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

Uncategorized

1 2 3 9

Homeopathy has been criticised since it first emerged 200 years ago. First, people mocked its utter implausibility. More recently, critics have pointed out that, despite 200 years of research, there is no good evidence that highly diluted remedies are anything other than placebos. In some countries, this has led to a ban of the public reimbursement of homeopathy.

In its homeland, Germany, homeopathy had a relatively long free ride. Vocal opposition only emerged a few years ago. But now it has become effective, sales figures (in excess of half a billion Euros) have started to drop and understandably, the German homeopathy-lobby is on high alert. Their latest attempt to sway public opinion is most revealing (if you read German, I highly recommend reading it in full).

A group of pro-homeopathy organisations and individuals make a series of accusations that seem like the frantic nonsense uttered in pure desperation and panic. The aim is no longer to attempt informing the public; the aim has now degenerated into a vile defamation of the critics. Amongst other claims, the lobbyists defame the critics by claiming that:

  • the current criticism of homeopathy is an expression of ‘ignorance’;
  • critics are wilfully misleading the public by dishonestly publishing wrong information;
  • critics monopolise their paradigm and that this amounts totalitarianism;
  • critics are not prepared to enter into a productive discussion;
  • critics merely follow a currently fashionable trend of arguing against homeopathy;
  • critics misrepresent scientific facts;
  • all of Prof Ernst’s homeopathy research is fraudulent (‘unserioes’);
  • critics are dogmatic ideologists and totalitarians.

The lobbyists further claim that:

  • leading universities in the US and elsewhere are on the side of homeopathy;
  • homeopathy is not in conflict with the principles of evidence-based medicine;
  • German law is on the side of homeopathy;
  • medical pluralism which includes homeopathy is in the interest of the patient;
  • only homeopaths are able to generate unbiased assessments of homeopathy;
  • homeopathy is an important part of integrated medicine for the benefit of the patient;
  • the Swiss example is something Germany should aim for;
  • Robert Hahn’s analysis invalidated the research of critics;
  • the Australian NHMRC-report is invalid;
  • homeopathy is fully dedicated to science;
  • placebos (such as homeopathic remedies?) are helpful interventions;
  • across the globe, the view is now accepted that integrative medicine must become the basis for good healthcare;
  • the German law forbids the authorities to regulate against homeopathy.

The arguments voiced here are by no means new; they have been voiced in every other country that has or is/was about to limit or abolish the public reimbursement of homeopathy. All they amount to, in fact, is a well-rehearsed, often-repeated and equally often refuted pack of lies and misleading statements. One has the impression of listening to a broken record.

Yet, many people will consider seriously what clearly is the last line of the defence of the indefensible, and they might ask themselves: who can we believe? For non-experts the confusion must be profound.

In all such cases, my advice is this: ask yourself who might be less motivated to mislead you, independent academics and sceptics with no ties to any industry, or the clinicians, their lobbyists and associations who all make their living via the multi-million industry of the SCAM in question?

 

By Guest Blogger Carlos Orsi, Instituto Questão de Ciência – Brazil

Elizabeth spent her whole adult life on yoga, follows a raw vegetable diet full of detox juices, studies acupuncture, and all of a sudden, in spite of this super healthy New age lifestyle, she is diagnosed with bowel and liver cancer, stage 4. After one course of chemotherapy and one of radiotherapy, both the main tumour and the metastasis vanished! She considers herself fully healed. A victory for Science, of course! Or isn’t it?

Not accordingly to the interpretation of “Heal”, Netflix’s recent documentary.

Even after Elizabeth’s doctor suggested that maybe the quick and relatively simple remission might be due to a misdiagnosis made at the beginning, that overestimated the severity of the tumour, the film insists that the actual reason for Elizabeth’s recovery was the release of negative emotions and energy. Those, they say, had accumulated for decades, ever since the day when the patient, still a small child, was humiliated by her kindergarten mates for bringing a pack of crackers for Show and Tell.

Produced, directed, written, and hosted by Kelly Noonan Gores (American actor that can be seen on the episode “Sex, Lies and Silicone” from the series CSI, New York), “Heal” tells the stories of two women struggling with disease. While Elizabeth deals with her cancer, Eva suffers from a mysterious type of rash, undiagnosed by doctors. Eva, of course, is also searching for a cure.

