I have already posted challenges to homeopaths. For instance, in a previous post, I asked the ‘homeopaths of the world’ to answer a few questions satisfactorily. In return, I promised to no longer doubt their memory of water theory. If they cannot do this, I contended, they should to admit that all their ‘sciency’ theories about the mode of action of highly diluted homeopathic remedies are really quite silly – more silly even than Hahnemann’s idea of a ‘spirit-like’ effect.
And then there is the challenge to correctly identify their own remedies. In return, they would even earn the neat sum of Euro 50 000.
So far, none of these challenges have been met. But one must not give up hope!!!
Meanwhile, I have decided to issue another one. Let me explain:
One argument that the ‘defenders of the homeopathic realm’ love and almost invariably use, when someone states that it is time to move on and ban homeopathy to the history books, is this one:
IF WE BANNED HOMEOPATHY FROM OUR CLINICAL ROUTINE, WE WOULD ALSO HAVE TO BAN MANY OF THE TREATMENTS USED IN CONVENTIONAL MEDICINE WHICH ARE EQUALLY POORLY SUPPORTED BY SOUND EVIDENCE FOR EFFICACY.
This looks like a good argument!
I am sure that politicians, journalists, consumers and even many healthcare professionals find it convincing.
We know that lots of conventional treatments are less well supported than many of us would hope or think.
But less well-supported than homeopathy?
Let’s see: Homeopathy has been around for ~200 years. Controlled clinical trials of homeopathy have been conducted since 1835. Today, we have about 500 controlled clinical trials of homeopathy. The totality of these data fails to convincingly demonstrate that homeopathy is more than a placebo.
Are there many other therapies that fulfil these criteria? Personally, I am not aware of such a therapy, and if I did know one, I am fairly certain that I would advocate its elimination from our clinical routine.
But I am, of course, not an expert in all fields of healthcare.
Perhaps such treatments do exist!
I want to find out, and – as always – the burden of proof is with those who use this argument.
Which brings me to my challenge.
I HEREWITH CHALLENGE HOMEOPATHS AND THEIR FOLLOWERS TO NAME THERAPIES THAT ARE AS USELESS AS HOMEOPATHY!
To be clear, they ought to fulfil the following criteria:
- The treatment must be about 200 years old (plenty of time for a thorough evaluation).
- It should have been extensively tested in about 500 controlled clinical trials.
- The totality of this evidence should be negative.
- The treatment should be part of the clinical routine and have ardent proponents who insist it should be paid for by public funds.
I hope lots of homeopaths can name lots of such therapies.
Failing this, they should think twice before they use the above argument again.
The literature on malpractice in medicine is huge: more than 33 000 articles listed in Medline. By contrast, the literature on malpractice in alternative medicine hardly exists. An exception is this recent article. I therefore thought I share it with you and provide a few comments:
START OF QUOTE
According to the (US) National Practitioner Data Bank, between September 1, 1990 and January 29, 2012, a total of 5,796 chiropractic medical malpractice reports were filed. Lawsuits with the highest payouts in any medical field are related to misdiagnosis, failure to diagnose and delayed diagnosis of a severe medical condition.
Common reasons for chiropractic malpractice lawsuits:
Chiropractor causes stroke: Numerous cases have been documented in which a patient suffers a stroke after getting his or her neck manipulated, or adjusted. Especially forceful rotation of the neck from side to side can overextend an artery that runs along the spine, which can result in a blockage of blood flow to the brain. Strokes are among the most serious medical conditions caused by chiropractic treatment, and can result in temporary or permanent paralysis, and even death.
Herniated disc following adjustment: Although many patients seek the medical attention of a chiropractor after they have experienced a herniated disc, chiropractors can actually be the cause of the problem. Usually a herniated disc is caused by wear and tear, but a sudden heavy strain, increased pressure to the lower back or twisting motions can cause a sudden herniated disc. The stress that chiropractors exercise in their adjustments have been known to be the root cause of some herniated discs.
