Category Archives: Homeopathy

Homeopathy improves fatigue and pain of cancer patients ten-fold

Few fields demonstrate the exercise of the pseudoscientific method more consistently than homeopathy. Any half-competent editor of a health magazine will be well aware of the red flags, and will steer clear of the junk studies that define the field.

You’ve already spotted the problem, haven’t you? Yes, the editor would have to be half competent. And also they would have to give a shit about facts, rather than their advertising sales.

Homeopathy dramatically improves the mental and physical well-being of cancer patients who are being treated with chemotherapy or radiotherapy, a major new study has discovered.

Really? I wonder who would produce such a study, and where it might get published?

Complementary Therapies in Medicine, 2015; http://dx.doi.org/10.1016/j.ctim.2015.03.004. A low impact factor (2.2) SCAM-specific journal.

“Influence of adjunctive classical homeopathy on global health status and subjective wellbeing in cancer patients – A pragmatic randomized controlled trial”

The word “pragmatic” is a red flag with homeopathy studies: it means that they are engaged in benefit finding, and have deliberately chosen not to try to eliminate many common sources of bias.

Half the 410 cancer patients, who were prescribed individual remedies, reported “significant improvements” in their levels of fatigue and pain, and had better appetites, than those who weren’t given the remedies. Improvements ranged from seven to 14 times in those taking homeopathy, say researchers from the Medical University of Vienna.

Did they indeed. So a group of people who received amateur talk therapy and magic sugar pills, reported subjective benefits, but no objective measures were used. This tells us precisely nothing that we did not already know.

Here’s something else we know: users of SCAM fare worse when they get cancer.  They delay treatment, trying worthless SCAM remedies first, so they present later and with more advanced disease, and even after controlling for that, they still die sooner.

With that in mind, one wonders why the Medical University of Vienna’s IRB approved this trial. Would they approve one on voodoo?  Maybe they would, it would not be the most unethical thing the university ever did, as Prof. Ernst reveals in his excellent A Scientist In Wonderland.

All the patients, who were being treated for stages 3 and 4 cancer, were interviewed every week while they were taking the remedies, and the improvements in the homeopathic group was very noticeable compared to the group who weren’t taking homeopathy.

According to a bunch of homeopaths. Of course the rigorous blinding that ensured that neither patient nor experimenter was aware of which group they were in, and the use of a carefully selected placebo (including controls for the homeopathic “consultation”, which another study shows is the only part of the whole charade that matters).

Oh, wait, no, they don’t appear to have done any of that.

Improvements in overall health were 10 times greater in the homeopathic group over the three weeks the remedies were taken.

Amazing, isn’t it? You wonder how such a striking finding could come out of a decently designed study given that three separate government reviews of homeopathy (Switzerland, UK and Australia) have failed to find a single condition for which it is provably effective.

There are two possibilities here:

  1. All the previous research is wrong, especially that showing that positive results are more likely when the study design is sloppy and less likely when it’s robust; most of physics is wrong; there are two complete parallel systems of action in human biochemistry, one of which has never been identified by scientists; and there is a form of energy that has never been detected or measured, but which has profound effects on human health.
  2. This is another badly-designed study by True Believers seeking to proselytise their faith.

Which is more likely? Answers on a razor please.

Evil ASA 6: H:MC21

This is the sixth of a short series on the examples highlighted in January 2015’s issue of WDDTY as “proof” that the ASA is fundamentally flawed, and as justification for replacing it by a body run by practitioners commercially vested in the claims under evaluation.

H:MC21 conducts a mass protest outside the ASA. Sadly, nobody noticed.

H:MC21

The charity Homeopathy: Medicine for the 21st Century (H:M C2 l) placed an advertisement in a supplement of the New Statesman magazine in 2010. A complaint against it led to a bitter 10-month deliberation,

Whenever WDDTY talk about Sense About Science, they put the word charity in scare quotes. For H:MC21, the scare quotes should be three times the size of the main font, and flashing.

Theopen-quotecharitable purpose close-quote is listed as:

We have been continuing to work with other groups to get the information to the public about the validity of homeopathy and the propagandist nature of the attacks on this therapy. We particularly welcome the initiative by the GRCCT to establish professional accreditation of websites for CAM therapies, and the challenge this offers to bizarre rulings by the ASA.

That’s not a charitable purpose. It’s barely even a political manifesto. The charity raises virtually nothing, spends virtually nothing, and the charitable purpose advances the business interests of the  chief actor, William Alderson.

Ironically, the “propaganda attacks” amount to stating the scientific consensus. The actions of H:MC21 involve cherry-picking, distortion and even outright fabrication. What’s the word? Oh yes: propaganda.

Please do read the adjudication. Note the update comment. H:MC21 did not go quietly, and they still very firmly believe they were right. The ASA showed saintly patience, and received only abuse in return.

The claims adjudicated were:

1. “Homeopathy has a history of success in chronic illness”;

2. “At Bristol Homeopathic Hospital 70.7% of 6,500 patients with chronic conditions benefited from homeopathic treatment and had reduced need for conventional medicine”;

3. “… more randomised controlled trials are positive than negative”; and

4. “In Cuba, an integrated approach to healthcare has led to homeopathy being used to enable 2.3 million, including the elderly, to be cheaply and effectively protected against endemic Leptospirosis”.

The complainants challenged whether the following claims were misleading:

5. “About 6 million people in the UK choose Homeopathy”;

6. “… of the 2,500 most commonly used treatments in the NHS, 51% have unknown effectiveness”;

7. “Even a small increase in spending on homeopathy could produce dramatic benefits, reducing care needs and increasing patient quality of life”;

8. “Sense About Science” is funded by pharmaceutical companies and relies on a strategy of propaganda stunts rather than scientific research”; and

9. “(Trick or Treatment?) has been shown to be scientifically unreliable”.

They also challenged whether the following claims were irresponsible or denigratory:

10. “The NHS spends £2 billion annually on treating adverse side effects of conventional drugs. Homeopathy has no side effects”;

11. “The leading so-called ‘expert’ and critic of homeopathy, Professor Edzard Ernst, has admitted that he has no qualifications in homeopathy”; and

12. “The recent Science and Technology Committee report on homeopathy was voted for by only three MPs”.

The evidence submitted included the “Swiss Report” which is not a Swiss report but is a case study of research misconduct, a customer satisfaction survey masquerading as evidence of efficacy, and sundry other supportive gems mined from the House of Commons Select Committe report whose conclusions (naturally!) they then proceeded to dismiss. Because in their bubble world, only positive outcomes are valid.

It is telling that H:MC21 chose to buy advertising space in a major national magazine, and use it to make an unwarranted personal attack on Professor Edzard ErnstW. a man upon whose academic credentials they cast aspersions – from the position of having absolutely no academic credentials themselves.

I discussed H:MC21’s fallacious response to the ASA on my blog at the time.  Actually Brian Cox has since put it better:

The problem with today’s world is that everyone believes they have the right to express their opinion AND have others listen to it. The correct statement of individual rights is that everyone has the right to an opinion, but crucially, that opinion can be roundly ignored and even made fun of, particularly if it is demonstrably nonsense! – Prof Brian Cox.

So, what did the ASA find?

On the “Swizz report”:

1. Upheld […] The publication’s main conclusion regarding efficacy was drawn from a reconsideration of a previous meta-analysis of qualifying trials which found no significant difference between placebo and homeopathic treatment and had been published in a reputable peer reviewed journal. It featured a reworking of the analysis of the data by considering only therapeutic studies, and removing the prevention studies. This led to the number of significant versus non-significant trials becoming 28 vs. 23, as opposed to 32 vs. 33 in the original publication. The publication’s editors described this as “a truly remarkable result in favour of homeopathy”. Our expert did not agree with this assertion. However, the authors, in the section that discussed the study, stated, “While the above argument does not allow us to draw the reverse conclusion that homeopathy is effective, it does support the claim that the Shang et al (2005a) study does not prove the ineffectiveness of homeopathy”. Our expert agreed with this second statement only.

This is charitable. The document is in fact shockingly poor: the authors have substantial undeclared conflicts of interest and reversed the normal hierarchy of evidence in order to produce the result they stated, at the outset, they wanted.

So, in summary:

We concluded that H:MC21 had not supplied sufficient evidence to substantiate the claim and noted there was a lack of evidence to support claims for its efficacy. We concluded that the ad was misleading.

This is no more or less than the scientific consensus view. Surely WDDTY don’t want the ASA to treat claims according to the belief systems of claimants? So, for example, allowing people who believe in white supremacism, to publish white supremacist advertisements? Where objective standards exist and are generally considered applicable, then they are the right standards, obviously.

2. Upheld. We considered that most readers would interpret the claim “At a Bristol Homeopathic Hospital 70.7% of 6,500 patients with chronic conditions benefited from homeopathic treatment and had reduced need for conventional medicine” to mean that the study demonstrated that over 70% of the patients tested experienced a reduction in the symptoms of their chronic illness following the introduction of homeopathic treatment.

In other words, customer satisfaction is not evidence of efficacy. The core problem that homeopaths can never actually understand, it seems.

3. Upheld […] We considered that within the context of the claim “… more randomised trials are positive than negative”, the 49% of inconclusive results was a significant piece of information and should have been included in the ad because it indicated that under RCT conditions, inconclusive results had occurred more often than positive results.

Controversial? Hardly.

4. Upheld […] We noted evidence had not been supplied to demonstrate that the homeopathic medicine referred to in the report had been shown to be efficacious against Leptospirosis under clinical conditions and therefore considered that the vast reduction in the incidences of the disease had not been shown to be directly attributed to the homeopathic remedy that had been administered. 

Correct: regression to the mean explains the observation, and the claim that Cuba uses homeopathy for leptospirosis is false, they use Vax-Spiral, a vaccine developed in Cuba. H:MC21 are suffering from “kleptospirosis” here.

5. Not upheld We noted the MHRA had informed the Commons Science and Technology Committee that over 10% of the nation chose homeopathic treatments. We considered that this was sufficient to substantiate the claim that six million people in the UK used homeopathy

The figures are incorrect for other reasons, but ASA correctly agreed that H:MC21 had substantiated this claim. Wait, I thought they were supposed to be anti-SCAM and always vote Upheld? This is soooo confusing!

