Edzard Ernst

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

In Traditional Chinese Medicine (TCM), the deer antler, the young, non-ossifying, and pilose antler on the head of deer, is known as Lu Rong. It is a prized and highly sought after commodity and thus an ideal X-mas present for TCM-fans.  Deer antler has been used for hundreds of years for health and  longevity and is considered a yang tonic.  The most expensive deer antler is harvested in Alaska; prices range from $100 to $ 500 per 100 gram.

TCM knows three main treasures – deer antler velvet (Lu Rong), Ginseng (Ren Shen), and carex meyeriana grass (Wu La Cao). Among them deer velvet antler is the most precious. It is used for curing all deficiency syndromes, especially deficiency of the kidney, weak constitution, premature aging, deficiency of qi, blood, and semen. Reportedly, deer antlers contain 25 kinds of amino acids and a variety of vitamins that can improve the body’s immune system and promote hematopoietic function. In his “Compendium of Materia Medica”, Li Shizhen stated that deer antler is for reinforcing kidney to strengthen yang, promoting essence production, enriching blood, supplementing marrow, and invigorating bone.

Does deer antler work? TCM-practitioners seem to have little doubt. They claim it can:

  • enhance immunity,
  • increase body resistance to disease
  • delay aging,
  • sharpen the brain,
  • and strengthen memory,
  • treat infertility,
  • cure deficient cold,
  • treat postpartum weakness,
  • cure metrorrhagia,
  • treat metrostaxis,
  • treat paediatric liver and kidney deficiency,
  • remedy slow growth,
  • help with delayed walking of children,
  • help with delayed eruption of teeth, delayed closure of the anterior fontanelle, soft bone condition, and more.

And what about any evidence for all this extraordinary claims and assumptions?

A 2013 review concluded that deer antler base has emerged as a good source of traditional medicine. However, further investigations are needed to explore individual bioactive compounds responsible for these in vitro and in vivo pharmacological effects and its mechanism of actions. Further safety assessments and clinical trials in humans need to be performed before it can be integrated into medicinal practices. The present review has provided preliminary information for further studies and commercial exploitations of deer antler base.

In plain language: there is no evidence that deer antler has any health effects whatsoever.

If you are nevertheless interested, you can very easily buy deer antler as a supplement.

But PLEASE, don’t let Rudolph hear about it; he empathises with his relatives who detest being harvested for useless TCM.

 

Need a last minute X-mas present?

I might have just the right thing for you: Healing Courses Online.

They are run by true professionals who clearly know what they are doing: The founders of The Online Bio Energy Healing Training Course are John Donohoe and Patricia Hesnan, both of whom have been working in the alternative complementary healing area for over 25 years. Our healing centre clinic has been involved in teaching, development and trainings since it was first established in 1990, and we continue to promote and hold our regular live training courses.

Healing Courses Online is registered with the CMA (Complementary Medical Association), which is internationally recognized as the leading organization in professional, ethical complementary medicine by professional practitioners, therapists, and the public in general. Having completed this course, you can apply for membership of the CMA which offers a number of benefits including supplying professional accreditation. The CAM industry does not have a single regulatory body at present. With this in mind here at Oisin Centre Limited and Healing Courses Online we provide certification and training of the highest standards and expect our students to adhere to all statutory regulations, standards and codes of ethics regarding professional practice as therapists. You can feel safe in the knowledge that we are an experienced and trusted provider of Energy Healing training courses.

 

AND HERE ARE THE DETAILS AND PRICE-TAGS OF 4 COURSES:

 

A diploma course in energy healing. It includes 58 professional video lessons, 8 PDF lectures in a carefully constructed A, B, C, step-by-step format, allowing you to learn each technique and each application in easy stages. When you have completed the course you receive a Certified Diploma in Energy Healing. Once you have the knowledge and understand how to apply this energy healing therapy you can help yourself and others to activate the body’s own natural process of self-healing.

€97.00 – Was €375.00

A diploma course in sound healing. It includes 37 professional video lessons, 18 PDF lectures in a carefully constructed A, B, C, step-by-step format, allowing you to learn each technique and each application in easy stages. When you have completed the course, you receive a Certified Diploma in Sound Healing. Learn the secrets to sound healing with Tibetan singing bowls, Chinese gong, Tuning forks, the Human Voice, plus energy healing clearing for chakras plus much more.