Sexual misconduct: The American Chiropractic Association has assembled a code of ethics “based upon the acknowledgement that the social contract dictates the profession’s responsibilities to the patient, the public and the profession.” Sexual misconduct is among the top ten reasons that patients file lawsuits against chiropractors. Often, chiropractic practices are unfamiliar to many new patients and can be misinterpreted as inappropriate even though they are absolutely normal, so it is important that patients familiarize themselves with common chiropractic methods of healing.
END OF QUOTE
In this context, a study of chiropractic from Canada might be interesting. It highlights the conclusions from Canadian courts: informed consent is an ongoing process that cannot be entirely delegated to office personnel… A further study showed that valid consent procedures are either poorly understood or selectively implemented by chiropractors. Arguably, not obtaining informed consent amounts to malpractice.
In our book, this is what we conclude about informed consent by alternative therapists in general: Genuine informed consent is unattainable for most CAM modalities. This presents a serious and intractable ethical problem for CAM practitioners. Attempts to square this circle by watering down or redeﬁning the criteria for informed consent are ethically indefensible. The concept of informed consent and its centrality in medical ethics therefore renders most CAM practice unacceptable. Conventional healthcare subscribes to the ethical principle ‘no consent, no treatment’: we are not aware of the existence of any good reasons to excuse CAM from this dictum.
I fear that, if we were to count the lack of informed consent by chiropractors (and other alternative practitioners) as malpractice, the numbers would be astronomical. Or, to put it differently, the often-cited relatively low malpractice rate in chiropractic is due to the omission of the vast majority of malpractice cases.
“The wishes of a patient do not over-rule medical knowledge!” (Patientenwunsch steht nicht über medizinischem Wissen)
This was one brave conclusion drawn in a discussion about homeopathy during a recent German radio programme. Specifically, the discussion was about the pros and cons of a leading paediatric hospital of the Ludwig Maximilian Universitaet (LMU) Munich offering homeopathy to its patients (they also run a course in homeopathy which we discussed previously).
The wishes of a patient does not over-rule medical knowledge!
This sentence made me think.
Is it correct?
An interesting question with ethical dimensions!
The short answer is NO, I believe..
Patients can always refuse to have a given therapy, if they so wish. Or they might opt for one evidence-based therapy instead of another. And in certain circumstances such wishes may well be completely against the current best medical knowledge.
But this is probably where the dominance of the patient’s wishes over medical knowledge ends — at least, if we only consider wishes paid for by the public purse (otherwise, anyone can, of course, buy almost any rubbish).
And that was not what the above-mentioned discussion was about. It focussed on the arguments by the LMU to justify their offer of homeopathy to sick children. Essentially, they seem to say:
- We believe in evidence-based medicine (EBM) and are fully dedicated to its principles.
- We know that homeopathy is not evidence-based.
- Yet, many of the parents want us to use homeopathy in the treatment of their kids.
- And the wish of a patient over-rules the medical evidence.
This is, of course, a flawed argument. One cannot subscribe to EBM and, at the same time, administer overt nonsensical, disproven treatments. A patient’s wish does not render a nonsensical treatment evidence-based. If one would follow the LMU logic, one would have to use any idiotic therapy … and could still pride oneself to follow EBM practice. In England, we call this ‘having the cake and eat it’; once you eat the cake, it’s gone and you cannot have it any longer.
What follows is simple: the decision makers at the LMU have been found out with (homeopathically potentised) egg on their faces (for some reason they had this homeopathy enclave for years, it is well-established and, I suspect, even better protected by some people of influence). They quickly tried to find a way out of their dilemma. Unfortunately, they did not think hard enough; the solution to bank on patient choice turns out to be a non-solution.
I therefore suggest they get in line with the role of a University hospital, with today’s medical thinking and medical ethics. This would mean re-considering their homeopathy course as well as their inclusion of homeopathy in publicly-funded routine care.
One of the aims in running this blog has always been to stimulate critical thinking (not just in my readers but also in myself).
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.
