Edzard Ernst

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

I was alerted to an outstanding article by an unusual author, a law firm, on the subject of chiropractic. Allow me to quote a few passages from it (without changing a word or adding a comment):

When Katie May passed away suddenly from a stroke at just 34 years old, it was initially ruled an accident. After further investigation, a coroner determined the stroke that claimed the model and single mother’s life was caused by injuries sustained during neck manipulation by a chiropractor. And Ms. May is not the first to be affected by this seemingly harmless procedure…

What health issues can be caused by chiropractic manipulation?

Chiropractors typically use their hands to apply pressure to joints, aiming to help alleviate pain and improve body function. This is referred to as a chiropractic adjustment.

Adjustments are commonly performed for neck and/or back pain. Although the Mayo Clinic says the risk of a serious complication is relatively small, these complications can include:

  • A herniated disk, or worsening of an existing herniated disk
  • Compression of nerves in the lower spinal column
  • Stroke, which can result in paralysis or death

The last item on this list is particularly concerning.

Patients who receive neck manipulation are at risk for a stroke caused by vertebral artery dissection. Located in the neck, the vertebral arteries supply blood to the brain and can be torn by stretching and sudden force applied during a neck adjustment.

Studies have shown that vertebral artery dissection occurs in approximately 1 in 100,000 people and can be caused by something as simple as cracking your neck.

How could a chiropractor be responsible for a patient’s injury?

Although the risk of being seriously injured by a chiropractor is low, tragic accidents can and do happen. If you or a loved one believe you have been the victim of medical malpractice, please contact an experienced personal injury attorney.

Explaining how an injury or medical error occurred will help your attorney determine the potential liability of a chiropractor and any other involved parties. A chiropractor’s liability could fall into a legal category such as:

  • Failure to Diagnose a Medical Condition – The chiropractor breaches a duty of care to their patients by failing to diagnose an underlying medical condition. This could occur when a patient reveals or exhibits symptoms of a severe issue, such as a stroke, and is not referred for appropriate medical attention.
  • Lack of Informed Consent – A patient is treated without being properly informed of the potential risks or side effects, and experiences an injury from that treatment.
  • Negligent Manipulation – The patient’s body is adjusted by the chiropractor in such a way that it causes a new injury or worsens an existing injury. This could also include manipulation of a patient who is pregnant and goes into premature labor.
  • Chiropractic Induced Injury – A patient suffers injury, permanent irreversible damage such as paralysis or wrongful death as the direct result of a chiropractic manipulation.

To find out whether or not you may have a case, please discuss your concerns with a qualified personal injury attorney.

What should I do if I think I have been injured by chiropractic manipulation?

A personal injury attorney can help recover compensation for victims of medical malpractice, including those who have experienced a chiropractic injury. Surviving loved ones can also pursue their case after a family member’s wrongful death.

An attorney will help you collect documents, photos and other items pertaining to your case – but staying organized early in the process will be helpful. Try to preserve important documents, such as:

  • Photographs before and after treatment
  • Medical records and medical bills
  • Receipts, appointment confirmations and other paperwork from your chiropractor

There is a time limit to file a medical malpractice lawsuit, referred to as a statute of limitations…

This challenge for all homeopaths of the world was inspired by an avid commentator to this blog who, at every fitting and unfitting occasion, insists that those who doubt homeopathy must do a homeopathic proving.

A homeopathic ‘proving’ (Arzneimittelpruefung in Hahnamann’s less confusing terminology) is a test where a healthy person takes a (usually potentised) homeopathic remedy and then carefully notes all the symptoms and sensations which appear subsequently. When Hahnemann ‘discovered’ homeopathy, he took some cinchona and thought to experience the symptoms of malaria. This was the reason why he, after further such experiments, postulated that LIKE CURES LIKE.

To the present day, homeopathy relies on such provings. If we cannot sleep after drinking coffee, it is not unlike a proving of coffee, and homeopaths conclude that potentised coffee is a remedy for insomnia. I have done several provings many years ago, but they never worked the way homeopaths expect. We also investigared whether a related phenomenon, homeopathic aggravations (the worsening of the presenting symptom after taking the a well-chosen homeopathic remedy), claimed by homeopaths do exist at all; the answer was simple: no! In fact, the only people who believe in provings and aggravations are the homeopaths.

All this inspired me to now issue

A challenge for all homeopaths of the world

Here is the deal:

  1. you, the convinced homeopath, name the 6 homeopathic remedies that you cannot possibly miss when doing a proving on yourself;
  2. I order them in the potency you wish (only condition: it must be higher than C12) from a reputable source;
  3. I have the bottles delivered unopened to a notary where I live;
  4. the notary fills them into containers marked 1-6 (if you wish, you can send the notary empty containers for that ppurpose);
  5. the notary keeps the code under lock and key that links the name of the remedies to the numbers 1-6;
  6. he then mails the coded 6 remedies to you;
  7. you can use the proving method which you consider best and do as many provings as you like (the only limiting factors are the number of globuli in the containers and the time you have to crack the code);
  8. I give you 100 days for conducting the provings;
  9. once you are ready, you send your verdicts to the notary (e.g. 1 = rhus, tox, 2 = sulfur, 3 = arsenic, etc., etc.);
  10. the notary looks up the code and lets us both know the result.

