Updated Edition!
Burning mouth syndrome (BMS) is a rare but potentially debilitating condition. So far, individualised homeopathy (iHOM) has not been evaluated or reported in any peer-reviewed journal as a treatment option. Here is a recently published case-report of iHOM for BMS.
At the Centre of Complementary Medicine in Bern, Switzerland, a 38-year-old patient with BMS and various co-morbidities was treated with iHOM between July 2014 and August 2018. The treatment involved prescription of individually selected homeopathic single remedies. During follow-up visits, outcome was assessed with two validated questionnaires concerning patient-reported outcomes. To assess whether the documented changes were likely to be associated with the homeopathic intervention, an assessment using the modified Naranjo criteria was performed.
Over an observation period of 4 years, an increasingly beneficial result from iHOM was noted for oral dysaesthesia and pains as well as for the concomitant symptoms.
The authors concluded that considering the multi-factorial aetiology of BMS, a therapeutic approach such as iHOM that integrates the totality of symptoms and complaints of a patient might be of value in cases where an association of psychological factors and the neuralgic complaints is likely.
BMS can have many causes. Some of the possible underlying conditions that can cause BMS include:
- allergies
- hormonal imbalances
- acid reflux
- infections in the mouth
- various medications
- nutritional deficiencies in iron or zinc
- anxiety
- diabetes
Threatemnt of BMS consists of identifying and eliminating the underlying cause. If no cause of BMS can be found, we speak of primary BMS. This condition can be difficult to treat; the following approaches to reduce the severity of the symptoms are being recommended:
- avoiding acidic or spicy foods
- reducing stress
- avoiding any other known food triggers
- exercising regularly
- changing toothpaste
- avoiding mouthwashes containing alcohol
- sucking on ice chips
- avoiding alcohol if it triggers symptoms
- drinking cool liquids throughout the day
- smoking cessation
- eating a balanced diet
- checking medications for potential triggers
The authors of the above case-report state that no efficient treatment of BMS is known. This does not seem to be entirely true. They also seem to think that iHOM benefitted their patient (the post hoc ergo propter hoc fallacy!). This too is more than doubtful. The natural history of BMS is such that, even if no effective therapy can be found, the condition often disappears after weeks or months.
The authors of the above case-report treated their patient for about 4 years. The devil’s advocate might assume that not only did iHOM contribute nothing to the patient’s improvement, but that it had a detrimental effect on BMS. The data provided are in full agreement with the notion that, without iHOM, the patient would have been symptom-free much quicker.
The field of so-called alternative medicine (SCAM) has long been actively supported by many celebrities. In 2006, we tried to study the phenomenon systematically. Here is our abstract:
OBJECTIVE:
To collect contemporary accounts of celebrity use of complementary and alternative medicine (CAM), to aid clinicians in determining which CAM treatments patients are likely to use.
DESIGN:
Articles published during 2005 and 2006 reporting celebrity use of CAM.
RESULTS:
38 celebrities were found to use a wide range of CAM interventions. Homeopathy, acupuncture and Ayurveda were the most popular modalities.
CONCLUSIONS:
There may be many reasons why consumers use CAM, and wanting to imitate their idols is one of them.
Since then, several celebs have sensed that SCAM offers an opportunity to make money, lots of money. Gwyneth Paltrow and others are earning millions by selling SCAM products to the gullible public. Now it seem that even those areas of SCAM are being targeted by celebs where the sale of SCAM products is not the main focus. This article explains:
Cameron Diaz is taking her passion for fashion health to new heights with her latest investment. The health advocate and Hollywood actress is the latest investor in Arizona-based acupuncture company Modern Acupuncture. Modern Acupuncture has been around for over three years and according to its CEO, Matt Hale, the group aims to provide affordable acupuncture across the United States.
