test of time
More reason to worry about our royal family? Apparently, Camilla (I apologise for calling her thus, as I am never entirely sure whether she is Queen or Queen Consort: Camilla, the wife of Prince Charles, will be formally known as Queen Consort now that her husband is King12. When Camilla and Charles married in a civil ceremony in 2005, it was announced Camilla would become known as Princess Consort – rather than Queen Consort – due to public sensitivity3. However, Queen Elizabeth II granted her the title of Queen Consort in February last year during the Platinum Jubilee45.) has been urged to take more time to recover after a bout of pneumonia.
At the start of November it was announced that she had been diagnosed with a ‘chest infection’ and was under doctors’ supervision. The 77-year-old Camilla was forced to withdraw from her engagements so she could rest at home. She has now revealed that she was suffering from a form of pneumonia.
It is understood Camilla’s condition was viral. She seems to be suffering significantly diminished reserves of energy following her chest infection. This led to her having to pull out of a number of events over recent weeks. Even though the lung infection has now cleared, she says she is still feeling tired. She has been advised by her doctors to take more time to recover. It was confirmed yesterday on the eve of the state visit that the Queen was also reducing her role at the glam state banquet later on Dec. 3 in light of her health.
So, is there anything special that might have triggered this unfortunate turn of events? To answer this question, I refer you to my post of 31 October this year:
… King Charles arrived in Bengaluru directly from Samoa, where he attended the 2024 Commonwealth Heads of Government Meeting from October 21-26. His visit to Bengaluru was strictly kept under wraps, and he was directly taken to Soukya International Holistic Health Centre (SIHHC), where he was also joined by his wife, Camilla.
According to sources, the couple’s day begins with a morning yoga session, followed by breakfast and rejuvenation treatment before lunch. After a brief rest, a second round of therapies follows, ending with a meditation session before dinner and lights out by 9 pm. They have been enjoying long walks around the campus, visiting the organic farm and cattle shed. Considering the high-profile secret visit, a high-security ring was thrown around SIHHC.
The health centre, founded by Dr. Issac Mathai, is located in Samethanahalli, Whitefield, on Bengaluru’s outskirts. This integrative medical facility combines traditional systems of medicine, including Ayurveda, Homoeopathy, Yoga, and Naturopathy, along with over 30 complementary therapies like reflexology, acupuncture, and dietetics.
… The royal couple has earlier taken wellness treatments, including anti-ageing, detoxification and rejuvenation. On November 14, 2019, the couple celebrated the then Prince Charles’ 71st birthday at SIHHC, an event that attracted a lot of publicity, unlike this visit.
Yes, you may well ask: isn’t Ayurvedic medicine supposed:
- to strengthen the immune system,
- to fortify you against infections,
- to replenish your reserves of energy,
- to enable you to recover swiftly from infections?
Of course, I know, correlation is not causation! Perhaps the recent Ayurvedic pampering in India and Camilla’s inability to make a timely recovery from what started merely as a ‘chest infection’ are not at all linked in any way. Yet, it does seem tempting to speculate that the stay in the SIHHC with all the Ayurvedic medicine did her not a lot of good.
Whatever might be the case, I would like to take this opportunity to wish Camilla a full recovery for her condition.
This study evaluated the real-world impact of acupuncture on analgesics and healthcare resource utilization among breast cancer survivors.
The authors selected from a United States (US) commercial claims database (25% random sample of IQVIA PharMetrics® Plus for Academics) 18–63 years old malignant breast cancer survivors who were experiencing pain and were ≥ 1 year removed from cancer diagnosis. Using the difference-in-difference technique, annualized changes in analgesics [prevalence, rates of short-term (< 30-day supply) and long-term (≥ 30-day supply) prescription fills] and healthcare resource utilization (healthcare costs, hospitalizations, and emergency department visits) were compared between acupuncture-treated and non-treated patients.
