Edzard Ernst

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

The fact that the NHS England has stopped reimbursing homeopathy in 2018 is probably quite well known. France followed more recently, and then Germany too reported trouble for homeopaths on various levels. About two years ago, the manufacturer of homeopathic products, Hevert (Germany),  threatened legal action against several German critics of homeopathy for expressing the fact that highly diluted homeopathic remedies do not work beyond placebo. Crucially, the medical associations of many regions in Germany have – one after the next – discontinued their training in and recognition of homeopathy.

Now similar difficulties are being felt also by Austrian homeopaths. In 2019, the Vienna medical school closed its course on homeopathy because students had filed a complaint about its unethical content. And recently, it was reported by the Austrian ‘Initiative für Wissenschaftliche Medizin‘ that at a secret webinar run by lobbyists in Vienna things were reported to no longer going well for homeopathy. Faced with such problems, the lobbyist, Dr. Jens Behnke, recommended in the above-mentioned secret webinar an alliance of all so-called alternative medicine (SCAM):

“…..and if we do not form this broad alliance now, in order to make appropriate professional PR and lobbying … then everything will fall apart….”

Now a union of pseudomedicine and politics is being forged with the aim of stopping the decline of quackery and paving the way for pseudomedicine in Austria. A resolution has been tabled in the Austrian parliament with the following demands:

  1. Institutionalising of the field of “Complementary Medicine” as “Integrative Medicine” in the academic education at all medical schools.
  2. Appropriate support for and funding of complementary medicine research, especially in the university sector.
  3. Establishment of a broad range of complementary medicine in the hospital sector, in outpatient but also inpatient healthcare.
  4. Promotion of active knowledge transfer in the area of integrative and complementary medicine within the Austrian medical profession.
  5. Securing of complementary diplomas by the Austrian Medical Association.

The motion was introduced by the Freedom Party (FPÖ, the Austrian far-right party) on 21.12.2020, forwarded to the Health Committee for consultation, and is now scheduled for consultation there. The application was introduced by the FPÖ-Nationalratsabgeordnete Mag. Gerhard Kaniak (Chairman of the Health Committee of Parliament, pharmacist), Peter Wurm (entrepreneur), Dr. Dagmar Belakowitsch (physician), and “other deputies”. It is supported by members of the “Initiative Complementary Medicine at Austrian Universities” of the Austrian Society for Homeopathic Medicine. The list of signatories of the motion reads like the “Who’s Who” of pseudo-medicine procedures in Austria – foremost homeopathy, but also anthroposophic medicine, ozone therapy, functional myo-diagnostics (= kinesiology), Ayurvedic medicine, orthomolecular medicine, TCM, etc. It almost goes without saying that it also includes Prof Michael Frass (a prominent member of THE ALTERNATIVE MEDICINE HALL OF FAME), who regular readers of my blog would have met several times before.

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Instead of a comment (other than I sincerely wish that reason prevails in Austria and the motion is going to be defeated), I think I will quote the concluding phrases from my memoir (which incidentally also covers my most turbulent time in Vienna):

When science is abused, hijacked, or distorted in order to serve political or ideological belief systems, ethical standards will inevitably slip. The resulting pseudoscience is a deceit perpetrated on the weak and the vulnerable. We owe it to ourselves, and to those who come after us, to stand up for the truth, no matter how much trouble this might bring.

 

 

 

I am pleased to report that our ‘resident homeopathic doctor’ from Germany, Dr. Heinrich Huemmer, posted a review of my new book on Amazon. As his comments are in German, I translated them which was not easy because they are confusing and confused. Now that it’s done, I cannot resist the temptation to show them to you (the references were inserted by me, and refer to my comments below):

