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

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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.

Over the years, I have become somewhat of an expert in spotting nonsense in the realm of alternative medicine, also known as SCAM. Here are – in no particular order – the 20 most remarkable examples of baloney that I came across (and wrote about) in 2018.

  1. Based on a totally inadequate study (which was tweeted by homeopaths as a success story), Indian homeopaths concluded that Ibuprofen and Belladonna 6C are effective and provide adequate analgesia with no statistically significant difference. Lack of adverse effects with Belladonna 6C makes it an effective and viable alternative.
  2. Chinese researchers conducted a meta-analysis and found that Ginkgo Leaf Extract and Dipyridamole Injection was associated with a curative effect for patients with angina pectoris.
  3. A German ‘journalist’ and PR-man likened critics of homeopathy (naming me and others) to the Nazis during the 1930s.
  4. A ‘landmark study‘ was celebrated by homeopaths (shortly afterwards it was suspected to be fraudulent. The journal published this note: Readers are alerted that the conclusions of this paper are subject to criticisms that are being considered by the editors. Appropriate editorial action will be taken once this matter is resolved.)
  5. The World President of the International Homeopathic Medical league published a book entitled ‘Cancer is Curable with Homeopathy’
  6. The WHO has decided to tolerate nonsensical TCM diagnoses by including a classification system on TCM in their next ICD.
  7. Osteopaths conducted a laughably insufficient study concluding that the results demonstrate that Osteopathic Manipulative Therapy should be considered in the treatment of patients with chronic symptoms of MS.
  8. Chinese authors reviewed the evidence on injectable TCM-preparations and found them to be ‘promising’ despite the lack of good evidence for them.
  9. The ‘Royal College of Chiropractors‘ made a rather pathetic attempt to re-invent chiropractic.
  10. A ‘respectable’ German medical journal published a homeopath’s claim that homeopathy can cure cancer.
  11. The UK Society of Homeopaths published recommendations that have the potential of killing many holidaymakers.
  12. The skeptical movement was called ‘an offshoot of the Communist Party‘ by a proponent of SCAM.
  13. I was accused of having falsified my qualifications.
  14. Dana Ullman decided that “evidence based medicine” can no longer be trusted.
  15. The Sunday Times broke my BS-meter.
  16. German osteopaths decided to promote intra-vaginal manipulations.
  17. A homeopath from Delhi advocated homeopathy for treating AIDS/HIV.
  18. A naturopaths was sued by a naturopath for telling the truth about naturopathy.
  19. Some homeopaths advocated increasing the height of children by giving them homeopathic remedies!
  20. A doctor from a Gerson clinic claims that Dr. Gerson, murdered in 1959, remains the most censured doctor in the history of medicine as he was reversing virtually every degenerative disease known to man, including TERMINAL cancer…

This is, of course, a highly personal choice. It nevertheless suggests that we have still more than enough work to do, if we want to instil some reason into SCAM.

Who would not like to get rid of their post-Christmas bulge? Diet and exercise would do the trick, of course, but they are all too cumbersome for most. And liposuction? That’s invasive. Why not chose something much easier? Why not ‘LASER LIPO’? This website explains it all:

If you have or are considering Liposuction, take a look at Laser Lipo. We utilize a cold laser non-invasively to turn fat cells into energy. This process allows you to lose inches and weight fast, safely and effectively. Our Laser Lipo will have those hard to lose inches melting away.

Obesity has been linked to the driving force of all major inflammatory diseases. These diseases include diabetes, obesity, and heart disease. Utilizing the most current technology in Lipo Laser, New-Start bares a cold laser, capable of transforming your fat tissue into energy, EFFORTLESSLY!

  • LOSE INCHES!
  • GAIN ENERGY!
  • Zero Side Effects
  • Zero Pain
  • Zero Surgery
  • Zero Down Time
  • Add a Detoxification Program to Lose Inches and Weight

What to Expect with Laser Assisted Fat Loss in Columbus!