Modern Acupuncture has 60 locations and hopes to double that in the upcoming year, and with an A-lister on the board, they seem to be on the right path…
The star’s investment in the alternative medicine space comes in partnership with Seth Rodsky and his firm Strand Equity, who clearly know what they’re doing. It’s the same firm that brought 50 Cent into Vitamin Water before most of us knew what Vitamin Water was. They also introduced Madonna into Vita Coco Coconut Water back in 2010. Now, Seth stated his team “reached out to Modern Acupuncture in late 2018 after identifying acupuncture as a healthcare and wellness service which we thought to be a large white space.” Bringing Cameron into the mix of investors marks an exciting time for Stand Equity, Cameron and Modern Acupuncture. The CEO explained that Cameron’s addition “amplifies it to an entire different ecosystem.”
MODERN ACUPUNCTURE advertise their services by pointing out that:
• The Mayo Clinic has adopted the practice of acupuncture nationwide.
• John Hopkin’s also uses acupuncture for pain and supports many other conditions treated around the world.
• Acupuncture helps reduce use of pain killers in U.S. Army patients. Two-thirds of military hospitals and other treatment centers offer acupuncture.
• Cleveland Clinic outlines new government advisory recommended non-addictive options before opioids. Acupuncture was recommended as a first-line treatment in lower back pain by the American College of Physicians.
• A recent article in the Washington Post highlights Medicare now researching acupuncture for back pain.
• Acupuncture is used in hospitals around the world Acupuncture in hospitals.
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I find this most lamentable. It shows two things quite clearly. Firstly, the public is an easy victim of fallacious reasoning; the fact that an reputable institution offers acupuncture (or anything else) is no proof of its efficacy, it merely is an example for the sly use of the ‘appeal to authority’. Secondly, the harm caused by established institutions adopting dubious treatments is not confined to those institutions; its effects are being felt nationally and even internationally. This, I think, should make these institutions think twice before they continue with their short-sighted adoption of SCAM.
I was recently struck by a short notice by the FACULTY OF HOMEOPATHY (FoH):
Following the publicity we got after the announcement of our royal patronage, it seems like a good time to remind all members of our media policy. If you are contacted by the media, please contact the faculty and get some advice rather than agreeing immediately. We can then decide together if it is something to get involved in and who would be the most suitable person to participate.
The text was an uncomfortable reminder of the moment when, years ago, I received similar instructions. This must have been around 2005 when my relationship with my Exeter peers were beginning to sour. I received an email from the dean of my medical school informing me that, in future, I was no longer permitted to speak directly to the press; all such contacts had to first get cleared by him. I was more than a little surprised. I had never contacted a journalist, but they were phoning me at a rate of 2-3 per week. Invariably, I did my best to provide them with the information they were looking for. Telling them to first clear an interview would, in my view, have been not practical, degrading and a violation of academic freedom and my right to free expression.
Freedom of speech is the principle that supports the right of an individual or a community to articulate their opinions and ideas without fear of retaliation, censorship, or legal sanction. It is a recognised human right. I explained all this to my dean – we had been on very friendly terms until then – but he insisted on his instructions. Crucially, he could not give me an acceptable reason why my freedom of speech should be curtailed in the way he proposed. I tried my best to reason with him, but it was to no avail. In the end, I told him that I would carry on as before, and if he felt like it, he was welcome to discipline me. Eventually, I carried on as before, and my dean took no action.
So, when the FoH tells its members this – If you are contacted by the media, please contact the faculty and get some advice rather than agreeing immediately. We can then decide together if it is something to get involved in and who would be the most suitable person to participate – does it amount to a limitation of their freedom of speech? I certainly think so. Crucially, the FoH fails to provide an acceptable reason for its action. People imposing the restrictions (whether they are governments, employers or anyone else) must be able to demonstrate the need for them, and they must be proportionate.
There simply is no conceivable reason for the FoH to impose or suggest such a restriction!
What are they afraid of?
Perhaps that someone tells a slanderous lie?