Among 495 (3%) acupuncture-treated patients (median age: 55 years, stage 4: 12%, average 2.5 years post cancer diagnosis), most had commercial health insurance (92%) and experiencing musculoskeletal pain (98%). Twenty-seven percent were receiving antidepressants and 3% completed ≥ 2 long-term prescription fills of opioids. Prevalence of opioid usage reduced from 29 to 19% (P < 0.001) and NSAID usage reduced from 21 to 14% (P = 0.001) post-acupuncture. The relative prevalence of opioid and NSAID use decreased by 20% (P < 0.05) and 19% (P = 0.07), respectively, in the acupuncture-treated group compared to non-treated patients (n = 16,129). However, the reductions were not statistically significant after adjustment for confounding. Patients receiving acupuncture for pain (n = 264, 53%) were found with a relative decrease by 47% and 49% (both P < 0.05) in short-term opioid and NSAID fills compared to those treated for other conditions. High-utilization patients (≥ 10 acupuncture sessions, n = 178, 36%) were observed with a significant reduction in total healthcare costs (P < 0.001) unlike low-utilization patients.
The authors concluded that, although adjusted results did not show that patients receiving acupuncture had better outcomes than non-treated patients, exploratory analyses revealed that patients treated specifically for pain used fewer analgesics and those with high acupuncture utilization incurred lower healthcare costs. Further studies are required to examine acupuncture effectiveness in real-world settings.
Oh, dear!
Which institutions support such nonsense?
- School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, 802 W Peltason Dr, Irvine, CA, 92697-4625, USA.
- School of Pharmacy, Chapman University, RK 94-206, 9401 Jeronimo Road, Irvine, CA, 92618, USA.
- College of Korean Medicine, Kyung Hee University, Seoul, South Korea.
- Integrative Medicine Program, Departments of Supportive Care Medicine and Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
- School of Pharmacy, Chapman University, RK 94-206, 9401 Jeronimo Road, Irvine, CA, 92618, USA. [email protected].
- School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, 802 W Peltason Dr, Irvine, CA, 92697-4625, USA. [email protected].
And which journal is not ashamed to publish it?
It’s the BMC Med!
The conclusion is, of course, quite wrong.
Please let me try to formulate one that comes closer to what the study actually shows:
This study failed to show that a ‘real world impact’ of acupuncture exists. Since the authors were dissatisfied with a negative result, subsequent data dredging was undertaken until some findings emerged that were in line with their expectations. Sadly, no responsible scienctist will take this paper seriously.
We all tend to believe that natural means harmless. Sadly this notion is far from true. The Korea Adverse Event Reporting System (KAERS) compiles spontaneously reported adverse event data for medicinal products including herbal medicines. This study analyzed adverse event data specifically related to herbal medicine products from the KAERS database.
Individual case safety reports (ICSRs) encompassing 84 types of herbal medicine products, identified by item codes from 2012 to 2021, were extracted from the KAERS database. Descriptive statistics were employed to analyze the characteristics of the extracted reports, and adverse event information was systematically categorized and analyzed based on the MedDRA System Organ Class and preferred term classification.
In total, 1,054 ICSRs were extracted, with some documenting multiple adverse events in a single ICSR, resulting in 1,629 extracted adverse events. When categorized by the MedDRA System Organ Class, gastrointestinal disorders were the most prevalent (28.7%), followed by skin and subcutaneous tissue disorders (20.1%). Based on the preferred terms, the most frequently reported adverse events were:
- diarrhea (5.8%),
- urticaria (5.3%),
- pruritus (4.7%),
- rash (4.4%),
- abdominal discomfort (4.2%).
The most frequently reported herbal medicines were:
- Bangpungtongseong-san (297 cases),
- Kyeongok-go (144 cases),
- Eunkyo-san (108 cases).
The authors conclused that spontaneously reported adverse events associated with herbal medicine products were systematically documented using the KAERS database. This study, which focused on voluntarily reported adverse reactions, underscores the need for additional research to estimate the incidence rate of adverse events and assess causality.
