test of time
Certain aspects of yoga can be used as a non-pharmacological conservative therapeutic approach to the management of chronic low back pain (CLBP). This overview summarized and evaluated data from current systematic reviews (SRs) on the use of yoga for CLBP.
The researchers searched SRs on the use of yoga for CLBP in nine electronic databases from inception to September 2023. The methodological quality was evaluated using the Assessment of Multiple Systematic Review Scale-2 (AMSTAR-2). The reporting quality of the included SRs was evaluated using the Preferred Reporting Item for Systematic Review and Meta-Analysis-2020 (PRISMA-2020), and the quality of data was graded using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Two independent researchers performed the screening, data extraction, and quality assessment process of SRs.
A total of 13 SRs were included. The results of the AMSTAR-2 indicated that the methodological quality of the included studies was relatively low. The PRISMA-2020 checklist evaluation results indicated that methodological limitations in reporting, especially regarding data processing and presentation, were the main weaknesses. The GRADE assessment indicated that 30 outcomes were rated moderate, 42 were rated low level, and 20 were rated very low level. Downgrading factors were mainly due to the limitations of the included studies.
The authors concluded that yoga appears to be an effective and safe non-pharmacological therapeutic modality for the Management of CLBP. Currently, it may exhibit better efficacy in improving pain and functional disability associated with CLBP. However, the methodological quality and quality of evidence for SRs/MAs in the included studies were generally low, and these results should be interpreted cautiously.
Sorry, but I beg to differ!
- The safety of a therapy cannot be ascertained on the basis of such small sample sizes.
- The effectiveness of yoga has not been demonstrated by these data.
- All that has been shown with this review is that the quality of the research in this area is too poor for drawing conclusions.
Congratulations to Joseph Prahlow, MD, who is the winner of the Excellence in Homeopathy Award! Here are the conclusions of his winning essay. Special thanks to Hermeet Singh and Boiron for their prize donation.
Despite the many obstacles and challenges which face homeopathy in the 21st century, the homeopathic community should be emboldened and encouraged by the fact that there are also many opportunities for the advancement of homeopathy as an alternative choice in health care.
Proclaim the Truth: Homeopathy Actually Works
Notwithstanding the challenges involved (especially for a student) in arriving at the correct simillimum for a case, let alone the appropriate follow-up and case management, the truth of the matter is that homeopathy does, in fact, work! Those of us who have been the beneficiaries of homeopathic care, or who have seen the benefits in others, know with no doubt whatsoever that homeopathy represents a truly amazing form of alternative medicine that is able to successfully treat patients having a wide range of health concerns, including some very ill individuals. And it’s not just based on “experience” or “perception,” although such evidence should not be discounted. Numerous studies show the effectiveness of homeopathy.6-9 The fact that homeopathy actually works represents one of the biggest and most important opportunities for homeopathy. The corresponding challenge relates to “getting the word out” into the general community as well as the medical community. Instead of homeopathy being the “last resort,” it should increasingly become the “first choice” amongst patients. Only by “spreading the word” of its success can this become a reality.
What intrigued me here was the evidence that an award-winning homeopath believes might justify the claim that
“Numerous studies show the effectiveness of homeopathy”
6. Mathie RT, Lloyd SM, Legg LA, et al. Randomised placebo-controlled trials of individualized homeopathic treatment: systematic review and meta-analysis. Syst Rev. 2014 Dec 6;3:142. doi: 10.1186/2046-4053-3-142.
As we have discussed previously that meta-analysis is phoney and created a false-positive result by omitting at least two negative studies.
7. Taylor JA, Jacobs J. Homeopathic ear drops as an adjunct in reducing antibiotic usage in children with otitis media. Glob Pediatr Health 2014 Nov 21;1:2333794X14559395. doi: 10.1177/2333794X14559395.
This study had the notorious A+B versus B design and thus was unable to test for specific effects of homeopathy. Moreover, the lead author, Dr Jennifer Jacobs, was a paid consultant to Standard Homeopathic Company.