The documentary features both women -either talking about their ailments or consulting with alternative doctors and practitioners – and interviews with authors of mystical self-help best-sellers, such as Deepak Chopra, Bruce Lypton and Kelly Turner.

For those not familiar with these celebrities, Chopra is the one who claims that the human body is a “field of energy and awareness”, and that it is possible to stop the process of aging, and even reverse it, using meditation, physical exercise and plain strong will. There is a parody twitter account, @WisdomOfChopra, that produces nonsense phrases, indistinguishable from the pseudo-sayings of this mighty guru. There is even a scientific paper (http://journal.sjdm.org/15/15923a/jdm15923a.html) showing clearly that everything Chopra says is actually identical to random nonsense.

Lypton, on the other hand, believes that since gene regulation – the study of which genes are active and which are not within the cells on a given moment – depends partly on environmental signals, then it obviously should be possible to turn genes on and off by sheer will and power of the mind. Kelly Turner has travelled the world interviewing cancer survivors who faced the worst prognoses, asking them how they assessed their own healing process. It makes sense of course, if you consider it wise asking lottery winners how they pick the numbers!

More self-help celebrities lend their grace to “Heal”. Rob Wergin, the “Divine conduit”, who claims to channel healing energy directly from God to the patients, and the so-called “medical medium” Anthony Williams, both show up in the documentary and even John of God, the famous Brazilian medium healer, features a small part. Heal was filmed in 2017, before John of God was tried and arrested for the sexual harassment and rape of over 400 women. Too bad no fortune-teller or tarot reader predicted this and warned the producer beforehand…

Quantum Physics, Buddha and Epigenetics

One guru/coach/master/whatever in the film cites the phrase “each men and women are the architects of their own health”, and attributes it to Buddha. That is false, Sidarta Gautama, the Buddha who taught in India around 500 BCE probably never said that. The statement, however, immersed in an atmosphere of profound “wisdom” and absolute certainty, is the hallmark of the documentary as a whole: every mention of science, epigenetics, physics or placebo effect is either false, twisted or out of context.

Let’s start with Physics: all the practitioners in the film seem to believe that the Matter and Energy equivalence, as described in the Theory of Relativity, together with certain aspects of Quantum Physics, somehow validate a kind of dualism in the world, where matter and soul would be separate entities. These scientific theories, in the film’s assessment, would also validate the predominant role of spirit over mundane things: if everything is about energy, then the physical world is nothing but an illusion, easily manipulated by sheer will.

No need to mention just how wrong this line of thinking is. Energy, in Quantum Physics, is a physical property of the world. It can be measured and manipulated with the appropriate tools, and it does not represent any kind of abstract or divine power.

Both in logic and rhetoric, this misuse of words is called “equivocation”: using the same word in the same argument several times, but with different meanings, pretending not to notice the change.

The stars of the film seem fascinated by examples that some mental states correlate with physiological states, but do not seem to realise that this does not mean mind rules over matter, but rather that the mind is also subject to physiological changes.

More scientific concepts are twisted during the show: epigenetics and the placebo effect are hyped all the way to the moon and back. Epigenetics – which deals with the cellular mechanisms responsible for turning genes on and off – is pictured as the key to positive thinking in cellular biology: “If I change my perception, my mind changes my beliefs about life, I change the signals that are going in and adjusting the functions of the cell”, says Bruce Lypton, author of “Biology of Belief”, looking straight into the camera.

Lypton jumps to the conclusion that if different hormones can make identical stem cells differentiate in different organs, by turning genes on and off, then surely thoughts can have the exact same effect, in any kind of cell! Of course, if there was any truth to this, it should be possible to differentiate an ear from a finger, or regenerate a lost member, just by wishful thinking.

A similar explanation is given by the author of “You are the placebo”. Joe Dispenza argues that if the placebo effect, generated by a combination of classic conditioning and self-suggestion, can make the body produce opioid-like molecules for pain, then surely faith and belief can make the body produce virtually anything necessary to heal. The writer claims to have healed himself of a severe spinal injury, using nothing but visualizations and positive thinking.

To sum up

Heal’s leading claims state that all illnesses are self-inflicted, result from emotional stress (bad emotions create “density” which weakens the immune system and causes cancer), and are as such, self-healing. And of course, we know that because of Quantum Physics, Epigenetics and blah-blah-blah.