6. Not upheld  We noted the ad claimed “Homeopathy has a growing evidence base, but according to the British Medical Journal, of the 2,500 most commonly used treatments, 51% have unknown effectiveness”. We also noted H:MC21 provided the pages from the BMJ site upon which this claim was based. We considered that, in the context of this ad, the claim invited readers to consider the view expressed in the BMJ article, but did not go so far as to discourage readers from seeking essential treatment for conditions for which medical treatment should be sought.

I disagree with this, but understand the rationale. The problem is that the study on which it is based essentially says that you can’t interpret the figures as H:MC21 do (for example, how would you conduct a randomised controlled trial for emergency repair of ruptured aortic aneurysm?). That said, the study is not as grossly misrepresented as it usually is by quacks and once again the ASA gives the benefit of the doubt to the advertiser.

7. Upheld We noted H:MC21 had not sent sufficiently robust scientific data, including double blinded clinical trials, to substantiate the claim that homeopathy could effectively treat chronic medical conditions.

We sympathise: it’s hard to do when no such good evidence exists, after all. How it must suck to be a homeopath if you actually care about evidence. Ah, wait…

8. Upheld The ASA noted the ad claimed “The leading organisation opposing Homeopathy, Sense About Science is funded by pharmaceutical companies”.

And no evidence was presented. They should have asked WDDTY. Oh, wait, they never present any evidence when making the identical claim either. It’s almost as if there is none.

9. Upheld We read the publication Trick or Treatment and the paper Halloween Science.

Halloween science is William Alderson’s comically bad “peer reviewed” critique of Trick Or Treatment. The latter is a properly published popular science book. The former is, well, a splenetic rant by someone who is suffering acute pain in the feels. I can’t trace any evidence that it’s really peer reviewed, other than passing round a few like-minded mates, which is not the same thing at all

Alderson also wrote a 62 page “critique” of a seven-year-old A4 flyer from  Sense About Science, which still managed not to make a single valid point. He is really good at this.

10. Not upheld We understood that homeopathy had been shown to have no side effects

Again, I’d have Upheld this as the claim is misleading (homeopathy has no effects) but the ASA again gave H:MC21 the benefit of the doubt. Quacks have no gratitude.

11. Not upheld […] we noted Professor Ernst, as a scientific commentator, did not fall under the definition of those parties that were subject to CAP Code rule 3.42 concerning denigration.

Out of scope. Fair enough, though still a shitty trick.

12. Not upheld We noted the Report made a series of policy recommendations about the future of NHS funding for homeopathy and considered that, without further clarification, the claim implied that MPs had disagreed with the scientific conclusions of the report. However, we noted the report and the Committee did not fall under the definition of those parties that were subject to CAP Code rule 3.42 concerning denigration and therefore concluded that the ad did not breach that Code rule.

In other words, H:MC21 lied but it’s out of scope.

with the ASA finding against both the advert and homeopathy, claiming there was no evidence to suggest it had any effect beyond that of a placebo.

Correct. That is the scientific consensus view. Three separate government level reviews (Switzerland, UK and Australia) have concluded it, the National Center for Complementary and Alternative Medicine says it, the NHS says it. It’s a fact. Not liking it does not make it perverse or any less a fact.

You might as well complain when they rule against free energy devices. Actually, being WDDTY, they probably do.

In addition, the ASA rejected a review of 6,500 patients who had received homeopathic treatment at Bristol’s Homeopathic Hospital, stating that the patients’ own assessments of their health were invalid (although it is common practice in conventional medical trials).

No, they did not reject it, they noted that it did not prove the claim that was made of it. The thing about refuted nonsense is that it only ever works once. Having been refuted, the same refutation works every time.

Patient satisfaction does not prove efficacy. Ever. Subjective self-reported scores are accorded low weight in any trial and generally only really useful to compare two active and proven treatments.

H:MC21 also said its other submitted evidence was either lost or edited.

No, it was just bullshit. Again, William Alderson is a world-leading expert on massive outpourings of tendentious nonsense.  He is pretty much the UK’s version of Dana “Mr Uncredible” Ullman.

So, looking at the actual text complained of, and the outcomes, with their mix of upheld and not upheld, did ASA brutally oppress H:MC21, or did they do a fair and even-handed job of picking apart the claims of a propagandist, allowing those items which are defensible, even if wrong? You decide.

Evil ASA 2: Islington Homeopathy Clinic

This is the second of a short series on the examples highlighted in January 2015’s issue of WDDTY as “proof” that the ASA is fundamentally flawed, and as justification for replacing it by a body run by practitioners commercially vested in the claims under evaluation.

Islington Homeopathy Clinic

I-Spy: Woo. How many mutually contradictory alternatives to medicine can you spot in this picture?
I-Spy: Woo. How many mutually contradictory alternatives to medicine can you spot in this picture?

Its website stated that homeopathy”is sanctioned by the UK government and has been an integral part of the National Health Service (NHS) since it was founded in 1948”. The Nightingale Collaboration challenged the statement as it suggested that homeopathy is an effective treatment. In response, the clinic pointed out that Aneurin Bevan, the architect of the NHS, stated that “homeopathic institutions will be enabled to provide their own form of treatment, and the continuity of the characteristics of those institutions will be maintained”.

Please read the adjudication.

The website home page on or about the date complained of said:

Homeopathy is the second most popular system of healing in the world, used by over 30 million people in Europe alone. In 2005, the World Health Organization estimated that homeopathy is the fastest growing healthcare modality in the world with more than half a billion users. It is over 200 years old, was introduced to the U.K. by Dr Quin in 1828, is sanctioned by the UK government and has been an integral part of the National Health Service (NHS) since it was founded in 1948. In November 2000, a House of Lords report on complementary and alternative therapies judged homeopathy to be one of five ‘group one’ therapies (out of thirty examined), with convincing research evidence of effectiveness, suggesting that it should be more widely available on the NHS.

(Archives from before and after the complaint do not differ materially).

In context, then, the claim of Government endorsement is very clearly being used in lieu of evidence of efficacy. In fact, they go one better, citing the House of Lords report in 2000 which found homeopathy to be a “group one” therapy. By which they mean:

The first group embraces what may be called the principal disciplines, two of which, osteopathy and chiropractic, are already regulated in their professional activity and education by Acts of Parliament. The others are acupuncture, herbal medicine and homeopathy. Each of these therapies claims to have an individual diagnostic approach and are seen as the ‘Big 5’ by most of the CAM world.

Oddly, Islington Homeopathic Clinic didn’t identify where in the Lord report they found the suggestion that homeopathy should be more widely available on the NHS. I say oddly, actually it’s because as far as I can tell it isn’t in there. The report deals with regulation. Feel free to point out if this is wrong.

Oddly, too, Islington Homeopathy Clinic didn’t mention the 2010 report by the House of Commons Science and Technology Committee which recommends the precise opposite, and which, unlike the Lords report, actually looks at the validity, not the regulation, of SCAM. Specifically:

23.  The Government should stop allowing the funding of homeopathy on the NHS. (Paragraph 110)

Homeopath in selective-and-misleading-presentation-of-evidence shock.

As to the Bevan quote. That is discussed in Hansard (see commenter Mojo at the Quackometer):

The Secretary of the Faculty also said: The Faculty of Homoeopathy is under an obligation by Act of Parliament to do everything in its power to advance the principles and extend the practice of homoeopathy and the Minister of Health has given assurances that under the National Health Service Act homoeopathic institutions will be enabled to provide their own form of treatment and that the continuity of the characteristics of those institutions will be maintained. For the sake of brevity, I shall not quote a great deal of what Aneurin Bevan said in 1946, when he was engaged on establishing the National Health Service, but he gave various categorical assurances. On 23rd November 1946 he said: If they”— homoeopathic hospitals— are to be brought in it must be the obligation of the Regional Boards in establishing their Management Committee to see that these Management Committees are of a character which maintains the continuity of the characteristics of those institutions. I think that I can give that absolute guarantee, because otherwise it would be an emotional mutilation which nobody could possibly defend. I am afraid that that guarantee has become less than absolute over the years, and I indict the Department of Health and Social Security for that.

Note that the speaker is Tom Ellis (Lab, Wrexham) apparently a homeopathy supporter.

The statement by Bevan does not itself appear in Hansard, nor, int seems, in any of the relevant Bills or Acts. It is taken from a speech, in which Bevan makes only one commitment: that the Management Committees of such homeopathic institutions as are brought in, should maintain their doctrinal purity. No guarantee of continuity is implied int his statement, nor would it be binding or even relevant given the subsequent scientific inquiry demonstrating homeopathy to be clinically ineffective.

In point of fact, the Management Committees have, since they were effectively devolved from NHS control as Trusts, have for the most part abandoned any form of doctrinal purity and adopted instead the omniwoo known as “integrative medicine”. This is hardly the fault of the NHS, as institutions were severed from NHS control by statutory instruments.

It is unequivocally the case that the present statutory framework holds no guarantees in respect of homeopathy. The speeches of Bevan are of no more relevance today than those of Churchill in support of the gold standardW. The road of politics is positively littered with broken promises, even if this was a promise as represented, which is debatable at best.

Were the ASA right to say that this claim of legitimacy was misleading? I think so. Actually I think they were more than fair. They could have expanded it to include the selective presentation of a tangential comment from a Lords report, editorialised without justification to give a conclusion which is firmly contradicted by a directly relevant subsequent Commons report.

The ASA found for the complainant, but it ended up being the best thing that could have happened to the clinic (see box, right), which is seeking to have its site sanctioned by the GRCCT initiative.

It will be interesting how the Quackvertising Standards Association (QSA) handles this. In particular it will be interesting to see what therapeutic claims they endorse.

This will be doubly interesting since the Society of Homeopaths apparently accept the validity of the ASA and have been working with them to provide clear guidance on copy. In fact, they specifically say:

Advertising and Media
38) Members should ensure that they do not allow misleading advertising and information about their practice. Advertising should be honest, decent, legal and truthful (as defined by the Advertising Standards Authority and conforming to the UK Code of Non-Broadcasting Advertising Practice (CAP)). [emphasis added]

That’s the problem with fields like homeopathy where everything is based on opinion instead of empirically testable fact: who’s to say whether the SoH is right, or the defiant homeopath who apparently also believes in (mutually exclusive) chiropractic?