8. Sorrentino L, Piraneo S, Riggio E, et al. Is there a role for homeopathy in breast cancer surgery? A first randomized clinical trial on treatment with Arnica montana to reduce post-operative seroma and bleeding in patients undergoing total mastectomy. J Intercult Ethnopharmacol 2017 Jan 3;6(1):1-8. doi: 10.5455/jice.20161229055245.
This study showed no significant result in the intention to treat analysis. The positive conclusion seems to be based on data dredging only.
9. Frass M, Lechleitner P, Grundling C, et al. Homeopathic treatment as an add-on therapy may improve quality of life and prolong survival in patients with non-small cell lung cancer: a randomized, placebo-controlled, double-blind, three-arm, multic0-e1955enter study. Oncologist 2020 Dec 25(12):e1930-e1955. doi: 10.1002/onco.13548.
Perhaps the award winning author should chance the crucial sentence into something like:
Numerous studies have shown how homeopaths try to mislead the public?
In any case, please do not let this stop you from reading the full paper by the award-winning author. I promise you that it will create much hilarity.
What does homeopathy offer our modern ailing world?
We have often discussed cupping on this blog, e.g.:
- The ‘WORST PAPER OF 2022 COMPETITION’ entry No 6: “The efficacy and safety of dry cupping in cervical spondylosis with optimization of cup application time – A randomized clinical trial”
- Cupping therapy for non-specific chronic low back pain
- Cupping for Olympic swimmers. Or: why breaking your shoulder is not necessarily good for writing a successful book
- Infant receiving cupping treatment prompts outrage
Yes, generally speaking I have been critical about cupping – not because I don’t like it (I even used the treatment as a young clinician many years ago) but because the evidence tells me to. I was glad to see that the authors of a recent article entitled “Utility of Cupping Therapy in Substance Use Disorder: A Novel Approach or a Bizarre Treatment?” offer even more outspoken words about the therapy. Here are their conclusions:
Established treatment modalities for substance use disorder and its withdrawal symptoms include pharmacotherapy and psychotherapy, but their utilization by the general population remains unsatisfactory. Taboos regarding mental health services and concerns about confidentiality are massive obstacles for patients seeking psychiatric help, and alternative forms of medicine may seem more approachable, even with the associated risks. As displayed in this case, cupping therapy is a traditional therapy with no role in treating polyaddiction and withdrawal symptoms, but it unnecessarily exposes individuals to really uncomfortable and often concealed complications such as bruising, and skin and blood infections, especially when carried out by untrained, incompetent individuals. While one can explore these options in addition to seeking professional mental health care, it is imperative to spread awareness about the roles, scientific soundness, and adverse effects of these alternative health practices. The health promotion and education sectors need reforms to educate the general population, especially the rural population in India, about the dangers of iatrogenesis caused by non-evidence-backed treatments. There needs to be an extensive advertisement of only the most effective and scientific treatment options provided by medical professionals, and the risks of overlooking them in favor of traditional cures propagated by unqualified individuals. With all the scientific advancements in the 21st century ranging from artificial intelligence in healthcare, and robotic surgeries, to extensive clinical trials for novel anti-cancer drugs, we cannot allow the propagation of ancient, scientifically unsound techniques that may cause more harm than benefit to patients.
Why, I am sure you ask yourself, are they so critical? The reason lies in the case they report in the same paper:
A 30-year-old man presented to the psychiatric outpatient department with complaints of nervousness, anxiety, a sense of impending doom, irritability, anger outbursts, headache, and reduced sleep and appetite for the last five days. The patient had a history of daily consumption of 5-10 mg of alprazolam tablets, 200-250 mg of codeine syrup, and about five packets of chewable tobacco over the last seven years; this was a pattern of polyaddiction to a benzodiazepine, opiate, and nicotine. The patient had no history of fever, confusion, or hallucinations. On eliciting the past history, the patient revealed that he went to an alternative medicine practitioner after his family persuaded him to seek help for his substance use disorder. After ceasing the consumption of all three substances for three days, he started developing the symptoms with which he presented to our hospital. He was hesitant to talk about his substance use disorder to medical professionals and concerned about confidentiality, and, hence, went to an alternative medicine practitioner whom he deemed approachable. There he was given wet cupping therapy on the head for four days, which involved the use of rubber pumps to create a suction inside the cups placed on his head. After three to five minutes, the cups were removed and small incisions were made on the cupping sites, following which a second suction caused the oozing out of blood from the incision sites on the scalp (Figure 1). But, this did not improve his symptoms, and hence, he stopped going there two days before coming to our tertiary care hospital.