There is a slight attempt – very slight indeed – not to blame the patients. It is mentioned at a certain point that the patients are not to blame for their own diseases; it is the modern lifestyle that poisons us all. The overall message, however, is very clear: everything happens for a reason, and it is all in your head. Noonan Gores tries to sell the documentary as a message of hope. Sadly, it is but a message of despair and guilt.

Perhaps the most naïve demonstration of this message is Kelly Turner’s idea -as stated in her book Radical Remission – that people who recover from malignant tumours have “found the cure to their own cancer”. Collecting and cataloguing these survivors’ “habits” makes no sense unless you compare them to a control group: a group pf people who shared the same habits and lifestyle, and did not recover.

The film also shows a man who presents himself as a brain cancer patient. He takes part in a very emotional sequence, where he shares a “mystical moment” in Rob Wergin’s arms. Everyone in the room looks really moved, and it is clear that the patient believes himself cured. But was he? The film conveniently stops right there.

Eva, the second protagonist, with the mysterious rash, has no closure either, and finishes the documentary exactly at the same place where she began: no diagnosis nor treatment – or so they say. One doctor put her on steroids, another gave her antibiotics. The holistic therapist that helped her go through childhood issues and release negative emotion did not seem to help either.

The main – and only – cure shown in “Heal” is Elizabeth’s, who treated her cancer with chemotherapy and radiotherapy. The producer, however, refuses to connect the dots and give credit to “Western medicine”. Western medicine is after all, an aggressive monster, and full credit is given to alternative medicine alone. The reality of course, lies on the other end: the adoption of alternative therapies actually increases the risk of death in cancer patients (https://jamanetwork.com/journals/jamaoncology/article-abstract/2687972 ).

The true “power of the mind”, it seems, lies in ignoring the obvious and falling desperately in love with a pseudoscientific fantasy. A cruel fantasy for those who fall, a very lucrative one for those who sell.

I am indebted to my good friend and long-term admirer Dana Ullman for alerting me to this new (2019) paper. It reports a study aimed to test whether homeopathic medication administration to COPD patients during the influenza-exposure period may help to reduce the frequency of common URTIs.

This prospective, observational, multicenter study was carried out in Cantabria, Spain. Patients with COPD were divided into two groups: group 1 received conventional treatment + homeopathic medication (diluted and dynamized extract of duck liver and heart; Boiron) (OG); group 2 received conventional treatment only (CG). The primary endpoint was the number of URTIs between the 4-5 months follow up (mean 4.72 ± 0.96) from basal to last visit. Secondary endpoints included the duration of URTIs, number and duration of COPD exacerbations, use of COPD drugs, changes in quality of life (QoL), compliance, and adverse events (AEs).

219 patients were analyzed (OG = 109, CG = 110). There was a significant reduction in mean number of URTIs during the follow-up period in OG compared to CG (0.514 ± 0.722 vs. 1.037 ± 1.519, respectively; p = 0.014). Logistic regression analysis showed a 3.3-times higher probability of suffering ≥2 URTI episodes in CG (p = 0.003, n = 72). OG patients having ≥1 URTI also had a significant reduction in mean URTI duration per episode (3.57 ± 2.44 days OG vs. 5.22 ± 4.17 days CG; p = 0.012). There was no significant difference in mean number of exacerbations, mean duration of exacerbations, or QoL between OG and CG. There was a greater decrease in proportion of patients using corticosteroids for exacerbations between baseline and visit 2 in OG compared to CG (22.1% vs. 7.5% fewer respectively, p = 0.005). Exacerbator phenotype patients had a significant decrease in number of URTIs (0.54 ± 0.72 vs. 1.31 ± 1.81; p = 0.011), and fewer COPD exacerbations (0.9 ± 1.3 vs. 1.5 ± 1.7; p = 0.037) in OG vs. CG, respectively.

The authors concluded that homeopathic medication use during the influenza-exposure period may have a beneficial impact at reducing URTIs’ number and duration in COPD patients and at reducing the number of COPD exacerbations in patients with the exacerbator phenotype. Further studies are needed to confirm the effects observed in this study.

Evidently, Dana thinks highly of this new evidence for Boiron’s duck diluted out of existence, markeded as Oscillococcinum. Do we now have to eat out words? Does homeopathy work after all? Has Dana been right all along?