I am happy to pay all the costs involved in the experiment (notary, remedies, postage, etc.). We can also discuss some of the details of this challenge, in case they run counter to your views on provings, rigorous science, etc.

To make sure we both ‘mean business’, once we both accept these conditions (you can flesh out the missing details as you wish), we both transfer a sum Euro 2 000 to an account with the notary. If you want to increase the sum, please let me know; as I said, we can discuss most of the details of my challenge to suit your needs. If you manage to ‘crack the code’ 1-6, the notary will transfer the sum of Euro 4 000 (your deposit and mine) to your account. If you fail, he will transfer the same amount to my account.

SIMPLE!

The entry into the challenge closes at the end of the year 2020.

Why should you take on this challenge? I can see several reasons:

  1. You want to prove that provings are valid.
  2. You want to teach me, and all other critics of homeopathy, a lesson.
  3. You want to earn Euro 2 000 quickly and without much work.
  4. You want the sceptics of the world to know that homeopathy is valid (we will report about our experiment fairly and to publish the report not just on this blog, but anywhere you want [provided the editors accept the paper for publication]).

Why do I take on the risk of losing a significant amount of money? Here too, I see more than one reason:

  1. I do not consider it a great risk; as I said, I did several provings myself and am quite certain they don’t work.
  2. I know about the implausiblity of the assumption that a remedy which contains nothing has any effects beyond expectation.
  3. I could do with the extra Euro 2 000.
  4. If no homeopath takes on the challenge, I shall henceforce declare that homeopaths were unable to prove that their provings are valid.

 

It has been pointed out to me that my recent posts on the thorny subject of Donald Trump have angered many of his devoted fans. I am so sorry! Now that Trump is (almost) history, these poor, disappointed people need our help; they urgently need some effective anger management before they start firing those weapons they have been amassing.

This is why, in the spirit of building bridges and in the interest of peace, I have made an effort and put together a list of so-called alternative medicines (SCAMs) that might be useful.

Various pharmaceutical medications are available for treating anxiety, stress and anger problems:

Anxiolytics e.g. Alprazolam, Diazepam,
Antidepressants e.g. Paroxetine, Fluoxetine,
Antipsychotics e.g. Paliperidone, Risperidone,
Mood regulators e.g. Lithium, Valproate.

Oh, sorry! I have angered you again! I forgot, you are SCAM only. Let me have a look into my own book and find something that works for your problems.

ANXIETY

  • Massage
  • Music therapy
  • Various relaxation techniques

DEPRESSION

  • St John’s wort

Yes, these are the only SCAMs that are listed as being supported by sound evidence.

What, you say, you care a f**k about evidence? Of course, I should have known!

But my book offers nothing for delusional disorders, sorry.

Not good enough, you say? Alright, alright, keep your gun where it is. I better look elsewhere.

Found something. Thanks heavens for homeopathy! One can always rely on homeopaths to offer help, and they certainly know a thing or two about delusions! One website has this long list of remedies for delusional disorders:

Stramonium

Vision of animals, black dogs etc. (It also cured pneumonia on these symptoms). Thinks himself double, tall and a part missing and objects around him small. Cannot bear solitude and darkness; must have light and company. Sees ghosts, hears voices and talks with spirits. Feeling as if a long trail of bedbugs is pursuing her, and after them a procession of beetles and then comes crawling over her a host of cockroaches. Sees horrifying images at his side than in front of him. Sings amorous songs and utters obscene speeches. Hallucination and delirium. Attempts to stab and bite. Calls things by wrong names, his boots the logs of wood; his bedroom the stable. Has communication from God, delivers sermons, prophecies.

Lactuca Virosa

As if swimming in the air or walking above the ground.

Chloralum

Night terrors. Sees visions of arches. Hears voices when in the dark or when eyes are shut.

Lac Can

Delusions about snakes. Imagines he is surrounded by them. Afraid of closing the eyes for fear of being bitten by a snake. Feels to be walking in air. Tormenting thoughts. No reality in things; thinks that everything she says is a lie; she is not herself; her properties not her own; wears someone else’s nose.

Sabadilla

Erroneous impressions as to the state of her body e.g. that she is pregnant when she is merely swollen with flatus.

Platinum

Pride or over-estimate of one-self. Thinks she is superior to all others. Thinks her body is longer than those of others. Arrogant and haughty.

Camphor

Everything that moves is a ghost and inanimate things in the room become alive and terrify him. Extreme nervousness. Fear of strangers and of the dark.

Calcarea Carb

Sees and talks to persons who are not present. Imagines as if she is surrounded by dogs. Aversion to do any business. She is sad and melan­choly. Full of fear, weary of life.

Ailanthus

Feels as if a rat or something small is crawling up the limb and over the body.

Anacardium

The patient finds himself to be between good and evil will. His external will wants him to do some­thing evil, but his internal will stops him from doing this.