  1. This is a twenty minute procedure designed to transform any trouble fat areas that you might have into usable energy.
  2. The cold laser technology stimulates your fat cells, allowing the stored water glycerol and fatty acids to leak out, leaving your body slimmer and trimmer.
  • This is not another “body wrap” procedure that only dehydrates the skin for temporary results — this is a positive change if you follow the simple New-Start Solution rules.
  1. After the relaxing 20 minute laser procedure, the New-Start protocol consists of spending 10 minutes on a hypervibe pivotal vibration machine.
  2. The hypervibe is a relatively new technology that has been developed in the exercise world. This machine is capable of helping you increase your inch loss results and stimulate your metabolism. Vibration technology has evidence to even strengthen your bones and muscles.
  3. This document will also help you understand our Laser Lipo procedure: How Does it Work? (pdf)

END OF QUOTE

Sounds great!

Even more so because the site belongs to Dr. Trent Mozingo who has recently proved himself to be such a reliable and avid commentator on this blog (see the comments section of this post). According to his site, he enrolled in Purdue University where he earned a Bachelor’s of Science degree. Upon completion of Purdue’s curriculum, Dr. Mozingo earned a Doctorate of Chiropractic at Palmer College of Chiropractic, Florida. During his time at Palmer, Dr. Mozingo, focused his education on a scientific approach to chiropractic care, where evidence backs up each diagnosis and treatment.  Additionally, Dr. Mozingo gave much attention to nutrition, inflammatory diseases, and the American diet. While musculoskeletal pain is the initial reason he pursued a chiropractic education, Dr. Mozingo has focused most of his patient treatment plans to the prevention of disease, with proper lifestyle changes.

As much as we all trust a man with such a background, I am sure, we might still ask whether there is any evidence that LASER LIPO takes any body fat away. My searches did not result in any such evidence, I am afraid. All I did find was a website that provides further explanation as well as some clinical impressions:

This is not a stand-alone treatment and requires that the guest do at least 30 minutes of exercise after the treatment. The fat cells are porous for approximately 3 hours, and any contents that are not peed, sweated or exercised out will settle back and reduce the results.

Many spas will do measurements around certain areas right before and after the treatment, usually resulting an about an average quarter inch loss. Some spas will do multiple measurements in one area and add up the results. For example, if three areas are measured around the abdomen (at the belly button and one inch above and below), and a quarter inch difference is noticed in all three areas, many spas will claim this is a three quarter inch reduction—this can be misleading.

The average cost (in Canadian) is $200 per treatment, with a series of 8 recommended. Many spas will give an introductory price of $50 or $100 for your first visit so you can see the results. Although there is usually an immediate inch loss difference (which gets you hooked), this rarely lasts until the next day.

With the numerous guests that I performed this service on, I found that about 80% of the people who completed their series of 8 were dissatisfied with the results. Many saw no change on their last measurement from the first, and a few even saw a gain at the end. For the guests who did see a difference, it was clear that their lifestyle had a big influence, with many going regularly to the gym. My professional opinion on this treatment is to skip it and save your money…

SORRY ‘DOCTOR’ TRENT MOZINGO!

And sorry also to all of those readers who had hoped the LASER LIPO might do them some good.

Carpal tunnel syndrome (CTS) is caused by the tendons in the wrist getting too tight and thus putting pressure on the nerves that run beneath them. The symptoms can include:

  • pain in fingers, hand or arm,
  • numb hands,
  • tingling or ‘pins and needles’,
  • a weak thumb or difficulty gripping.

These symptoms often start slowly and they can come and go but often get worse over time. They are usually worse at night and may keep patients from having a good night’s sleep.

The treatments advocated for CTS include painkillers, splints and just about every alternative therapy one can think of, particularly acupuncture. Acupuncture may be popular, but does it work?