Perhaps something as bad as what the FoH’s ‘Simile’ newsletter recently published about me?
A prepublication draft [of the Smallwood report] was circulated for comment with prominent warnings that it was confidential and not to be shared more widely (I can personally vouch for this, since I was one of those asked to comment). Regrettably, Prof Ernst did precisely this, leaking it to The Times who used it as the basis of their lead story. The editor of The Lancet, Richard Horton, certainly no friend of homeopathy, promptly denounced Ernst for having “broken every professional code of scientific behaviour”.
Sir Michael Peat, the Prince of Wales’ Principal Private Secretary, wrote to the vice chancellor of Exeter University protesting at the leak, and the university conducted an investigation. Ernst’s position became untenable, funding for his department dried up and he took early retirement. Thirteen years later he remains sore; in his latest book More Harm than Good? he attacks the Prince of Wales as “foolish and immoral”.
Huuuuuuh, that would be gross!
Yes, they did (had to) publish a full retraction:
In his editorial in the February 2018 issue of simile , Dr Peter Fisher stated that Prof Edzard Ernst leaked a confidential pre-publication draft of the 2005 Smallwood Report to the The Times . The Faculty of Homeopathy accepts that an investigation by Exeter University found no evidence Prof Ernst was responsible for this breach of confidentiality. The Faculty of Homeopathy and Dr Peter Fisher apologise unreservedly to Prof Ernst for this inaccuracy and for any embarrassment it may have caused him and his family.
Given this background and history, I find the note of the FoH to its members bizarre, unjustified and in breach of their right to free expression.
Guys, you are dealing with homeopathy.
There is nothing in it.
It’s not nuclear physics or high diplomacy.
Get real!
Allow your members to say what they think.
Dilute your remedies if you must, but please leave human rights alone.
The use of so-called alternative medicine (SCAM) are claimed to be associated with preventive health behaviors. However, the role of SCAM use in patients’ health behaviors remains unclear.
This survey aimed to determine the extent to which patients report that SCAM use motivates them to make changes to their health behaviours. For this purpose, a secondary analysis of the 2012 National Health Interview Survey data was undertaken. It involved 10,201 SCAM users living in the US who identified up to three SCAM therapies most important to their health. Analyses assessed the extent to which participants reported that their SCAM use motivated positive health behaviour changes, specifically: eating healthier, eating more organic foods, cutting back/stopping drinking alcohol, cutting back/quitting smoking cigarettes, and/or exercising more regularly.
Overall, 45.4% of SCAM users reported being motivated by SCAM to make positive health behaviour changes, including exercising more regularly (34.9%), eating healthier (31.4%), eating more organic foods (17.2%), reducing/stopping smoking (16.6% of smokers), or reducing/stopping drinking alcohol (8.7% of drinkers). Individual SCAM therapies motivated positive health behaviour changes in 22% (massage) to 81% (special diets) of users. People were more likely to report being motivated to change health behaviours if they were:
- aged 18-64 compared to those aged over 65 years;
- of female gender;
- not in a relationship;
- of Hispanic or Black ethnicity, compared to White;
- reporting at least college education, compared to people with less than high school education;
- without health insurance.
The authors concluded that a sizeable proportion of respondents were motivated by their SCAM use to undertake health behavior changes. CAM practices and practitioners could help improve patients’ health behavior and have potentially significant implications for public health and preventive medicine initiatives; this warrants further research attention.
This seems like an interesting finding! SCAM might be ineffective, but it motivates people to lead a healthier life. Thus SCAM has something to show for itself after all.
Great!
Except, there is another explanation of the results, one that might be much more plausible.
What if some consumers, particularly females who are well-educated and have no health insurance, one day decide that it’s time to do something for their health. Thus they initiate several things:
- they start using SCAM;
- they exercise more regularly;
- they eat more healthily;
- they consume organic food;
- they stop smoking;
- they stop boozing.