Indecisive

One moment he thinks it is so and the next moment has enough reason left that it is not so. Low spirited, disheartened, fears he is pursued by someone; looks for thieves, expects enemies, fears everything and everybody. He is pursuaded by his evil will to do acts of violence and injustice, but is withheld and restrained by his good will. (See also Hyosc, Bell., and Stram.) Hears voices of sister and mother who are far away.

Helleborus Nig

Stupefaction and sluggishness of the body and mind. Stupor from which he can be aroused with” difficulty and when so aroused he will talk about spirits or say that he sees devils with horns and tails. Hallucination.

Causticum

Conscience stricken as if she had committed a crime.

Ferrum Iod:

As if body had grown 30 feet high.

Baptisia T:

Feels as if body scattered into pieces.

Chamomilla

Hearing voices of absent persons which disturb his sleep.

Zincum Met

Voices from within him speaking in abusive and filthy language.

Belladonna

Sees frightful faces and monsters. Bites and strikes. Patient will not injure himself or others unless he thinks he is acting in self-defence. He will attack the person who is “acting against the patient’s will.

Spigelia

For apprehensive and nervous persons. Will not use razor, as something is constantly urging him to cut throat with it. Urge to commit suicide with fork when at dining table and so on. Afraid of sharp and pointed instruments.

Thuja

Sensation as though a living child were in the abdomen. Feels body thin and delicate, frail, easily breakable as if made of glass.

Cannabis Ind

Errors of perception as to space and as to time. The patient feels as if he had not taken any food for the last six months, although he had just finished his meals. A mile distance looks as if it were a hundred miles. Mind is full of unfinished ideas. Delusion of rhinoceros and elephants following him up. Imagines he hears sweet music, shuts his eyes and is lost in most delicious thoughts and dreams. Imagines someone calling him. Imagines as if he exists without form throughout a vast extent of space. His body seems to expand and the arch of his skull to be broader than the vault of heaven. All seem unreal. Feels himself unreal. All impressions extremely exaggerated. Hears voices and most sublime music; sees vision of beauty and glory, only to be equalled in paradise.

Arsenic Alb

Imagines house full of thieves. Runs through the house in search of them or hides himself in the house on account of fear.

Cicuta Virosa

Feels as if he were in a strange place and not living in ordinary conditions; everything appeared strange and almost frightful. Contempt of mankind. Runs away from his friends on account of disgust with their follies.

Viscum Alb

Delusion as if upper part of the body is floating in the air.

Coculus

Delusion as if something is rolling on walls, chairs, floor or elsewhere and will also roll on him.

Hyoscyamus

Talks to imaginary people as if they are sitting by his side. Talking to dead wife, sister or husband as if they were here again on earth. Imagines the things are worms, vermin, rats, cats, and mice. Feels as if his hands and fingers are too large.

Cocaine

Thinks he hears unpleasant remarks about himself; hallucination of hearing. Cannot sleep for hours after retiring. Sees and feels bugs and worms in his room and bed. Moral sense blunted.

Alumina

When he says anything, he feels as if another person has said it. Similarly if he sees anything, he feels as if another person had seen it, or as if he could transfer himself into another person and then only he could see. Confusion of personal identity.

Glonoine

Chin feels elongated to knees. Touching the chin repeatedly to be sure that it was not so.

Carboneum Sul

Hears voices and believes he has committed robbery.

Lachesis

When she sees anyone in whispering conversation, she thinks they are talking about her to her detriment. She thinks herself under superhuman control whose commands (partly in dream) she must obey. Fears that she is pursued by enemies; the medicine is a poison; that there are robbers in the house and she wants to jump out of window.

Melilotus

Delusion; thinks everyone is looking at her; fears to talk aloud; wants to run away.

Agnus C

Delusion of smell as of herring (kind of fish) or musk.

Coca

Delusion; of worms on the skin or clothing.

Aethusa

Delusion; sees cats and dogs; wants to jump out of bed or window.

Asarum Europ

As if hovering in the air. Vertigo as if drunk.

Baryta Carb

As if everything rocks with him, as in a ship.

Crocus

As if something alive is in abdomen. Imaginary pregnancy. Alternating mood.

Morphinum

As if room filled with babies. Man at foot of bed. Cannot describe symptoms.  Sobs at trifles.

Medorrhinum

Feels as if things done today were done a week ago; as if someone is whispering behind her, faces appearing from behind the furniture and look at her and say, “come”. Feels life unreal like a dream. Had committed unpardonable sin, and was going to hell. Not caring whether she goes to hell or heaven. Impatient, very selfish.

Mercurius

Feels as if worm rising in throat; apple-core stuck in throat; ice hi ear; cold water running from ears.

Palladium

Feels that she has been neglected. Wounded pride.

Petroleum

Imagines that another person or a child is in bed with her. Dreams that she is two or more. That her limbs are double.

Psorinum

Feels as if brain separated from the body; as if there is not enough room in forehead; as if he heard with ears not his own.

Cyclamen

Thinks herself impure and wants to take bath every time she touches somebody or something. Every thing seems double. As if person lying in bed. Ailments from duty not done or bad act committed.