Carl Sagan explained it best: “It seems to me what is called for is an exquisite balance between two conflicting needs: the most skeptical scrutiny of all hypotheses that are served up to us and at the same time a great openness to new ideas. Obviously those two modes of thought are in some tension. But if you are able to exercise only one of these modes, whichever one it is, you’re in deep trouble. If you are only skeptical, then no new ideas make it through to you. You never learn anything new. You become a crotchety old person convinced that nonsense is ruling the world. (There is, of course, much data to support you.) But every now and then, maybe once in a hundred cases, a new idea turns out to be on the mark, valid and wonderful. If you are too much in the habit of being skeptical about everything, you are going to miss or resent it, and either way you will be standing in the way of understanding and progress. On the other hand, if you are open to the point of gullibility and have not an ounce of skeptical sense in you, then you cannot distinguish the useful as from the worthless ones.”
Critical thinking is not something one is born with; but I strongly believe that most people can be taught this skill. This study suggests that I may be right. The 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. Student pre-course endorsement of religious, paranormal, and pseudo-scientific beliefs ranged from 21 to 53%, with religion having the highest endorsement rate. Pre-course belief in paranormal and pseudo-scientific subjects was correlated with high scores in some fantasy thinking scales and showed a gender and a religion effect with females having an 11.1% higher belief across all paranormal and pseudo-science subcategories. Students’ religion, and frequency of religious service attendance, was also important with agnostic or atheist students having lower beliefs in paranormal and pseudo-science subjects compared to religious students. Students with either low religious service attendance or very high attendance had lower paranormal and pseudoscientific beliefs.
Following the critical thinking course, overall beliefs in paranormal and pseudo-scientific subcategories lowered 6.8–28.9%, except for superstition, which did not significantly change. Change in belief had both a gender and religion effect with greater reductions among religious students and females.
The link between religion and alternative medicine is relatively well-established. A 2014 study, for instance, showed an association between alternative medicine use and religiosity. The finding that females have an 11.1% higher belief in the paranormal and pseudo-science is new to me, but it would tie in with the well-documented fact that women use alternative medicine more frequently than men.
The most important finding, however, is clearly that critical thinking can be taught.
That must be good news! As discussed previously, critical thinkers experience fewer bad things in life than those of us who do not have acquired that skill. This cannot come as a surprise – being able to tell useful concepts from worthless ones should achieve exactly that.
An article has just been published announcing the reform of the German Heilpraktiker, the profession of alternative practitioners that has been discussed repeatedly on this blog and criticised recently by the ‘Muensteraner Kreis’. As the new article is in German, I will try to summarise the essence of it here:
The health ministers of all German counties have decided yesterday that they will start reforming the profession of the Heilpraktiker that has attracted much criticism in recent months. The current laws are no longer fit for purpose. There is neither a mandatory agreement for the education of the Heilpraktiker, nor a uniform regulation of the profession.
The senator for health from Hamburg stated: “We feel that the Heilpraktiker should not be allowed to do certain thing, but be permitted to do plenty of activities that remain legal.” At present, the Heilpraktiker is allowed to treat fractures, malignancies, give injections, and even manufacture certain medicines. “We believe there is a need for regulation to protect patients.”
Now a working group will be formed to investigate and produce a report within a year. Remarkably, the German health secretary avoided commenting. In a statement, it was said that patients must be empowered to make decisions on the basis of quality-assured information.
The full German text is below.
Nach mehreren deutschlandweit Aufsehen erregenden Todesfällen beispielsweise von Krebspatienten, die kurz nach der Therapie durch einen Heilpraktiker in Brüggen-Bracht starben, will die Politik sich nun diesen Berufszweig vornehmen. Die Gesundheitsminister aller Bundesländer haben am Donnerstag beschlossen, eine Reform anzugehen. „Das unzureichend regulierte Heilpraktikerwesen mit seiner umfassenden Heilkundebefugnis steht unverändert in der Kritik“, heißt es in einer Erklärung. Das Heilpraktikergesetz könne dem heutigen Anspruch an den Gesundheitsschutz der Patienten nicht mehr gerecht werden. Für Heilpraktiker gebe es weder verbindliche Regeln zur Ausbildung noch eine einheitliche Berufsordnung. Andere Gesundheitsberufe müssten hingegen strenge Qualifikationskriterien erfüllen.