The motivation common to all these changes is their determination to do something about their health. Contrary to the authors’ wishful thinking, SCAM has little or even nothing to do with it. The notion was induced by SCAM practitioners who like to think that they play a role in disease prevention, by the leading questions of the interviewer, by recall bias, or by other factors..
What did the wise man say once upon a time?
CORRELATION IS NOT CAUSATION!
Professor Anthony Pelosi just published an intriguing paper. Here is the abstract:
During the 1980s and 1990s, Hans J Eysenck conducted a programme of research into the causes, prevention and treatment of fatal diseases in collaboration with one of his protégés, Ronald Grossarth-Maticek. This led to what must be the most astonishing series of findings ever published in the peer-reviewed scientific literature with effect sizes that have never otherwise been encounterered in biomedical research. This article outlines just some of these reported findings and signposts readers to extremely serious scientific and ethical criticisms that were published almost three decades ago. Confidential internal documents that have become available as a result of litigation against tobacco companies provide additional insights into this work. It is suggested that this research programme has led to one of the worst scientific scandals of all time. A call is made for a long overdue formal inquiry.
The Guardian reported further details on this story sating that the work of one of the most famous and influential British psychologists of all time, Hans Eysenck, is under a cloud following an investigation by King’s College London, which has found 26 of his published papers “unsafe”.
In relation to so-called alternative medicine (SCAM), it is foremost this claim of Eysenck that is relevant:
It is argued that there is now suficient evidence to regard psychosocial variables, in
particular personality and stress, as important risk factors for cancer and coronary heart
disease (CHD), equal in importance to smoking, heredity, cholesterol level, blood pressure,
and other physical variables. Furthermore, it is now clear that both types of factors act
synergistically; that is, each by itself is relatively benign, but their effects multiply to produce
high levels of disease…
The claim (which Eysenck published many times over, for instance here) was picked up and promoted by many believers in SCAM. This might have been helped by Eysenck’s bizarre openness to all things paranormal. Today his belief of a link between personality/stress and cancer is deeply engrained in SCAM.
King’s College says the results and conclusions of the papers “were not considered scientifically rigorous” by its committee of inquiry. Prof Sir Robert Lechler, the provost at King’s, has contacted the editors of the 11 journals where the papers appeared, recommending they should be retracted.
Prof Anthony Pelosi, consultant psychiatrist at the Priory Hospital, Glasgow, whose own investigation prompted the inquiry by King’s, said their work “led to what must be the most astonishing series of findings ever published in the peer-reviewed scientific literature, with effect sizes that have never otherwise been encountered in biomedical research”.
Among more than 3,000 people in the studies, Eysenck and his colleague claimed people with a “cancer-prone” personality were 121 times more likely to die of the disease than those without. Cancer-prone personalities were described as generally passive in the face of stress from outside.
Eysenck and Grossarth-Maticek apparently even had a cure for cancer. In one study, they gave 600 “cancer-prone” individuals a leaflet on how to be more “autonomous” and take control of their destiny. It contained such advice as: “Your aim should always be to produce conditions which make it possible for you to lead a happy and contented life.” It appeared to deliver miracles. Over 13 years, the 600 people randomly assigned to bibliotherapy, as it was called, had all-cause mortality of 32%, compared with 82% of 600 people not fortunate enough to receive a leaflet.
“I honestly believe, having read it so carefully and tried to find alternative interpretations, that this is fraudulent work,” said Pelosi, who is concerned Eysenck’s ideas still have a following. “His acolytes always bragged he was the most cited psychologist of all time… In the social sciences citation index, he was number three. Number two was Freud. Number one was Karl Marx. He was hugely prolific, widely cited and very influential… Many fringe medical practitioners hold the same conviction.”