On examination, the patient had a pulse rate of 76 beats per minute, blood pressure of 128/78 mm Hg, and respiratory rate of 22 per minute. He was well-oriented to time, place, and person. Systemic examination of the cardiovascular system was unremarkable. He denied any other substance use. The skin over his head had distinct cupping marks but no signs of infection or active bleeding, which are some common complications after cupping therapy (Figure 2). On assessment, the patient had a Clinical Opiate Withdrawal Scale (COWS) score of 13 and a Clinical Institute Withdrawal Assessment (CIWA) scale score of 26.
Later, the patient was admitted to the psychiatric ward to manage the withdrawal symptoms, where we initiated pharmacotherapy. Tablet diazepam (20 mg/day), sodium valproate (800 mg/day), tramadol (200 mg/day), thiamine (300 mg/day), paracetamol (500 mg/day) and intravenous fluids were given to the patient. We counseled the patient regarding substance abuse, its harmful effects, and de-addiction. The patient’s symptoms started to improve, and we continued the treatment for four days and discharged him with a COWS score of 4 and a CIWA score of 2. We intended to reassess him after 14 days, but we lost him to follow-up.
It has been reported that a cancer patient died of multiple organ failure after he took a herbalist’s remedy that included mistletoe. Retired electrician Haydn Owen Jones had been receiving a third course of treatment for his multiple myeloma when he turned to a herbalist. Alongside two chemotherapy drugs and a steroid, Jones started using a remedy which included mistletoe, yarrow, lily of the valley, cat’s claw, echinacea, and corn silk. Days later he fell ill with a fever, swelling and a rash. He was treated for sepsis but never recovered as his liver function deteriorated. Coroner concluded that it was probable the mix of cancer drugs and the alternative therapy proved deadly to him.
As with all tragic cases of this nature, it is difficult or even impossible to establish what caused the death. Was the herbal remedy involved at all? If so, it could be the toxicity of one or more of its ingredients, interactions between them, interactions with prescribed drugs, or contaminations/adulterations of the remedy. If there is a lesson at all to learn from this case, it is, I think, this: be very cautious about using herbal remedies, particularly when combined with other medicines, and seek professional advice, preferably NOT from a herbalist.
Here we go, enjoy!
When the media does not adhere to reporting guidelines regarding so-called alternative medicine (SCAM), this may deceive or mislead consumers about the safety and efficacy of these practices. A team of researchers analyzed whether Serbian online media adheres to reporting guidelines and described dominant psychological appeals used to promote TM/CAM.
They conducted a content analysis of 182 articles from six news and six magazine websites, published July–December 2021. Biologically based treatments – predominantly herbal products – were the most common (205/289 practices). SCAM practices were claimed to:
- improve general health (71/386 claims),
- alleviate respiratory problems,
- boost the immunity,
- and detox the body.
The tone was overwhelmingly positive, with most of the positive articles (145/176) neglecting to disclose the potential harms of SCAM. Few articles provided a recommendation to speak with a healthcare provider (24/176). Articles tended to appeal to SCAM’s long tradition of use (115/176), naturalness (80/176), and convenience (72/176). They used vague pseudoscientific jargon (105/176) and failed to cite sources for the claims that SCAM use is supported by science (39/176).
The authors concluded that given that SCAM use may lead to harmful outcomes (such as adverse events, avoidance of official treatment or interaction with it), Serbian online media reports on SCAM are inadequate to assist consumers’ decision-making. Our findings highlight issues that need to be addressed towards ensuring more critical health reporting, and, ultimately, better informed SCAM consumption choices.