‘fraid not!

Here are just a few of the most obvious flaws of this trial:

  1. It was not an observational study as I understand it.
  2. It followed the infamous A+B versus B design (which never generates a negative result).
  3. As such it did not control for placebo effects.
  4. It cannot achieve its stated aim.
  5. Its statistical analysis seems faulty.
  6. It lacks randomisation which means the 2 groups differed in many undetected ways.
  7. The primary endpoints were assessed by an undisclosed method.

But there is more, much more.

Conflicts of interest:

J.L. Garcia-Rivero has received speaker’s fees from Boiron Laboratories. G. Diaz Saez (the senior author of the trial) was the Medical Director of Boiron Laboratories when the study was carried out and continued to collaborate in the study after leaving this post. A. Viejo Casas has received speaker’s fees from Boiron Laboratories. All authors of this study, except for G. Diaz, received fees for including patients.

Funding:

This work was supported by Boiron Laboratories.

I REST MY CASE

About a year ago, I published a blog-post about LIVE BLOOD ANALYSIS (LBA). My conclusion at the time was that LBA is an ineffective, potentially dangerous diagnostic method for exploiting gullible consumers. My advice is to avoid practitioners who employ this technique. But perhaps it was too harsh?

Recently, this post started to attract a lively discussion. Surely, a good reason to re-visit the subject and see whether anything has changed.

First, we need to remind ourselves what LBA is. This website by a LBA practitioner explains:

Live Blood Analysis uses a drop of live blood from the patient’s finger that has not been killed by staining, and viewed under a special microscope using a darkfield condenser.

This enables the blood sample to be illuminated from the sides, making the various components phosphoresce behind a dark background. This makes it possible to see very small particles, smaller than a cell that would not normally be visible under a normal light microscope. All the living components of the blood are seen clearly, and can be viewed by the patient and therapist using a video camera and a dedicated monitor.

The examination of live blood is valuable for the early detection of serious health conditions. It is possible to see at what stage of pathological development the body is in, simply from using one drop of blood. Because the precursors to serious health imbalances may be observed in the state of ever-present floras found in the blood, health imbalances may be averted by reading these early warning signs and making the necessary changes that will allow one to rebalance the physiology. These markers are also applicable in the course of tracking the progression and reversal of degenerative conditions that may already be in motion…

Depending on the irregularities found in the blood, there are a wide variety of different conditions that can be determined.

The following are just a few examples:

  • Indication of low immune status
  • Liver and spleen stress
  • Vitamin and mineral deficiencies
  • Hormonal imbalances
  • Fungal infections
  • Parasite infestation
  • Digestive problems
  • Atherosclerotic predisposition
  • Heavy metal toxicity
  • Predisposition to cancer or other degenerative diseases

END OF QUOTE

Next, we need to see whether there is any new evidence that might support these astonishingly far-reaching claims. To find out, I conducted a couple of Medline-searches. The result is easily reported: none of the claims seems to be supported by any evidence. Neither did I find any evidence to show that LBA is a valid diagnostic tool – nothing on sensitivity, reliability, etc.

And what does that mean for LBA-practitioners and their patients?

Evidently, I am not an expert on legal matters, but I guess it means that the former are fraudulent and the latter should ask their money back. In any case, as an expert in SCAM, I can confidently tell you that, in my view, LBA is bogus.

Really? Acupuncture for chronic back Pain?

If you doubt it, the following announcement might amaze you:

In response to the U.S. opioid crisis, HHS is focused on preventing opioid use disorder and providing more evidence-based non-pharmacologic treatment options for chronic pain. The Agency for Healthcare Research and Quality (AHRQ), the Centers for Medicare & Medicaid Services (CMS) and that National Institutes of Health (NIH) are collaborating in this effort. The Agency for Healthcare Research and Quality published a systematic review of noninvasive, nonpharmacological treatment for chronic pain in June 2018 (https://effectivehealthcare.ahrq.gov/sites/default/files/cer-209-evidence-summary-non-pharma-chronic-pain.pdf). This review included assessment of several nonpharmacological interventions, including exercise, acupuncture, spinal manipulation, and multidisciplinary rehabilitation for CLBP. The NIH recently issued a Funding Opportunity Announcement for interested parties to apply to conduct an efficient, large-scale pragmatic trial to evaluate the impact of, and strategies to best implement, acupuncture treatment of older adults (65 years and older) with chronic low back pain. The announcement can be found here: https://grants.nih.gov/grants/guide/rfa-files/RFA-AT-19-005.html.