€69.00 – Was €275.00

A diploma course in animal energy healing. It includes 30 practical video lessons and 5 PDF lectures in a carefully constructed A, B, C, step-by-step format, allowing you to learn each technique and each application in easy stages. When you have completed the course, you receive a Certified Diploma in Animal Healing. This is an ideal course to learn how you can help your pet or any animal so they may be healthy, happy and content.

€59.00 – Was €225.00

SELF HEALING / SELF HELP ONLINE COURSE includes 24 professional video lessons, plus 20 PDF lectures in a carefully constructed A, B, C, step-by-step format, allowing you to learn each technique and each application in easy stages and certification of completion. You can view a video with simple Qi-Gong exercises filmed at picturesque Galway Bay in Ireland. The aim of using singing bowls, crystal bowls, tuning forks, healing music, or the human voice as a self healing modality is to help restore the body to its normal.

€19.99 – Was €199.00

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IN CASE YOU WONDER WHAT YOU CAN DO ONCE YOU HAVE PASSED ONE OF THOSE COURSES, THE COURSE DIRECTORS GIVE IT TO YOU STRAIGHT:

Energy healing can be used as a standalone therapy or in conjunction with many other modalities including counselling, psychotherapy, hypnosis, acupuncture, massage, reflexology, and many more.

As soon as you have completed the course plus a short 10 question test, you will be granted your diploma, which you can download and print. (Your diploma is also automatically sent to your email account.)

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On this blog and elsewhere, my critics regularly complain that I do not have any qualifications in alternative medicine. Therefore, I am tempted to enrol (as a generous and high-value X-mas present to myself) – even though I am still uncertain which of the 4 courses might be best for me (and, of course, I cannot be sure to pass the ’10 question test’!).

How about you?

Will you join me?

Naturopathy is an eclectic system of health care that uses elements of alternative and conventional medicine to support and enhance self-healing processes. Naturopaths employ treatments based on therapeutic options that are thought of as natural, e. g. naturally occurring substances such as herbs, as well as water, exercise, diet, fresh air, pressure, heat and cold – but occasionally also acupuncture, homeopathy and manual therapies.

Naturopathy is steeped in the obsolete concept of vitalism which is the belief that living organisms are fundamentally different from non-living entities because they contain some non-physical element or are governed by different principles than are inanimate things. Naturopaths claim that they are guided by a unique set of principles that recognize the body’s innate healing capacity, emphasize disease prevention, and encourage individual responsibility to obtain optimal health. They also state that naturopathic physicians (NDs) are trained as primary care physicians in 4-year, accredited doctoral-level naturopathic medical schools.

However, applied to English-speaking countries (in Germany, a doctor of naturopathy is a physician who has a conventional medical degree), such opinions seem little more than wishful thinking. It has been reported that New Brunswick judge ruled this week that Canadian naturopaths — pseudoscience purveyors who promote a variety of “alternative medicines” like homeopathy, herbs, detoxes, and acupuncture — cannot legally call themselves “medically trained.”

The lawsuit was filed because actual physicians were frustrated that fake doctors were using terms like “medical practitioner” and saying they worked at a “family practice.” This conveyed the false idea that naturopaths were qualified at the same level as real doctors.

The argument from naturopaths was that they weren’t misleading anyone. “There’s not even the slightest hint of evidence that anyone has been misled — or worse, harmed,” [attorney Nathalie Godbout] said. “This mythical patient that has to be protected by naturopathic doctors — I haven’t met them yet.”

However, Justice Hugh McLellan wasn’t buying it. He said the justification for naturopaths using terms such as “doctor” and “family physician” are based on the assumption that “people are attuned to the meaning of words like “naturopathy.” Many patients might read a website or a Facebook ad out of context, he said, and fail to pick up on the difference between “a doctor listing his or her qualifications as ‘Dr. So-and-So, B.Sc., MD,’ as opposed to the listing that might include ‘B.Sc., ND [naturopathic practitioner].’”

“I see a risk here,” McLellan said, “that the words … could, in fact, imply or be designed to lead the public to believe these various naturopaths are entitled to practise medicine.”

Britt Marie Hermes, a former naturopath who now warns people about the shortcomings of the profession, said she was thrilled with the judge’s ruling: “This is a very encouraging step in the right direction toward ensuring public safety. Naturopaths are not doctors. The onus should not be on patients to vet the credentials and competency of someone holding themselves out to be a medically trained physician. Now, patients will have an easier time separating truly medically qualified physicians from naturopathic practitioners. Bravo New Brunswick!”