First of all, the author, who as a scientist [1] once had a thoroughly positive attitude towards homeopathy [and in a meta-analysis even attested to it significantly positive results in a certain clinical picture [2]], explains the principles and procedures in homeopathy in a clear and objective manner.
In explaining the principle of potentization, however, Ernst’s one-dimensional and completely unscientific matter-bound, quasi-medieval understanding of science shines through for the first time. With the assertion, “both the dilution and the similarity rule contradict the laws of nature” he clearly reveals his unscientific thinking, whereby he could have easily relativized this by an inserted differentiation “presently, known laws of nature”. [3] And not even the following sentence “…we understand very well that it can function only if the known laws of nature would be invalid” is agreed by critically thinking natural scientists. [3] Also the assertion: “The totality of this evidence does not show that homeopathic remedies would be no more than placebo”, is countered by a well-known – belonging to the skeptic movement – expert of the homeopathic study situation with the remark: “Furthermore, you should read my statements and those of the INH more carefully again: Our statement is that there is no robust/reliable/convincing evidence for efficacy beyond placebo. ALSO NOT “NONE” but “none conclusive”, which yes makes a difference in absolute numbers. Just like “no beer” is different than “not a good beer”. ” [4] Since patients usually turn to homeopathy only when so-called scientific medicine negates their illnesses and accordingly has nothing to offer them [5], Ernst’s reference to the fact that patients could “endanger their health” is to be seen as a cheap attempt at discrediting. [6] The reference that this assessment comes from the Australian National Health and Medical Research Council is not without a particularly piquant note, since this NHMRC may have to be held responsible for a particularly infamous attempt at scientific fraud to the disadvantage of homeopathy. [7] Also, the alleged “fact” that “[positive] experiences […] are the result of a long, empathetic, sympathetic encounter with a homoeopath…” can be disproved by immediate – also diagnostically verified – cures, which occurred immediately without a long admission or which failed to appear even after several intensive anamneses under most sympathetic admission against all expectations…..[8] Finally Ernst’s argument “the benefit-cost-argument of homeopathy is not positive” is an absolute air number, because the saving of 1 €/patient and year (in case of abolition of the homeopathy-reimbursement) would not even allow a free new glasses-nose-pad…. [9]

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  1. I am not sure where Homeopathy Heinrich Huemmer (HHH) got the claim from that I, as a scientist, once had a thoroughly positive attitude towards homeopathy. This is not even remotely true! As a very young clinician (40 years ago), I once was quite impressed by homeopathy, never as a scientist (for full details, see my memoir). What HHH seems to display here is his very own misunderstanding about science and scientists: if they are for real (i.e. not pseudoscientists like many of those who research homeopathy), scientists try not to let their personal attitudes get in the way of good science.
  2. I presume that HHH refers here to this meta-analysis: Homeopathy for postoperative ileus? A meta-analysis. I fear that HHH has yet to learn how to read a scientific paper. Our conclusions were: There is evidence that homeopathic treatment can reduce the duration of ileus after abdominal or gynecologic surgery. However, several caveats preclude a definitive judgment. These results should form the basis of a randomized controlled trial to resolve the issue. 
  3. This made me laugh! Does HHH think that only the handful of homeopathic loons who claim that homeopathy has a scientific basis in the unknown laws of nature are truly scientific? And all the rest are unscientific?
  4. I doubt that anyone can understand this passage, perhaps not even HHH. My conclusion that “the totality of this evidence does not show that homeopathic remedies are more than placebo”  merely expresses what even most homeopaths would admit and is unquestionably correct.
  5. This statement is untrue in more than one way. Firstly, responsible clinicians never tell a patient that they have nothing more to offer, simply because this is never the case – there is always something a good clinician can do for his/her patient, even if it is just in terms of palliation or moral support. Secondly, we know that German patients opt to use homeopathy for all sorts of reasons, including as first-line therapy and not as a last resort.
  6. In the book, I refer (and reference the source) to the phenomenon that many homeopaths discourage their patients from vaccination. Unfortunately, this is no ‘cheap attempt’, it is the sad reality. HHH does not even try to dispute it.
  7. HHH does not like the NHMRC report. Fair enough! But he omits to mention that, in the book, I list a total of 4 further official verdicts. Does HHH assume they are all fraudulent? Is there perhaps a worldwide conspiracy against homeopathy?
  8. We all know that HHH is enormously proud of his only publication to which he refers here (on this blog, he must have mentioned it a dozen times). However, in the book, I refer to an RCT for making my point. Which is more convincing, a case report or an RCT?
  9. Here HHH simply demonstrates that he has not understood the concept of cost-effectiveness.

So, what we have here is a near-perfect depiction of a homeopath’s way of thinking. But there is worse in HHH’s comment< I fear.

My book (of 224 pages) scrutinizes – as even its title states – not one but 40 types of so-called alternative medicine (SCAM); 20 of the most effective and 20 of the most dangerous SCAMs. In addition, it covers (in ~ 50 pages) many general topics (like ‘WHAT IS EVIDENCE? or WHY IS SCAM SO POPULAR?). It includes over 200 references to published papers. Yet, HHH reviews and judges the book by commenting exclusively on the meager 5 pages dedicated to homeopathy!