Are West Africans dying needlessly of Ebola for the sake of Pharma profits?

No.

Thanks for reading.

Oh, wait, what? Ah. Rob Verkerk wants to add his peerless insight. Let’s see how that goes. Advance notice: there is a word I am really struggling not to use here. It is a very short word, beginning with C and ending with -unt. Read on, and be prepared to be very very angry.

Visiting Sierra Leone amidst the Ebola crisis is an experience that will remain deeply etched into my memory. The single most outstanding feature is the resilience of the people. Villages like Kigbal have lost about half their population to Ebola, yet the villagers still greeted us with warm, broad smiles-even the now mostly orphaned children. Only when reminded of their loss do the cracks appear and the depth of their loss emerges. One woman has lost four children and her husband to Ebola, while her two remaining children are still fighting for their lives. Despite her pain, she still stood proud and strong, ready for another day.

Rob, one simple question.

What the fuck were you doing in Sierra Leone?

Seriously. What the fuck?

You have no medical qualifications. You are not a doctor. This is a health emergency, and every single person in the area is at risk. Every single Westerner has to be watched and monitored to prevent them bringing the disease back. A westerner who gets infected has to be evacuated, which is a monstrous cost in resources that are already stretched to breaking point.

Have you ever heard of Dr. Martin Salia? Nina Pham RN? Dr. Craig Allen Spencer? Thomas Eric Duncan? Do you read newspapers? Listen to the radio? Watch TV? Do you have access to the internet? Because, and I am really struggling not to shout here, it is blindingly obvious that this is no place to play doctor.

You have gone to a disaster zone, basically as a fucking tourist, and you have gone without the only thing they ACTUALLY NEED: medical skills. You have imposed a cost and a burden on an area already groaning under the weight of a crisis that is barely under control. For what? To boost your own ego and your own profits? Or because you are actually so dangerously deluded that you think your facile remedies for the worried well are a valid intervention?

I am really struggling to think of a third option here, and neither makes you look good.

I also won’t forget the international presence-the logistics personnel organizing medical supplies and protective equipment, the foreign, especially British, army presence, and the fleets of World Health Organization (WHO), US Centers for Disease Control and Prevention (CDC) and Medecins Sans Frontieres (MSF) vehicles and staff.

Indeed. People with, you know, relevant medical expertise. The world’s religions have sent doctors and money. The worlds quacks have sent quacks. And the people of Sierra Leone, assuming good faith, let them in, only to discover that they were there for propaganda.

To the endless credit of the locals, the quacks were not lynched but sent home.

There’s also the sharp contrast between the elaborate foreign aid-built Ebola treatment centres and those built with local money, sometimes with the help of smaller non-governmental organizations. These are often built around vacated schools and community centres, with wooden frames made of tree branches, and walls and ceilings of UNICEF tarpaulin. There are around 200 of these around the country.

Yup. Sierra Leone is dirt poor. Send money, some of the cash you make from the legion of the credulous worried well.

These centres and the logistic operations are the only proven medicine against Ebola so far. They allow people with signs of fever or other symptoms of the deadly virus to be removed from their communities by ambulance, often within minutes of trained health workers-who are monitoring communities continuously-dialing the 117 emergency number on their mobiles.

And let us not forget what a staggering logistical achievement this is, given the infrastructure challenges. It’s a good job no tourists are clogging up the roads. Except you.

Once extracted, these people no longer pose a threat to their community, but are generally facing a 70 to 90 per cent certainty of death if positive for Ebola. Following death, burial is ideally within 24 hours, and a huge countrywide government campaign has been largely successful in re-educating communities to avoid their traditional practices for honouring the dead, which include touching the corpse.

25% to 90% depending on outbreak. Medical care has got survival to around 50/50 in Sierra Leone, which is average for outbreaks with good medical support, thanks to actual doctors (not vitamin pill salesmen, Rob, people with actual medical qualifications).

And the local religious communities have been doing an amazing job training people that this is a bad move, and trying to work out ways of protecting the living while honouring the dead.

Think about that for a minute. Your response is less reality-based than the religious community.

If a person brought to a holding centre tests negative, and has malaria or cholera or even morning sickness from pregnancy-which has similar symptoms to Ebola in the early stages-that person is discharged. Once discharged, though, the sad reality is that the person is now more likely to die of those other diseases or in childbirth, as the country’s healthcare system is stretched to the limits dealing with Ebola.

Correct. That’s why they need more doctors and nurses, not quacks. How many doctors and nurses did you take with you, Rob, and why did you not just send them and stay at home yourself, not being a doctor or a nurse?

Thought not.

Would now be a good time to remind everybody that 365 PEOPLE DIED A BLOODY AND AGONISING DEATH BECAUSE A TRADITIONAL “HEALER” THOUGHT SHE KNEW MORE THAN THE MEDICAL FRATERNITY?

Sorry, I said I wouldn’t shout. But, well.

The care of patients in the treatment and holding centres is largely dictated by the WHO and CDC. But one stunning fact is that their guidelines don’t advocate the use of intravenous (IV) support. This is almost unthinkable, as most Ebola patients suffer chronic dehydration due to severe vomiting and diarrhoea. It’s no surprise that one British police officer who was managing the Ebola patient extraction system and burials referred to these centres as ‘death camps’.

Gosh, I am sure the massive interdisciplinary teams of doctors, nurses, virologists and other medical researchers will be profoundly grateful for your insight, because it’s clear that they won’t have thought about this at all. It’s not as if each health worker has the potential to save a large number of lives, making them a scarce and valuable pool of resource, after all. And there are almost no reports of health workers being infected by needle stick injuries are there?

Frankly, your facile pontifications are about as useful as Matthias Rath in an AIDS epidemic. No, actually less useful: at least he is actually a doctor.

Could more lives be saved? Could more be done to improve outcomes for those struck by Ebola? I believe the answer to both is a resounding’yes’.

No doubt the Nobel Prize is in the post. After all, the WHO only has a few thousand trained staff on the ground. They must be gagging for the input of vitamin salesmen.

The best clinical evidence comes from Sierra Leonean Dr Santigie Sesay, who runs the Hastings treatment centre outside Freetown. After receiving training from the WHO – which recommends no IV in Ebola patients largely because of the risk of needle-stick injuries and cross infection to nursing staff – he and his medical team decided to act otherwise. Given that dehydration is an obvious major issue in these patients, they decided to administer IV dextrose and saline along with broad-spectrum antiobiotics and multivitamins. These simple interventions are consistently saving a further 20 per cent of lives, with the death toll falling from 60 per cent to 40 per cent of confirmed cases of Ebola before and after, respectively, the introduction of these interventions.

They take the risk, they are the ones who may die. I am in awe of their professionalism and dedication. But the average death rate form controlled Ebola outbreaks is only 50%, so it’s a big risk: they are deeply vested in the community and they should be celebrated in the same way as other medical martyrs.

That doesn’t make the WHO advice wrong. There is a reason why we celebrate first responders who enter burning buildings to rescue people. And there is a reason why orders are given against this.

The entire point of a co-ordinated response is to place objective judgments ahead of emotion. And yes, it can look callous, especially to those who have an agenda and don’t bother to think it through.

One can only wonder what would happen if more elaborate nutritional protocols were introduced, ones designed to enhance cellular hydration, modulate the immune system, reduce virus levels in the body and support recovery.

Jesus fucking wept. The period from diagnosis to death or survival is typically a week or so from first symptoms, maybe only a few days from diagnosis, during much of which time the patient is typically  emitting fluids from every bodily orifice.

Do you really think they haven’t thought about the role of hydration?

Seriously?

That is breathtakingly arrogant. Really, monstrous hubris.

Because, you know, there are some pretty smart people on the case. And your “insight” is pretty bloody facile when you consider that the standard of care has reduce fatality from around 90% to around 50% over successive outbreaks. The fatality rate in the Zaire outbreak was 88%, the Sierra Leone outbreak is, as noted, around 50%.

What could they have achieved if only they’d listened to you, eh?

But the current West African Ebola epidemic is as much a health and economic crisis for the region as it is a political tool being manipulated by Western interests. Would it be advantageous for the West to find an inexpensive solution to Ebola that could be administered locally to help break the transmission cycle?

Perhaps they could try talking sternly to it?

Or maybe, you know, they could try something really difficult, like developing a vaccine. And yes, that is staggeringly difficult for this disease.

Because in the end massive multidisciplinary medical teams are not bad at working out the best approach for dealing with a disease, it’s just that delivering the cure or preventative is normally rather harder than sitting in an office writing about it form the perspective of no realistic understanding whatsoever.

Surely not, as the high mortality rates drive fear about Ebola in both West Africa and everywhere else in the world. And bear in mind that GSK’ s vaccine, at the time of writing, is being prepped for release. Is this another example of that well-oiled business model favoured by pharmaceutical interests: first create the problem, then provide the solution? The ultimate travesty is that so many lives are being lost-and many of them perhaps needlessly.

Rob, you are an idiot. A fact-blind, agenda-driven idiot.

Vaccines are not profitable. Vaccines for rare diseases of dirt-poor countries are seriously unprofitable. Two companies have put substantial resources into developing a vaccine that will not make either of them very much money.

Did it not occur to you that they might be doing this because it’s the right thing, rather than for your own motives, profit and ideology?

No, of course it didn’t.

Idiot.

Religion: The latest scientific exploration. Or not.

If there’s one thing that doesn’t seem to trouble Lynne McTaggart, it’s doubt. When her world-view is contradicted by science, then it’s science that’s wrong. MMR-autism link refuted? Not in WDDTY it’s not. Urotherapy is derided nonsense? Not in WDDTY. Intercessory prayer? Let’s have a talk about that.

Lately I’ve been thinking a good deal about how in modern times science and religion have exchanged places. This was initially prompted by an email from What Doctors Don’t Tell You reader about an article in the new Scottish newspaper the National, reporting that Lanarkshire Health Board has stopped referring patients to the Glasgow Integrative Care Centre where they practise homeopathy.