„Wir sehen es als kritisch an, dass einige Tätigkeiten zwar den Heilpraktikern untersagt sind, aber es noch eine Fülle von Tätigkeiten gibt, die zugelassen sind“, sagte die Hamburger Senatorin für Gesundheit, Cornelia Prüfer-Storcks, auf einer Pressekonferenz – sie hatte die Initiative maßgeblich vorangetrieben. So dürfen Heilpraktiker Knochenbrüche therapieren, schwere und bösartige Erkrankungen behandeln und Injektionen geben. Selbst die Herstellung von Arzneimitteln für bestimmte Patienten sei Heilpraktikern erlaubt. „Ohne die Prüfmechanismen, die wir normalerweise haben, wenn wir Arzneimittel zulassen und produzieren“, kritisierte Prüfer-Storcks. „Wir glauben, dass es hier Regelungsbedarf gibt aus Sicht des Patientenschutzes.“
„Die Ministerinnen und Minister, Senatorinnen und Senatoren für Gesundheit sehen eine zwingende Reformbedürftigkeit des Heilpraktikerwesens“, heißt es in dem kurzen, MedWatch vorliegenden Beschluss. „Der Bund wird gebeten, eine Bund-Länder-Arbeitsgruppe einzurichten, die eine grundlegende Reform des Heilpraktikerwesens prüft.“ Das Ergebnis der Prüfung solle bis zur Gesundheitsministerkonferenz in einem Jahr vorgelegt werden.
Bundesgesundheitsminister Jens Spahn erklärte auf der Pressekonferenz das Patientenwohl zwar zum entscheidenden Maßstab für die Gesundheitspolitik. „Deshalb finde ich es richtig, dass die Gesundheitsministerkonferenz bei der Patientenorientierung ihren Schwerpunkt setzt“, sagte er. Auf mögliche Reformen des Heilpraktikerberufes ging der Minister bei der Pressekonferenz jedoch nicht ein. Inwiefern sein Haus die von den Landesministern geforderte Reform des Heilpraktikerwesens mit unterstützen wird, bleibt offen. Auf Nachfrage, ob das Ministerium eine Bund-Länder-Arbeitsgruppe unterstützen würde, versteckte sich eine Sprecherin bereits im Mai hinter der Mini-Reform von Gröhe. Mit Blick auf die kurze Zeit seit Inkrafttreten dieser Änderungen sei es angemessen, zunächst zu prüfen, ob und inwieweit diese zum Schutz des Patientenwohles beiträgt, erklärte sie – „ehe weitere gesetzliche Maßnahmen in Betracht gezogen werden sollten“.
In einem Grundsatzbeschluss sprach sich die Gesundheitsministerkonferenz außerdem für „Patientenorientierung als Element einer zukunftsweisenden Gesundheitspolitik“ aus. „Das heißt, dass der Patient natürlich das Heft in der Hand haben muss, dass er versteht, was mit ihm gemacht wird, warum es mit ihm gemacht wird, mit welchen Chancen die Behandlung verbunden ist“, sagte NRW-Gesundheitsminister Karl Laumann. Auch in der Ausbildung des Gesundheitspersonals sollten diese Aspekte einen großen Stellenwert bekommen, betonte Laumann – und erwähnte zwar Ärzte als Berufsgruppe explizit, nicht aber Heilpraktiker. Der frühere Bundespatientenbeauftragte forderte außerdem mehr Transparenz ein. In Teilen des Gesundheitssystems gebe es wegen mangelnder Transparenz „eine gewisse Misstrauenskultur“, sagte er.