This new Cochrane review was aimed at assessing the evidence for acupuncture and similar treatments for CTS. It included 12 studies with 869 participants. Ten studies reported the primary outcome of overall clinical improvement at short‐term follow‐up (3 months or less) after randomisation. Most studies could not be combined in a meta‐analysis due to heterogeneity, and all had an unclear or high overall risk of bias. Only 7 studies provided information on adverse events.

The authors (two of them are from my former Exeter team) found that, in comparison with placebo or sham-treatments, acupuncture and laser acupuncture have little or no effect in the short term on symptoms of CTS. It is uncertain whether acupuncture and related interventions are more or less effective in relieving symptoms of CTS than corticosteroid nerve blocks, oral corticosteroids, vitamin B12, ibuprofen, splints, or when added to NSAIDs plus vitamins, as the certainty of any conclusions from the evidence is low or very low and most evidence is short term. The included studies covered diverse interventions, had diverse designs, limited ethnic diversity, and clinical heterogeneity.

The authors concluded that high‐quality randomised controlled trials (RCTs) are necessary to rigorously assess the effects of acupuncture and related interventions upon symptoms of CTS. Based on moderate to very‐low certainty evidence, acupuncture was associated with no serious adverse events, or reported discomfort, pain, local paraesthesia and temporary skin bruises, but not all studies provided adverse event data.

This last point is one that I made very often: most trials of acupuncture fail to report adverse effects. This is doubtlessly unethical (it gives a false-positive overall impression about acupuncture’s safety). And what can you do with studies that are unethical? My answer is simple: bin them!

Most of the trials were of poor or very poor quality. Such studies tend to generate false-positive results. And what can you do with studies that are flimsy and misleading? My answer is simple: bin them!

So, what can we do with acupuncture trials of CTS? … I let you decide.

But binning the evidence offers little help to patients who suffer from chronic, progressive CTS. What can those patients do? Go and see a surgeon! (S)he will cure you with a relatively simply and safe operation; in all likelihood, you will never look back at dubious treatments.

I have repeatedly discussed the risks of chiropractic manipulation. Sadly, when doing so, we have to rely mostly on case reports (there is no monitoring system that would record such events, reliable incidence figures are therefore not available). This means every new case report is of considerable importance.

Korean neurosurgeons recently reported the case of a patient who had an infarction of the posterior inferior cerebellar artery (PICA) after a chiropractic cervical manipulation. A 39-year-old man visited the emergency room with signs of cerebellar dysfunction, presenting with a 6-hour history of vertigo and imbalance. Two weeks before, he had been treated by a chiropractor for intermittent neck pain. At the time of admission, brain computed tomography, magnetic resonance imaging, and angiography revealed an acute infarction in the left PICA territory and occlusion of the extracranial vertebral artery (VA; V1/2 junction) as a result of a dissection of the VA. Angiography revealed complete occlusion of the left PICA and arterial dissection was shown in the extracranial portion of the VA. The patient was treated with antiplatelet therapy. Three weeks later, he was discharged without any sequelae.

The authors concluded that the possibility of VA dissection should be considered at least once in patients presenting with cerebellar dysfunctions with a recent history of chiropractic cervical manipulation.

In the discussion section, the authors leave little doubt about the question of causality: damage to the V3 portion is the most common injury that may occur after chiropractic manipulation related to anatomical structures. The VA is located horizontally in a groove in the upper side of the atlas’ posterior arch. During abruptly forced neck rotation and stretching, the gap between the atlas and the atlanto-occipital membrane, which the VA penetrates, can be stretched, resulting in dissection. In our case, it appeared that the V1/2 junction had been dissected due to excessive lateral bending of the neck, thought to be caused by an impact to the left transverse foramen of the sixth cervical spine, through which the left VA passes. It is presumed that there was a mechanical injury to the vessel wall at the time of the procedure, which caused dissection and then the thrombus generated, and two weeks after small emboli caused the occlusion of PICA. Low-speed, high-amplitude manipulations that consist of a series of smooth, repetitive movements are configured in certain areas of the neck, and this does not often cause damage. However, a sudden thrust or high-speed, low-amplitude manipulation is often considered the cause of VA dissection. In particular, this type of manipulation can be theorized to result in a sudden, symmetrical rotation of the extended cervical vertebrae, leading to damage to the high cervical and proximal parts of the carotid artery and VA.