The authors also noted that serious adverse events, including death, life-threatening conditions, initial or prolonged hospitalization, and other importantmedical events, were individually evaluated for each reported adverse event. Out of the 1,054 ICSRs, 48 (4.6%) included one or more serious adverse events (four ICSRs were identified with duplicate labels spanning two serious adverse event categories). Further, among the 1,629 adverse events, 99 (6.1%) were identified as serious adverse events. Two cases of death were reported, with causality categorized as unknown or unlikely. Regarding life-threatening conditions, three cases of dyspnea, nausea, and dizziness have been reported, all of which resulted in recovery. Thirty-one cases of initial or prolonged hospitalization have been reported. Among the adverse events associated with hospitalization (51 events in total, considering the multiple events reported in one ICSR with hospitalization), the most frequent were:
- increased aspartate amino transferase and alanineaminotransferase levels (7 case seach),
- dyspnea (3 cases),
- liver function test abnormality (2 cases),
- nausea (2 cases),
- rash (2 cases).
Sixteen cases of other important medical events were reported, and among 43 related events, dyspnea (5 cases), angioedema (4 cases), urticaria (4 cases), anaphylactic reaction (3 cases), chest discomfort (2 cases), and dizziness (2 cases) were reported.
Yes, the ‘natural equals harmless’ fallacy is very widespread. It certainly is an excellent advertising gimmick. However, as this study demonstrates very clearly, it is as fallacious as it is dangerous.
This paper discussed the potential for collaboration of Rongoā Māori, the Indigenous healing practices of Māori, with New Zealand’s contemporary healthcare system. It aims to bridge the gap between Rongoā Māori and Western medicine by exploring the perspectives of practitioners from both fields, identifying barriers to integration, and highlighting potential areas for collaboration.
Qualitative interviews were conducted with both Rongoā practitioners and Western surgeons. The data collected were subjected to thematic analysis to extract key themes related to the integration process, challenges faced, and the potential for mutual recognition and respect between the two healing paradigms.
The study reveals a deep respect for Rongoā Māori among Western surgeons but identifies significant systemic barriers that impede its integration. These include bureaucratic challenges and the absence of clear referral pathways. Rongoā practitioners express concerns over being overlooked within the healthcare system and highlight a lack of awareness among healthcare professionals about their practices. Despite these challenges, there is a shared interest in collaborative approaches to healthcare that respect and incorporate Rongoā Māori.
The authors concluded that their findings underscore the need for systemic changes to facilitate the integration of Rongoā Māori into mainstream healthcare, including the development of clear referral pathways and initiatives to raise awareness among healthcare professionals. The study highlights the need for a more collaborative healthcare approach that values the contributions of Rongoā Māori, aiming to improve patient care through holistic practices.
The authors also stated that Rongoā Māori, the Indigenous healing system of Māori, encompasses a holistic approach to health that acknowledges the complex interplay of cultural values, connection to wairua, tinana, tikanga, whakaora, whānau, and whenua. Despite its comprehensive approach to health and well-being, Rongoā Māori remains largely marginalized within New Zealand’s mainstream healthcare system.
I beg to differ!
A ‘healing system’ – no matter what its origin or tradition might be – does not need to be adopted into current healthcare because it is ‘holistic’ or because it ‘acknowledges the complex interplay of cultural values’. It must be considered for integration once it has been shown to be effective and safe, i.e. if it demonstrably generates more good than harm.
And has Rongoā Māori been shown to fulfill these criteria?
No!
In this case, please do the research. Until compelling evidence is available, do me a favour and stop the BS!
It has been reported that King Charles is on a secret trip to Bengaluru, his first visit to India since being coronated as king of the United Kingdom on May 6, 2023, at Westminster Abbey, London. Charles arrived in Bengaluru on October 27 and will be at the Soukya International Holistic Health Centre (SIHHC) in Whitefield for wellness treatment till Wednesday (30/10) night, when he is expected to fly to London.
Sources privy to his secret visit said that King Charles arrived in Bengaluru directly from Samoa, where he attended the 2024 Commonwealth Heads of Government Meeting from October 21-26. His visit to Bengaluru was strictly kept under wraps, and he was directly taken to SIHHC, where he was also joined by his wife, Queen Camilla.
According to sources, the couple’s day begins with a morning yoga session, followed by breakfast and rejuvenation treatment before lunch. After a brief rest, a second round of therapies follows, ending with a meditation session before dinner and lights out by 9 pm. They have been enjoying long walks around the campus, visiting the organic farm and cattle shed. Considering the high-profile secret visit, a high-security ring was thrown around SIHHC.