Die Minister wollen laut dem Beschluss die Patientensouveränität und der Orientierung im Gesundheitswesen verbessern, die Gesundheitskompetenz und gesundheitliche Eigenverantwortung beispielsweise durch die Einrichtung eines nationalen Gesundheitsportals deutlich stärken und Kommunikation und Wissenstransfer zwischen Patienten und allen Beteiligten im Gesundheitswesen fördern. „Patienten sollen so in die Lage versetzt werden, ihre Interessen besser zu vertreten und ihre Entscheidungen auf der Basis qualitätsgesicherter Informationen zu treffen“, heißt es.
Kommunikationskompetenz und wertschätzende Beziehungsgestaltung sei im Gesundheitswesen von wesentlicher Bedeutung für die Partizipation, Qualität, Sicherheit und den Erfolg der gesundheitlichen Prävention und der medizinischen Behandlung, betonen die Minister. Allgemeinverständliche „Patientenbriefe“ sollen als erster Schritt die Informiertheit von Patienten nach Krankenhausbehandlungen erhöhen. Außerdem soll das Bundesgesundheitsminister eine Pflicht schaffen, dass niedergelassene Ärzte ihren Patienten neutrale und evidenzbasierte schriftliche Informationen zu Zusatzangeboten – sogenannten „Individuellen Gesundheitsleistungen“ – zur Verfügung stellen müssen.
Bei Behandlungsfehlern sollen nach Ansicht der Landesminister auf Bundesebene weitere Erleichterungen umgesetzt werden: Die Beweislast und das Beweismaß soll zu Gunsten von Patienten überarbeitet werden. Außerdem sollten Krankenkassen gesetzlich verpflichtet werden, Patienten beim Nachweis eines Behandlungsfehlers besser zu unterstützen.
I have been banging on about the German Heilpraktiker, its infamous history and its utter inadequacy since many years. This is what I published in 1996, for instance:
Complementary medicine is increasing in popularity. In most countries its practice is in the hands of non-medically trained practitioners, professions which are often not properly regulated. When discussing solutions to this problem the German “Heilpraktiker” is often mentioned. The history and present situation of this profession are briefly outlined. The reasons why the “Heilpraktiker concept” is not an optimal solution are discussed. It is concluded that the best way forward consists of regulation and filling the considerable gaps in knowledge relating to complementary medicine.
It goes without saying that, after so many tears of warning about the risks involved in allowing poorly trained practitioners, who are all too often unable to see the limits of their competency (and after many unnecessary fatalities), I am delighted that progress seems finally to be on the horizon.
This is a somewhat unusual post.
I do not normally dwell on personal anecdotes or experiences – but this one might be relevant, and it is absolutely true.
About 7 or 8 years ago (we had just published our book Trick or Treatment), I was invited to a meeting of health insurers. Not just any old meeting, but a top-notch conference where many of the world’s most influential executives of large insurance companies were gathered. It took place in one of the most luxurious hotels of Istanbul. The most prominent speaker was the brother of France’s president Sarkozy (who flew in by helicopter and came with two body-guards). He began his lecture by stating “You of course all know me because I have a famous sister in law.”
I did not have such a witty opening phrase for my talk. My task was to review the evidence for and against the major alternative therapies (at the time, I did such lectures regularly). My audience of about 300 people listened politely to what I had to say and, during, question time, they made some relevant comments. Altogether, it was a good and well-received lecture.
But the interesting bit came later.
Over coffee, I was surrounded by people who came to me and said something like this: “We know the evidence, of course, and we know how flimsy it is, particularly for homeopathy. But we still pay for it, because the competition does it too. We cannot be seen to offer less than they do. This is purely a commercial decision about being seen to be competitive.”
Such honesty came as a surprise to me. I had expected that they were well-informed about the evidence; after all, they were in charge of huge companies selling health insurances. Not knowing about the evidence would have been negligent. But I had not expected they would volunteer their motives quite so openly. I got the impression that they were trying to justify their nonsensical actions without seeming irrational. In a way, they seemed to say: ‘Such treatments might not work for the patient, but they do work for us’.
I remember suggesting to some of these executives that they could even be more competitive, progressive and ethical by telling their customers that they took better care of their money that the competition by NOT paying for ineffective treatments. Such remarks resulted in blank faces or vague smiles. I felt my audience had not really understood the opportunity. Being honest, transparent and evidence-based was evidently not understood as a viable marketing tool.