It is high time, I think, that chiropractors take such events seriously. At the very minimum, we need a system of monitoring such cases, so that – eventually – we will be able to define their frequency. In this context, it is obviously important to remember that there is precious little evidence to suggest that neck manipulations are effective for any condition. What inescapably follows is clear: until we have reliable incidence data, it is wise to avoid chiropractic neck manipulations altogether.

This is an unusual post: it is by an osteopath who sent it to me for publication but insists he does not want to be named because he is still working in the profession. I think he has an interesting story to tell and therefore agreed to publishing his article, even though its author has to remain anonymous.

I graduated with an honours degree in osteopathic medicine in 2000 and remain registered as an osteopath. I am writing to help others avoid the same errant thought patterns that I developed, when assessing osteopathy.

My venture into the world of osteopathy began, as I am aware many have, with the assurance that osteopathy is far better than physiotherapy. There is an established musculoskeletal pathway in this country provided by physiotherapists and to wish to practice a therapy other than this, one must be sure that it is superior to physiotherapy in many aspects: effectiveness, remuneration, job satisfaction etc. And this belief was drummed into me ad nauseam by virtually all the osteopaths that I encountered. Despite hearing this for over 20 years, I have yet to see any evidence that it is the case.

The manipulative therapy at the heart of osteopathy should be a focus of strong suspicion. It is obvious that the cracks and pops elicited from spinal and peripheral joints are nothing more than a placebo party-trick, but it is a key feature of the treatment taught and practised by osteopaths throughout the country. In fact, the evidence appears to contradict the structural/mechanical model that underlies osteopathy. Spinal alignment, muscular and postural imbalances are seemingly not predisposing or maintaining factors for many musculoskeletal conditions, despite what continues to be taught in osteopathic colleges. It is hugely underappreciated that most of the factors deemed by osteopaths to be significant to a patient’s symptoms are prevalent in asymptomatic people.

The reality facing osteopaths is that spinal and musculoskeletal pain in general is so little understood, that you can only be confident in your ability to ‘treat’ it with osteopathic manipulative therapy by ignoring the complexity and opacity of the problem. Chronic low back pain for example, is such an obscure entity that it seems the success of one practitioner over another has little or nothing to do with their technical knowledge or ability, and more, maybe, to do with interpersonal dynamics. This makes for a frustrating and somewhat embarrassing career, given that the technical side of much of the work is a charade. I saw no objective reason to believe that I could do significantly more good for a patient than could be done with some basic exercise and possibly a massage.

When I graduated, there was widespread debate over whether dysfunction of the lumbo-sacral joints or the sacro-iliac joints was the most significant factor in back pain. Some osteopaths focused on one area, others on the other. I didn’t however perceive a difference in results from either group of practitioners, or from me, when switching between the two models. In fact, if I made no attempt to differentiate between the two, still no change. This proved true across the board – little or no change in outcome from a wide variety of approaches to the same issue. This is the nature of osteopathy; it is mostly vacuous as a form of assessment and treatment.

A common remark amongst osteopaths is that if you see ten osteopaths, you will get ten different diagnoses. This has consistently been my experience with my own symptoms, those of friends and family, and clinical observation. Good luck developing your ‘skill’ in that environment. Inter-practitioner repeatability was virtually non-existent when assessing the position and function of most joints of the body, especially the spine. If it is not repeatable (and very little in osteopathy is), then it is not science.