CMS is opening this national coverage analysis (NCA) to complete a thorough review of the evidence to determine if acupuncture for CLBP is reasonable and necessary under the Medicare program. CMS is soliciting public comment on this topic. We are particularly interested in comments that include scientific evidence and discuss appropriate clinicians and training requirements to provide acupuncture that improves health outcomes. In addition, for commenters recommending Coverage with Evidence Development, we are interested in comments related to appropriate outcomes and study designs. While CMS has conducted previous national coverage analyses on acupuncture, the scope of this current review is limited to acupuncture for chronic low back pain.

END OF QUOTE

The evidence whether acupuncture is effective for chronic back pain is far from clear. NICE recently stated that it no longer recommends acupuncture because the evidence is not strong. Others have shown that acupuncture is superior to sham as well as no acupuncture control for back pain, with differences between groups close to .5 SDs compared with no acupuncture control, and close to .2 SDs compared with sham. A further systematic review stated that acupuncture provides a short-term clinically relevant effect when compared with a waiting list control or when acupuncture is added to another intervention.Yet another systematic review found that acupuncture for chronic nonspecific low back pain was associated with significantly lower pain intensity than placebo but only immediately post-treatment (VAS: -0.59, 95 percent CI: -0.93, -0.25). However, acupuncture was not different from placebo in post-treatment disability, pain medication intake, or global improvement in chronic nonspecific low back pain. Acupuncture did not differ from sham-acupuncture in reducing chronic non-specific neck pain immediately after treatment (VAS: 0.24, 95 percent CI: -1.20, 0.73). Acupuncture was superior to no treatment in improving pain intensity (VAS: -1.19, 95 percent CI: 95 percent CI: -2.17, -0.21), disability (PDI), functioning (HFAQ), well-being (SF-36), and range of mobility (extension, flexion), immediately after the treatment. In general, trials that applied sham-acupuncture tended to produce negative results (i.e., statistically non-significant) compared to trials that applied other types of placebo (e.g., TENS, medication, laser). Results regarding comparisons with other active treatments (pain medication, mobilization, laser therapy) were less consistent Acupuncture was more cost-effective compared to usual care or no treatment for patients with chronic back pain.

Confused?

Me too!

My reading of these and other papers is that acupuncture might have a small and probably not clinically relevant effects which is hard to differentiate from bias and confounding.

Is this enough for reimbursement from the public purse?

In my view, the answer is no.

I am sure that others will have different interpretations of the published evidence. If so, you have until 14 February to write to the CMS.

Having been frantically searching for a decent quality study reporting a positive result, I am delighted to announce that I might have had some luck.

This study examined the effects of whole-body massage on knee osteoarthritis, compared to active control (light-touch) and usual care. Assessments were done at baseline and weeks 8, 16, 24, 36, and 52. Subjects in massage or light-touch groups received eight weekly treatments each lasting one hour, then were randomized to biweekly intervention or usual care to week 52. The original usual care group continued to week 24. Analysis was performed on an intention-to-treat basis. Five hundred fifty-one screened for eligibility, 222 adults with knee osteoarthritis enrolled, 200 completed 8-week assessments, and 175 completed 52-week assessments.

The primary endpoint was the ‘Western Ontario and McMaster Universities Arthritis Index’. Visual analog pain scale, PROMIS Pain Interference, knee range of motion, and timed 50-ft walk were secondary outcome measures.

At 8 weeks, massage significantly improved WOMAC Global scores compared to light-touch and usual care. Massage also improved pain, stiffness, and physical function WOMAC subscale scores compared to light-touch and usual care. At 52 weeks, the omnibus test of any group difference in the change in WOMAC Global from baseline to 52 weeks was not significant, indicating no significant difference in change across groups. Adverse events were minimal.

The authors concluded that the efficacy of symptom relief and safety of weekly massage make it an attractive short-term treatment option for knee osteoarthritis. Longer-term biweekly dose maintained improvement, but did not provide additional benefit beyond usual care post 8-week treatment.