McTaggart could mitigate the obvious falsity of her argument by couching it as opinion, while acknowledging the legitimacy of Simon’s more robust standpoint. But she doesn’t. She insists instead that she is right and the reality-based community wrong.

Yes, this was great news. A review of the evidence and public opinion, which included input from users of the service and from the homeopathy industry, concluded, as such reviews usually do, that there is no credible evidence homeopathy works.

The journo of the story dutifully quoted physicist Simon Singh, Mr Rent-a-Quote on these matters, whose point was that even if lots of people want homeopathy, as they do, “public demand did not necessarily equate to the best public service.” “If lots of people wanted voodoo on the NHS should we have voodoo?” he said. Of course, it is fairly easy to unpick all of his statements, but I’ll focus on just one: If lots of people wanted voodoo on the NHS should we have voodoo?

That’s Doctor Rent-a-Quote to you, sunshine. Unpick his statements? That should be comedy gold. Carry on, I’ve got the popcorn.

The answer to that is, of course, yes.

Er, no it isn’t. No, it really, really isn’t. There are at least three common variants: West African Vodun, Haitian Vodou and Louisiana or New Orleans Voodoo. They share many facets of African shamanic magic, including rituals of dance and myths of spirit possession. The classic voodoo doll is, I believe, primarily associated with the Louisiana version. There’s a mish-mash of traditional African cultures and Christian, especially Catholic elements, and much of what is currently known as voodoo owes its existence to the twin  evils of colonialism and slavery. Continue reading Religion: The latest scientific exploration. Or not.

Chronic Lying Disease part 2

ByjnKcqCcAABtXL[1]In Treatment wars: Chronic Lying Disease we noted a regrettable tendency of quacks to promote the fictional “chronic Lyme disease”.

Note that there is nothing fictional about the symptoms, but as you’ll see in a moment they are generally either (a) hopelessly generic – “symptoms of life” if you will or (b) caused by something else.

Nor is there anything fictional about Lyme disease. It is real, a tick-borne infection caused by the borrelia burgdorferiW bacterium (in the US) or a close relative (in th Europe). The symptoms are characteristic – erythema migrans, a bull’s-eye rash – and the infection can be confirmed pathologically by blood test.

And indeed there is a real thing called post-Lyme syndrome, or post-borrelia syndrome, or “Lyme arthritis”, which is characterised by fatigue and muscular pains, especially, in patients who have had Lyme disease.

No, the fictional disease is chronic Lyme disease, which is a disease diagnosed by quacks and treated using quack treatments, especially long-term antibiotics (ironically WDDTY also fulminates against antibiotics, but promoting mutually contradictory ideas in the same story has never been a problem for the editors).

Continue reading Chronic Lying Disease part 2

How homeopathy might work

How might homeopathy workThe article has referenciness. Several of these references are familiar. As usual TatMaggot doesn’t give the full reference (wouldn’t want to follow journal practice, after all, or make it too easy to debunk her credulous nonsense)`, and references include that peerless source of cutting edge medical discovery, the Daily Mail.

TL;DR summary

In the end, I’m disappointed. After the debunking of the previous WDDTY advertorial on homeopathy and the Banerjis, this amounts to little more than repeating precisely the same refuted claims because TatMaggot believes she’s right so refutation of Benveniste etc. can be ignored. I was hoping for something new to get my skeptical teeth into, this provides nothing new. Not even a new spin on the tired old conspiracy theories. Medicine sometimes fails, therefore unicorns.

The only genuinely new study since the last go-round is ” The potentized homeopathic drug, Lycopodium clavatum (5C and 15C) has anti-cancer effect on hela cells in vitro” (J Acupunct Meridian Stud. 2013 Aug;6(4):180-7).

 

Bang!

 

This has yet to be replicated (as is the case for most homeopathy basic research) and contains, as usual, no evidence of generalisability, no evidence of potential therapeutic effect, no credible rationale for selection of the “remedy” and no evidence that this will be linked to the “similimum” or any other symptomatic presentation.

It’s all the same old long-debunked rubbish. It’s almost as if there is no credible evidence for homeopathy, just a lot of wishful thinking by believers.

Oh, wait…

Seriously? It is just possible that a homeopath might stumble upon a substance that at clinical doses produces a useful effect. Given the sheer number of substances they use, anything else would be statistically improbable. But there’s no compelling evidence of any persistent effect at homeopathic dilutions, no credible evidence that the diluted and potentised “remedies” have any specific clinical effect, and ridiculous quote mining expeditions like this do nothing other than perpetuate the smokescreen of confabulation used by homeopaths to hide the fact that everything about their beliefs is simply wrong.

The first batch of references seem to be drawn from those cited in the Homeopathy journal’s special issue on the memory of water. We can assume that these are the best of the bunch from that issue.

  • Complement Ther Med. 2007 Jun;15(2):128-38 is “The in vitro evidence for an effect of high homeopathic potencies–a systematic review of the literature” by Witt et. al. Witt is paid by a homeopathy promotion body, the Carstens Foundation. This paper reviews primary research into mechanisms for homeopathy, finding 67 experiments of which 1/3 were replicated (i.e. 2/3 were not replicated, in line with the norm for homeopathy). It notes that the designs were inhomogeneous. Witt claims that “[e]ven experiments with a high methodological standard could demonstrate an effect of high potencies” but notes that “[n]o positive result was stable enough to be reproduced by all investigators. So the take-home from this is that believers can produce a positive result, but can’t replicate it.
  • J Therm Anal Calorim, 2004; 75: 815-36 is “New Physico-Chemical Properties of Extremely Diluted Aqueous Solutions” by V. Elia and M. Nicoli. This was discussed in a Bad Science Journal Club. The significance of this is that Elia claims, according to another paper in homeopathy, to have documented an effect which increases over time – i.e. which apparently violates the second law of thermodynamics. In the nine years since, this has not become anything like mainstream.
  • Homeopathy, 2007; 96: 175–182 is “The defining role of structure (including epitaxy) in the plausibility of homeopathy” by ML Rao, Rustum RoyW, Iris Bell and Claudia Witt (again). BadSciencers fisked this one too, noting that “different” spectra turned out to be the same graph and so on. A letter to the journal, reproduced in a JREF discussion, notes fatal flaws with the data as presented.
  • Physica A, 2003; 323: 67-64 is “Thermoluminescence of ultra-high dilutions of lithium chloride and sodium chloride” by Louise Rey. The Bad Sciencers didn’t have a lot to say about this other than that it’s speculative: it seeks to project condensed matter effects onto liquids. Definitive or conclusive it ain’t.
  • Biochim Biophys Acta, 2003, 1621: 253-60 is “Effects of ultrahigh dilutions of 3,5-dichlorophenol on the luminescence of the bacterium Vibrio fischeri“, by Brack et. al. I can’t find any significant discussion of this other than drive-by citations in laundry lists of references on homeopathy apologist websites.

So TatMaggot sets out her stall with a series of papers that include weak, irreproducible or uninterpretable results, and which advance in some cases contradictory hypothetical explanations for how homeopathy might work in some classes of substance.

None of these shows any link between “remedy” and symptom or disease, none of them shows any evidence of a clinically useful effect, none of them shows any evidence of a general or universal effect that is unambiguous and specific. This is, in other words, a re-warming of the Homeopathy “memory of water” issue.

Molehill Montagnieering

No paean to the refuted “memory of water” thesis would be complete without reference to Jacques Benveniste and Luc Montagnier.

TatMaggot of course believes Benveniste, it goes without saying, all avid homeopathy believers do. The special pleading is all reproduced: the pejorative characterisation of Randi, the claims that they “changed” the protocol and so on. It really doesn’t mater how sincerely you want to believe in it, the Benveniste experiment is a busted flush. Attempted replications have failed.

Montagnier has a self-published series of experiments that purport to back Benveniste, but these have not been independently validated either and when interviewed by CBC’s Marketplace he acknowledged that his work “cannot be extrapolated to the products used in homeopathy” – and indeed the same is true of Benveniste’s work, had it not been refuted.

Lastly, there is the knotty problem of shelf life. The effects Montagnier claims to have observed, last a few tens of femtoseconds – a fraction of a picosecond. This is entirely incompatible with the claims of an effect that increases over time, or is stable.

Jumping on the Banerji wagon

As with the previous issue of WDDTY claiming homeopathy is “much more than placebo”, the intellectual heart of this thread lies in the Banerji foundation and their extraordinary claim to reverse cancer using homeopathy alone.

Papers cited include the uninterpretable rubbish that is “Cytotoxic effects of ultra-diluted remedies on breast cancer cells” (Int J Oncol. 2010 Feb;36(2):395-403) and the followup “Ruta 6 selectively induces cell death in brain cancer cells but proliferation in normal peripheral blood lymphocytes: A novel treatment for human brain cancer” (Int J Oncol. 2003 Oct;23(4):975-82). The balance of the sources are: a WashPo editorial, the Banerjis’ publication in the best cases series (which explicitly does not establish the validity of the treatment), a Yahoo group, the Banerji website, the “journal of acupuncture and meridian studies“, the only genuinely new source since the last go-round as far as I can tell, (spoiler alert: meridians don’t exist and acupuncture is an elaborate placebo), and the BBC News website. Oh, and the Daily Mail, often cited in the top-tier medical journals for its groundbreaking basic research on the influence of immigration on the British pint or some such.

100 ways to live to 100: 10 situations that don’t usually require a doctor

Part of a series on WDDTY’s “free” advertorial report “100 ways to live to 100

10 situations that don’t usually require a doctor

If there’s one thing you can rely on doctors telling you, it’s when you don’t need a doctor. They are about as keen to see people with the common cold as WDDTY is to see evidence that vaccines are safe and effective. And in both cases, that doesn’t stop it happening, all the time.

61 Backache

Some 80 per cent of us suffer from back pain, but medicine doesn’t offer much besides potentially dangerous surgery (which leaves only a quarter of patients free of pain) and drugs. In most cases, an osteopath, chiropractor or Alexander Technique practitioner can sort you, as can exercise.