Many paediatric oncology patients report use of so-called alternative medicine (SCAM), and naturopathic ‘doctors’ (NDs) often provide supportive paediatric oncology care. However, little information exists to formally describe this clinical practice. This survey was aimed at filling the gap. It was conducted with members of the ‘Oncology Association of Naturopathic Physicians’ (OncANP.org) to describe recommendations across 4 therapeutic domains:
- natural health products (NHPs),
- nutrition,
- physical medicine,
- mental/emotional support.
The researchers received 99 responses from practitioners with a wide variance of clinical experience and aptitude to treat children with cancer. 52.5% of respondents stated that they did, in fact, not treat such children. The three primary reasons for this decision were:
- lack of public demand (45.1%),
- institutional or clinic restrictions (21.6%),
- personal reasons/comfort (19.6%).
The 10 most frequently considered NHPs by those NDs who did treat childhood cancer patients were:
- fish-derived omega-3 fatty acid (83.3%),
- vitamin D (83.3%),
- probiotics (82.1%),
- melatonin (73.8%),
- vitamin C (72.6%),
- homeopathic Arnica (69.0%),
- turmeric/curcumin (67.9%),
- glutamine (66.7%),
- Astragalus membranaceus (64.3%),
- Coriolus versicolor/PSK (polysaccharide K) extracts (61.9%).
The top 5 nutritional recommendations were:
- anti-inflammatory diets (77.9%),
- dairy restriction (66.2%),
- Mediterranean diet (66.2%),
- gluten restriction (61.8%),
- and ketogenic diet (57.4%).
The top 5 physical interventions were
- exercise (94.1%),
- acupuncture (77.9%),
- acupressure (72.1%),
- craniosacral therapy (69.1%),
- and yoga (69.1%).
The top 5 mental/emotional interventions were:
- meditation (79.4%),
- art therapy (77.9%),
- mindfulness-based stress reduction (70.6%),
- music therapy (70.6%),
- and visualization therapy (67.6%).
The Canadian authors concluded that the results of our clinical practice survey highlight naturopathic interventions across four domains with a strong rationale for further inquiry in the care of children with cancer.
Personally, I don’t see a ‘strong rationale’ for anything here. I was, however, struck by the fact that about half of the naturopaths (they are NOT doctors!) dare to treat children with cancer. Equally, I was impressed by the list of treatments they use for this purpose; most are pure quackery! Finally, I was struck by the reasons given by those naturopaths who laudably abstained from treating cancer: they did not take this decision because of the lack of evidence that naturopaths and the treatments they like to employ fail to do more good than harm.
Altogether, this survey confirmed my view that naturopaths should not be allowed near children, especially those suffering from cancer.
Four speakers have been announced for next year’s conference (25-26 April 2020) of the UK ‘Society of Homeopaths’ (SoH). It has the theme ‘All About Men’ (which is surprising considering the majority of homeopathy fans are women). The meeting will aim to provide a better understanding of men’s lives and illnesses in order for practitioners to help them seek homeopathic treatments with confidence.
One of the 4 speakers will be California-based chiropractor, homeopath and health coach Joel Kriesberg. The SoH’s announcement proudly states that “Joel Kreisberg is going to bring the very interesting tool, the Enneagram, which was originally devised by the famous philosopher, George Gurdjieff. This is the first time Joel has lectured in the UK and he is well respected and highly thought of by the likes of Karen Allen and Dana Ullman.”
(A note to the SoH: Gurdjieff did not devise the Enneagram, he popularised it; perhaps you want to correct this statement?)
But, what is the ENNEAGRAM?
According to Wikipedia, the Enneagram (from the Greek words ἐννέα [ennéa, meaning “nine”] and γράμμα [grámma, meaning something “written” or “drawn”[1]]), is a model of the human psyche which is principally understood and taught as a typology of nine interconnected personality types. Although the origins and history of many of the ideas and theories associated with the Enneagram of Personality are a matter of dispute, contemporary Enneagram claims are principally derived from the teachings of Oscar Ichazo and Claudio Naranjo. Naranjo’s theories were partly influenced by some earlier teachings of George Gurdjieff. As a typology the Enneagram defines nine personality types (sometimes called “enneatypes”), which are represented by the points of a geometric figure called an enneagram,[2] which indicate connections between the types. There are different schools of thought among Enneagram teachers, therefore their ideas are not always in agreement.
