user group. After adjusting for age, sex, use of CHM, and comorbidities, patients with prednisolone usage exhibited a lower risk of overall mortality than those who did not use prednisolone. CHM users showed a lower risk of overall mortality after adjusting for age, sex, prednisolone use, and comorbidities. The cumulative incidence of the overall survival was significantly higher in CHM users. One main CHM cluster was commonly used to treat patients with muscular dystrophies; it included Yin-Qiao-San, Ban-Xia-Bai-Zhu-Tian-Ma-Tang, Zhi-Ke (Citrus aurantium L.), Yu-Xing-Cao (Houttuynia cordata Thunb.), Che-Qian-Zi (Plantago asiatica L.), and Da-Huang (Rheum palmatum L.).
The authors concluded that the data suggest that adjunctive therapy with CHM may help to reduce the overall mortality among patients with muscular dystrophies. The identification of the CHM cluster allows us to narrow down the key active compounds and may enable future therapeutic developments and clinical trial designs to improve overall survival in these patients.
What the authors have shown is a CORRELATION, and from that, they draw conclusions implying CAUSATION. This is such a fundamental error that one has to wonder why a respected journal let it go past.
A likely causative explanation of the findings is that the CHM group of patients differed in respect to features that the statistical evaluations could not control for. Statisticians can never control for factors that have not been measured and are thus unknown. A possibility in the present case is that these patients had adopted a different lifestyle together with employing CHM which, in turn, resulted in a longer survival.
The global market for dietary supplements has grown continuously during the past years. In 2019, it amounted to around US$ 353 billion. The pandemic led to a further significant boost in sales. Evidently, many consumers listened to the sly promotion by the supplement industry. Thus they began to be convinced that supplements might stimulate their immune system and thus protect them against COVID-19 infections.
During the pre-pandemic years, the US sales figures had typically increased by about 5% year on year. In 2020, the increase amounted to a staggering 44 % (US$435 million) during the six weeks preceding April 5th, 2020 relative to the same period in 2019. The demand for multivitamins in the US reached a peak in March 2020 when sales figures had risen by 51.2 %. Total sales of vitamins and other supplements amounted to almost 120 million units for that period alone. In the UK, vitamin sales increased by 63 % and, in France, sales grew by around 40–60 % in March 2020 compared to the same period of the previous year.
Vis a vis such impressive sales figures, one should ask whether dietary supplements really do produce the benefit that consumers hope for. More precisely, is there any sound evidence that these supplements protect us from getting infected by COVID-19? In an attempt to answer this question, I conducted several Medline searches. Here are the conclusions of the relevant clinical trials and systematic reviews that I thus found:
- KSK (a polyherbal formulation from India’s Siddha system of medicine) significantly reduced SARS-CoV-2 viral load among asymptomatic COVID-19 cases and did not record any adverse effect, indicating the use of KSK in the strategy against COVID-19. Larger, multi-centric trials can strengthen the current findings.
- There is currently insufficient evidence to determine the benefits and harms of vitamin D supplementation as a treatment of COVID-19.
- Herbal supplements may help patients with COVID-19, zinc sulfate is likely to shorten the duration of olfactory dysfunction. DS therapy and herbal medicine appear to be safe and effective adjuvant therapies for patients with COVID-19. These results must be interpreted with caution due to the overall low quality of the included trials. More well-designed RCTs are needed in the future.
- No significant difference with vitamin-D supplementation on major health related outcomes in COVID-19.
- there is not enough evidence on the association between individual zinc status and COVID-19 infections and mortality.
- Omega-3 supplementation improved the levels of several parameters of respiratory and renal function in critically ill patients with COVID-19.
- A 5000 IU daily oral vitamin D3 supplementation for 2 weeks reduces the time to recovery for cough and gustatory sensory loss among patients with sub-optimal vitamin D status and mild to moderate COVID-19 symptoms. The use of 5000 IU vitamin D3 as an adjuvant therapy for COVID-19 patients with suboptimal vitamin D status, even for a short duration, is recommended.