A long time agao, in 2000, we did a similar survey. We compared what UK newspapers published about SCAM and conventional medicine to what German papers did. We found that the proportion of articles about SCAM seems to be considerably larger in the UK (15% v 5%), and, in contrast to articles on medical matters in general, reporting on SCAM in the UK was overwhelmingly positive. I wonder whether, 23 years later, the situation has changed.
So-called alternative medicine (SCAM) is widely used in Saudi Arabia. One of the common practices is the use of camel urine alone or mixed with camel milk for the treatment of cancer, which is often supported by religious beliefs.
This study observed cancer patients who insisted on using camel urine, and to offer some clinically relevant recommendations. The authors observed 20 cancer patients (15 male, 5 female) from September 2020 to January 2022 who insisted on using camel urine for treatment. They documented the demographics of each patient, the method of administering the urine, reasons for refusing conventional treatment, period of follow-up, and the outcome and side effects.
All the patients had radiological investigations before and after their treatment with camel urine. All of them used a combination of camel urine and camel milk, and their treatment ranged from a few days to 6 months. They consumed an average of 60 ml urine/milk per day. No clinical benefit was observed after the treatment; 2 patients developed brucellosis. Eleven patients changed their mind and accepted conventional antineoplastic treatment and 7 were too weak to receive further treatment; they died from the disease.
The authors concluded that camel urine had no clinical benefits for any of the cancer patients, it may even have caused zoonotic infection. The promotion of camel urine as a traditional medicine should be stopped because there is no scientific evidence to support it.
If you suspected that this was a hoax, you were wrong!
Here is a recent paper on the ‘therapeutic potentials of camel urine’:
Camel urine has traditionally been used to treat multiple human diseases and possesses the most beneficial effects amongst the urine of other animals. However, scientific review evaluating the anticancer, antiplatelet, gastroprotective and hepatoprotective effects of camel urine is still scarce. Thus, this scoping review aimed to provide scientific evidence on the therapeutic potentials of camel urine. Three databases were searched to identify relevant articles (Web of Science, PubMed and Scopus) up to September 2020. Original articles published in English that investigated the effects of camel urine in various diseases were included. The literature search identified six potential articles that met all the inclusion criteria. Three articles showed that camel urine possesses cytotoxic activities against different types of cancer cells. Two studies revealed camel urine’s protective effects against liver toxicity and gastric ulcers, whilst another study showed the role of camel urine as an antiplatelet agent. All studies demonstrated significant positive effects with different effective dosages. Thus, camel urine shows promising therapeutic potential in treating human diseases, especially cancer. However, the standardised dosage and potential side effects should be determined before camel urine could be offered as an alternative treatment.
I have often asked myself the question whether some SCAMs are too absurd to merit scientific study. Over the years, I changed my mind on it; while initially I tended to answer it in the negative, I now think that YES: some ideas – even those that are ancient and, as Charles Windsor would argue, have thus stood the ‘test of time’ – are not worth the effort. Camel urine as a therapy might well be one of them.
It has been reported that a UK Conservative candidate for the next general election reportedly claimed she healed a man’s hearing through the power of prayer. Kristy Adams has been chosen to represent the Conservatives in Mid Sussex at the next general UK election, which is expected to take place in May or the autumn of next year. Mrs Adams previously stood as the Tory candidate in Hove in 2017, placing a distant second behind Labour MP Peter Kyle.
In a recording from 2010, the Conservative hopeful reportedly told the King’s Arms Church in Bedford how she healed a deaf man by placing her hands over his ears and saying: “Be healed in Jesus’s name”. Mrs Adams is reported to have said: “He had hearing aids in both ears and I just thought that wasn’t right. It just annoyed me. I said ‘can I pray for you?’ and his eyes lit up, which is unusual when you offer to pray for someone’s healing.” After removing her hands, she claims the man could hear without his hearing aids. “I don’t know if he was more surprised or me,” she reportedly said.