Let’s unpick that. If medicine cures back pain by surgery, that’s evil. If medicine gives drugs to manage the pain, that’s evil. If medicine recommends exercise and physiotherapy, that’s ignored because it would undermine WDDTY’s pretence that these are “alternative” and thus the sole preserve of quacks like their advertisers.

Why don’t doctors tell you that Alexander Technique works for low back pain? They do. They also recommend osteopathy and chiropractic, but there are severe problems with both these fields, due to the prevalence of crank ideas. Osteopaths need to discipline and exclude charlatans who practice “cranial osteopathy”, and chiropractors need to recognise that there is no evidence that chiropractic works better than evidence-based manipulation therapy, and substantial evidence of actively dangerous practices such as cervical spinal manipulation, potentially leading to stroke, bullshit claims to treat ear infections, asthma and other things unrelated to the musculoskeletal system, anti-vaccination propaganda, and of course the big scam: never discharging a cured patient, but instead trying to sell them an indefinite course of worthless “maintenance”.

If you have back pain, see your doctor, they will recommend the most appropriate treatment. Which might be surgery, drugs, exercise or some form of physiotherapy. Unlike WDDTY’s advice, this won’t be based on dogma or pleasing the advertisers, it’ll be based on the best currently available evidence.

62 Earache

Shout it loud: antibiotics just don’t work for earache. Nor does removing adenoids fix glue ear.39 Instead, try time, mullein oil, a woolly hat, a hot-water bottle, homeopathic Pulsatilla,40 osteopathy or auricular therapy (acupuncture of the ear). Before having grommets inserted in your child’s ear, cut down his fat and sugar, and investigate food or airborne allergies as the potential cause.

Reference 39a: JAMA, 2006; 296: 1235–41 Wait-and-see prescription for the treatment of acute otitis media: a randomized controlled trial. Spiro DM, Tay KY, Arnold DH, Dziura JD, Baker MD, Shapiro ED.

Reference 39b: BMJ, 2004; 328: 487 Adenoidectomy versus chemoprophylaxis and placebo for recurrent acute otitis media in children aged under 2 years: randomised controlled trial. Koivunen P, Uhari M, Luotonen J, Kristo A, Raski R, Pokka T, Alho OP.

Reference 40: Ullman D. Discovering Homeopathy: Medicine for the 21st Century. Berkeley, CA: North Atlantic Books, 1991; AHZ, 1985; 230: 89–94

If you follow this advice, a repeat of a recent and particularly dreadful article,  you’ll have to “shout it loud” because your child may be deaf.

The standard of care is watchful waiting, but adenoidectomy may be indicated in the presence of both glue ear and persistent nasal symptoms. Antibiotics work as a primary treatment for bacterial ear infections. Most children will grow out of them in time, but leaving the infection untreated when treatment is indicated, on ideological grounds as WDDTY propose, is perverse.

HomeopathyW has three problems: first, there’s no reason to think it should work; second, there’s no way it can work; and third, there’s no proof it does work. Of all alternatives to medicine, it is the most thoroughly debunked. Its doctrines were refuted over a century ago and its only real value now is as a litmus test for lack of critical thinking. A test WDDTY fails on a truly epic scale.

Dana Ullman, the cited source, is a high priest of the cult of homeopathy, he is a proven liar who claims Darwin and Nightingale for homeopathy despite their well documented contempt for it, and is responsible for propagating the lies that Montagnier’s work proves homeopathy and that the Swiss Government found it safe and effective. His propagandising for homeopathy knows no bounds. Each new publication by a True Believer is presented as the final clinching proof of homeopathy, and when it’s shown to be flawed or fraudulent he merely moves on to the next, occasionally repeating the old ones if he thinks nobody will notice. His self-promotion and steadfast denial of reality got him banned from Wikipedia.  There’s even an eponymous law: the Dull-Man Law. In any discussion of homoeopathy, being Dana Ullman loses you the argument – and gets you laughed out of the room.

AcupunctureW is also nonsense, though it is only recently proven to be completely useless. Auricular acupuncture has absolutely no basis in fact and lacks even the marginal credibility of acupuncture. The ear looks a bit like a baby, therefore the bits of the ear correspond to the organs that would be there if it was a baby. No, not even vaguely sensible.

63 Infection

For common and non-serious infections, try Echinacea, essential oils like clove, lavender, lemon, marjoram, mint, niaouli (Melaleuca), pine, rosemary and thyme oils, and goldenseal, manuka honey, tea tree oil, good old garlic and cranberry, all of which are powerful alternatives to antibiotics.

Alternatives they may be. Effective? Not so much. There’s some evidence of manuka honey as a topical antibiotic but why on earth would you not use antibiotics? They work very well, are generally well tolerated, and they have saved countless millions of lives.

This references a May 2013 article, we’ve added it to the work list.

64 Just-in-case checkups, particularly if you’re aged over 50

If you have nothing particularly wrong with you, going to the doctor won’t necessarily protect but is likely to unleash the entire arsenal testing apparatus have you leaving prescription (or three) in your hands.

So let’s get this straight: it’s wrong to see your doctor in case he finds something wrong with you.

Er, right.

65 Menopause In most cases, holistic measures

In most cases holistic measures (diet, homeopathy, herbs) will help you through the change in a safer way than using hormone replacement therapy (HRT), which continues to be discredited, despite protestations by doctors, because of a link with breast cancer.41 Our medical detective Dr Harald Gaier has had greater success with Phytoestrol N (which contains rhubarb root) than most of the popular herbals for menopause.

Reference 41:  Am J Public Health, 2010; 100 [Suppl 1]: S132–9 Decline in US Breast Cancer Rates After the Women’s Health Initiative: Socioeconomic and Racial/Ethnic Differentials Nancy Krieger, PhD,corresponding author Jarvis T. Chen, ScD, and Pamela D. Waterman, MPH.

HRT was discredited years ago, when it was shown not to protect against coronary heart disease but instead to promote it. Well-informed doctors don’t push it unless the symptoms of menopause are extremely bad, or for very early menopause or occasionally hysterectomy.

Homeopathy doesn’t work. Herbs may or may not (remember that a herbal remedy is basically an unknown dose of a potentially pharmacologically active compound with unknown impurities). The source for Harald Gaier’s success stories is Harald Gaier – WDDTY seem to think that blatant conflict of interest is fine as long as the message is ideologically acceptable.

66 Chronic but non-life-threatening conditions

Eczema, psoriasis, non-life-threatening asthma, arthritis and the like generally respond better to alternative measures than drugs, which only suppress symptoms. Check out the alternatives before resorting to lifelong drug use.

Few things are more infuriating than the claim that medicine “only suppresses symptoms” so alternatives are better.

Alternatives do one of two things: suppress the symptoms less effectively and less predictably, or nothing.

There are no alternatives which cure chronic conditions. If there were, they would no longer be alternative (Minchin’s Law).

The easiest way to demonstrate how wrong this advice is, is with a simple case study of one of the “non-life-threatening conditions” listed: eczema.

A couple whose baby daughter died after they treated her with homeopathic remedies instead of conventional medicine have been found guilty of manslaughter.

Gloria Thomas died aged nine months after spending more than half her life with eczema.

The skin condition wore down her natural defences and left her completely vulnerable when she developed an eye infection that killed her within days of developing.

And it’s not the only case. It’s extremely clear that the very last thing you should do when faced with a chronic condition is to consult an “alternative” practitioner, who will follow an ideologically-determined path with no provable value to you, for profit.

67 Slimming

All doctors usually have to offer are drugs and calorie counting, which aren’t long term solutions, and numerous slimming drugs have potentially fatal side-effects. Look first for potential food intolerances, get your thyroid checked out, clean up your diet, and opt for low-GI foods and lots of fruit and veg.

The GI diet was developed by doctors. It’s recommended by doctors, who also recommend exercise and weight management clinics. Oh, and they can also refer you for lap band or other surgical interventions which have a reasonable success rate in the chronically obese who are not compliant with diet regimes. Doctors are also pretty good at spotting thyroid problems.

In the end, though, there is only one diet that is proven to work 100% of the time: the ELEM diet. Eat less, exercise more. Every reputable doctor in the UK, and probably the world, will tell you the same. WDDTY seem to prefer nutritionists who generally have no recognised qualifications whatsoever but nevertheless often sell miracle or fad diets.

68 Colds and flu

Unless you’re elderly and your immune system is compromised in some way, there’s nothing your doctor can give you (or your children) to end a cold or flu, which is usually caused by a viral infection (against which antibiotics mostly don’t work). Bed rest and plenty of fluids, plus zinc, Echinacea, Pelargonium sidoides, Andrographis paniculata, vitamin C and probiotics can all shorten the life of a cold (see WDDTY December 2013).

We’ve critiqued these claims recently. No reputable doctor prescribes antibiotics for uncomplicated viral illness. WDDTY’s view of current medical advice seems to be 20 years out of date and from another continent.

69 Fever

Heat is the body’s extremely clever method of killing foreign invaders of all varieties, and taking anti-inflammatories and other drugs to lower your temperature just hampers that process. Allow your body to self-help by not interfering with a fever unless it’s so high that it may cause permanent damage. Fevers for ordinary viral and bacterial infections won’t exceed 105 degrees F (40.5 degrees C), which generally isn’t dangerous. But see a doctor immediately if you suspect a serious problem like meningitis.

WDDTY don’t seem to know the difference between anti-inflammatories and antipyretic|antipyreticsW. As it happens, Clay Jones at Science Based Medicine recently wrote a much more nuanced piece on fever, in the context of acute cases in hospital, which seems to be the situation WDDTY are considering.

As it happens, Clare Gerada, chair of the Royal College of General Practitioners, recently tweeted a much more pragmatic piece by an actual doctor. Why would you allow your child to suffer the symptoms of fever, if a cheap and safe drug can bring them relief and let them at least get to sleep?