If that does not exemplify the limitations of the homeopathic mind, please tell me what does.

THANK YOU, HHH, FOR MAKING THIS SO CLEAR TO US!

Physicians who include so-called alternative medicine (SCAM) in their practice are thought to have an understanding of health and disease different from that of colleagues practicing conventional medicine. The aim of this study was to identify and compare the thoughts and concepts concerning infectious childhood diseases (measles, mumps, rubella, chickenpox, pertussis, and scarlet fever) of physicians practicing homeopathic, anthroposophic and conventional medicine.

This qualitative study used semistructured interviews. Participating physicians were either general practitioners or pediatricians. Data collection and analysis were guided by a grounded theory approach.

Eighteen physicians were interviewed (6 homeopathic, 6 anthroposophic, and 6 conventional). All physicians agreed that while many classic infectious childhood diseases such as measles, mumps, and rubella are rarely observed today, other diseases, such as chickenpox and scarlet fever, are still commonly diagnosed. All interviewed physicians vaccinated against childhood diseases.

  • A core concern for physicians practicing conventional medicine was the risk of complications of the diseases. Therefore, it was considered essential for them to advise their patients to strictly follow the vaccination schedule.
  • Homeopathic-oriented physicians viewed acute disease as a biological process necessary to strengthen health, fortify the immune system and increase resistance to chronic disease. They tended to treat infectious childhood diseases with homeopathic remedies and administered available vaccines as part of individual decision-making approaches with parents.
  • For anthroposophic-oriented physicians, infectious childhood diseases were considered a crucial factor in the psychosocial growth of children. They tended to treat these diseases with anthroposophic medicine and underlined the importance of the family’s resources. Informing parents about the potential benefits and risks of vaccination was considered important.

All physicians agreed that parent-delivered loving care of a sick child could benefit the parent-child relationship. Additionally, all recognized that existing working conditions hindered parents from providing such care for longer durations of time.

The authors concluded that the interviewed physicians agreed that vaccines are an important aspect of modern pediatrics. They differed in their approach regarding when and what to vaccinate against. The different conceptual understandings of infectious childhood diseases influenced this decision-making. A survey with a larger sample would be needed to verify these observations.

The authors (members of a pro-SCAM research group) stress that the conventional physicians saw many risks in the natural course of classic childhood illnesses and appreciated vaccinations as providing relief for the child and family. By contrast, the physicians trained in homeopathy or anthroposophic medicine expected more prominent unknown risks because of vaccinations, due to suppression of the natural course of the disease. Different concepts of disease lead to differences in the perceptions of risk and the benefit of prevention measures. While prevention in medicine aims to eliminate classic childhood diseases, anthroposophic and homeopathic literature also describes positive aspects of undergoing these diseases for childhood development.

This paper thus provides intriguing insights into the bizarre thinking of doctors who practice homeopathy and anthroposophical medicine. The authors of the paper seem content with explaining and sometimes even justifying these beliefs, creeds, concepts, etc. They make no attempt to discuss the objective truths in these matters or to disclose the errors in the thought processes that underly homeopathy and anthroposophical medicine. They also tell us that ALL  the interviewed physicians vaccinated children. They, however, fail to provide us with information on whether these doctors all recommend vaccinations for all patients against all the named infectious diseases. From much of previous research, we have good reasons to fear that their weird convictions often keep them from adhering strictly to the current immunization guidelines.

 

My father invented a therapy for which there was no disease, my mother caught it and died.”

This type of scurrility makes me laugh. And it reminds me of the missing link in so-called alternative medicine (SCAM). We have heard about alternative therapies, alternative diagnostic methods, but what about alternative diseases and conditions? Here are some that SCAM practitioners seem to be oddly fond of:

  • – adrenal fatigue
  • – chi deficiency
  • – yeast overgrowth
  • – leaky gut syndrome
  • – leaky brain syndrome
  • – chronic Lyme disease
  • – various food ‘sensitivities’
  • – methylation dysfunction
  • – spinal subluxation
  • – vaccine-induced ‘toxicity’
  • – toxin-overload

But surely, these cannot be enough! For the field of SCAM to make progress, we definitely need many more. So, I had a brainstorm and came up with the following suggestions:

  • Ataxia: the condition (of many SCAM practitioners, but also others) where patients fail to declare their income to the taxman; usually cured by a short stay in the nick.
  • Cardioversion: an insurmountable dislike of conventional clinicians like cardiologists; a self-limiting condition that usually improves after receiving proper medical attention during a serious illness.
  • Collagen: a genetic disorder that shows itself through a strong dislike of experts who have been to college; incurable.
  • Deepak Chopra Syndrome: a serious neurosis where the patient cannot stop uttering BS; incurable.
  • Digitoxin: the unfortunate condition where a spiritual healer sends toxic spirits into the patient via his/her fingers; needs urgent detox.
  • Donovan bodies: a psychiatric affliction where patients are compelled to look and sing like Donavan; requires a sound-proof cell.
  • Duodenal ulcer: an unfortunate condition where the patient has two denal ulcers at the same time; emergency Reiki is advised.
  • Dyspepsia: the pathological preference of Coke over Pepsi; incurable.
  • Familial diseases: an umbrella term for all the few conditions that SCAM practitioners actually know about; can improve with reading a few textbooks.
  • Free radicals: terrorists on the run; call the police!
  • Fungal infection: a rare form of food poisoning where the magic mushrooms were off; needs detox.
  • Iridocyclitis: an obsession that afflicts iridologists who cannot stop riding bicycles; incurable.
  • Keratosis: the dangerous situation where a patient develops an aversion to his/her carer; change of carer is often needed.
  • Murial dyslexia: the inability to be able to read the writing on the wall; incurable.
  • Myositis: is always worse than your ositis.
  • Osteoblast: an event where, after chiropractic manipulation, a bone breaks with an audible noise; see an orthopedic surgeon.
  • Semi-colon: the embarrassing situation where a colonic irrigationist managed to clean out only half of the colon; manageable by changing your therapist.

If you, the reader, can think of more ways to expand the repertoire of SCAM terminology, please feel free to let us all know by posting your ideas below.

My ‘ALTERNATIVE MEDICINE HALL OF FAME’ is filling up nicely. But I noticed that so far we have nobody from Spain. That can be rectified ever so easily. I think I found the ideal candidate to join this group of illustrious experts who never bring themselves to publish a negative conclusion: JORGE VAS.

Jorge Vas works at the ‘Pain Treatment Unit, Doña Mercedes Primary Health Care Center, Dos Hermanas’ in Spain. I have long noticed his research which is focused on ACUPUNCTURE. From memory, I had the impression that his findings are always positive.

But is this true? To find out, I did a Medline search and found 11 clinical trials of acupuncture in his name, published between 2006 and 2019. Here are the conclusions:

  1. After 2 weeks of treatment, ear acupuncture applied by midwives and associated with standard obstetric care significantly reduces lumbar and pelvic pain in pregnant women, improves quality of life and reduces functional disability.
  2. Individualised acupuncture treatment in primary care in patients with fibromyalgia proved efficacious in terms of pain relief, compared with placebo treatment. The effect persisted at 1 year, and its side effects were mild and infrequent. Therefore, the use of individualised acupuncture in patients with fibromyalgia is recommended.
  3. The use of acupuncture to treat impingement syndrome seems to be a safe and reliable technique to achieve clinically significant results and could be implemented in the therapy options offered by the health services.
  4. …all 3 modalities of acupuncture were better than conventional treatment alone…
  5. Moxibustion treatment applied at acupuncture point BL67 can avoid the need for caesarean section and achieve cost savings for the healthcare system in comparison with conventional treatment.
  6. The application of auriculopressure in patients with non-specific spinal pain in primary healthcare is effective and safe, and therefore should be considered for inclusion in the portfolio of primary healthcare services.
  7. The degree of pain relief experienced by patients from acupuncture justifies a more rigorous study.
  8. Moxibustion at acupuncture point BL67 is effective and safe to correct non-vertex presentation when used between 33 and 35 weeks of gestation. We believe that moxibustion represents a treatment option that should be considered to achieve version of the non-vertex fetus.
  9. Single-point acupuncture in association with physiotherapy improves shoulder function and alleviates pain, compared with physiotherapy as the sole treatment. This improvement is accompanied by a reduction in the consumption of analgesic medicaments.
  10. Acupuncture plus diclofenac is more effective than placebo acupuncture plus diclofenac for the symptomatic treatment of osteoarthritis of the knee.
  11. In the treatment of the intensity of chronic neck pain, acupuncture is more effective than the placebo treatment and presents a safety profile making it suitable for routine use in clinical practice.