- In this 2-sample MR study, we did not observe evidence to support an association between 25OHD levels and COVID-19 susceptibility, severity, or hospitalization. Hence, vitamin D supplementation as a means of protecting against worsened COVID-19 outcomes is not supported by genetic evidence.
- These antiviral and immune-modulating activities and their ability to stimulate interferon production recommend the use of probiotics as an adjunctive therapy to prevent COVID-19. Based on this extensive review of RCTs we suggest that probiotics are a rational complementary treatment for RTI diseases and a viable option to support faster recovery.
- In this randomized clinical trial of ambulatory patients diagnosed with SARS-CoV-2 infection, treatment with high-dose zinc gluconate, ascorbic acid, or a combination of the 2 supplements did not significantly decrease the duration of symptoms compared with standard of care.
- These findings neither support nor refute the claim that 3M3F alters the severity of COVID-19 or alleviates symptoms. More rigorous studies are required to properly ascertain the potential role of Chinese Herbal Medicine in COVID-19.
- NSO (Nigella sativa oil) supplementation was associated with faster recovery of symptoms than usual care alone for patients with mild COVID-19 infection. These potential therapeutic benefits require further exploration with placebo-controlled, double-blinded studies.
- The clinical application of LQ (Lianhua Qingwen Granules or Capsules ) on the treatment of COVID-19 has significant efficacy in improving clinical symptoms and reducing the rate of clinical change to severe or critical condition. Nevertheless, due to the limited quantity and quality of the included studies, more and higher quality trials with more observational indicators are expected to be published.
- The study identified some important potential traditional Indian medicinal herbs such as Ocimum tenuiflorum, Tinospora cordifolia, Achyranthes bidentata, Cinnamomum cassia, Cydonia oblonga, Embelin ribes, Justicia adhatoda, Momordica charantia, Withania somnifera, Zingiber officinale, Camphor, and Kabusura kudineer, which could be used in therapeutic strategies against SARS-CoV-2 infection.
- Shenhuang Granule is a promising integrative therapy for severe and critical COVID-19.
- Low-certainty or very low-certainty evidence demonstrated that oral CPM (Chinese patent medicine) may have add-on potential therapeutic effects for patients with non-serious COVID-19. These findings need to be further confirmed by well-designed clinical trials with adequate sample sizes.
- XYP (Xiyanping) injection is safe and effective in improving the recovery of patients with mild to moderate COVID-19. However, further studies are warranted to evaluate the efficacy of XYP in an expanded cohort comprising COVID-19 patients at different disease stages.
- Our meta-analysis of RCTs indicated that LH (Lianhuaqingwen) in combination with usual treatment may improve the clinical efficacy in patients with mild or moderate COVID-19 without increasing adverse events. However, given the limitations and poor quality of included trials in this study, further large-sample RCTs or high-quality real-world studies are needed to confirm our conclusions.
- Reduning injection might be effective and safe in patients with symptomatic COVID-19.
- In light of the safety and effectiveness profiles, LH (Lianhuaqingwen) capsules could be considered to ameliorate clinical symptoms of Covid-19.
- QPT (Qingfei Paidu Tang) was associated with a substantially lower risk of in-hospital mortality, without extra risk of acute liver injury or acute kidney injury among patients hospitalized with COVID-19.
- This community-based RCT found that the use of a herbal medicine therapy (Jinhaoartemisia antipyretic granules and Huoxiangzhengqi oral liquids) could significantly reduce the risks of the common cold among community-dwelling residents, suggesting that herbal medicine may be a useful approach for public health intervention to minimize preventable morbidity during COVID-19 outbreak.
- Based on unresolved controversies and inconclusive findings, it could be said that generally, a single and specific therapeutics to COVID-19 is still a mirage.
- Keguan-1-based integrative therapy was safe and superior to the standard therapy in suppressing the development of ARDS in COVID-19 patients.
Does the evidence justify the boom in sales of dietary supplements?
More specifically, is there good evidence that the products the US supplement industry is selling protect us against COVID-19 infections?
No, I don’t think so.
So, what precisely is behind the recent sales boom?
It surely is the claim that supplements protect us from Covid-19 which is being promoted in many different ways by the industry. In other words, we are being taken for a (very expensive) ride.