The Enneagram of Personality has been widely promoted in both business management and spirituality contexts through seminars, conferences, books, magazines, and DVDs.[3][4] In business contexts it is generally used as a typology to gain insights into workplace interpersonal-dynamics; in spirituality it is more commonly presented as a path to higher states of being, essence, and enlightenment. Both contexts say it can aid in self-awareness, self-understanding and self-development.[3]
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In a nutshell, the Enneagram is an obsolete personality test that has never been properly validated and is today used mostly by quacks and other dubious characters and institutions. Yet, this is what Kriesberg has to say on his website about the use of the Enneagram in homeopathy:
The Enneagram’s application to homeopathy and health coaching makes a dramatic difference as it allows practitioner to identify the client’s learning style quickly. As we engage the Enneagram, we are able to provide specific developmental paths and activities based on their Enneagram style. Healing is faster, deeper, and has longer-lasting results.
To teach all this, Kriesberg is offering classes that are grounded in Tinus Smits’ method for studying universal healing with homeopathy, in which direct experience of the Enneagram types is enhanced by the use of homeopathic remedies.
Tinus Smits! … where have I heard this name before?
Ah yes, this is the homeopath who invented CEASE!
Smits became convinced that autism is caused by a child’s exposure to an accumulation of toxic substances and published several books about his theory. In his experience (as far as I can see, Smits never published a single scientific paper in the peer-reviewed literature) autism is caused by an accumulation of different toxins. About 70% is due to vaccines, 25% to toxic medication and other toxic substances, 5% to some diseases. According to the ‘like cures like’ principle of homeopathy, Smits claimed that autism must be cured by applying homeopathic doses of the substances which caused autism. Step by step all assumed causative factors (vaccines, regular medication, environmental toxic exposures, effects of illness, etc.) are detoxified with the homeopathically prepared substances that has been administered prior to the onset of autism. Smits and his followers believe that this procedure clears out the energetic field of the patient from the imprint of toxic substances or diseases.
I herewith congratulate the SoH on their forthcoming conference – an event that must not be missed! They have managed to pack an unprecedented amount of unethical nonsense into just one lecture!
Traditional Chinese Medicine (TCM) is a term created by Mao lumping together various modalities in an attempt to pretend that healthcare in the People’s Republic of China (PRC) was being provided despite the most severe shortages of conventional doctors, drugs and facilities. Since then, TCM seems to have conquered the West, and, in the PRC, the supply of conventional medicine has hugely increased. Today therefore, TCM and conventional medicine peacefully co-exist side by side in the PRC on an equal footing.
At least this is what we are being told – but is it true?
I have visited the PRC twice. The first time, in 1980, I was the doctor of a university football team playing several games in the PRC, including one against their national team. The second time, in 1991, I co-chaired a scientific meeting in Shanghai. On both occasions, I was invited to visit TCM facilities and discuss with colleagues issues related to TCM in the PRC. All the official discussions were monitored by official ‘minders’, and therefore fee speech and an uninhibited exchange of ideas are not truly how I would describe them. Yet, on both visits, there were occasions when the ‘minders’ were absent and a more liberal discussion could ensue. Whenever this was the case, I did not at all get the impression that TCM and conventional medicine were peacefully co-existing. The impression that I did get was that their co-existence resembled more a ‘shot-gun marriage’.