Massage therapy is supported by encouraging evidence from several systematic reviews, for instance:

  • One overview identified 31 systematic reviews of massage for pain control, of which 21 were considered high-quality. The most common type of pain included in systematic reviews was neck pain (n=6). Findings from high-quality systematic reviews describe potential benefits of massage for pain indications including labour, shoulder, neck, back, cancer, fibromyalgia, and temporomandibular disorder. However, no findings were rated as moderate- or high-strength.
  • A systematic review showed that massage therapy has promise for caner palliation: massage can alleviate a wide range of symptoms: pain, nausea, anxiety, depression, anger, stress and fatigue. However, the methodological quality of the included studies was poor, a fact that prevents definitive conclusions. The evidence is, therefore, encouraging but not compelling. The subject seems to warrant further investigations which avoid the limitations of previous studies.

So, should massage be recommended for knee osteoarthritis?

Yes and NO.

Yes, because it does seem to alleviate pain with only few adverse effects.

No, because it is merely symptomatic and does not cure the problem. Patients who want to treat the ‘root cause’ of knee osteoarthritis (which is often possible) ought to see an orthopaedic surgeon.

Come to think of it, this is almost a general rule: Patients who want to treat the ‘root cause‘ of any disease (which is often possible) ought to see a real doctor and not an alternative practitioner.

By guest blogger Dr Richard Rawlins (Orthopaedic and trauma surgeon and author of Real Secrets of Alternative Medicine)

The National Center for Complementary and Alternative Medicine (NCCAM) was the US Federal Government’s lead agency, under the auspices of the US National Institutes of Health (NIH), for scientific research on complementary and alternative medicine (CAM). Originally set up in 1991 as the Office for Alternative Medicine (OAM), its first Director, Dr Joseph J. Jacobs had impeccable scientific credentials and intentions but resigned two years later, telling Science he “blasted politicians – especially Senator Tom Harkin…for pressuring his office, promoting certain therapies and attempting an end run around objective science”, and expressing his concern he was expected to “dance to the tune of the alternative medicine lobby.” OAM changed its name to NNCAM in 1998 continuing with a remit “To answer important scientific questions about natural products, mind and body practices and pain management.” It has failed. It has become directed by those who have no intention of enquiring into any scientifically derived evidence as to whether CAMs have a beneficial effect on any specific condition, and is now directed by doctors who believe that they do, and who want to have CAM (SCAM/camistry – by whatever name known), integrated with regular orthodox progressive medical practice. Apparently still dancing to lobbyists’ tunes.

NCCAM even rebranded itself a couple of years ago, dropping any suggestion it might critically consider ‘alternative’ medical approaches such as chiropractic, osteopathy, acupuncture or homeopathy (all of whose founders or original proponents stated that their modalities were ‘alternative’ to the regular medicine of their day) – and is now styled as the ‘National Center for Complementary and Integrated Health’ (NCCIH).

Ad hominem commentary is normally best avoided, but when the NCCIH’s current Director speaks, we should take note. The 2019 New Year’s Message from Dr Helene Langevin M.D. allows us critical insight into her state of mind, her facility with logical fallacies, and her lack of critical thinking. All of which is important considering that the Center has spent $2.5B over the past ten years on research, and found no benefit from the modalities studied beyond the placebo. The Center’s current budget is $142M p.a.

Here follows Dr Langevin’s ‘2019 New Year message’, and a slightly more critical review (in italics) than her own insights and editing offered:

”It has been my longstanding conviction that integrative health care is more than just the sum of conventional and complementary health approaches. When combined, these approaches provide a frontier of new insights into the physiology of health and the pathophysiology underlying diseases and disorders. Dr. Straus, Dr. Briggs, and Dr. Shurtleff have built a strong foundation for NCCIH’s strategic priorities and partnerships.”

Dr Langevin fails to mention her predecessor Dr Josephine Brigg’s opinion when, as Director of the US National Center for Complementary and Alternative Medicine she said: “Integrative medicine represents an invasive rebranding of modern equivalents of ‘snake oil’ by practitioners who raise unrealistic hopes and promote approaches that are not sensible, supported by evidence or proven safe.”

“I plan to help the Center continue to reach beyond its walls and across NIH, encouraging an emphasis on health promotion, whole person care, and nonpharmacologic treatments, especially for pain management.”