Staphisagria

When he walks he feels as if someone were following him. This causes anxiety and fear and he cannot look behind.

Sulphur

Everything turns into beauty. Old rag and old stick looks to be a beautiful piece of workmanship. Every thing looks pretty which the patient takes fancy to. Wishing to touch everything.

Cannabis Sat

Hears hissing whisper to kill himself. This is an order from the Most High Command.

Cuprum Aceticum

Delusion that a policeman has come to seize him. Hallucinations of all kinds of figures and premises, especially in the evening, when shutting eyes or when going to sleep.

Oleander

Washes herself and her clothes after touching anything or any person, as she believes she has touched a dirty thing as a result of which she must wash.

Pyrogenium

Hallucination that he is very wealthy and has a large sum of money in the bank.

Nux Moschata

Seems as if he is two persons and watches his other self playing. He seems lost, and when spoken to would come to himself confused. Feels as if she has two heads.

________________________________

Did you find something that fits?

No?

Then let me help you: Pride or over-estimate of one-self. Thinks she is superior to all others. Arrogant and haughty. Yes, that must be for you; PLATINUM it is!!!

Hope you get better soon.

And, if I may, I suggest PYROGENIUM for your idol.

____________________________

 

 

PS

A personal note: during the last 4 years, I have turned down all invitations for lectures in the US and argued that I do not travel to counties with fascistoid leaders. Once the pandemic is under control, I’d be happy to reconsider.

The issue of informed consent has made regular appearances on this blog. It is important and has many intriguing aspects, particularly for so-called alternative medicine (SCAM). On the one hand, it is a ‘conditio sine qua non’ for any form of healthcare, while, on the other hand, it is a near impossibility in SCAM practice.

In this new article published in a chiro-journal, the authors review the origins of informed consent and trace the duty of disclosure and materiality through landmark medical consent cases in four common law (case law) jurisdictions. The duty of disclosure has evolved from a patriarchal exercise to one in which patient autonomy in clinical decision making is paramount. Passing time has seen the duty of disclosure evolve to include non-medical aspects that may influence the delivery of care. The authors argue that a patient cannot provide valid informed consent for the removal of vertebral subluxation. Further, vertebral subluxation care cannot meet code of conduct standards because it lacks an evidence base and is practitioner-centered.

The uptake of the expanded duty of disclosure has been slow and incomplete by practitioners and regulators. The expanded duty of disclosure has implications, both educative and punitive for regulators, chiropractic educators and professional associations. The authors discuss how practitioners and regulators can be informed by other sources such as consumer law. For regulators, reviewing and updating informed consent requirements is required. For practitioners it may necessitate disclosure of health status, conflict of interest when recommending “inhouse” products, recency of training after attending continuing professional development, practice patterns, personal interests and disciplinary findings.

The authors conclude that, ultimately such matters are informed by the deliberations of the courts. It is our opinion that the duty of a mature profession to critically self-evaluate and respond in the best interests of the patient before these matters arrive in court.

In their paper, the authors also provide a standard list of items required for ‘informed’ consent:

(1) emphasizing the patient’s role in shared decision-making

(2) disclosure of information

a. explaining the patient’s medical status including diagnosis and prognosis

b. describing the proposed diagnostic and therapeutic intervention, including the likelihood and effect of associated risks and benefits of the proposed action, including material risks

c. discussing alternatives to the proposed intervention, including doing nothing

(3) prompting and answering patient questions related to the proposed course of action (NB. this involves probing for understanding, not simply asking ‘do you have any questions’), and

(4) eliciting the patient’s preference (usually by signature). (NB. A signed form is not consent. The conversation between the clinician and the patient or carer is the true process of obtaining informed consent. The signature on the consent form is proof that the conversation took place and that the patient understood and agreed.)

The authors of this article – I do commend it to all chiropractors – take a mostly judicial view of informed consent (for an ethical perspective on the subject, I recommend our book). They do not discuss, whether chiropractors do, in fact, adhere to the ethical imperative of informed consent. As I have stated before, there is not much research on this issue. But the little that does exist fails to show that chiropractors care much about it.

But why?

If it’s an ethical imerative, why do chiropractors not abide by it?

The answer to this question is not difficult to find. Just imagine a conversation between a chiropractor (C) and a patient with neck pain (P):

  • P: What’s your diagnisis?
  • C: You are suffering from acute neck pain.
  • P: Thanks, that much was clear to me. What do you suggest I do?
  • C: I will perform a manipulation of your neck, if you agree.
  • P: Why would this help?
  • C: It can realign the vertebrae that are out of place, simply put.
  • P: And my pain will disappear?
  • C: Sometimes it does, yes.
  • P: But will it disappear quicker than without manipulation.
  • C: Some of the evidence says so.
  • P: Ok, but what does the most reliable evidence say?
  • C: It is not entirely clear cut.
  • P: Hmm, that does not sound too good.
  • P: So, tell me, are there any risks?
  • C: About 50% of patients suffer from minor to moderate pain for 2-3 days afterwards.
  • P: That’s a lot!
  • P: Anything else?
  • C: In some cases, neck manipulation was followed by a stroke.
  • P: Gee that’s bad; how often has this happened?
  • C: We know of about 500 such cases.
  • P: Heavens!
  • C: Now, do you want the treatment or not?
  • P: How much will you charge?
  • C: Only 60 Euros per session.
  • P: You mean I have to come back for more, each time risking a stroke?
  • C: Well… You don’t have to.
  • P: Thanks for the info; I am off. Cherio!