During my time running the SCAM research unit at Exeter, I had the opportunity to welcome several visiting researchers from the PRC. This experience seemed to confirm my impression that TCM in the PRC was less than free. As an example, I might cite one acupuncture project I was once working on with a scientist from the PRC. When it was nearing its conclusion and I mentioned that we should now think about writing it up to publish the findings, my Chinese colleague said that being a co-author was unfortunately not an option. Knowing how important publications in Western journals are for researchers from the PRC, I was most surprised by this revelation. The reason, it turned out, was that our findings failed to be favourable for TCM. My friend explained that such a paper would not advance but hinder an academic career, once back in the PRC.
Suspecting that the notion of a peaceful co-existence of TCM and conventional medicine in the PRC was far from true, I have always been puzzled how the myth could survive for so many years. Now, finally, it seems to crumble. This is from a recent journalistic article entitled ‘Chinese Activists Protest the Use of Traditional Treatments – They Want Medical Science’ which states that thousands of science activists in the PRC protest that the state neglects its duty to treat its citizens with evidence-based medicine (here is the scientific article this is based on):
Over a number of years, Chinese researcher Qiaoyan Zhu, who has been affiliated with the University of Copenhagen’s Department of Communication, has collected data on the many thousand science activists in China through observations in Internet forums, on social media and during physical meetings. She has also interviewed hundreds of activists. Together with Professor Maja Horst, who has specialized in research communication, she has analyzed the many data on the activists and their protests in an article that has just been published in the journal Public Understanding of Science:
“The activists are better educated and wealthier than the average Chinese population, and a large majority of them keep up-to-date with scientific developments. The protests do not reflect a broad popular movement, but the activists make an impact with their communication at several different levels,” Maja Horst explained and added: “Many of them are protesting individually by writing directly to family, friends and colleagues who have been treated with – and in some cases taken ill from – Traditional Chinese Medicine. Some have also hung posters in hospitals and other official institutions to draw attention to the dangers of traditional treatments. But most of the activism takes place online, on social media and blogs.
Activists operating in a regime like the Chinese are obviously not given the same leeway as activists in an open democratic society — there are limits to what the authorities are willing to accept in the public sphere in particular. However, there is still ample opportunity to organize and plan actions online.
“In addition to smaller groups and individual activists that have profiles on social media, larger online groups are also being formed, in some cases gaining a high degree of visibility. The card game with 52 criticisms about Traditional Chinese Medicine that a group of activists produced in 37,000 copies and distributed to family, friends and local poker clubs is a good example. Poker is a highly popular pastime in rural China so the critical deck of cards is a creative way of reaching a large audience,” Maja Horst said.
Maja Horst and Qiaoyan Zhu have also found examples of more direct action methods, where local activist groups contact school authorities to complain that traditional Chinese medicine is part of the syllabus in schools. Or that activists help patients refuse treatment if they are offered treatment with Traditional Chinese Medicine.
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I am relieved to see that, even in a system like the PRC, sound science and compelling evidence cannot be suppressed forever. It has taken a mighty long time, and the process may only be in its infancy. But there is hope – perhaps even hope that the TCM enthusiasts outside the PRC might realise that much of what came out of China has led them up the garden path!?
Spinal manipulation is a treatment employed by several professions, including physiotherapists and osteopaths; for chiropractors, it is the hallmark therapy.
- They use it for (almost) every patient.
- They use it for (almost) every condition.
- They have developed most of the techniques.
- Spinal manipulation is the focus of their education and training.
- All textbooks of chiropractic focus on spinal manipulation.
- Chiropractors are responsible for most of the research on spinal manipulation.
- Chiropractors are responsible for most of the adverse effects of spinal manipulation.
Spinal manipulation has traditionally involved an element of targeting the technique to a level of the spine where the proposed movement dysfunction is sited. This study evaluated the effects of a targeted manipulative thrust versus a thrust applied generally to the lumbar region.