The health centre, founded by Dr. Issac Mathai, is located in Samethanahalli, Whitefield, on Bengaluru’s outskirts. This integrative medical facility combines traditional systems of medicine, including Ayurveda, Homoeopathy, Yoga, and Naturopathy, along with over 30 complementary therapies like reflexology, acupuncture, and dietetics.
Although this is his first visit as a monarch, Charles has visited the centre on nine earlier occasions and celebrated Deepavali on three occasions there. The royal couple has earlier taken wellness treatments, including anti-ageing, detoxification and rejuvenation. On November 14, 2019, the couple celebrated the then Prince Charles’ 71st birthday at SIHHC, an event that attracted a lot of publicity, unlike this visit.
_______________________
The website of the SIHHC modestly claims to be “THE WORLD’S FIRST INTEGRATIVE HEALTH DESTINATION’
As I reported in 2022, at a press conference in Goa it was claimed, that Prince Charles had been cured of COVID-19 after seeking treatment from a Bengaluru-based alternative treatment resort, SOUKYA International Holistic Health Centre’ run by a doctor Isaac Mathai. The Palace later denied that this was true.
And what about Dr. Issac Mathai? This is what he writes about himself:
A journey that began from the hills of Wayanad (northern Kerala) in 1985, started to bloom in 1998, and today is an international destination for Holistic health and wellbeing. When Dr. Issac Mathai embarked on this journey influenced by his mother, a Homeopathy practitioner who “helped people get better”, little did he know that one day he would lead a team to redefine the essence of health and wellbeing.
As a confident youngster aspiring to be an ‘exceptional Homeopathic Doctor’, Dr. Mathai encountered two key turning points in life – one, an internationally well-received research paper on integrating Yoga with Homeopathy to cure respiratory disorders, and two, learning at the Hahnemann Postgraduate Institute of Homeopathy, London.
Later he was made a Consultant Physician at the Hale Clinic in London, where he treated a number of high-profile people. This helped him establish a reputation in the holistic healing community in quick time. SOUKYA, is today, a residential holistic centre comparable to any facility in the world.
In a world that is comfortable with the conventional practice of ‘popping pills’, the world at large practices a combination of self-medication based on preconceived notions about what is wrong with individuals. In such a scenario, Dr. Issac Mathai and his team of experienced practitioners from different streams have achieved an important goal – create awareness about the possibility of prevention of adverse health conditions, rather than just addressing the symptom.
Education:
M.D. (Homeopathy),
Hahnemann Post-Graduate Institute of Homeopathy, London M.R.C.H, London
Chinese Pulse Diagnosis and Acupuncture, WHO Institute of Traditional Chinese Medicine, Nanjing, China
Trained (Mind-Body Medicine Programme) at Harvard Medical School, USA
Of the 3 institutions mentioned above, I could only find the last one: Harvard CME | Mind Body Medicine.
And under MD (Homeopathy), I found this: MD in Homoeopathy is a 3-year long postgraduate course in medicine including a year of house job, and remaining 2 years of research and study.
So, should we be concerned about the health of our King?
What do you think?
I was alerted to an article that makes several interesting points about the current popularity of so-called alternative medicine. Here is a section of it:
The rise of alternative medicine invites the question, what is conventional medicine doing, or not doing, that leads to all this alternative medicine? Here are some hypotheses that I invite you to comment on.
1. Time. Over the short span of my career, visits to conventional medicine providers have gotten shorter. A physician with an established practice can make a 20 minute visit work for most patients but for a less experienced doctor, or one seeing new patients with whom they don’t have an established relationship, or even a seasoned practitioner with an established practice who is just having a bad day, 20 minutes is not enough. This leaves patients wanting the greater time and attention that alternative medicine providers usually spend with patients.
2. Better use of placebos. I use the term placebo with absolutely no negative connotations. As I wrote above, and as I have written in this space, the use of the placebo effect, usually in the form of a therapeutic relationship, is a critical part of conventional and alternative medicine. Because conventional medicine does not depend on the placebo effect – your electrophysiology cardiologist can be an uncaring jerk and still effectively ablate your atrial fibrillation – we have gotten lazy in its use.2 Therefore, for the problems for which we have no real solutions, alternative medicine practitioners often do a better job.