As I said, this was almost a decade ago
… lots has happened since.
I wonder whether the message might be more attractive today.
An announcement by the UK Society of Homeopaths caught my attention. Here it is in its full and unabbreviated beauty:
START OF ANNOUNCEMENT
Homeopaths are being urged to contribute to an inquiry exploring ways to tackle a looming public health crisis threatened by ‘superbugs’ – bacteria resistant to antibiotics and other antimicrobial drugs.
The Commons Select Committee on Health and Social Care is inviting evidence for its investigation into the progress made by the government so far in responding to the challenge.
The two angles it is exploring are:
- What results have been delivered by the current UK strategy on antimicrobial resistance (AMR), launched in 2013?
- Key actions and priorities for the government’s next AMR strategy, due to be published at the end of 2018.
The Society of Homeopaths is putting together a submission and is asking members to submit their own evidence to the inquiry of using homeopathic alternatives to antimicrobials.
According to the inquiry background papers, antimicrobial resistance – in which bacteria have evolved into ‘superbugs’, resistant to drugs devised to kill them – is a “significant and increasing threat” to public health in the UK and globally. EU data indicates that it is responsible for 700,000 deaths a year worldwide and at least 50,000 in the US and Europe.
The death toll could reach 10m people a year by 2050 if the rise in resistance is not headed off, it is estimated.
Society Chief Executive Mark Taylor said: “Our members know a great deal about the alternatives to antibiotics through their own practice and knowledge. This is a timely inquiry from the Health and Social Care Committee to assess the success of the existing strategy and an opportunity to make the case again for fresh thinking on this pressing public health challenge.”
END OF ANNOUNCEMENT
Yes, of course!
We have a crisis of antibiotic resistance.
Who is going to offer the solution?
They are going to treat us all with homeopathic remedies when the superbugs strike.
And the result?
No more crisis.
Because they have turned it into a catastrophe!!!
Traditional vaginal practices usually relate to personal hygiene, genital health or sexuality. Hygiene practices involve external washing and intravaginal cleansing or douching and ingestion of substances. Health practices include intravaginal cleansing, traditional cutting, insertion of herbal preparations, and application of substances to soothe irritated vaginal tissue.
One such traditional practice is ‘vaginal steaming’.
Recently vaginal steaming has become a fad promoted by SCAM-promoters (such as the vagina-obsessed Gwyneth Paltrow) with the claim that it leads to a range of health benefits. According to one website, for instance, vaginal steaming, Yoni Eggs, yoni or v-steam, as it is casually known, acts as an internal cleanser of the membranes of the vaginal tissues and uterus. This is considered especially important for stagnant fertility conditions and/or incomplete emptying of menses each cycle. This women’s treatment gently but effectively cleanses, tones and revitalizes a woman’s center, providing a myriad benefits from reduced menstrual cramps to increased fertility and more. Support your natural feminine cycle, help your body to heal, relax, and detoxify both physically and emotionally with a yoni steam.
The method is recommended for a wide range of conditions and is said to achieve all of the following and much, much more:
- Significant reduction of pain, bloating and exhaustion associated with menstruation.
- Significant reduction of PMS.
- Decrease of menstrual flow as well as reduction of dark purple or brown blood at the onset or end of menses.
- Regulation of irregular or absent menstrual cycles.
- Increased fertility.
- Faster healing and toning of the reproductive system following childbirth.
- Assisting in healing uterine fibroids, ovarian cysts, uterine weakness, uterine prolapse & endometriosis.
- Breaking down of reproductive adhesion/scar tissue. Assisting with the repair of a vaginal tear, episiotomy, or C-section scar.
- Assisting with the healing of haemorrhoids.
- Treating chronic vaginal/yeast infections and maintaining healthy vaginal odour.
- Relief of menopausal symptoms such as vaginal dryness or pain during sex.
- Detoxification of the womb/removal of toxins from the body. Release of stored emotions.