Speaking to The Argus during her 2017 election campaign, Mrs Adams said she had asked the Daily Mirror to remove a story about the alleged recording but refused to answer whether she believed non-scientific medical miracles can happen. She said: “Millions of Christians around the world pray every day to help people.”
- Daily prayer against severe COVID – an update of a study started two years ago
- Resolution of blindness after prayer?
- Prayer as a therapy: a new randomised study
- Prayer as a medical therapy? Time to stop this nonsense!
- When an undercover journalist tests alternative cancer healers
- Biblical Naturopathy, another SCAM that is new to me
- The ‘Association of Catholic Doctors’ and homeopathic conversion therapy
- Prof Harald Walach’s new ground breaking study of praying the Rosary
- Higher religiousness/spirituality is associated with a more frequent use of so-called alternative medicine (SCAM)
- ‘The power of all religions’ is being tested in a study with severely ill corona-virus patients
- Does religiosity influence post-operative survival?
- Daniel P Wirth, his dubious research, and the remarkable apathy of some medical journals
Suffice to say, perhaps, that the evidence for prayer as a therapy is not positive.
King Charles III is an enthusiastic, albeit uncritical proponent of so-called alternative medicine (SCAM). Does that boost his popularity in the general population? Or does it have the opposite effect? I am not aware of reliable data on this issue, yet I suspect it is neither here nor there. So, his waning popularity is probably caused by other factors.
A survey of more than 2,000 adult Brits found that overall, 62% want to keep the monarchy and 59% of people thought Charles was “personally doing a good job”.. At first glance, this looks not too bad for Charles and William but a more detailed analysis is far less optimistic: among 18 to 24-year-olds, only 30% say the monarchy is “good for Britain”. This “remarkable difference between generations”, demonstrates that younger people are much less supportive on remaining a monarchy and more sceptical about the Royal Family representing good value for money.
A decade ago, the same YouGov tracking survey found 17% preferred an elected head of state, which in this latest survey has risen to 26%. On the question whether Britain should continue to be a monarchy or be replaced with an elected head of state, the poll found:
- 62% wish no change,
- 26% want an elected head of state,
- 11% don’t know.
On the question whether the Royal Family is good value for money, 75% of the over-65s believe they are, but only 34% of 18 to 24-year-olds feel the same. And while 80% of the over-65s want Britain to stay as a monarchy, that figure falls to 37% for the 18 to 24-year-olds. There is also less support for the royals in Scotland or Wales than in England, where London has higher levels of people against the monarchy than elsewhere in the country.
Historian and royal commentator Ed Owens says the lack of support among the young should “certainly be of concern” to the Royal Family. But he says it will be difficult for the royals to turn this around, when many of the factors are outside their control. Dr Owens says opposition to the monarchy is part of a wider sense of “disenchantment” for younger generations about issues such as unaffordable housing, stagnant wages and student debt. “The system doesn’t seem to be working for them, so why should they celebrate an institution that seems to be at the heart of that system?” says Dr Owens.
Graham Smith, chief executive of the anti-monarchy campaign Republic, said the survey showed a “general trend of falling support, and that younger people will not be won back to the monarchist cause. Sooner rather than later we’ll see support for the monarchy fall below 50%.”
When the 1st edition of my book about about Charles’ (at the time, he was still ‘Prince of Wales’) love affair with SCAM came out, it was reviewd by the Daily Mail. They courageously asked Charles’ press office for a comment on it. A Clarence House spokesperson then told the journalist: ‘The Prince of Wales believes in combining the best of evidence based, conventional medicine with an holistic approach to healthcare – treating the whole person rather than just the symptoms of disease and taking into account the effects on health of factors such as lifestyle, the environment and emotional well-being.’ I know this is not all that meaningful and just a (fairly daft and uninformed) formular for getting rid of a tedious request, yet – for what it’s worth – it does not indicate that, in the realm of SCAM, Charles is all that open to change. More recent activities of King Charles seem to support this impression.
With regards to his overall popularitiy in the UK, this might mean that Charles will continue to lose the support of skeptics, while gaining the one of SCAM enthusiasts.