Confirmation bias was a huge factor in my education. ‘Successes’ were celebrated and failures ignored. We enjoyed reports from patients of how much good we had done but had practically no training in how osteopathy relates to scientific evidence. We still don’t have a decent body of research as to how it fares as a therapy compared to other approaches, or how specifically osteopathic treatment outcomes differ from the natural progression of symptoms.

 

Osteopathy is so far removed from mainstream medicine that it has been possible to build and maintain it on a foundation of anecdotal evidence; born of a vague perception that it must be superior to large institutionalised medicine, which is inherently inept and corrupt. There is an awareness amongst osteopaths that the evidence for osteopathy is pretty much all anecdotal but there is a faith that it will be proven effective once tested properly. Never mind the fact that anecdotal evidence is the worst form of evidence and you should not follow a system of healthcare produced by it. It is worse than no evidence, because when heeded it can lead to believing falsehoods that seem true.  In osteopathy, the scientific method has largely been ignored for groupthink and indoctrination.

Osteopaths in private practice (which is most of them) encounter huge financial pressure to over-diagnose and over-treat. Most episodes of musculoskeletal pain should be viewed as a normal part of life. They are self-limiting and do not require any formal intervention. Unfortunately, people’s anxieties are perpetuated by osteopaths who pander to the worried-well, to maintain the core of their income. Best practice for the majority of people seeking help from an osteopath is reassurance and advice to stay positive and active. This doesn’t pay well, so instead patients are given a course of manual therapy and extended ‘maintenance sessions’, both of which are of little to no short-term benefit and absolutely no long-term benefit.

But we all know that osteopaths earn more than physiotherapists right? Again, no clear data. In my experience of working in private multi-disciplinary practices, the flow of work heading the way of physiotherapists is far more consistent, given the long-established referral pathways from within the NHS and private medical insurance. Also, the NHS provides solid financial benefits and security that are not available in the parochial, private environments that osteopaths have to work in. Public and student perception of the likely earnings of an osteopath is remarkably high but there is a large swathe of osteopaths that never make a decent living from it. It is tragic to see otherwise intelligent people plough their money, time and effort into an alternative medicine cult. The same time and money could be spent pursuing a career that offers a net benefit to society and provides significant opportunity for personal development and progress, intellectually and financially.

The exultation of historical leading figures, derision of those questioning the status quo, veneration of tutors, delusions of grandeur and unshakable faith in the veracity of osteopathy are difficult influences to identify and navigate as a young student. Undergraduates need to be taught to think critically, both scientifically and philosophically. And this is especially crucial in the quagmire of alternative medicine; as the world is awash with misinformation about health. We should engender a clarity of thought, appropriate scepticism and strength of character that enables people to call bullshit sooner rather than later, in the face of such patent nonsense.

Numerous times I have been assured that osteopaths receive a similar level of education to doctors (albeit for a shorter duration), however, the serious academic training that occurs in actual medical schools makes this claim risible. Osteopaths mostly seem to think far too highly of their training; which is, in fact, fairly rudimentary. (Speaking as someone who has recently observed for a number of days in a leading teaching clinic in the UK.)

If you wish to study a musculoskeletal therapy, please, for the sake of your mental health, your financial income, your family and the good of the public; study physiotherapy. There is value in helping people deal with physical pain, the use of therapeutic exercise, and certain forms of manual therapy. Osteopathy, however, has nothing uniquely effective to offer and forms one of the most over-rated careers imaginable.

An exhaustive study of homeopathic remedies for Eczema“, this is the title of an article I just stumbled across. It leaves no doubt that homeopathy is effective for eczema (which is also what I was told all those years ago when I trained in a homeopathic hospital). Here are a few excerpts from the article:

The appropriate internal remedy will usually be one of the following, according to the indications:

Aconite

In the simpler forms of eczema, and when there is much febrile disturbance. Acute cases, with stinging and pricking of the skin, in plethoric persons.

Alumina

Hard crusts on the scalp, face and extremities. Gnawing itching, worse in the evening, not relieved by scratching. Aggravated on alternate days and from eating new potatoes. Dryness of the skin.Constipation.