70 Acne

All your doctor can offer are drugs with horrendous side-effects; isotretinoin, marketed as Accutane and Roaccutane, can cause permanent damage to the cornea, impaired hearing, fatal pancreatitis, depression and even suicide.42 Try changing your diet, balancing your blood sugar and identifying any food intolerances first, then look to acupuncture, shown to help in 80 per cent of cases, or herbs like the Ayurvedic herb guggul (Commiphora wightii).43

Reference 42a: Arch Dermatol, 2012; 148: 803–8 Ocular Adverse Effects of Systemic Treatment With Isotretinoin Meira Neudorfer, MD; Inbal Goldshtein, MSc; Orna Shamai-Lubovitz, MD; Gabriel Chodick, PhD; Yuval Dadon; Varda Shalev, MD

Reference 42b: Am J Ther, 2004; 11: 507–16 Polar hysteria: an expression of hypervitaminosis A. O’Donnell J.

Reference 43a: J Tradit Chin Med, 1993; 13: 187–8 Treatment of 86 cases of local neurodermatitis by electro-acupuncture (with needles inserted around diseased areas). Liu JX.

Reference 43b: J Dermatol, 1994; 21: 729–31 Nodulocystic acne: oral gugulipid versus tetracycline. Thappa DM, Dogra J.

The first source says that “Isotretinoin use may be associated with short-term ocular events, especially conjunctivitis, underscoring the importance of educating patients and caregivers about these potentially important AEs of the therapy.” In other words: always read the label and be mindful of the balance of risks and benefits. To spin “may be associated with short-term ocular events” as “can cause permanent damage to the cornea” is typical of WDDTY.

The second source discusses accutane’s similarity to vitamin A, and thus the possibility that it may lead to hypervitaminosis A (but of course no actual vitamin is bad, as because natural). It’s an interesting paper that specifically note that accutane is indicated only for severe recalcitrant nodular acne but is being prescribed for less serious cases. However, this applies almost exclusively in the US, where drug manufacturers can advertise direct to consumers. In the UK, doctors are much closer to following the actual indications, because parents and patients are much less likely to pester the doctor for the drug they just saw advertised on TV. The increase in suicide with accutane should also be weighed against the fact that acne itself may induce suicidal thoughts. Bottom line: ask your doctor. This is the kind of thing GPs are trained for.

The third source is in a journal dedicated to promoting “traditional” Chinese medicine – in fact largely an invention of Mao. Such journals have serious issues with publication bias. The combined weight of evidence is pretty clear: needling results in only placebo effects. Electroacupuncture may have similar effects to TENS, but traditional it is not. Chinese acupuncture uses bamboo needles – bamboo is a notoriously poor conductor of electricity,

The fourth source, from 1994, promotes gugulipid (guggul). There’s decent evidence this works, but (as with every effective treatment) it has side-effects, which WDDTY either haven’t seen or don’t care about because natural.

It can cause side effects such as stomach upset, headaches, nausea, vomiting, loose stools, diarrhea, belching, and hiccups. Guggul can also cause allergic reactions such as rash and itching. Guggul can also cause skin rash and itching that is not related to allergy […].

Hormone-sensitive condition such as breast cancer, uterine cancer, ovarian cancer, endometriosis, or uterine fibroids: Guggul might act like estrogen in the body. If you have any condition that might be made worse by exposure to estrogen, don’t use guggul.

Underactive or overactive thyroid (hypothyroidism or hyperthyroidism): Guggul might interfere with treatment for these conditions. If you have a thyroid condition, don’t use guggul without your healthcare provider’s supervision.

So, quite a lot of problems there. And guess what? Thanks to assiduous lobbying by the supplement industry, you might well never find out about these.

Acne is a bugger. See your doctor for good evidence-based advice, and see a counsellor if you find the bullying of your peers to be distressing.

100 ways to live to 100: Think twice about these tests

Part of a series on WDDTY’s “free” advertorial report “100 ways to live to 100

Think twice about these tests

This is an area where WDDTY is more likely to be right, simply because there is a reasonable consensus that screening leads to overdiagnosis and false positives. However, WDDTY’s advice is based on prejudice and dogma. It is less complete and less well argued than the numerous evidence-based discussions of the pros and cons of various tests.

Our advice on avoiding unnecessary tests is this: read Dr. Margaret McCartney’s The Patient Paradox. This will help you to understand false positives and false negatives, and to ask intelligent and informed questions that will lead you to make a pragmatic choice over a particular test, rather than hysterical anti-medicine rejection of all tests however appropriate.

51 The PSA (prostatespecific antigen) blood test for prostate cancer

It produces false negatives a third of the time and has overdiagnosed more than one million men since its introduction in 1987.29 Unless you have an aggressive cancer, consider watchful waiting. Ditch statin drugs, which increase your risk of this cancer by one-and-a-half times, and reduce carbs, avoid red meat and eat a Mediterranean diet.

Reference 29: J Natl Cancer Inst, 2009; 101: 1325–9 Prostate cancer diagnosis and treatment after the introduction of prostate-specific antigen screening: 1986-2005. Welch HG, Albertsen PC.

PSA is a marker, it is useful in monitoring progression as part of “watchful waiting” (the standard of care for indolent prostate cancers) but its use as a screening test is controversial, not least because the “normal” level of PSA varies widely. From the Wall Street Journal:

Richard Ablin, a professor of pathology at University of Arizona College of Medicine, discovered the prostate-specific antigen in 1970, and for nearly as long, he has argued that it should not be used for routine screening.

So the fact that PSA screening is problematic is not only not something “doctors don’t tell you”, it’s something that the inventor of the test itself has been saying for decades, and which medical journals are confirming.

PSA screening has been discouraged in the UK since the 1990s.

WDDTY can never resist a dig at statins (we’ll review that later), or an opportunity to plug the mediterranean diet (presumably in a modified version that does not include pasta, breads or tomatoes, since these are all fingered as causing problems within this article as well as elsewhere).

52 Routine mammograms (unless cancer is suspected)

This blunderbuss approach, which uses X-rays to detect breast cancer, doesn’t see cancer at its earliest stages and fails to pick up aggressive tumours. For every woman whose cancer is correctly detected, 10 healthy women will go through unnecessary worry, further testing and even treatment before doctors realize they’ve been misled by a false-positive. Consider thermography instead.

So close! This was almost a correct piece of advice, and then they went and ruined it by promoting a quack diagnostic technique instead.

Breast thermography is, to put it bluntly, useless as a diagnostic tool. It’s dissected here by David Gorski, a surgical oncologist specialising in breast cancer. To quote the American Cancer Society:

Thermography has been around for many years, but studies have shown that it’s not an effective screening tool for finding breast cancer early. Although it has been promoted as helping detect breast cancer early, a 2012 research review found that thermography detected only a quarter of the breast cancers found by mammography. Thermography should not be used as a substitute for mammograms.

Oh, and mammograms do detect cancer, just not perfectly. As with any area of medicine, breast cancer staging and screening is a work in progress. There is a debate about what to do with DCIS, for example. There is certainly a debate about routine mammography and the ages at which it should be considered. Above all, our understanding of the nature of indolent disease is developing rapidly. It seems likely that as the population ages many more people are likely to die with cancer than die of cancer.

53 Blood pressure readings

Many factors can distort a BP reading by as much as 5 mmHg: acute exposure to cold, recent alcohol intake, incorrect arm position, an incorrect cuff size—and even the presence of the doctor, now so common that it’s called ‘white-coat’ hypertension. Blood pressure falls at night, and night-time blood pressure is considered the most accurate predictor of heart attack.30 Consider 24-hour blood-pressure monitoring, not the old-fashioned cuff.

Reference 30: Lancet. 2007 Oct 6;370(9594):1219-29. Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study. Boggia J et. al.

Why don’t doctors tell you this? Oh, they do. A single high reading in the doctor’s surgery is never the trigger for intervention unless it’s very high. Normal range is 120/80 to 140/90, so the uncertainty of 5 mmHg is clinically insignificant – if your pressure is 200/100 this is not going to be down to the white coat effect.

Compare and contrast WDDTY’s advice with that from the National Institutes for Health.

54 Routine smear tests

Many doctors still offer women an annual smear test for cervical cancer—even though they’ve been told the test can do more harm than good. The test throws up many false positives—incorrectly ‘seeing’ abnormal tissue that triggers a series of further and more invasive tests, plus needless worry. Even the advises a smear test once every three for those aged over and once every five years for those between 30 and 65.31

Reference 31: Am J Prev Med, 2013; 45: 248–9 The times they (may) be a-changin’: too much screening is a health problem. Harris R, Sheridan S.

Routine smear tests are a curate’s egg. In women at high risk, they are likely to be warranted. In women at low risk, not so much. If your GP is not up on the current state of knowledge (and they should be), ask for a referral to a specialist gynaecological clinic.

The take-home message that must be reinforced here is not that screening is evil, but that a borderline positive smear is not a cause for worry, it is a prompt for further investigation only.

55 Routine dental X-rays

Your dentist keeps telling you it’s safer than an airplane flight, but dental X-rays could triple the risk of meningioma, a kind of brain tumour. Children who have a Panorex or full-mouth X-ray before the age of 10 run the greatest risk, and even bitewing X-rays increase risk. Regular exposure may also cause heart disease. Annual checkups should be urgently reconsidered, say Yale University researchers.32

Reference 32: Cancer, 2012; 118: 4530–7 Dental x-rays and risk of meningioma. Claus EB, Calvocoressi L, Bondy ML, Schildkraut JM, Wiemels JL, Wrensch M.

Actually we agree that you should avoid unnecessary X-rays, because unlike WDDTY we understand the difference between ionising and non-ionising radiation. X-rays are ionising radiation. 

But good dentists don’t do routine X-rays. They use them to diagnose and guide treatment. If your dentist recommends routine X-rays then consider changing your dentist.

If you want an example of gratuitous exposure to unnecessary X-rays, look to your local chiropractor.

56 CT (computed tomography) scans

This whole-body, three dimensional imaging system is one of the most sensitive early-warning detectors of cancer, internal bleeding, heart problems, stroke and neurological disorders, but the standard course of two or three CT scans is equivalent to the radiation levels of Hiroshima or Nagasaki atomic bombs;33 just one scan is equivalent to around 500 standard chest X-rays, reckons the Royal College of Physicians of Edinburgh. Children who are scanned run a far higher risk of developing cancer.34 Ask for any other kind of imaging exam first.