In view of the many horror-stories that emerge about naturopathy, I am inclined to agree with Britt:

In the context of healthcare the title ‘doctor’ or ‘physician’ must be reserved to those who have a conventional medical degree. Anything else means misleading the public to an unacceptable degree, in my view.

 

A few weeks ago, I was interviewed by a journalist who wanted to publish the result in a magazine. He now informed me that his editor decided against it, and the interview thus remained unpublished. I have the journalist’s permission to publish it here. The journalist who, in my view, was well-prepared (much better than most), prefers to remain unnamed.

Q: How would you describe yourself?

A: I am a researcher of alternative medicine.

Q: Not a critic of alternative medicine?

A: Primarily, I am a researcher; after all, I have published more Medline-listed research papers on the subject than anyone else on the planet.

Q: You are retired since a few years; why do you carry on working?

A: Mainly because I see a need for a critical voice amongst all the false and often dangerous claims made by proponents of alternative medicine. But also because I enjoy what I am doing. Since I retired, I can focus on the activities I like. There is nobody to tell me what to do and what not to do; the latter happened far too often when I was still head of my research unit.

Q: Fine, but I still do not quite understand what drives you. Who is motivating you to criticise alternative medicine?

A: Nobody. Some people claim I am paid for my current activities. This is not true. My blog actually costs me money. My books never return enough royalties to break even, considering the time they take to write. And for most of my lectures I don’t charge a penny.

Q: There are people who find this hard to believe.

A: I know. This just shows how money-orientated they are. Do they want me to publish my tax returns?

Q: Sorry, but I still don’t understand your motivation.

A: I guess what motivates me is a sense of responsibility, a somewhat naïve determination to do something good as a physician. I am one of the only – perhaps even THE only – scientist who has researched alternative medicine extensively and who is not a promoter of bogus therapies but voices criticism about them. There are several other prominent and excellent critics of alternative medicine, of course, but they all come ‘from the outside’. I come from the inside of the alternative medicine business. This probably gives me a special understanding of this field. In any case, I feel the responsibility to counter-balance all the nonsense that is being published on a daily basis.

Q: What’s your ultimate aim?

A: I want to create progress through educating people to think more critically.

Q: Which alternative medicine do you hate most?

A: I do not hate any of them. In fact, I still have more sympathy for them than might be apparent. For my blog, for instance, I constantly search for new research papers that are rigorous and show a positive result. The trouble is, there are so very few of those articles. But when I find one, I am delighted to report about it. No, I do not hate or despise any alternative medicine; I am in favour of good science, and I get irritated by poor research. And yes, I do dislike false claims that potentially harm consumers. And yes, I do dislike it when chiropractors or other charlatans defraud consumers by taking their money for endless series of useless interventions.

Q: I noticed you go on about the risks of alternative medicine. But surely, they are small compared to the risks of conventional healthcare, aren’t they?

A: That’s a big topic. To make it simple: alternative medicine is usually portrayed as risk-free. The truth, however, is that there are numerous risks of direct and indirect harm; the latter is usually much more important than the former. Crucially, the risk-free image is incongruent with reality. I want to redress this incongruence. And as to conventional medicine: sure, it can be much more harmful. But one always has to see this in relation to the proven benefit. Chemotherapy, for instance, can kill a cancer patient, but more likely it saves her life. Homeopathic remedies cannot kill you, but employed as an alternative to an effective cancer treatment, homeopathy will certainly kill you.

Q: Homeopathy seems to be your particular hobby horse.

A: Perhaps. This is because it exemplifies alternative medicine in several ways, and because I started my alternative ‘career’ in a homeopathic hospital, all those years ago.

Q: In what way is homeopathy exemplary?

A: Its axioms are implausible, like those of many other alternative modalities. The clinical evidence fails to support the claims, like with so many alternative therapies. And it is seemingly safe, yet can do a lot of harm, like so many other treatments.

Q: You have no qualification in homeopathy, is that right?

A: No, I have no such qualifications. And I never said so. When I want to tease homeopaths a little, I state that I am a trained homeopath; and that is entirely correct.

Q: In several countries, homeopathy has taken spectacular hits recently. Is that your doing?

A: No, I don’t think so. But I do hope that my work has inspired the many dedicated activists who are currently protesting against the reimbursement of homeopathy by the public purse in the UK, Germany, France, Spain, etc.

Q: You often refer to medical ethics; why is that?