3. People value what they pay for. In the US, and in most developed counties, people do not pay directly for their conventional care. On the other hand, it is the rare insurance policy that pays for acupuncture, chiropractic manipulation, or a consultation with a naturopath. Cognitive dissonance occurs when people are faced with the possibility that what they spent their hard-earned dollars on didn’t work. We resolve the dissonance by convincing ourselves that the treatments we paid for did work.
4. The downside of evidence-based medicine. It hurts me to propose this. Practicing evidence-based medicine entails integrating clinical experience and expertise (science knowledge) with the best available evidence from systematic research. […] conventional doctors often use practices not supported by robust studies. Chapter 2 in Ending Medical Reversal tells us how bad we are at knowing something works just based on our practice experience.3 That leaves science. We are in an age where education and an understanding of science can be a liability. Anybody who knows how to use social media can convince millions that something, anything, is supported by “their science.” Many people regard a treatment based on “rebalancing your life force” or “natural immunomodulators” to be as likely to be effective as ones based on actual biochemistry, immunology, and pathophysiology.
Has the articulation of evidence-based medicine opened the door to alternative medicine practitioners? If we all practice (some occasionally, some always) without data, if we can all quote “clinical experience”, if we all claim that “science” supports our treatment, what does conventional medicine offer that alternative medicine cannot?
In my ideal world, conventional and alternative practitioners would work together. Conventional doctors would diagnose, treat, and prognosticate as best as they can. They would nurture helpful therapeutic alliances with patients. They would also recognize that there are many symptoms that we cannot adequately treat and syndromes that we do not yet understand. Patients with these symptoms and syndromes would be referred to alternative medicine providers. These providers would see if what they have to offer can help. They would also refer back to traditional doctors if the situation changed, progressed, or if findings concerned them.
__________
2 It is not uncommon that I have to encourage trainees to “sell” their recommendations. This is important not only to get the patient to try the meds but because, in the short term at least, belief that a treatment will work might be the most important aspect of its pharmacology.
3 I still haven’t gotten over the commenter who, after I wrote that one of the things that makes me think masks are effective for COVID is that I worked, unvaccinated but masked for 9 months without getting COVID, asked me if I also put tinfoil inside my white coat.
END OF QUOTE
I disagree with several points the author makes here. Nevertheless, his overall notion -namely that conventional medicine is partly the cause for the popularity of so-called alternative medicine – is correct, in my view. I have often stated that modern medicine often lacks time, compassion, empathy and understanding. Yet patients frequently crave these qualities. Many practitioners are particularly good at providing them, and it is little wonder that patients then seek their help.
The bottom line is that many conventional medics might need to re-learn the necessary skills; and for doing so, they could do worse than to look at the ‘bed-side manners’ (as we used to call this aspect of patient care) of practitioners of so-called alternative medicine.
The Canadian Kwantlen Polytechnic University (KPU) has announced that it will launch Canada’s first bachelor’s degree in Traditional Chinese Medicine (TCM). Greenlit by the B.C. government to fill what it calls rising demand in the labour market, the new program marks a major step in Canadian recognition of TCM. However, skeptics of TCM and other so-called alternative medicine (SCAM) remain wary of movement in this direction.
TCM is regulated in British Columbia, Alberta, Quebec, Ontario and Newfoundland and Labrador, with more than 7,000 licensed practitioners working in these provinces.
John Yang has worked for nearly a decade toward KPU’s bachelor’s degree, which will welcome its inaugural cohort starting September 2025. As chair of KPU’s TCM program, he hopes the new offering will boost its acceptance and encourage more integration with the Canadian health-care system. “The degree program can let the public [feel] more confident that we can train highly qualified TCM practitioners. Then there will be more mainstream public acceptance,” he said. “Currently we are not there yet, but I hope in the future there’s an integrated model.”