Eleven of 11 trials with a positive conclusion!

That surely is a rare feast.

Actually, I cheated a tiny bit. The unabridged sentence from the conclusion of paper N4 was: In the analysis adjusted for the total sample (true acupuncture relative risk 5.04, 95% confidence interval 2.24-11.32; sham acupuncture relative risk 5.02, 95% confidence interval 2.26-11.16; placebo acupuncture relative risk 2.57 95% confidence interval 1.21-5.46), as well as for the subsample of occupationally active patients, all 3 modalities of acupuncture were better than conventional treatment alone, but there was no difference among the 3 acupuncture modalities, which implies that true acupuncture is not better than sham or placebo acupuncture. Thus this (multicentre) study was negative with just a touch of positivity.

But still, look at the range of conditions that respond positively to acupuncture in Vas’ hands. Is there anyone who doubts that Jorge Vas does not deserve to join all these other geniuses in THE ALTERNATIVE MEDICINE HALL OF FAME?

I am sure that Vas has more than merited to join them.

WELCOME JORGE VAS!

There are skeptics who keep claiming that there is no research in so-called alternative medicine (SCAM). And there are plenty of SCAM enthusiasts who claim that there is an abundance of good research in SCAM.

Who is right and who is wrong?

I submit that both camps are incorrect.

To demonstrate the volume of SCAM research I looked into Medline to find the number of papers published in 2020 for the SCAMs listed below:

  • acupuncture 2 752
  • anthroposophic medicine 29
  • aromatherapy 173
  • Ayurvedic medicine 183
  • chiropractic 426
  • dietary supplement 5 739
  • essential oil 2 439
  • herbal medicine 5 081
  • homeopathy 154
  • iridology 0
  • Kampo medicine 132
  • massage 824
  • meditation 780
  • mind-body therapies 968
  • music therapy 539
  • naturopathy 68
  • osteopathic manipulation 71
  • Pilates 97
  • qigong 97
  • reiki 133
  • tai chi 397
  • Traditional Chinese Medicine 15 277
  • yoga 698

I think the list proves anyone wrong who claims there is no (or very little) research into SCAM.

As to the enthusiasts who claim that there is plenty of good evidence, I am afraid, I disagree with them too. The above-quoted numbers are perhaps impressive to some SCAM proponents, but they are not large. To make my point more clearly, let me show you the 2020 volumes for a few topics in conventional medicine:

  • psychiatry 668,492
  • biologicals 300,679
  • chemotherapy 109,869
  • radiotherapy 17,964
  • rehabilitation 21,751
  • rehabilitation medicine 21,751
  • surgery 256,958

I think we can agree that these figures make the SCAM numbers look pitifully small.

But the more important point is, I think, not the quantity but the quality of the SCAM research. As this whole blog is about the often dismal rigor of SCAM research, I do surely not need to produce further evidence to convince you that it is poor, often even very poor.

So, both camps tend to be incorrect when they speak about SCAM research. The truth is that there is quite a lot, but sadly reliable studies are like gold dust.

But actually, when I started writing this post and doing all these Medline searches to produce the above-listed volumes of SCAM research, I was thinking of a different subject entirely. I wanted to see which areas of SCAM were research-active and which are not. This is why I chose terms for my list that do not overlap with others (yet we need to realize that the figures are not precise due to misclassification and other factors). And in this respect, the list is interesting too, I find.

It identifies the SCAMs that are remarkably research-inactive:

  • anthroposophic medicine
  • iridology
  • naturopathy
  • osteopathy
  • Pilates
  • qigong

Perhaps more interesting are the areas that show a relatively high research activity:

  • acupuncture
  • dietary supplements
  • essential oils
  • herbal medicine
  • massage
  • meditation
  • mind-body therapies
  • TCM
  • yoga

This, in turn, suggests two things:

  1. It is not true that only commercial interests drive research activity.
  2. The Chinese (TCM and acupuncture) are pushing the ferociously hard to conquer SCAM research.

The last point is worrying, in my view, because we know from several independent studies that Chinese studies are often the flimsiest and least reliable of all the SCAM literature. As I have suggested recently, the unreliability of SCAM research might one day be its undoing: This self-destructive course of SCAM might be applauded by some skeptics. However, if you believe (as I do) that there are a few good things to be found in SCAM, this development can only be regrettable. I fear that the growing dominance of Chinese research will help to speed up this process.