- Reconnection with our female bodies and tapping into the sexual energy that is our creative potential.
Frequently, entrepreneurs recommend adding herbal or other ingredients. Herbs often used include:
- vaginal steaming arms your bank account;
- it disrupts the normal pH balance of the vagina;
- in turn, this increases the risk of fungal and bacterial infections;
- vaginal steaming can cause burns;
- with added herbs, it can cause allergies.
New Zealand psychologists analysed online accounts of vaginal steaming to determine the sociocultural assumptions and logics within such discourse, including ideas about women, women’s bodies and women’s engagement with such ‘modificatory’ practices. Ninety items were carefully selected from the main types of website discussing vaginal steaming: news/magazines; health/lifestyle; spa/service providers; and personal blogs. Within an overarching theme of ‘the self-improving woman’ the researchers identified four themes: (1) the naturally deteriorating, dirty female body; (2) contemporary life as harmful; (3) physical optimisation and the enhancement of health; and (4) vaginal steaming for life optimisation. The authors concluded that online accounts of vaginal steaming appear both to fit within historico-contemporary constructions of women’s bodies as deficient and disgusting, and contemporary neoliberal and healthist discourse around the constantly improving subject.
For the sake of ‘journalistic balance’, let’s give Gwyneth the last word about the benefits of vaginal steaming. She knows best because she has done it and was quoted uttering these profound and scientific views: “The first time I tried v-steaming, I was like, ‘This is insane’. My friend Ben brought me and I was like, ‘You are out of your f**king mind. What is this? But then by the end of it I was like, ‘This is so great.’ Then I start to do research, and it’s been in Korean medicine for thousands of years and there are real healing properties. If I find benefit to it and it’s getting a lot of page views, it’s a win-win.”
And who would or could argue with that?
I have often pointed out that, in contrast to ‘rational phytotherapy’, traditional herbalism of various types (e. g. Western, Chinese, Kampo, etc.) – characterised by the prescription of an individualised mixture of herbs by a herbalist – is likely to do more harm than good. This recent paper provides new and interesting information about the phenomenon.
Specifically, it explores the prevalence with which Australian Western herbalists treat menstrual problems and their related treatment, experiences, perceptions, and inter-referral practices with other health practitioners. Members of the Practitioner Research and Collaboration Initiative practice-based research network identifying as Western Herbalists (WHs) completed a specifically developed, online questionnaire.
Western Herbalists regularly treat menstrual problems, perceiving high, though differential, levels of effectiveness. For menstrual problems, WHs predominantly prescribe individualised formulas including core herbs, such as Vitex agnus-castus (VAC), and problem-specific herbs. Estimated clients’ weekly cost (median = $25.00) and treatment duration (median = 4-6 months) covering this Western herbal medicine treatment appears relatively low. Urban-based women are more likely than those rurally based to have used conventional treatment for their menstrual problems before consulting WHs. Only 19% of WHs indicated direct contact by conventional medical practitioners regarding treatment of clients’ menstrual problems despite 42% indicating clients’ conventional practitioners recommended consultation with WH.
The authors concluded that Western herbal medicine may be a substantially prevalent, cost-effective treatment option amongst women with menstrual problems. A detailed examination of the behaviour of women with menstrual problems who seek and use Western herbal medicine warrants attention to ensure this healthcare option is safe, effective, and appropriately co-ordinated within women’s wider healthcare use.
Apart from the fact, that I don’t see how the researchers could possibly draw conclusions about the cost-effectiveness of Western herbalism, I feel that this survey requires further comments.
There is no reason to assume that individualised herbalism is effective and plenty of reason to fear that it might cause harm (the larger the amount of herbal ingredients in one prescription, the higher the chances for toxicity and interactions). The only systematic review on the subject concluded that there is a sparsity of evidence regarding the effectiveness of individualised herbal medicine and no convincing evidence to support the use of individualised herbal medicine in any indication.