The degree will add topic areas like herbology and more advanced TCM approaches to the current diploma’s acupuncture-focused study, as well as courses in health sciences, arts and humanities, ethics and working with conventional health practitioners, says Sharmen Lee, dean of the B.C. school’s faculty of health. “You’re getting a much broader, deeper education that allows you to develop additional competencies, such as being able to critically think, to evaluate and participate in research, and all of those other things that a university-based education can provide.” Lee believes future graduates will be able to work alongside with biomedical professionals, with some becoming researchers as well — able to pursue post-grad studies abroad. “They start to understand the fundamentals of conducting research, of reviewing published studies and then … to critically analyze what that means so that they can apply that to their practice,” Lee said. “It’s going to help to elevate the practice of traditional Chinese medicine … in our province.”
With the World Health Organization (WHO) encouraging governments toward integrating traditional and complementary medicine into their health-care systems, there’s a need for researchers to develop strong evidence to guide policy-makers, says Nadine Ijaz, an assistant professor at Carleton University in Ottawa and president of the International Society for Traditional, Complementary and Integrative Medicine Research. “Most Canadians at some point in their lifetime are using some form of what we call traditional and complementary medicine: that might be acupuncture, chiropractic, massage therapy, vitamins, yoga … people who are participating in Indigenous healing ceremonies within their own communities,” she said. “How are governments to make good determinations about what to include? What is rigorous? What is safe? What is effective and what is cost effective, in addition to what is culturally appropriate?”
More research and scientific inquiry is a good thing, but it depends on the type of research, says Jonathan Jarry, a science communicator for the McGill Office of Science and Society and co-host of the health and medicine podcast Body of Evidence. Jarry said many studies on SCAM are low quality: too few participants, too short in duration, lacking follow-up or a proper control group. It’s an issue that plagues research on conventional therapies too, he acknowledged. “I’m all for doing research on things that are plausible enough that they could realistically have a benefit, but then you have to also do very good, rigorous studies. Otherwise you’re just creating noise in the research literature.”
Ijaz and a group of colleagues around the globe are working toward determining strong research parameters without forcing alternative approaches “into a box where they don’t fit.” For instance, a randomized controlled trial is the gold standard of research in biomedicine and excellent for studying pharmaceutical drugs and their effects, because participants in the control group get a placebo, perhaps a sugar pill, that means they can’t tell if they’re being treated with medication or not. But it doesn’t work for studying acupuncture treatment, chiropractic or even psychotherapy, Ijaz pointed out. “If you’re getting an acupuncture treatment, you usually know that you’re getting a treatment…. It’s a little bit challenging to develop a placebo control for for those approaches,” said Ijaz. “When we apply that particular gold standard to researching all therapeutic approaches … it sort of privileges the issue in favour of pharmaceutical drugs immediately.”
“A randomized controlled trial is the gold standard of research in biomedicine and excellent for studying pharmaceutical drugs … but it doesn’t work for studying acupuncture treatment, chiropractic or even psychotherapy.” When I hear nonsensical drivel like this, I know what to think of a university course led or influenced by people who believe this stuff. They should themselves go on a course of research methodology for beginners rather that try brainwashing naive students into believing falsehoods.
Alternative cancer clinics (I’d prefer to call them SCAM cancer clinics), that provide treatments associated with hastening death, actively seek to create favorable views of their services online. An unexplored means where such clinics can shape their public appeal is their Google search results.
For this study, a team of researchers retrieved the Google listing and Google reviews of 47 prominent SCAM cancer clinics. They then conducted a content analysis to assess the information cancer patients are faced with online.
The results show that Google listings of alternative treatment providers rarely declare that the clinic is a SCAM clinic versus a conventional primary cancer treatment provider (12.8% declared; 83.0% undeclared). The clinics were highly rated (median, 4.5 stars of 5). Reasons for positive reviews included:
- treatment quality (n = 519),
- care (n = 420),
- outcomes (n = 316).
288 reviews claimed that the clinics cured or improved cancer. Negative reviews presented SCAM clinics to:
- financially exploit patients with ineffective treatment (n = 98),
- worsen patients’ condition (n = 72),
- provide poor care (n = 41),
- misrepresent outcomes (n = 23).