Reference 33: N Engl J Med, 2007; 357: 2277–84 Computed Tomography — An Increasing  Source of Radiation Exposure David J. Brenner, Ph.D., D.Sc., and Eric J. Hall, D.Phil., D.Sc

Reference 34: Radiat Res, 2010; 174: 753–62 Thyroid cancer risk 40+ years after irradiation for an enlarged thymus: an update of the Hempelmann cohort. Adams MJ, et. al.

This is a rehash of a story in the December 2013 issue, “CT scans increase children’s cancer risk“. The second reference is puzzling as it refers to patients who had radiotherapy, not CT scans. The evidence for increased risk of cancers in children following CT scans is epidemiologically sound and does not rely on making inferences from unrelated research.

CT scans are used to rule out potentially life-threatening conditions, especially in children. Brain haemorrhage, for example. The sources are unanimous in supporting their diagnostic use and the fact that the benefits outweigh the risks, but equally unanimous in urging caution and ruling out other diagnostic tests first.

It should be pointed out that radiation increases risk, but does not inevitably produce cancer. Tsutomu YamaguchiW was exposed to radiation equivalent to the Hiroshima and Nagasaki bombs, having been caught in not one but both blasts. He died in 2010 aged 93. The Wikipedia article on hibakushaW (survivors of the atomic bombs) is interesting; the fact that the memorials are still being updated annually does indicate that being exposed to radiation is not a death sentence, however undesirable it might be.

The take-away message here is that it’s fine to challenge the diagnostic necessity of any test, but don’t rule out scans that reveal potentially fatal conditions just because of fear of some uncertain future consequence.

57 Routine prenatal ultrasound

The prenatal ‘miracle’, which uses high-frequency pulsed sound waves to image the fetus in the womb, gets it wrong so often that up to one in 23 women told by doctors they’ve miscarried may end up terminating a pregnancy. Scans see’ a miscarriage the pregnancy is viable, say researchers London and Belgium.35 Reserve this when something really wrong, and consider waiting before ‘completing’ termination if the test concludes you’ve miscarried.

Reference 35: Ultrasound Obstet Gynecol, 2011; 38: 503–9 Gestational sac and embryonic growth are not useful as criteria to define miscarriage: a multicenter observational study. Abdallah Y, et. al.

A second bite at the cherry for ultrasound (should we dock one from the tally of 100 things and make it 99 things?). Does the source support WDDTY’s conclusion? Only partly:

There is an overlap in MSD growth rates between viable and non-viable IPUV. No cut-off exists for MSD growth below which a viable pregnancy could be safely excluded. A cut-off value for CRL growth of 0.2 mm/day was always associated with miscarriage. These data suggest that criteria to diagnose miscarriage based on growth in MSD and CRL are potentially unsafe. However, finding an empty gestational sac on two scans more than 7 days apart is highly likely to indicate miscarriage, irrespective of growth.

In other words, there is a level at which ultrasound can detect a definitely non-viable pregnancy, but the margins are more blurred than was thought. This is in first trimester pregnancies, where only a few generations ago many women would not even know they were pregnant. Spontaneous abortionW is common in the early stages, often before the woman is even aware that she’s pregnant.

The source absolutely does not support a blanket rejection of obstetric ultrasonographyW, or even of early ultrasound where bleeding is present. However, the mandatory use of ultrasound introduced by anti-abortionists in some US states is unquestionably abusive and morally repugnant.

58 Peripheral bone densitometry

It’s the most commonly diagnostic tool for osteoporosis, and it measures usually the hip and spine, but bone mineral density (BMD) is not uniform throughout the skeleton. Although the WHO criteria for a healthy BMD apply only to the hip and spine, a wide range of ‘normal’ BMDs elsewhere in the body may be misdiagnosed as abnormal by these criteria. Diagnosing osteoporosis is still not an exact science, say researchers; you have a strong chance of being misclassified, especially when the test is done in those under 65.36

Reference 36: BMJ, 2000; 321: 396–8 The increasing use of peripheral bone densitometry (Editorial)

Differential diagnosis of osteoporosisW versus osteopeniaW is indeed a grey area, but it’s a distinction without a difference as both indicate a loss of bone density. DEXA scans can be perofrmed on central or peripheral bones, peripheral scans are easier and the machinery is smaller (and often portable).

Needless to say the BMJ article does not undermine the use of bone densitometry, but does question the use of a pragmatic epidemiological definition of osteoporosis, as the threshold for intervention. In other words, it may be valid to treat low-end osteoporosis as osteopenia – essentially using calcium and vitamin D as a first line of treatment before launching right in with bisphosphonatesW. This is what any good doctor would do anyway. But how will the doctor make the diagnostic call without a DEXA scan? Would you prefer a core DEXA, involving a trip to the radiology department of your nearest big hospital and a longer procedure with greater X-ray exposure, or a possibly clinic-based scan that will give a less accurate but probably still clinically useful answer?

As usual, WDDTY takes an absolutist stance that doesn’t help.

59 Biopsy

In a biopsy, a small bit of tissue is removed under local anaesthetic to diagnose a serious illness like cancer. Besides infection, puncturing nearby organs, and causing tears and bleeding, the greatest danger is that biopsies can inadvertently ‘seed’ or spread cancer. With breast biopsies, the risk of recurrent cancer from a ‘needle metastasis’ is about one in 15.37 Request PET (positron emission tomography) or MRI (magnetic resonance imaging) instead.

Reference 37: Acta Radiol Suppl. 2001 Dec;42(424):1-22. Aspects in mammographic screening. Detection, prediction, recurrence and prognosis. Thurfjell MG.

The relevant section of the abstract is:

Local recurrences in 303 nonpalpable breast cancers with preoperative localizations and breast conservation therapy were evaluated for needle-caused implant metastasis. A total of 214 percutaneous biopsies were performed. There were 33 local recurrences. Needle-caused seeding or implantation as based on the location of the recurrence in comparison to the needle path in the mammograms was suspected in 3/44 (7%) invasive cancers without radiotherapy.

This absolutely does not support the idea of rejecting biopsy. These instances of needle-caused seeding are primarily in women who had breast-conserving surgery (“lumpectomy”) for active cancers, and note that it’s more likely to happen when women opt not to have radiotherapy. In the absence of cancer, there are no seed cells.

The overall thrust of the article is actually a vindication of diagnostic mammography:

Screening mammograms comprising of 32 first round, 10 interval and 32 second round detected cancers and 46 normal were examined by an expert screener, a screening radiologist, a clinical radiologist and a computer-assisted diagnosis (CAD) system. The expert screener, screening radiologist, clinical radiologist and the CAD detected 44, 41, 34 and 37 cancers, respectively, while their respective specificities were 80%, 83%, 100% and 22%. Later, with CAD prompting, the screening and the clinical radiologist detected 1 and 3 additional cancers each with unchanged specificities. Screening mammograms comprising 35 first round, 12 interval and 14 second round detected cancers and 89 normal findings were examined without and with previous mammograms by experienced screeners. Without previous mammograms, the screeners detected 40.3 cancers with a specificity of 87%. With previous mammograms, 37.7 cancers were detected with a 96% specificity.

Neither PET nor MRI can accurately diagnose whether a tumour is malignant or not. If your doctors recommend a biopsy, it’s because they think you are likely to have cancer. The utility of baseline mammograms is demonstrated, as is the importance of having a properly trained clinical radiologist review the films.

As to the issue of seeding, Prof. Bill Heald CBE, pioneer of the total mesorectal excisionW procedure for colorectal cancer, is a firm advocate of lavage to minimise seeding – he routinely flushed the abdominal cavity and port sites with copious amounts of dilute antiseptic.

Discouraging people from having a truly accurate differential diagnostic pathological test to differentiate the presence, type and possibly aggression of a cancer? I’d question the medical credentials of anyone giving such advice. If indeed they had any.

60 Computed tomography (CT) angiography

The use of intravenous dye and CT technology to provide an ‘inside view’ of the coronary arteries is fast replacing the exercise stress test done in doctors’ surgeries. It’s also doubling the rate of invasive cardiac procedures, including surgery, say Stanford University School of Medicine researchers.38 Ask to have the standard gym bike or treadmill stress test instead.

Reference 38: JAMA. 2011 Nov 16;306(19):2128-36. Association of coronary CT angiography or stress testing with subsequent utilization and spending among Medicare beneficiaries. Shreibati JB, Baker LC, Hlatky MA.

WDDTY advocate an older test because it finds fewer cases. Remind me again why that would be a valid criticism? Computed tomography angiographyW is a relatively new technique. As with any CT scan, there is exposure to ionising radiation. As with any CT scan, it will only be appropriate when the risks are outweighed by benefits. Rejecting a test on ideological grounds, as WDDTY do, is foolish.

 

Natural pain relief

From WDDTY e-news 3 April 2007 No.347

Natural pain relief

A reader is eager for advice on how he can replace prescription pain medication with a natural alternative.  He suffers from multiple herniated discs and degenerative disc disease and without medication the pain is unbearable.  He has chronic pain in his lower back, buttocks and sciatic nerve.  He currently takes oxycodone, fetanyl (skin patch) and methadone in high doses, but doctors say his medication can be reduced if he opts for surgery.  He has had surgery for his condition in the past and is not keen to have any more operations.  Is there a natural remedy out there that may be able to help?

If you seriously believe that a magnetic bracelet can replace high dose methadone, then you have absolutely no business offering health advice.

Let’s be really clear here: as @LennyLaw pointed out on Twitter, this man is in agony due to serious structural problems. He is unlikely to get relief without some form of surgical intervention. The pain killers he is using are among the strongest available, and go way beyond the “ooh my dodgy knee felt a bit better” kinds of effects that the quack treatments proposed could provide, even if they worked as advertised.

But what counts as “natural”? What “works”? Let’s review the responses one by one:

Bioflow wristbands

According to Nick, you should try a Bioflow wristband, which uses a patented magnetic module to treat the blood and assist the body to heal itself, providing natural pain relief.  “My arthritic thumbs and knees no longer give me any pain and I am sleeping better and have more energy,” he reports.  Another reader points out that the wristbands have been proven to reduce pain in a clinical trial of nearly 200 men and women with osteoarthritis of the hip or knee (BMJ, 2004; 329: 1450-4).