What she plans is the integration of implausible pseudo-scientific modalities with regular medical practices. She ignores the wise words of Dr Mark Crislip: “If you integrate fantasy with reality, you do not instantiate reality. If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse.”

“Our current approach to patient care, in general, is fundamentally limited. It often emphasizes the treatment of disease alone, while it many times neglects the promotion, support, and restoration of health.”

That may be a valid critique of ‘our current approach’, but that need not be the case. Orthodox treatment can adopt the other dimensions Dr Langevin identifies without having to ‘integrate’ with CAM modalities.

“Integrative health care can help correct this limitation by giving more consideration to the patient’s long-term recovery and overall health when treating an acute illness or injury.”

But can only do so within a framework of implausible pseudo-science.

“Another limitation of the conventional medical approach is its specialization, based on the basic organization of the body into physiological systems, which can lead not only to fragmented health care, but also fragmented research.”

That is because as ‘medicine’ has advanced since the 16th century Enlightenment, and specialisation has allowed the more focussed scientific consideration and attention to detail that is necessary to advance understanding. The CAM modalities have failed to ‘move on’ and are anachronistic. Any perceived fault of ‘the conventional medical approach’ leading to ‘fragmented health care’ can be remedied by greater co-operation and collaboration amongst conventional doctors. ‘Integration’ with camists (who practice CAMs) is simply not necessary, and proves a distraction.

“In contrast, many traditional healing systems, especially those based on Eastern philosophies, emphasize an understanding of the person as a whole.”

That may be their emphasis – given the lack of scientific endeavour in ‘traditional’ systems, they can hardly do otherwise – they have little else to offer. But conventional medicine is doing all it can to ‘understand the person as a whole’, without the encumbrance of outmoded approaches.

“Further, the widespread role of pharmaceuticals as the default means of medical treatment is an important issue, and nowhere is this more urgent than for pain management.”

So, don’t use them! Conventional medicine can change its ‘default mode’, and does so in the face of scientific evidence.

“NCCIH is playing an increasing role in finding solutions to the current opioid crisis with research on non-drug approaches for pain.”

We must all look forward to published evidence of the benefit arising from NCCIH’s approach to pain management.

Happy New Year, and may the Wu be with you all. (Wu: Chinese, nothingness – wherein CAM resides.)

Acupressure is the stimulation of specific points, called acupoints, on the body surface by pressure for therapeutic purposes. The required pressure can be applied manually of by a range of devices. Acupressure is based on the same tradition and assumptions as acupuncture. Like acupuncture, it is often promoted as a panacea, a ‘cure all’. While it certainly not a ‘cure all’, one may well ask whether it is good for anything.

The aim of this study was to evaluate the effect of acupressure on pain severity in patients undergoing a coronary artery graft. Seventy patients were selected randomly after coronary artery bypass grafting (CABG) surgery based on inclusion criteria and then assigned to two groups (35 in acupressure and 35 in control) randomly by the minimization method. The intervention group received acupressure at the LI4 point for 20 minutes in 10-second pressure and 2-second resting periods. In the control group, only touching was applied without any pressure in the same pattern as the intervention group. Pain severity was measured before, immediately, and 20 minutes after applying pressure and touch in both groups using the visual analogue scale.

The results of repeated measures analysis of variance showed a decrease in the pain score in the intervention group (group effect) during multiple measurements (time effect) and a reduction in the mean pain score in the various measurements taking into account the groups (the interaction between time and group; P = 0.001).

(1 = after regaining consciousness, 2 = 6 hours later, 3 = 7 hours later)

The authors concluded that acupressure can be used as a complementary and alternative therapeutic approach to relieve post-operative pain in CABG patients.

I find it hard to believe those results.

Why?

For several reasons:

  1. Even though the authors call this study ‘double blind’, it clearly was not. The patients were obviously able to tell whether pressure was applied or not. Similarly, the therapist applying acupressure cannot have been blinded.
  2. All patients received standard care. The control group received more anaesthetics than the acupressure group, according to the authors. I feel that the lack of pain control in the control group is not plausible and needs an explanation.

For me, the most plausible explanation of these (only seemingly impressive) results is that the therapist exerted influence other than acupressure on the patients which made the control group admit to more pain than the experimental group. One possibility is that social desirability made the acupressure group to claim they had less pain than they actually felt.