The authors concluded that the favorable Google listing and reviews of alternative clinics contribute to harmful online ecosystems. Reviews provide compelling narratives but are an ineffective indicator of treatment outcomes. Google lacks safeguards for truthful reviews and should not be used for medical decision-making.
These findings suggest that the Google listings and reviews of SCAM cancer clinic create a favorable online impression to prospective patients. Google listings and reviews are thus part of a most effective multi-level propaganda network promoting SCAM even for the most desperately ill of all patients. As discussed some time ago, in the UK, such misinformation can even be traced back to King Charles. In nearly all cases, these clinics were labeled as speciality primary cancer options. Only a few clinics were marked as an ‘alternative’ option. Positive reviews stated that alternative treatments can cure cancer or prolong life, even in terminal cases. Positive reviews also undermine evidence-based cancer treatments in favor of SCAM. They generate an impression that dangerously misleads patients. As we have seen repeatedly on this blog, the results can be devastating, e.g.:
- SCAM: So-Called Alternative Medicine (Societas): Amazon.co.uk: Ernst, Edzard: 9781845409708: Books
- So-called alternative medicine (SCAM) for cancer: does it prolong survival?
- Leah Bracknell (1964-2019): another victim of cancer quackery?
- Germany, the ‘promised land’ for cancer quacks
- Use of alternative medicine hastens death of cancer patients
- Fatalities in a German alternative medicine clinic caused by 3BP?
- Suzanne Somers has died – another victim of so-called alternative medicine?
The BBC has repeatedly misled the public on matters related to so-called alternative medicine (SCAM). Examples include:
- Dangerous BS from the BBC
- The BBC, Michael Mosely, air ionization, depression, and an appalling lack of critical thinking.
Recently the BBC published an article about Ashwagandha. Here it is in its untouched beauty:
Ashwagandha is a herb (Withania somnifera) in the nightshade family, which also includes tomatoes and chilli peppers. It has been used in traditional Indian medicine (Ayurveda) for thousands of years to make preparations for treating various ailments, from infectious diseases, like tuberculosis, to pain and inflammation, baldness and hiccups. In classic Ayurvedic texts, it’s also described as a ‘mental strength promoter’ (or ‘Balya’).
While lots of research has been done on ashwagandha, studies for specific conditions can be sparser. Perhaps the most recent assessment of its use for stress and anxiety comes from a 2022 review of studies by the Cochrane Collaboration, which is internationally recognised for its high-standard medical reviews. Although the Cochrane researchers were only able to find 12 studies on the subject, which together tested the herb on just 1,002 participants, their findings did suggest that ashwagandha can lower stress and anxiety. The researchers rated the ‘certainty’ of the evidence as ‘low’ and called for more detailed studies, though.
The benefits of ashwagandha are thought to be related to natural steroids called withanolides, but this group includes hundreds of compounds, with tens having been isolated from ashwagandha so far. As with any herbal remedy, the combination of compounds and the exact concoction you get depends on how and where the plant is grown, and how it’s prepared. This means that not all supplements based on the same plant are equal.
Remember, too, that herbal doesn’t mean risk-free. For some people, ashwagandha causes drowsiness and more serious side effects aren’t unknown. It’s best to treat it like a drug and not ‘just’ a herb.
The review cited in the article is this one:
Clinical trial studies revealed conflicting results on the effect of Ashwagandha extract on anxiety and stress. Therefore, we aimed to evaluate the effect of Ashwagandha supplementation on anxiety as well as stress. A systematic search was performed in PubMed/Medline, Scopus, and Google Scholar from inception until December 2021. We included randomized clinical trials (RCTs) that investigate the effect of Ashwagandha extract on anxiety and stress. The overall effect size was pooled by random-effects model and the standardized mean difference (SMD) and 95% confidence interval (CIs) for outcomes were applied. Overall, 12 eligible papers with a total sample size of 1,002 participants and age range between 25 and 48 years were included in the current systematic review and meta-analysis. We found that Ashwagandha supplementation significantly reduced anxiety (SMD: −1.55, 95% CI: −2.37, −0.74; p = .005; I2 = 93.8%) and stress level (SMD: −1.75; 95% CI: −2.29, −1.22; p = .005; I2 = 83.1%) compared to the placebo. Additionally, the non-linear dose–response analysis indicated a favorable effect of Ashwagandha supplementation on anxiety until 12,000 mg/d and stress at dose of 300–600 mg/d. Finally, we identified that the certainty of the evidence was low for both outcomes. The current systematic review and dose–response meta-analysis of RCTs revealed a beneficial effect in both stress and anxiety following Ashwagandha supplementation. However, further high-quality studies are needed to firmly establish the clinical efficacy of the plant.