I rest my case. 

 

Many people have pointed out that the US election was disappointing because, after Trump’s four years in office, people must have realised that he is a vile and dangerous president. Yet, a very large proportion of Americans voted for him. Some commentators even speak of a cult-like movement supporting Trump.

Many people have also pointed out that some forms of so-called alternative medicine (SCAM) are irrational and even harmful. Yet, a sizable proportion of the population continue to use them. Some experts even speak of a cult-like movement supporting SCAM.

WHY?

Why do so many people make irrational choices?

Are they all stupid?

I don’t think so!

The way I see it, a key here must be critical thinking. Critical thinking means making decisions and judgements based on (often confusing) evidence. According to the ‘National Council for Excellence in Critical Thinking’ it is the intellectually disciplined process of actively and skilfully conceptualizing, applying, analysing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action.

Critical thinking is not something one is born with; but most people can learn this skill. In one study, researchers measured the relationship between student’s religion, gender, and propensity for fantasy thinking with the change in belief for paranormal and pseudoscientific subjects following a science and critical thinking course. Following the course, overall beliefs in paranormal and pseudo-scientific subcategories were lower by 6.8–28.9%.

Though easily confused with intelligence, critical thinking has little to do with it. Critical thinking is a collection of cognitive skills that allow us to rationalise. Critical thinkers are flexible thinkers who require evidence to support their beliefs and recognize fallacious attempts to mislead them. Critical thinking is the skill of minimising cognitive biases.

If I am correct, those people who voted for Trump in the US (or similar politicians, such as Boris Johnson in the UK) and those consumers who spend their money on bogus SCAMs both are deficient in their ability to think critically. This does not mean that they are the same individuals. I merely suggest they have one characteristic in common.

It is crucial, I think, to realise that critical thinking can be improved with education. In the final analysis, disappointing results of any election in which (far too many) people voted for a dishonest, corrupt politician, and the disappointingly high usage of bogus SCAMs have, I believe, their roots in poor education. This means that, if we want to reduce the risk of the Trump disaster repeating itself, we need to invest effectively and generously in better educating our children (and adults). And if we want to minimise the risk of consumers wasting their money or damaging their health with bogus SCAMs, we need to make sure the public has a sufficient understanding of logic, reason, evidence and science.

Reflexology (originally called ‘zone therapy’ by its inventor) is a manual technique where pressure is applied to the sole of the patient’s foot. Reflexology is said to have its roots in ancient cultures. Its current popularity goes back to the US doctor William Fitzgerald (1872-1942) who did some research in the early 1900s and thought to have discovered that the human body is divided into 10 zones each of which is represented on the sole of the foot. Reflexologists thus drew maps of the sole of the foot where all the body’s organs are depicted. Numerous such maps have been published and, embarrassingly, they do not all agree with each other as to the location of our organs on the sole of our feet. By massaging specific zones which are assumed to be connected to specific organs, reflexologists believe to positively influence the function of these organs.

So, does reflexology do more good than harm?

The aim of this review was to conduct a systematic review, meta-analysis, and metaregression to determine the current best available evidence of the efficacy and safety of foot reflexology for adult depression, anxiety, and sleep quality.

Twenty-six studies could be included. The meta-analyses showed that foot reflexology intervention significantly improved adult depression, anxiety, and sleep quality. Metaregression revealed that an increase in total foot reflexology time and duration can significantly improve sleep quality.

The authors concluded that foot reflexology may provide additional nonpharmacotherapy intervention for adults suffering from depression, anxiety, or sleep disturbance. However, high quality and rigorous design RCTs in specific population, along with an increase in participants, and a long-term follow-up are recommended in the future.

Sounds good!

Finally a so-called alternative medicine (SCAM) that is backed by soild evidence!

Or perhaps not?

Here are a few concerns that lead me to doubt these conclusions:

  • Most of the primary studies were of poor methodological quality.
  • Most studies failed to mention adverse effects.
  • Very few studies controlled for placebo effects.
  • There was evidence of publication bias (negative studies tended to remain unpublished).
  • Studies published in languages other than English were not considered.
  • The authors fail to point out that a foot massage is, of course, agreeable (and thus may relieve a range of symptoms), but reflexology with all its weird assumptions is less than plausible.
  • Many of the studies located by the authors were excluded for reasons that are less than clear.

The last point seems particularly puzzling. Our own trial, for instance, was excluded because, according to the review authors, it did not include relevant outcomes. However, our method secion makes it clear that the primary focus for this study was the subscores for anxiety and depression, which comprise four and seven items, respectively. As it happens, our study was negative.