And the net result of this?
I fear it will almost be negligible.
We have discussed the currently fashionable herbal remedy, ‘kratom‘, before:
A quick recap:
Kratom is made of the leaves of Mitragyna speciosa, a tree endogenous to parts of Southeast Asia. It has been used traditionally for its stimulant, mood-elevating, and analgesic effects. The plant’s active constituents, mitragynine and 7-hydroxymitragynine, have been shown to modulate opioid receptors, acting as partial agonists at mu-opioid receptors and competitive antagonists at kappa- and delta-opioid receptors. Both alkaloids are G protein-biased agonists of the mu-opioid receptor and therefore, may induce less respiratory depression than classical opioid agonists. The Mitragyna alkaloids also appear to exert diverse activities at other brain receptors (including adrenergic, serotonergic, and dopaminergic receptors), which may explain the complex pharmacological profile of raw kratom extracts. By the early 2000s, kratom was increasingly used in the US as a substitute for prescription and illicit opioids for managing pain and opioid withdrawal by people seeking abstinence from opioids. There are numerous assessments where people have been unable to stop using kratom and withdrawal signs and symptoms are problematic. Kratom does not appear in normal drug screens and, when taken with other substances of abuse, may not be recognized.
Now it has been reported that the family of a Florida woman who died in 2021 after ingesting kratom has been awarded more than $11m from a distributor of the herbal extract. “There is of course no amount of money that will make up for the pain and suffering that Ms Talavera’s children are enduring because of their mother’s death,” Middlebrooks wrote in court records addressing the sanction against Kratom Distro. “The law nonetheless recognizes that the defendant must pay something, however inadequate.”
The US Drug Enforcement Agency in 2016 had imposed its strictest restrictions on kratom, which is made from the leaves of an evergreen tree and is often used by people to self-treat pain, anxiety, depression, and opioid addiction as well as withdrawal. There was an intense, immediate public backlash to that approach, however, and it prompted the DEA to rescind its prohibition of kratom, which is sold in stores and online.
The US Food and Drug Administration nonetheless has warned consumers over possible safety and addiction risks associated with kratom, and it has spoken in favor of more research aimed at gaining a better understanding of “the substance and its components”.
Friends of Talavera, a resident of the Florida community of Boynton Beach, introduced her to kratom years before her death. Her family said she regarded it as a safe, natural supplement and had taken some after buying it online from the Kratom Distro when her partner and the father of her youngest child – Biagio Vultaggio – found her unconscious in the living room on 20 June 2021. The 39-year-old Talavera was face down on the ground next to an open bag of a kratom derivative marketed as a “space dust”, her family has said. Vultaggio called paramedics, and they took Talavera to a hospital where she was pronounced dead. An autopsy later listed Talavera’s cause of death as acute intoxication from mitragynine, the main kratom component. The local coroner wrote in a report that “at high concentrations, mitragynine produces opioid-like effects, such as respiratory failure”.
Kratom Disro claims that
- Our kratom powder is sourced directly from Indonesia monthly. Your order was literally on a farm in Indonesia two months ago. No old powder.
- Our kratom extracts are produced in the US by a licensed chemist and a professionally trained staff.
- We only use delicious flavors and quality ingredients.
- Every batch of products we receive is lab tested and will not ship out without meeting our meticulous quality standards.
- Current labs – We will never show you an out-of-date lab with our products.
- Guaranteed purity levels and free of all toxins.
Get It When You Want It
- Many orders shipped same day.
- USPS shipping on all orders under 6 pounds.
- Larger orders can ship USPS Priority for a small additional charge.
Back to the above lawsuit:
One of the attorneys for Talavera’s family, Tamara Williams, said in a statement that the judgment won by her clients “should be a wakeup call to the kratom industry”. Williams’s law firm had also recently won a $2.5m jury verdict against a kratom manufacturer in Washington state after a separate lawsuit alleging wrongful death. A colleague of Williams called on government officials to take steps “to protect other families from having to deal with unnecessary kratom overdose deaths”.