Since Gwyneth Paltrow, as well as US Olympic swimmers, were publicly sporting their cupping marks, cupping has repeatedly occupied the pages of this blog. Now, cupping is in the news yet again. It has been reported that an image of a self-proclaimed ‘cupping’ expert performing treatment on a newborn baby has caused a major outcry. The photo shows a three-month-old baby’s skin on its back being sucked into a cup with the skin deformed and bright red.

The man, known as Mustafa, who refers to himself as an ‘expert’ at a ’cupping centre’ in the city of Istanbul, recently shared the images on social media where he was apparently treating the baby for ‘gas’. “We provide cupping for everyone from three-month-old babies to 70-year-olds. We do it since it is an Islamic tradition and we believe that everyone should take part in it,“ Mustafa said. “I am not a swindler. I do not demand money from people. They give as much as they choose.”

Child and adolescent psychiatrist associate, Dr Veysi Ceri, slammed the parents who allowed the procedure to be performed on their children. “Children cannot be left at the mercy of their parents,” Dr Ceri said. “Cupping is something that is not based on scientific evidence and children are physically harmed from it.”

On social media, people expressed their fury, labelling the practice as “questionable”. One commenter wrote: “Are these people crazy? They don’t read or learn anything.” But there were also those who shared their positive experiences. “I congratulate the family who had cupping performed on their baby,” one person wrote. “I also do cupping regularly and I haven’t had a headache in years. I do not take any medicine either. It is also beneficial for children to have cupping.“

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So, is there any reliable evidence about dry cupping for children?

Is it demonstrably effective for any paediatric condition?

Is it harmful?

Believe it or not, there has been at least one clinical trial of dry cupping as a treatment of constipation in children:

One hundred and twenty children (4-18 years old) diagnosed as functional constipation according to ROME III criteria were assigned to receive a traditional dry cupping protocol on the abdominal wall for 8 minutes every other day or standard laxative therapy (Polyethylene glycol (PEG) 40% solution without electrolyte), 0.4 g/kg once daily) for 4 weeks, in an open label randomized controlled clinical trial using a parallel design with a 1:1 allocation ratio. Patients were evaluated prior to and following 2, 4, 8 and 12 weeks of the intervention commencement in terms of the ROME III criteria for functional constipation.

Results: There were no significant differences between the two arms regarding demographic and clinical basic characteristics. After two weeks of the intervention, there was a significant better result in most of the items of ROME III criteria of patients in PEG group. In contrast, after four weeks of the intervention, the result was significantly better in the cupping group. There was no significant difference in the number of patients with constipation after 4 and 8 weeks of the follow-up period.

Conclusion: This study showed that dry cupping of the abdominal wall, as a traditional manipulative therapy, can be as effective as standard laxative therapy in children with functional constipation.

This study is squarely negative, yet the conclusions are clearly positive. I have stopped being amazed by such contradictions. After all, we are dealing with so-called alternative medicine (SCAM)!

For what it’s worth, here is our 2011 overview of all systematic reviews of cupping:

Several systematic reviews (SRs) have assessed the effectiveness of cupping for a range of conditions. Our aim was to provide a critical evaluation and summary of these data. Electronic searches were conducted to locate all SRs concerning cupping for any condition. Data were extracted by two authors according to predefined criteria. Five SRs met our inclusion criteria, which related to the following conditions: pain conditions, stroke rehabilitation, hypertension, and herpes zoster. The numbers of studies included in each SR were small. Relatively clear evidence emerged only for one indication, that cupping may be effective for reducing pain. Based on evidence from the currently available SRs, the effectiveness of cupping has been demonstrated only as a treatment for pain, and even for this indication doubts remain.