Also cuirous is the fact that the authors did not mention our own 2011 systematic review of reflexology:

Reflexology is a popular form of complementary and alternative medicine (CAM). The aim of this update is to critically evaluate the evidence for or against the effectiveness of reflexology in patients with any type of medical condition. Six electronic databases were searched to identify all relevant randomised clinical trials (RCTs). Their methodological quality was assessed independently by the two reviewers using the Jadad score. Overall, 23 studies met all inclusion criteria. They related to a wide range of medical conditions. The methodological quality of the RCTs was often poor. Nine high quality RCTs generated negative findings; and five generated positive findings. Eight RCTs suggested that reflexology is effective for the following conditions: diabetes, premenstrual syndrome, cancer patients, multiple sclerosis, symptomatic idiopathic detrusor over-activity and dementia yet important caveats remain. It is concluded that the best clinical evidence does not demonstrate convincingly reflexology to be an effective treatment for any medical condition.

I wonder why!

As the world is waiting for the drawn-out process of vote-counting in the US to end, and as Trump has already declared himself to be the winner, it is easy to get emotional about the harm the current POTUS has done (and might do in future) to his country and the world. One comment I read this morning:

Christians have feared the arrival of the Anti-Christ for 2 000 years. And as soon as he appears, they vote for him.

I have to admit that I find it amazing that close to 50% of the US citizens, after observing Trump in action, are not wiser than to vote for him – amazing and frightening!

Yet, we must remain rational.

He might still be voted out!

To remind myself why I, as a scientist, find Donald Trump so deeply objectionable, I have collected a few of his quotes on science. I hope you see my point:

  • Not only are wind farms disgusting looking, but even worse they are bad for people’s health
  • Remember, new “environment friendly” lightbulbs can cause cancer. Be careful– the idiots who came up with this stuff don’t care.
  • Healthy young child goes to doctor, gets pumped with massive shot of many vaccines, doesn’t feel good and changes – AUTISM. Many such cases!
  • The concept of global warming was created by and for the Chinese in order to make U.S. manufacturing non-competitive.
  • So, supposing we hit the body with a tremendous — whether it’s ultraviolet or just very powerful light — and I think you said that that hasn’t been checked, but you’re going to test it. And then I said, supposing you brought the light inside the body, which you can do either through the skin or in some other way, and I think you said you’re going to test that too. It sounds interesting…
  • And then I see the disinfectant, where it knocks it out in a minute. One minute. And is there a way we can do something like that, by injection inside or almost a cleaning. Because you see it gets in the lungs and it does a tremendous number on the lungs. So it would be interesting to check that. So, that, you’re going to have to use medical doctors with. But it sounds — it sounds interesting to me.
  • People are surprised that I understand it [science]. Every one of these doctors said, ‘How do you know so much about this?’ Maybe I have a natural ability. Maybe I should have done that instead of running for President.
  • Some say that and some say differently [global warming]. I mean, you have scientists on both sides of it. My uncle was a great professor at MIT for many years. Dr. John Trump. And I didn’t talk to him about this particular subject, but I have a natural instinct for science, and I will say that you have scientists on both sides of the picture.
  • And when you’re talking about an atmosphere, oceans are very small. And it blows over and it sails over.
  • I’m speaking with myself, number one, because I have a very good brain and I’ve said a lot of things.
  • What do I know about it? All I know is what’s on the internet

To this picture, we evidently have to add

NO UNDERSTANDING OF OR RESPECT FOR SCIENCE.

If you think that the papers published on SCAM for humans are bad, you should have a look at those in the veterinary sector. Take for instance this article from the AHVMA (American Holistic Veterinary Medical Association) Journal:

Evidence demonstrates that acupuncture and herbal medicine are useful and effective for the treatment of seizures. In the perspective of Traditional Chinese Veterinary Medicine (TCVM), seizures in dogs and cats can be classified into 6 patterns:

  1. Obstruction by WindPhlegm,
  2. Internal Profusion of Phlegm-Fire,
  3. Stagnation of Blood,
  4. Liver Blood Deficiency,
  5. Liver/Kidney Yin Deficiency,
  6. Yin Deficiency with Blood Deficiency.

This article focuses on how to differentiate and treat these patterns using herbal medicine and acupuncture. An overview of clinical trials is provided, and case examples are also included.

The authors from the ‘Equine Acupuncture Center/University of Florida, USA, concluded that the combination of TCVM and Western medicine (WM) can be an effective therapeutic approach to control seizures and epilepsy. WM is effective for initial control of severe seizures and in identification of the cause of the disease. TCVM can be effectively used for the treatment of milder cases and to help control seizures in those patients that fail to respond to WM. 