A: Because, in the final analysis, many of the questions we already discussed are really ethical issues. And in alternative medicine, few people have so far given the ethical dimensions any consideration. I think ethics are central to alternative medicine, so much so that I co-authored an entire book on this topic this year.

Q: Any plans for the future?

A: Plenty.

Q: Can you tell me more?

A: I will publish another book in 2019 with Springer. It will be a critical evaluation of precisely 150 different alternative modalities. I am thinking of writing yet another book, but have not yet found a literary agent who wants to take me on. I have been offered a new professorship at a private University in Vienna, and am hesitant whether to accept or not. I have been invited to give a few lectures in 2019 and hope to receive more invitations. Last not least, I work almost every day on my blog.

Q: More than enough for a retiree, it seems. Thank you for your time.

A: My pleasure.

Most chiropractors claim that their manipulations prevent illness, not just spinal but also non-spinal conditions. But is there any sound evidence for that assumption? A team of chiropractic researchers wanted to find out. Specifically, the objective of their systematic review was to investigate if there is any evidence that spinal manipulations/chiropractic care can be used in primary prevention (PP) and/or early secondary prevention in diseases other than musculoskeletal conditions.

Of the 13.099 titles scrutinized by the authors, 13 articles were included. These were

  • 8 clinical studies,
  • 5 population studies.

These studies dealt with various issues such as

  • diastolic blood pressure,
  • blood test immunological markers,
  • and mortality.

Only two clinical studies could be used for data synthesis. None showed any effect of spinal manipulation/chiropractic treatment.

The authors’ conclusions were straight forward: we found no evidence in the literature of an effect of chiropractic treatment in the scope of PP or early secondary prevention for disease in general. Chiropractors have to assume their role as evidence-based clinicians and the leaders of the profession must accept that it is harmful to the profession to imply a public health importance in relation to the prevention of such diseases through manipulative therapy/chiropractic treatment.

Many chiropractors have adopted the ‘dental model’ in their practice, proposing to prevent all sorts of conditions through treatment of spinal subluxations before symptoms arise. Some call this approach ‘maintenance care’ and liken it to the need for servicing a car. They tell their patients that regular consultations will prevent problems in the future. It seems obvious that this can be a nice little earner. In 2009, I reviewed the evidence on chiropractic maintenance treatment. Here is the abstract:

Most chiropractors advise patients to have regular maintenance treatments with spinal manipulation, even in the absence of any symptoms or diseases. This article evaluates the evidence for or against this approach. No compelling evidence was found to indicate that chiropractic maintenance therapy effectively prevents symptoms or diseases. As spinal manipulation has repeatedly been associated with considerable harm, the risk benefit balance of chiropractic maintenance care is not demonstrably positive. Therefore there are no good reasons to recommend it.

The new review confirms that this approach is useful only for filling the pockets of chiropractors.

The inevitable question arises: WHEN WILL CHIROPRACTORS STOP MISLEADING THE PUBLIC FOR THEIR PERSONAL GAIN?

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

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

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

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

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

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

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

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

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

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

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

On their website, the UK ‘ROYAL COLLEGE OF CHIROPRACTORS (RCC) published a short statement regarding the safety of chiropractic. Here it is in full:

Experiencing mild or moderate adverse effects after manual therapy, such as soreness or stiffness, is relatively common, affecting up to 50% of patients. However, such ‘benign effects’ are a normal outcome and are not unique to chiropractic care.

Cases of serious adverse events, including spinal or neurological problems and strokes caused by damage to arteries in the neck, have been associated with spinal manipulation. Such events are rare with estimates ranging from 1 per 2 million manipulations to 13 per 10,000 patients; furthermore, due to the nature of the underlying evidence in relation to such events (case reports, retrospective surveys and case-control studies), it is very difficult to confirm causation (Swait and Finch, 2017).

For example, while an association between stroke caused by vertebral artery damage or ‘dissection’ (VAD) and chiropractor visits has been reported in a few case-control studies, the risk of stoke has been found to be similar after seeing a primary care physician (medical doctor). Because patients with VAD commonly present with neck pain, it is possible they seek therapy for this symptom from a range of practitioners, including chiropractors, and that the VAD has occurred spontaneously, or from some other cause, beforehand (Biller et al, 2014). This highlights the importance of ensuring careful screening for known neck artery stroke risk factors, or signs or symptoms that there is an ongoing problem, is performed prior to manual treatment of patients (Swait and Finch, 2017). Chiropractors are well trained to do this on a routine basis, and to urgently refer patients if necessary.