And here is our 2011 SR of cupping as a treatment of pain:

The objective of this study was to assess the evidence for or against the effectiveness of cupping as a treatment option for pain. Fourteen databases were searched. Randomized clinical trials (RCTs) testing cupping in patients with pain of any origin were considered. Trials using cupping with or without drawing blood were included, while trials comparing cupping with other treatments of unproven efficacy were excluded. Trials with cupping as concomitant treatment together with other treatments of unproven efficacy were excluded. Trials were also excluded if pain was not a central symptom of the condition. The selection of studies, data extraction and validation were performed independently by three reviewers. Seven RCTs met all the inclusion criteria. Two RCTs suggested significant pain reduction for cupping in low back pain compared with usual care (P < .01) and analgesia (P < .001). Another two RCTs also showed positive effects of cupping in cancer pain (P < .05) and trigeminal neuralgia (P < .01) compared with anticancer drugs and analgesics, respectively. Two RCTs reported favorable effects of cupping on pain in brachialgia compared with usual care (P = .03) or heat pad (P < .001). The other RCT failed to show superior effects of cupping on pain in herpes zoster compared with anti-viral medication (P = .065). Currently there are few RCTs testing the effectiveness of cupping in the management of pain. Most of the existing trials are of poor quality. Therefore, more rigorous studies are required before the effectiveness of cupping for the treatment of pain can be determined.

The included trials frequently were silent about adverse effects. Others reported no adverse effects and one mentioned three cases of vaso-vagal shock. None of the studies was on children.

So, here are my answers to the questions above:

  1. Is there any reliable evidence about dry cupping for children? No
  2. Is it demonstrably effective for any paediatric condition? No
  3. Is it harmful? Probably not that much (other than undermining common sense and rationality).

Yes, I have just published a new book! Its title is ‘Alternativmedizin – was hilft, was schadet: Die 20 besten, die 20 bedenklichsten Methoden’ (Alternative medicine – treatments that help and treatments that harm: The 20 best and the 20 most worrying methods). Yes, it is in German, and somehow I doubt that there will be an English version of it. Therefore I take the liberty of translating a short section for those who do not read German.

But first, let me tell you about the book’s concept.

Some people who read this blog seem to have the impression that I am dead against so-called alternative medicine (SCAM) – my friend Dana Ullman, for instance, is convinced of it. This, however, is not quite correct (Dana rarely is). The truth is that I am

  • FOR evidence-based medicine,
  • FOR a level playing field in all areas of healthcare,
  • FOR critically evaluating all options.

This also means, of course, that I am against misleading consumers about the value of SCAM. And therefore I am FOR any SCAM that demonstrably does more good than harm.

This attitude should have been clear from all my books. However, it seems to be difficult to understand for those who are on the more fanatical end of the SCAM spectrum. And because it is not that obvious, I decided to write a book that analyses (understandably yet analytically [including ~300 references of the original science]) the evidence for 20 SCAMs that are supported by reasonably sound evidence together with 20 for which this is not the case. My hope is that, with this approach, I might reach more consumers who are in favour of SCAM.

There is a risk, of course. Chances are that, instead of reaching more people from the pro-camp, I will merely offend both the sceptics as well as the enthusiasts.

We shall see.

Anyway, here is the promised bit that I translated for you. It is the postscript of the book, and I hope it gives you a flavour of what it is all about. Here we go:

 

In the first chapter of the book, I promised that I would neither uncritically hype alternative medicine nor unfairly condemn it. I have taken great pains to keep this promise.

Have I succeeded?

I fear there will be many who answer this question in the negative. And I can’t even blame my critics! Who likes to be criticized for something in which he deeply believes? Who likes to hear that his prejudices against everything called alternative medicine are wrong and counter-productive? Who doesn’t mind an ugly fact that destroys his beautiful theory? Both the dogmatic naysayers and the naive believers will be dissatisfied with my book (or at least parts of).

That’s a shame, but ultimately it is irrelevant. My point was not to take the word of one camp or another in the endless trench warfare that is alternative medicine. My main concern was to present the evidence as up-to-date, understandable, and objective as possible, and to serve those who are seriously interested in facts.

The book is thus not for dogged trench warriors; rather, it is aimed at ordinary consumers with an interest in their health. After all, the vast majority of the population is not among the unteachables of one camp or the other. Most people don’t want ideology, they want effective medicine. And most of them are baffled by the unmanageable variety of alternative medicine on offer, the grandiose promises of healing, and the vehement emotions that it all triggers.

In the area of alternative medicine, there is undoubtedly a lot of nonsense, charlatanry, and danger. But there are also some things that demonstrably do more good than harm. In order to separate the wheat from the chaff, consumers don’t need creeds. What they need above all is reliable evidence!

You can read about this evidence in my book. How you then deal with it is solely your decision. I do not want to tell anyone what to do with my presentation of the facts. But I know that the abundance of misinformation in the field of alternative medicine causes great damage and that the consumer and reader of my book, deserve better than to be led up the garden path.