Apparently, Bioflow comes with a 90-day money back guarantee, so there is nothing to lose – but the pain!  See www.usefulmagnets.co.uk for more information.

Does it work?

Bioflow have a sciencey-looking study and are apparently classified as a class 1 medical device. So how do they work?

ernst-bioflowEr, apparently they don’t. The website makes no claims for therapeutic effect other than to cite the study. To see the problem with this approach, check this crank website making all kinds of inflated claims for the product – note the weasel words. Intriguingly the study is from Peninsula, and was overseen by Edzard ErnstW. I asked @EdzardErnst whether the result was reliable. His reply was unequivocal (right).

The consensus of systematic reviews is that magnets do not objectively improve symptoms of arthritis or any other condition (Complement Ther Med. 2009 Oct-Dec;17(5-6):249-56, FACT Volume 13, Issue 1, pages 5–6, March 2008).

Is it plausible?

No. There is no reason to suppose that these permanent magnets should have any effect whatsoever. They are, after all, quite small magnets, much stronger fields are used in medical imaging with no evidence of clinical effect (CSI, BBC). Some of the authors of the study Bioflow cite, have since published a rather different view.

 

Is it natural?

No. There is nothing remotely natural about wearing chunks of rare-earth magnets. These are an industrially manufactured product. And a profitable one: the magnet therapy industry was estimated at $1bn by CSI five years ago.

Should WDDTY have known this?

Probably. They promoted Bioflow in vol 16 no. 9 (Dec 2005), vol 17 no. 4 (Jul 2006) and vol 18 no. 3 (Jun 2007), as well as in this article from their e-news. Claims for magnets date back a long way, with sciencey-looking studies in the late 90s being prominently promoted (CSI). They have been busted for at least as long (e.g. Ann Intern Med. 1993;118(5):376-383).

Icewave

Another recommended product for natural pain relief is IceWave.  According to the manufacturer’s website, IceWave is “a non-invasive nanotechnology product that works within minutes to provide a cooling effect and soothing relief to inflamed and injured areas.”  See www.lifewave.com for more information.

Does it work?

You have to be kidding. LifeWave is a vendor of devices to “protect” you from non-ionising (i.e. essentially harmless) radiation, it is a predator on the vulnerable (people with chronic pain).

Our exclusive non-transdermal patch system utilizes new technology to gently stimulate acupuncture points – literally improving the flow of energy in the body for improvement of pain and discomfort – within minutes of use!

Needless to say, there is no good evidence that acupuncture points are of any physiological significance (J Intern Med. 2006 Feb;259(2):125-37). There’s no uniform definition of where they are or what they do; the apparent uniformity within parts of TCM is largely an artifact of the Maoist refactoring f TCM in the 1950s – Japanese analogues exist but are different, and needling does not seem to have any different effect whether the “correct” points are used or not.

The sales pitch relies on the usual anecdotes. Oh, and the packaging says they are homeopathic, hence the nanobollocks, presumably. And note the quack Miranda warningW.

Is it plausible?

Not remotely. And to be fair they don’t even try to make it look plausible, other than using sciencey-sounding language.

Is it natural?

No. It’s an entirely synthetic product with completely made up claims.

Should WDDTY have known this?

Almost certainly. The community that promotes LifeWave’s numerous bogus products is well aware of the fact that skeptics know it to be bogus. Oh, and it seems to be sold via multi-level marketingW, which is another red flag.

Homeopathy

If these suggestions don’t appeal to you, why not try readers’ favourite, homeopathy. According to Sue, the homeopathic remedy Mag Phos in a 200C potency (available from homepathic pharmacies such as Helios and Ainsworth’s) is known to be very effective for pain relief, especially if dissolved in a little warm water and sipped at regular intervals.  Norene also swears by homeopathy for the treatment of pain – although she uses arnica:  “Start with a very high dose of arnica (for myself I used 10M).  After a couple of days, reduce the dose and continue taking the remedy for a while, according to personal needs.  To maximise effectiveness, take homeopathic Symphytum (comfrey) in addition to arnica.”

Does it work?

No. There is not one case where homeopathy has been unambiguously and objectively proven to have cured anything, ever. All observations are consistent with the null hypothesis (see homeopathyW at Wikipedia, which goes into great detail).

Is it plausible?

No remotely plausible mechanism has ever been advanced, and the doctrines of homeopathy conflict at a fundamental level with basic principles of physics such as the Heisenberg uncertainty principle and the laws of thermodynamics and conservation of energy. Unless you believe in “future-information medicine“, in which case you may be interested in buying this rather fine bridge I have for sale.

Is it natural?

No. Not only is the entire system of preparation by dilution and twerking entirely man-made, most over the counter remedies are manufactured by industrial scale pharmaceutical companies.

Should WDDTY have known this?

Yes. Homeopathy has been known to be wrong since at least 1840, and the doctrines were refuted by the early years of the 20th Century.

Bowen therapy

Other suggestions for this problem are Bowen therapy and osteopathy.  Says Lorraine of osteopathy, “I cannot sing its praises enough…I suffered terrible back problems but have not felt a twinge in the past six years since my treatment.”  As for Bowen, Angela reckons it can bring amazing relief to many pain sufferers.

Does it work?

It depends who you believe. SCAM believers claim it is “useful” (source),  but when challenged, practitioners were unable to provide any credible evidence.

So that’s a no.

Is it plausible?

Bowen was an unregistered osteopath. There’s no reason to suppose that Bowen technique  has any effect beyond that of massage, which is basically what it is, when the bullshit is stripped away. Claims to allow the body to “reset” itself are fanciful. You’re probably better off with a warm bath.

Is it natural?

Massage is sort of natural, Bowen technique is completely made up.

Should WDDTY have known this?

If you look for any credible evidence, you find none. If on the other hand you routinely believe the claims of commercial providers of services at face value without looking for evidence or applying any critical judgment then you’ll probably not spot that it’s quackery.

So, if WDDTY pretends to be in any way scientific or evidence based, it absolutely should have spotted this.

Osteopathy 

Finally, we have an encouraging story from Diane:

“I have suffered from bulging discs, sciatica, oedema and a host of related problems for the past three years.  But recently I have started several therapies which have helped me immensely.  First of all I started going to acupuncture once a week, then I began drinking Green’s Plus – adding powdered calcium, magnesium, and powdered MSM (Methyl-sulfonyl-methane) to the drink – everyday for nutrition.  MSM is a great natural pain reliever, along with magnesium.  I also use magnesium oil – either in the bath or applied directly to the site of pain.  It works wonders!

Does it work?

Osteopathy is a grey area. There is evidence of effects for musculoskeletal pain, as for any manipulative therapy, but the claims of the fringes of osteopathy (and especially cranial osteopathy aka cranio-sacral therapy) are unambiguously bogus. The writer also adds acupuncture (bogus), magnesium (plausible to a degree) and MSM (bogus) to the mix.

Is it plausible?

As invented by Andrew Taylor Still the practice is completely speculative – he surmised that the bone (osteon) was the root of all disease, and this is unambiguously nonsense, but subsequent changes have resulted in a variety of manipulative therapy which is plausible for some conditions, but wildly implausible for others. Note that this varies around the world, the Wikipedia article on osteopathyW is essential reading.

Is it natural?

The practice was invented from whole cloth in 1874. It’s a manual therapy so you could defend it as natural, but the practice is largely a set of man-made rituals.

Should WDDTY have known this?

Yes. The consensus around osteopathy has been settled for a long time.

Chiropractic

In addition to this, last year I started seeing a chiropractor, who uses a ‘Pro Adjuster’ on me.  I have now been free of pain for the last month.  I was told that I was going to have to have back surgery, but now I am feeling so wonderful that I am considering not having the surgery at all.  I can go all day without my pain medication and can sit and stand longer than I ever thought I would again!”

Does it work?

No. OK, technically, it is as effective as other forms of manipulation therapy for musculo-skeletal pain, but so many chiropractors exceed the bounds of evidential supportability that it is safer t avoid them altogether, especially given their history of antivaccinationism and the fact that one of their signature moves is potentially deadly.

The chiropractic profession includes some of the most cynical charlatans on the planet. Their training is big on “practice building” (i.e. maximising revenue) and chiropractors’ aim is to get you in, and keep you coming back, not to discharge a healthy patient. They use all manner of superstitious nonsense about “maintenance adjustments” and maintaining optimum wellness, but basically they are the canonical manipulative quacks.

Is it plausible?

As Wikipedia says:

A critical evaluation found that collectively, spinal manipulation failed to show it is effective for any condition. The scientific consensus is that chiropractic may be on a par with other manual therapies for some musculoskeletal conditions such as lower back pain, but that there is no credible evidence or mechanism for effects on other conditions, and some evidence of severe adverse effects from cervical vertebral manipulation. The ideas of innate intelligence and the chiropractic subluxation are regarded as pseudoscience.

So as with osteopathy, it’s plausible up to a point, but the profession as a whole is deeply untrustworthy due to widespread belief in completely bogus ideas, and a tendency to duplicate the action of hanging.

Is it natural?

No. It was invented from whole cloth by D. D. Palmer in 1895

Should WDDTY have known this?

The facts about chiropractic have been known for a long time. Yes, WDDTY should know that this is a dangerous woo-riddled field that no responsible person could possibly recommend without serious caveats around the likely harms and the costs of endless unnecessary treatments.

Summary

WDDTY’s ideas of what constitutes a “natural” remedy are absurd and seem to be founded more on the absence of credible evidence (i.e. being “alternative”) than on any actual natural origin. They try to have their cake and eat it, simultaneously claiming that something is “natural” and that it’s “nanotechnology”.

Their approach to the therapies is entirely credulous. Homeopathy was refuted over a century ago, they still promote it. There is no evidence that their enthusiasm for a product or treatment is conditional on plausibility or evidence of effect.

The article acts primarily as a propaganda piece for disproven or unproven therapies, often at significant potential cost.