2019 starts well, namely with a comment entitled ‘Unproven medicines a risk to health and wallet’ on the recent statement of the Australian Medical Association (AMA) . As it is remarkable in that it confirms what I have been saying ad nauseam for years, I reproduce it here in full:

Australians are in danger of wasting their money on unproven complementary medicines and therapies, which could not only have serious side effects but could also leave them unable to pay for evidence-based treatments.

The AMA has released its updated Position Statement on Complementary Medicine 2018, which reflects changes to State laws and national monitoring systems that have come into place since the Position Statement was last reviewed in 2011-12.

AMA President, Dr Tony Bartone, said that Australian complementary medicine industry revenue had doubled over the past 10 years to $4.9 billion annually, including $630 million on herbal products and $430 million on weight loss products in 2017.

“While the AMA recognises that evidence-based aspects of complementary medicine can be part of patient care by a doctor, there is little evidence to support the therapeutic claims made for most of these medicines and therapies,” Dr Bartone said.

“The majority of complementary medicines do not meet the same standards of safety, quality, and efficacy as mainstream medicines, as they are not as rigorously tested.

“Some can cause adverse reactions, or interact with conventional medicine. Most just don’t do anything much at all.

“But they do pose a risk to patient health, either directly through misuse, or indirectly if a patient puts off seeking medical advice, or has spent so much on these products that they cannot afford necessary, evidence-based treatment.

“Children are particularly vulnerable, as diagnosing and treating illness in children is complex. A doctor must be involved in any diagnosis and ongoing treatment plan, including the use of complementary medicine.”

Dr Bartone said the AMA had long advocated for better regulation of non-registered health practitioners, such as naturopaths, herbalists, and Ayurveda practitioners.

“We have seen some positive changes over the past six years,” Dr Bartone said.

“All States and Territories now have regulations to protect Australians from unsafe and unethical practitioners.

“All unregistered practitioners must comply with a code of conduct, and they can be sanctioned or banned if they breach the code.

“But we still do not have a national, public register of non-registered practitioners who have been banned from working in their State or Territory, despite all Governments agreeing in 2015 to establish one.

“This register should be established as quickly as possible to alert the public and potential employers of any risks.”

The AMA Position Statement on Complementary Medicine 2018 is at https://ama.com.au/position-statement/ama-position-statement-complementary-medicine-2018

Background

  • Complementary medicine includes a wide range of products and treatments with therapeutic claims that are not presently considered to be part of conventional medicine.
  • These include herbal medicines, some vitamin and mineral supplements, other nutritional supplements, homeopathic formulations, and traditional medicines such as ayurvedic medicines and traditional Chinese medicines.
  • Complementary therapies include acupuncture, chiropractic, osteopathy, naturopathy, and meditation.
  • Registered health practitioners are those who are registered under the Health Practitioner Regulation National Law in force in each State and Territory. They include doctors, nurses, dentists, occupational therapists, and other allied health practitioners.

END OF QUOTE

These are clear and timely words indeed!

One would wish that other national medical associations would have the courage to ignore the numerous and often powerful lobby groups that try to prevent them from following suit and issuing similarly clear, evidence-based and helpful comments. They have a responsibility to protect the public from exploitation and dangers to health, in my view.

“An optimist stays up until midnight to see the New Year in. A pessimist stays up to make sure the old year leaves.” (Bill Vaughan)

Any New Year resolutions?

As far as my blog is concerned, I can think of a few:

  1. Be more polite to people whose opinions differ from mine. I have to admit that I sometimes find it hard to respond politely to offensive or offensively stupid comments. I will try to improve in this respect.
  2. Try harder to keep an open mind (while being careful that my brain does not fall out in the process).
  3. Avoid technical lingo so that all people understand what I am trying to say.
  4. Try to enlarge the readership of my blog (not quite sure how to do this; perhaps by sticking to my resolutions?).
  5. Cover more areas of alternative medicine. I have always strived to include even the most exotic modalities; the problem, however, is that most are not supported by evidence, and in the absence of evidence I don’t know what to discuss.
  6. Report more positive results; the problem is that there are very few sound studies with positive findings – but I will try.
  7. Have fun.

1 2 3 9
Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted but you must tick the box: “Save my name, email, and website in this browser for the next time I comment.”

The most recent comments from all posts can be seen here.

Categories