Having done some research into acupuncture for animals myself, I was particularly interested in this aspect of the paper – interested and disappointed, I have to admit. The sad truth is that, despite the opimistic conclusions of the authors, there is no sound evidence. As no good evidence has emerged since, our own systematic review of 2006 (which was not cited by the authors of the above article) still holds true:

Acupuncture is a popular complementary treatment option in human medicine. Increasingly, owners also seek acupuncture for their animals. The aim of the systematic review reported here was to summarize and assess the clinical evidence for or against the effectiveness of acupuncture in veterinary medicine. Systematic searches were conducted on Medline, Embase, Amed, Cinahl, Japana Centra Revuo Medicina and Chikusan Bunken Kensaku. Hand-searches included conference proceedings, bibliographies, and contact with experts and veterinary acupuncture associations. There were no restrictions regarding the language of publication. All controlled clinical trials testing acupuncture in any condition of domestic animals were included. Studies using laboratory animals were excluded. Titles and abstracts of identified articles were read, and hard copies were obtained. Inclusion and exclusion of studies, data extraction, and validation were performed independently by two reviewers. Methodologic quality was evaluated by means of the Jadad score. Fourteen randomized controlled trials and 17 nonrandomized controlled trials met our criteria and were, therefore, included. The methodologic quality of these trials was variable but, on average, was low. For cutaneous pain and diarrhea, encouraging evidence exists that warrants further investigation in rigorous trials. Single studies reported some positive intergroup differences for spinal cord injury, Cushing’s syndrome, lung function, hepatitis, and rumen acidosis. These trials require independent replication. On the basis of the findings of this systematic review, there is no compelling evidence to recommend or reject acupuncture for any condition in domestic animals. Some encouraging data do exist that warrant further investigation in independent rigorous trials.

The AHVMA-article becomes wholly farcical, once we see the heading the AHVMA-journal has given it:

SCIENTIFIC REVIEW

The AHVMA-journal is the official publication of the American Holistic Veterinary Medical Association, according to their own statement, is the mindful leader elevating the veterinary professional through innovation, education, and advocacy of integrative medicine.

One stated objective of the AHVMA is to advance and educate in the science and art of holistic veterinary medicine. If their new ‘scientific review’ is anything to go by, they seem to have a most bizarre view about science. The question that occurred to me while reading the paper was this: are they not promoting animal abuse, a term defined as any use or treatment of animals that seems unnecessarily cruel, regardless of whether the act is against the law?

 

I know of one patient who turned to the Gerson Therapy having been told that she was suffering from terminal cancer and would not survive another course of chemotherapy. Happily, seven years later she is alive and well. So therefore it is vital that, rather than dismissing such experiences, we should further investigate the beneficial nature of these treatments.

HRH The Prince of Wales (2004)

I was reminded of this embarrassing (because displaying profound ignorance) quote when I looked at the website of the ‘GERSON SUPPORT GROUP UK‘ where it is prominently cited. Under the heading ‘SCIENCE & CLINICAL RATIONAL’ the site offers a long article about the Gerson therapy (GT). Allow me to show you a few quotes from it:

Dr Max Gerson’s therapy is based on the belief that insufficient nutrients within the cells and an accumulation of toxins in the tissues lead to a breakdown in healthy cellular function which, if left unchecked, can trigger cancer.

That is interesting, I find, because the statement clearly admits that the GT is not an evidence-based therapy but a belief-based treatment.

The therapy that he developed uses a restrictive, plant-based diet and specific supplements to boost healthy cellular function; and various detoxification procedures, including coffee enemas, to eliminate waste products.

The claims hidden in this sentence remain unproven. There is no evidence that cellular fuction is boosted, nor that the procedures eliminate toxins.

… we only need to look at communities across the globe which exist in a pre-industrialised state to see that, whilst they might be more likely to die from pneumonia or tuberculosis, rates of degenerative illness are a fraction of those in the ‘developed‘ world. The age-adjusted death rate from breast cancer is less than 2 per 100,000 of the population in Thailand, Sri Lanka and El Salvador and around 33 per 100,000 in the UK, US, The Netherlands and numerous other affluent, Western countries.

Correlation is not causation! Pre-industrial societies also watch less TV, eat less ice-cream, read less fashion magazines, etc., etc. Are these habits also the cause of cancer?

… migrant studies show that within two generations the cancer rates of migrants increase rapidly towards Western rates, again underlining the assertion that cancer is caused primarily by diet and lifestyle rather than ‘faulty’ genes.

In no way is this an argument for eating raw vegetable and taking your coffee via the rectum.

In the German scientific golden age of the 1920s and 30s…

Golden age for what, for fascists?

Gerson had used a restricted diet to cure himself of migraines. He then helped another patient to reverse tuberculosis, and many others to reverse a variety of degenerative illnesses, all by similar means. He later developed his therapy to the point where he was able to help individuals reverse cancer. 

In this case, Max Gerson was ignorant of the fact that experience and evidence are two fundamentally different things.

Max Gerson developed his therapy in an iterative way, starting with a restrictive plant-based diet, adding vitamins, minerals and enzymes to encourage the oxygenation of the cells and then introducing the coffee enemas to aid detoxification of waste products. What is fascinating is that science has subsequently explained the mechanism of action behind some of his theories. (See Biochemical Basis to the Therapy).

Science has not explained the mechanism of action, not least because the action has never been verified. There are no robust clinical trials of Gerson’s therapy. Evidently, 100 years were not enough to conduct any – or perhaps the proponents know only too well that they would not generate the results they hoped?