Moreover, VAC (the ‘core herb’ for menstrual problems) is hardly a herb that is solidly supported by evidence either. A systematic review concluded that, although meta-analysis shows a large pooled effect of VAC in placebo-controlled trials, the high risk of bias, high heterogeneity, and risk of publication bias of the included studies preclude a definitive conclusion. The pooled treatment effects should be viewed as merely explorative and, at best, overestimating the real treatment effect of VAC for premenstrual syndrome symptoms. There is a clear need for high-quality trials of appropriate size examining the effect of standardized extracts of VAC in comparison to placebo, selective serotonin reuptake inhibitors, and oral contraceptives to establish relative efficacy.
And finally, VAC is by no means free of adverse effects; our review concluded that frequent adverse events include nausea, headache, gastrointestinal disturbances, menstrual disorders, acne, pruritus and erythematous rash. No drug interactions were reported. Use of VAC should be avoided during pregnancy or lactation. Theoretically, VAC might also interfere with dopaminergic antagonists.
So, to me, this survey suggests that the practice of Western herbalists is:
- not evidence-based;
- potentially harmful;
- and costly.
In a nutshell: IT IS BEST AVOIDED.
It has been reported that, between 1 January 2018 and 31 May 2018, there have been 587 laboratory confirmed measles cases in England. They were reported in most areas with London (213), the South East (128), West Midlands (81), South West (62), and Yorkshire/Humberside (53). Young people and adults who missed out on MMR vaccine when they were younger and some under-vaccinated communities have been particularly affected.
Public Health England (PHE) local health protection teams are working closely with the NHS and local authorities to raise awareness with health professionals and local communities. Anyone who is not sure if they are fully vaccinated should check with their GP practice who can advise them.
Dr Mary Ramsay, Head of Immunisation at PHE, said:
“The measles outbreaks we are currently seeing in England are linked to ongoing large outbreaks in Europe. The majority of cases we are seeing are in teenagers and young adults who missed out on their MMR vaccine when they were children. Anyone who missed out on their MMR vaccine in the past or are unsure if they had 2 doses should contact their GP practice to catch-up. This serves as an important reminder for parents to take up the offer of MMR vaccination for their children at 1 year of age and as a pre-school booster at 3 years and 4 months of age. We’d also encourage people to ensure they are up to date with their MMR vaccine before travelling to countries with ongoing measles outbreaks. The UK recently achieved WHO measles elimination status and so the overall risk of measles to the UK population is low, however, we will continue to see cases in unimmunised individuals and limited onward spread can occur in communities with low MMR coverage and in age groups with very close mixing.”
And what has this to do with alternative medicine?
More than meets the eye, I fear.
The low vaccination rates are obviously related to Wakefield’s fraudulent notions of a link between MMR-vaccinations and autism. Such notions were keenly lapped up by the SCAM-community and are still being trumpeted into the ears of parents across the UK. As I have discussed many times, lay-homeopaths are at the forefront of this anti-vaccination campaign. But sadly the phenomenon is not confined to homeopaths nor to the UK; many alternative practitioners across the globe are advising their patients against vaccinations, e. g.:
- Governments take action to prevent vaccination-rates from falling
- Use of alternative medicine is associated with low vaccination rates
- Integrative medicine physicians tend to harbour anti-vaccination views
- Vaccination: chiropractors “espouse views which aren’t evidence based”
- Faith-healing as an alternative to vaccination?
- Recommending homeoprophylaxis is unethical, irresponsible and possibly even criminal
- Chiropractors are undermining public health
- CAM use is risk factor for the failure to immunize children
- Let’s be blunt: homeopathy is bogus – but homeoprophylaxis is worse, much worse!
- Are mothers being taught by homeopaths to become anti-vaxers?
- Some naturopaths are clearly a danger to public health
Considering these facts, I wish Dr Mary Ramsay, Head of Immunisation at PHE, would have had the courage to add to her statement: IT IS HIGH TIME THAT ALTERNATIVE PRACTITIONERS DO MORE THAN A MEEK LIP SERVICE TO THE FACT THAT VACCINATIONS SAVE LIVES.