Sixty patients with low back pain were randomly allocated to two groups: one group received a targeted manipulative thrust (n=29) and the other a general manipulation thrust (GT) (n=31) to the lumbar spine. Thrust was either localised to a clinician-defined symptomatic spinal level or an equal force was applied through the whole lumbosacral region. The investigators measured pressure-pain thresholds (PPTs) using algometry and muscle activity (magnitude of stretch reflex) via surface electromyography. Numerical ratings of pain and Oswestry Disability Index scores were collected.
Repeated measures of analysis of covariance revealed no between-group differences in self-reported pain or PPT for any of the muscles studied. The authors concluded that a GT procedure—applied without any specific targeting—was as effective in reducing participants’ pain scores as targeted approaches.
The authors point out that their data are similar to findings from a study undertaken with a younger, military sample, showing no significant difference in pain response to a general versus specific rotation, manipulation technique. They furthermore discuss that, if ‘targeted’ manipulation proves to be no better than ‘general’ manipulation (when there has been further research, more studies), it would challenge the need for some current training courses that involve comprehensive manual skill training and teaching of specific techniques. If simple SM interventions could be delivered with less training, than the targeted approach currently requires, it would mean a greater proportion of the population who have back pain could access those general manipulation techniques.
Assuming that the GT used in this trial was equivalent to a placebo control, another interpretation of these results is that the effects of spinal manipulation are largely or even entirely due to a placebo response. If this were confirmed in further studies, it would be yet one more point to argue that spinal manipulation is not a treatment of choice for back pain or any other condition.
When Samuel Hahnemann translated Cullen’s ‘Treatise on Materia Medica’ in 1790, he learnt of Cullen’s explanation of the actions of Peruvian (or China) bark, Cinchona officinalis, a malaria treatment. Hahnemann disagreed with it and decided to conduct experiments of his own. He thus ingested high doses of Cinchona and noticed that subsequently he developed several of the symptoms that are characteristic of malaria. This is how Hahnemann later described his experience:
I took for several days, as an experiment, four drams of good china daily. My feet and finger tips, etc., at first became cold; I became languid and drowsy; my pulse became hard and quick; an intolerable anxiety and trembling (but without rigor); trembling in all limbs; then pulsation in the head, redness in the cheeks, thirst; briefly, all those symptoms which to me are typical of intermittent fever, such as the stupefaction of the senses, a kind of rigidity of all joints, but above all the numb, disagreeable sensation which seems to have its seat in the periosteum over all the bones of the body – all made their appearance. This paroxysm lasted for two or three hours every time, and recurred when I repeated the dose and not otherwise. I discontinued the medicine and I was once more in good health.
Hahnemann described what de facto was the 1st homeopathic proving. Despite the fact that Hahnemann misinterpreted the event, provings thus became the very basis of homeopathy. At Hahnemann’s time, it was highly uncommon for doctors to test their medicines in this way. So, one might wonder: where did the idea come from? Is it his very own innovation, or did he get the idea from someone else?
In 1777, Hahnemann had studied medicine in Vienna. The medical school was at the time strongly influenced by Gerard van Swieten (1700-1772) He was the innovator of a new way of medical thinking and is honoured for this legacy to the present day in Vienna.
Van Swieten’s aim was to put medicine on new scientific foundations based on objective clinical observation, botanical and chemical research, and the introduction of new, powerful remedies.
One of the pupils of this school was Anton Störck (1731-1803). He became the director of Austrian public health and medical education, appointed by Empress Maria Theresia. Störck was the first medical scientist to systematically test the effects of medicines, including poisonous plants (e.g., hemlock, henbane, meadow saffron).
In numerous cases, Störck used himself as a subject in his experiments to determine adverse effects and tolerable dose levels. One of his pupils was Joseph Quarin who fully adopted his teacher’s concepts. He later rose to considerable prominence in the Viennese medical establishment.
Hahnemann’s clinical teacher at Vienna was Joseph Quarin. Hahnemann’s idea of ‘homeopathic provings’ are thus to a significant extent influenced by Störck’s innovation.