END OF QUOTE

The statement reads well but it might not be entirely free from conflicts of interest. Yet, in the name of accuracy, completeness and truthfulness, I take the liberty of making a few slight alterations. Here is my revised version:

Experiencing mild or moderate adverse effects after chiropractic spinal manipulations, such as pain or stiffness (usually lasting 1-3 days and strong enough to impair patients’ quality of life), is very common. In fact, it affects around 50% of all patients. 

Cases of serious adverse events, including spinal or neurological problems and strokes often caused by damage to arteries in the neck, have been reported after spinal manipulation. Such events are probably not frequent (several hundred are on record including about 100 fatalities).  But, as we have never established proper surveillance systems, nobody can tell how often they occur. Furthermore, due to our reluctance of introducing such surveillance, some of us are able to question causality.

An association between stroke caused by vertebral artery damage or ‘dissection’ (VAD) and chiropractic spinal manipulation has been reported in about 20 independent investigations. Yet one much-criticised case-control study found the risk of stoke to be similar after seeing a primary care physician (medical doctor). Because patients with VAD commonly have neck pain, it is possible they seek therapy for this symptom from chiropractors, and that the VAD has occurred spontaneously, or from some other cause, beforehand (Biller et al, 2014). Ensuring careful screening for known neck artery stroke risk factors, or signs that there is an ongoing problem would therefore be important (Swait and Finch, 2017). Sadly, no reliable screening tests exist, and neck pain (the symptom that might be indicative of VAD) continues to be one of the conditions most frequently treated by chiropractors.

I do not expect the RCC to adopt my improved version. In case I am wrong, let me state this: I am entirely free of conflicts of interest and will not charge a fee for my revision. In the interest of advancing public health, I herewith offer it for free.

According to the investigators, the primary objective this study (thanks again Dr Jens Behnke) was to evaluate the effectiveness of homoeopathic remedies in improving quality of life (QoL) of chronic urticaria (CU) patients.

The study population included patients attending the Outpatient Department of State Homoeopathic Dispensary, Ahmadpur, India. Quality of Life (QoL) questionnaire (CU-Q2oL) and average Urticaria Activity Score for 7 days (UAS7) questionnaires were filled at baseline and 3rd, 6th, 9th and 12th months. The study included both male and female patients diagnosed with CU. Eighteen homoeopathic remedies were used. The individualised prescriptions were based on the totality of each patient’s symptoms.

A total of 134 patients were screened and 70 were diagnosed with CU and enrolled in the study. The results were analysed under modified intention-to-treat approach. Significant difference was found in baseline and 12th month CU-Q2oL score. Apis mellifica (n = 10), Natrum muriaticum (n = 9), Rhus toxicodendron (n = 8) and Sulphur (n = 8) were the most frequently used remedies.

The authors concluded that homoeopathic medicines have potential to improve QoL of CU patients by reducing pruritus, intensity of wheals, swelling, nervousness, and improve sleep, mood and concentration. Further studies with more sample size are desirable.

The primary objective of this study was, I would argue, to promote the erroneous idea that homeopathy is an effective therapy. It cannot have been to evaluate its effectiveness, because for such an aim one would clearly have needed a control group. Without it, the findings are consistent with the following facts:

  1. Homeopathy is useless.
  2. CU responds to placebo treatments.
  3. CU gets better over time.
  4. Regression towards the mean has contributed to the outcome.
  5. Homeopaths often have no idea about clinical research.
  6. Further trials are not needed.
  7. If someone disagrees with my point 6, the sample size is less important than the inclusion of a control group.

An article alerted me to a new report on alternative medicine in the NHS. The report itself is so monumentally important that I cannot find it anywhere (if someone finds a link, please let us know). Behind it is our homeopathy-loving friend David Tredinnick MP, chair of the All-Party Parliamentary Group. I am sure you remember him; he is ‘perhaps the worst example of scientific illiteracy in government’. And what has David been up to now?

His new report by the All-Party Parliamentary Group for Integrated Healthcare is urging the NHS to embrace more medicine to ease the mounting burden on service provision. It claims that more patients suffer from two or more long-term health conditions than ever before, and that their number will amount to 18 million by 2025.

And the solution?

Isn’t it obvious?