Equally interesting is that in 2012 Dr Thomas Seyfried published the results of many years research in Cancer as a Metabolic Disease. 

Really? On Medline, I find only two cancer-related papers for Seyfried T. 2012:

Thus, nearly a century after their original proposition that the fundamental cause of cancer was faulty cellular metabolism, it seems that doctors Otto Warburg and Max Gerson might be vindicated.

No, to ‘vindicate’ a therapeutic suggestion one needs several rigorous clinical trials. And for the GT, they remain absent.

_______________________________

So, what does the GT amount to?

  • proponents had ~100 years to produce evidence;
  • they failed to do so;
  • thus the therapy is at best unproven;
  • it is also biologically implausible;
  • moreover, it is expensive;
  • crucially it is not free of serious adverse effects;
  • it is promoted only by those who seem to make money from it.

The only controlled clinical trial of a Gerson-like therapy that I know of is this one (rarely cited by Gerson fans):

Conventional medicine has had little to offer patients with inoperable pancreatic adenocarcinoma; thus, many patients seek alternative treatments. The National Cancer Institute, in 1998, sponsored a randomized, phase III, controlled trial of proteolytic enzyme therapy versus chemotherapy. Because most eligible patients refused random assignment, the trial was changed in 2001 to a controlled, observational study.

METHODS

All patients were seen by one of the investigators at Columbia University, and patients who received enzyme therapy were seen by the participating alternative practitioner. Of 55 patients who had inoperable pancreatic cancer, 23 elected gemcitabine-based chemotherapy, and 32 elected enzyme treatment, which included pancreatic enzymes, nutritional supplements, detoxification, and an organic diet. Primary and secondary outcomes were overall survival and quality of life, respectively.

RESULTS

At enrollment, the treatment groups had no statistically significant differences in patient characteristics, pathology, quality of life, or clinically meaningful laboratory values. Kaplan-Meier analysis found a 9.7-month difference in median survival between the chemotherapy group (median survival, 14 months) and enzyme treatment groups (median survival, 4.3 months) and found an adjusted-mortality hazard ratio of the enzyme group compared with the chemotherapy group of 6.96 (P < .001). At 1 year, 56% of chemotherapy-group patients were alive, and 16% of enzyme-therapy patients were alive. The quality of life ratings were better in the chemotherapy group than in the enzyme-treated group (P < .01).

CONCLUSION

Among patients who have pancreatic cancer, those who chose gemcitabine-based chemotherapy survived more than three times as long (14.0 v 4.3 months) and had better quality of life than those who chose proteolytic enzyme treatment.

Considering all this, I believe, it would be hard to name a cancer quackery that is less credible than the GT.

Coffee enemas consist of the administration of warm coffee via the rectum into a patient’s intestines. They are popular, not least because they cause profuse bowel movements and thus lead to immediate relief of constipation and therefore to short-lasting weight loss.

Coffee enemas are promoted for detox under the erroneous assumption that that the content of our colon is toxic, an obsolete theory known as ‘autointoxication’. Other notions assume that coffee enemas have beneficial antioxidant effects or stimulate the liver. Supporters of coffee enemas also claim they are effective treatments for:

  • boosting immunity
  • increasing energy
  • preventing yeast overgrowth
  • treating autoimmune diseases
  • excreting parasites from the digestive tract
  • removing heavy metals from the body
  • alleviating depression
  • treating cancer

Coffee enemas can cause adverse reactions some of which can be severe and have even caused fatalities:

  • electrolyte imbalances
  • rectal burns
  • nausea
  • vomiting
  • cramping
  • bloating
  • dehydration
  • bowel perforation

This new systematic review was conducted to investigate the safety and effectiveness of self-administered coffee enema and to provide evidence about its benefits and risks.

Relevant studies were retrieved from multiple electronic literature searches. Considering self-administered coffee enema being used in a various indication, study population was not restricted. Any types of published studies that included outcomes of effectiveness or safety of self-administered coffee enema with or without comparators were eligible for inclusion in this systematic review. Data on biomedical indications, patient-reported outcomes, and adverse events were collected. Descriptive analyses were planned because diverse health conditions and outcome variables did not allow for quantitative synthesis.

Nine case reports that describe adverse events were identified and included in the analysis. The reported problems included:

  • colitis,
  • proctocolitis,
  • rectal perforation, peritonitis,
  • rectal burn,
  • cardiorespitatory arrest, followed by death,
  • hepatic failure, followed by death,
  • vomiting, dyspnoea, followed by death.

No study reporting on the effectiveness of coffee enema was found.

The authors concluded that, based on the evidences reviewed, this systematic review does not recommend coffee enema self-administration as a SCAM modality that can be adopted as a mean of self-care, given the unsolved issues on its safety and insufficient evidence with regard to the effectiveness.

So-called alternative medicine (SCAM) is full of truly barmy ideas, but coffee enems are amongst the worst. They are disgusting, uncomfortable, useless and risky. I am posting this article with the sincere hope that nobody reading it will ever consider using such nonsense.

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