Ammonium carbonicum

Eczema in the bends of the extremities. Excoriations between the legs, and about the anus and genitals. Violent itching relieved by scratching. Aggravated by either cold applications or hot poultices. In children.

Ammonium muriaticum

Anacardium orientale

Acute eczema on the face, neck and chest. Intense itching usually aggravated, but occasionally relieved by scratching. Redness of the skin with eruption of small vesicles. Sensitiveness to draught.

Antimonium crudum

Pustular eczema about the face and joints. Painful cracks in the corners of the mouth. Violent itching and burning, better in the open air, worse after bathing. Thick, heavy, yellow crusts upon the face. Gastric derangement with thick white coated tongue. In children who grow fat.

Antimonium tartaricum

Eruptions about the nose and eyes, neck and shoulders, and back of the ears. Vesicles surrounded by a red areola. Pustules, as large as peas. Itching worse in the evening, better in the open air. Eruption leaves bluish-red stains upon the face. Child wants to be carried; cries if touched.Desire for acids ; aversion to milk. Rattling cough.

Apis mellifica

Red and edematous skin, with burning and stinging. Better from cold applications, worse after warm applications. Large vesicles. Urine scanty and high colored.

Argentum nitricum

Eczema on the genitals. Urging to urinate. In children who eat too much sweets.

Arsenicum album

Eczema on the face, legs and genitals. Intense burning of the surface. Itching worse during the first hours of sleep. Better from external heat ; worse from cold or from scratching. Dry scaly eruption with parchment-like skin. Falling out of hair in patches. Useful in chronic cases.

Arundo

Eruption on the chest, upper extremities and behind the ears. Intolerable itching, crawling sensation, especially over the loins and shoulders. In young children.

Astacus fluviatilis

Thick crusts on the scalp. Enlargement of the lymphatic glands. Clay colored stools.

Aurum muriaticum

Smarting, itching papular eruption on the lips or above the pubis. Constant desire to be out in the open air. In corpulent old people. After abuse of mercury.

END OF QUOTE

And the evidence, where is the evidence for these seemingly detailed recommendations?

The answer is, there is none, at least not in this article.

So, I look into Medline. Apart from some observational studies, the most recent relevant paper on controlled clinical trials happens to be my very own systematic review published in the British Journal of Dermatology entitled “Homeopathy for eczema: a systematic review of controlled clinical trials.” Here is its abstract:

BACKGROUND:

Homeopathy is often advocated for patients with eczema.

OBJECTIVES:

This article systematically reviews the evidence from controlled clinical trials of any type of homeopathic treatment for any type of eczema.

METHODS:

Electronic searches were conducted in Medline, Embase and the Cochrane Library with no restrictions on time or language. In addition, the bibliographies of the retrieved articles and our departmental files were hand searched. All controlled trials of homeopathy in patients with eczema were considered. Their methodological quality was estimated using the Jadad score.

RESULTS:

One randomized and two nonrandomized clinical trials met the inclusion criteria. All were methodologically weak. None demonstrated the efficacy of homeopathy.

CONCLUSIONS:

The evidence from controlled clinical trials therefore fails to show that homeopathy is an efficacious treatment for eczema.

________________________________________________________________

So, what does that tell us?

I think it demonstrates the following relevant points:

  • Homeopaths seem convinced to be able to treat eczema effectively.
  • They teach this to junior clinicians and tell it to their patients.
  • They trumpet this message out on the internet (a Google search on ‘homeopathy for eczema’ generates 242 000 hits).
  • They even claim that they have done ‘exhaustive studies’ that prove their point.
  • Yet, the actual evidence fails to show that homeopathy works for eczema.

Does that mean homeopaths are lying?

Does that mean homeopaths mislead their patients thus causing needless suffering?

Does that mean homeopaths care more about their cash-flow than the welfare of their patients?

What do you think?

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