If this book helps readers to make wise treatment decisions, my efforts will have been worthwhile. And if they get half as much pleasure from reading it as I did from writing it, my goal has been achieved.

THE END

(If by any chance you do read German and are in the position to publish a book review, please let me know and I will see that you get a free review copy of my book)

The objective of this review (entitled ‘Systematic Review on the Use of Homeopathy in Dentistry:
Critical Analysis of Clinical Trials‘) was to map the literature on homeopathy in dentistry and to evaluate the effectiveness of using homeopathy in dental practice through the critical analysis of clinical studies.

The search for scientific articles in any language, year, and place of publication was made in the databases of Public Medline (PUBMED), Web of Science, Cochrane, and Virtual Health Library; the articles selected were later classified according to the type of study. Gray literature was accessed through Google Scholar. Clinical trials were analyzed for methodological quality. Two trained reviewers accomplished the entire process independently.

Of the 281 studies retrieved by means of the search, 44 met the eligibility criteria. The included papers were:

  • literature reviews (56.8%),
  • clinical trials (34.1%),
  • cross-sectional studies (6.8%),
  • laboratory research (6.8%),
  • longitudinal observational studies (4.5%).

The clinical trials were published from 1965 to 2019, using homeopathy in several dental specialties:

  • Endodontics,
  • Periodontics,
  • Orofacial Pain,
  • Surgery,
  • Pediatric Dentistry,
  • Stomatology,
  • dental anxiety.

Qualitative failures, in all criteria investigated, and positive influences of the individual prescriptions on the results of treatments reported were observed.

The authors concluded that there is still a scarcity of studies about homeopathy and dentistry. The clinical trials selected showed positive effects on oral health; however, when they were critically evaluated, it was possible to recognize qualitative failures, mainly relative to double-blinding. It is necessary to encourage research on the subject, using standardized methodological procedures, to obtain better evaluation of the clinical applicability.

According to the authors, their review adhered to the PRISMA guideline of systematic reviews. This is, however, not the case. The authors correctly point out that the primary studies had many flaws: methodological failures were observed in the clinical trials, mainly related to double-blinding (66.7%). Significant failures were also observed in similarity (61.1%), randomization (27.8%), description of losses and exclusions (27.8%), and exclusion criteria (27.8%). They do not seem to realize that flaws of this nature and frequency should prevent positive conclusions.

So, what does this paper actually demonstrate? In my view, it shows that:

  • the peer-review process at the JACM continues to be a joke;
  • poor quality trials run by enthusiasts tend to produce false-positive results;
  • in so-called alternative medicine (SCAM), people get away with publishing even the most obvious falsehoods.

This week, it was reported that a UK bookkeeper has pleaded guilty to abusing his position at In-Light Ltd. by making unauthorized bank transfers to Stroud Accounting Solutions Ltd. The fraud amounted to the sizable sum of  £67,000.

In-Light Limited is the holding company for the School of Homeopathy, The School of Health, and Yondercott Press. It offers alternative medicine courses, seminars, books, and webinars focusing on nutrition, homeopathy, herbal medicine, yoga, Indian and Chinese Medicine.

On Twitter, the news of these events prompted several comments, e.g.:

Bookkeeper stole stolen funds, then?

That is typical of a skeptic! Nothing but vicious negativity!!!

Instead of displaying such sarcasm and Schadenfreude, we should empathize, I feel. If not with In-Light Ltd., then with the poor bookkeeper. As another, more compassionate Tweet pointed out, the man is surely innocent:

It started out as 7 pence, but he dropped it in his water bottle and shook it and now look what happened…

This, I think, should have been the line of the bookkeeper’s defense counsel. “My client did nothing wrong at all; he accidentally dropped a penny of In-Light Ltd. that was lying around the office into a water bottle. The bottle then got inadvertently shaken and the water/money mixture thus got potentised. Before my client could do anything to avert the disaster, the money had become the sizable sum of £ 67 000 which my client dutifully put on his bank account for safe-keeping. We, therefore, plead not guilty, your honour

What, you think the owners of In-Light Ltd. would not have believed this story?

But if they believe in homeopathy, they have no choice. If you believe in homeopathy, you believe anything.

And the judge? Well, the judge has to accept that homeopathy is a fact. And a fact for more than 200 years! Thus, potentisation is real. If all else failed, the defense counsel could call expert witnesses …

Prince Charles, for instance.

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