David Tredinnick MP, chair of the All-Party Parliamentary Group, insists that the current approach being taken by the government is unsustainable for the long-term future of the country. “Despite positive signs that ministers are proving open to change, words must translate into reality. For some time our treasured NHS has faced threats to its financial sustainability and to common trust in the system. Multimorbidity is more apparent now in the UK than at any time in our recent history. As a trend it threatens to swamp a struggling NHS, but the good news is that many self-limiting conditions can be treated at home with the most minimal of expert intervention. Other European governments facing similar challenges have considered the benefits of exploring complementary, traditional and natural medicines. If we are to hand on our most invaluable institution to future generations, so should we.”

Hold on, this sounds familiar!

Wasn’t there something like it before?

Yes, of course, the ‘Smallwood Report‘, commissioned over a decade ago by Prince Charles. It also proclaimed that the NHS could save plenty of money, if it employed more bogus therapies. But it was so full of errors and wrong conclusions that its impact on the NHS was close to zero. At the time, I concluded that the ‘Smallwood report’ is one of the strangest examples of an attempt to review CAM that I have ever seen. One gets the impression that its conclusions were written before the authors had searched for evidence that might match them. Both Mr Smallwood and the ‘Freshminds’ team told me that they understand neither health care nor CAM. Mr Smallwood stressed that this is positive as it prevents him from being ‘accused of bias’. My response was that ‘severely flawed research methodology almost inevitably leads to bias’.

And which other European countries might the Tory Brexiter David refer to?

Not Spain?

Not France?

Not Austria?

Not Germany?

Sadly, I have not seen Tredinnick’s  new oeuvre and do not know its precise content. What I do know, however, that the evidence, for alternative medicine’s cost effectiveness has not improved; if anything, it has become more negative. From that, one can safely conclude that Tredinnick’s notions of NHS-savings through more use of alternative medicine are erroneous. Therefore, I suspect the new report will swiftly and deservedly go the same way as its predecessor, the ‘Smallwood Report’: straight into the bins of Westminster.

The most frequent of all potentially serious adverse events of acupuncture is pneumothorax. It happens when an acupuncture needle penetrates the lungs which subsequently deflate. The pulmonary collapse can be partial or complete as well as one or two sided. This new case-report shows just how serious a pneumothorax can be.

A 52-year-old man underwent acupuncture and cupping treatment at an illegal Chinese medicine clinic for neck and back discomfort. Multiple 0.25 mm × 75 mm needles were utilized and the acupuncture points were located in the middle and on both sides of the upper back and the middle of the lower back. He was admitted to hospital with severe dyspnoea about 30 hours later. On admission, the patient was lucid, was gasping, had apnoea and low respiratory murmur, accompanied by some wheeze in both sides of the lungs. Because of the respiratory difficulty, the patient could hardly speak. After primary physical examination, he was suspected of having a foreign body airway obstruction. Around 30 minutes after admission, the patient suddenly became unconscious and died despite attempts of cardiopulmonary resuscitation.

Whole-body post-mortem computed tomography of the victim revealed the collapse of the both lungs and mediastinal compression, which were also confirmed by autopsy. More than 20 pinprick injuries were found on the skin of the upper and lower back in which multiple pinpricks were located on the body surface projection of the lungs. The cause of death was determined as acute respiratory and circulatory failure due to acupuncture-induced bilateral tension pneumothorax.

The authors caution that acupuncture-induced tension pneumothorax is rare and should be recognized by forensic pathologists. Postmortem computed tomography can be used to detect and accurately evaluate the severity of pneumothorax before autopsy and can play a supporting role in determining the cause of death.

The authors mention that pneumothorax is the most frequent but by no means the only serious complication of acupuncture. Other adverse events include:

  • central nervous system injury,
  • infection,
  • epidural haematoma,
  • subarachnoid haemorrhage,
  • cardiac tamponade,
  • gallbladder perforation,
  • hepatitis.

No other possible lung diseases that may lead to bilateral spontaneous pneumothorax were found. The needles used in the case left tiny perforations in the victim’s lungs. A small amount of air continued to slowly enter the chest cavities over a long period. The victim possibly tolerated the mild discomfort and did not pay attention when early symptoms appeared. It took 30 hours to develop into symptoms of a severe pneumothorax, and then the victim was sent to the hospital. There he was misdiagnosed, not adequately treated and thus died. I applaud the authors for nevertheless publishing this case-report.

This case occurred in China. Acupuncturists might argue that such things would not happen in Western countries where acupuncturists are fully trained and aware of the danger. They would be mistaken – and alarmingly, there is no surveillance system that could tell us how often serious complications occur.

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