This review is NOT a Cochrane Review; what is more (and more important), it seem rather uncritical.
The BBC article seems to down-play the safety issue related to Ashwagandha. As we have discussed on this blog, Ashwagandha is far from harmless. In fact, Ashwagandha has been shown to be a herb with a high risk of hepatobiliary toxicity as well as heart problems.
So, why does the BBC misinform the public?
Search me.
This study aimed to investigate the clinical effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention to prevent the recurrence of low back pain.
WalkBack was a two-armed, randomised clinical trial, which recruited adults (aged 18 years or older) from across Australia who had recently recovered from an episode of non-specific low back pain that was not attributed to a specific diagnosis, and which lasted for at least 24 h. Participants were randomly assigned to an individualised, progressive walking and education intervention facilitated by six sessions with a physiotherapist across 6 months or to a no treatment control group (1:1). The randomisation schedule comprised randomly permuted blocks of 4, 6, and 8 and was stratified by history of more than two previous episodes of low back pain and referral method. Physiotherapists and participants were not masked to allocation. Participants were followed for a minimum of 12 months and a maximum of 36 months, depending on the date of enrolment. The primary outcome was days to the first recurrence of an activity-limiting episode of low back pain, collected in the intention-to-treat population via monthly self-report. Cost-effectiveness was evaluated from the societal perspective and expressed as incremental cost per quality-adjusted life-year (QALY) gained. The trial was prospectively registered (ACTRN12619001134112)
Between Sept 23, 2019, and June 10, 2022, 3206 potential participants were screened for eligibility, 2505 (78%) were excluded, and 701 were randomly assigned (351 to the intervention group and 350 to the no treatment control group). Most participants were female (565 [81%] of 701) and the mean age of participants was 54 years (SD 12). The intervention was effective in preventing an episode of activity-limiting low back pain (hazard ratio 0·72 [95% CI 0·60–0·85], p=0·0002). The median days to a recurrence was 208 days (95% CI 149–295) in the intervention group and 112 days (89–140) in the control group. The incremental cost per QALY gained was AU$7802, giving a 94% probability that the intervention was cost-effective at a willingness-to-pay threshold of $28 000. Although the total number of participants experiencing at least one adverse event over 12 months was similar between the intervention and control groups (183 [52%] of 351 and 190 [54%] of 350, respectively, p=0·60), there was a greater number of adverse events related to the lower extremities in the intervention group than in the control group (100 in the intervention group and 54 in the control group).
The authors concluded that an individualised, progressive walking and education intervention significantly reduced low back pain recurrence. This accessible, scalable, and safe intervention could affect how low back pain is managed.
Rigorous clinical trials of excercise therapy are difficult to conceive and conduct because of a range of methodological issues. For instance, there is no obvious placebo and thus it is hardly possible to control for placebo effects. Nonetheless, the benefits of exercise therapy for back pain is undoubted. As previously discussed on this blog, a recent systematic review concluded that “the relative benefit of individualized exercise therapy on chronic low back pain compared to other active treatments is approximately 38% which is of clinical importance.”
I have always been convinced of the health benefits of excercise. In fact, 40 years ago, when I did my inaugural lecture at the University of Munich (LMU), excercise was its topic and I concluded that, if exercise were a pharmaceutical product, it would out-sell any drug. The new study only confirms my view. It adds to our knowledge by suggesting that exercise also reduces the risk of recurrences.
Forget about spinal manipulation, acupuncture, etc., despite the undeniable weaknesses in the evidence, exercise is by far the most promissing treatment for back pain
