Tuesday, December 15, 2009

Help beat the gag on the BBC!

You can help beat Trafigura’s gag on the BBC by embedding this Youtube video on your website…

…and linking to this pdf! See here (full blogpost) as to why.

(H/T to Carmen Gets Around and Don't Get Fooled Again.)


Friday, December 4, 2009

Merseyside Skeptics Society Stick the Boots in.

10:23pm on a Friday night - this is my rock and roll life. Due to moving house, I've had a month off blogging. Luckily nothing in the areas that I tend to blog about has happened in the last month.

Oh, apart from the UK Parliament having an evidence check session on homeopathy which is brilliantly on YouTube, so you can watch some governmental weaselling and squirming at your convenience. Lots of good blogs have been covering this such as Ben Goldacre's Bad Science, Lay Science and The Quackometer.

All this, and I missed it.....

The upshot of the session was a glut of anti-homeopathy pieces in the press, such as The Sun's Homeopathy is a Resources Drain. (Sadly, there are still plenty of people who think sugar pills may cure AIDS).

One of biggest gaffes from the session was by Paul Bennett, Chief Pharmacist of Boots who, despite selling homeopathic products in a manner contrary to MHRA regulations said he had seen no evidence for their efficacy, but sold them because "large numbers of [Boot's] customers thought they worked". This is nothing new in reality, the Quackometer blogged about this in 2006 and the Guardian ran a story on Boots & homeopathy in May 2008.

The Merseyside Skeptical Society wrote an open letter to Boots, reprinted below, outlining the ridiculous position Boots are placing themselves in. (MSS kindly discussed the Thinking is Dangerous blogpost on Boots removing homeopathic sulphur 30c in Episode 8 on their excellent "Skeptics with a K" podcast.)

Well said, MSS.

An Open Letter to Alliance Boots

The Boots brand is synonymous with health care in the United Kingdom. Your website speaks proudly about your role as a health care provider and your commitment to deliver exceptional patient care. For many people, you are their first resource for medical advice; and their chosen dispensary for prescription and non-prescription medicines. The British public trusts Boots.

However, in evidence given recently to the Commons Science and Technology Committee, you admitted that you do not believe homeopathy to be efficacious. Despite this, homeopathic products are offered for sale in Boots pharmacies – many of them bearing the trusted Boots brand.

Not only is this two-hundred-year-old pseudo-therapy implausible, it is scientifically absurd. The purported mechanisms of action fly in the face of our understanding of chemistry, physics, pharmacology and physiology. As you are aware, the best and most rigorous scientific research concludes that homeopathy offers no therapeutic effect beyond placebo, but you continue to sell these products regardless because “customers believe they work”. Is this the standard you set for yourselves?

The majority of people do not have the time or inclination to check whether the scientific literature supports the claims of efficacy made by products such as homeopathy. We trust brands such as Boots to check the facts for us, to provide sound medical advice that is in our interest and supply only those products with a demonstrable medical benefit.

We don’t expect to find products on the shelf at our local pharmacy which do not work.

Not only are these products ineffective, they can also be dangerous. Patients may delay seeking proper medical assistance because they believe homeopathy can treat their condition. Until recently, the Boots website even went so far as to tell patients that “after taking a homeopathic medicine your symptoms may become slightly worse,” and that this is “a sign that the body’s natural energies have started to counteract the illness”. Advice such as this directly encourages patients to wait before seeking real medical attention, even when their condition deteriorates.

We call upon Boots to withdraw all homeopathic products from your shelves. You should not be involved in the sale of ineffective products, because your customers trust you to do what is right for their health. Surely you agree that your commitment to excellent patient care is better served by supplying only those products whose claims can be substantiated by rigorous scientific research? Or do you really believe that Boots should be in the business of selling placebos to the sick and the injured?

The support lent by Boots to this quack therapy contributes directly to its acceptance as a valid medical treatment by the British public, acceptance it does not warrant and support it does not deserve. Please do the right thing, and remove this bogus therapy from your shelves.

Yours sincerely,
Merseyside Skeptics Society


Wednesday, October 28, 2009

MHRA cause Boots to remove homeopathic product and update website

Back in July, Boots had been promoting Nelson's Sulphur 30c homeopathic remedies, alongside a pdf to download to help you choose which homeopathic product you thought you needed, complete with therapeutic indications. (I hate it when I forget to cache a website that's being complained about. Never mind...)

After a complaint from this site, the MHRA contacted Boots and instructed them to change their website, using only the phrase
Nelsons Sulphur 30c Pillules is a homeopathic medicinal product without approved therapeutic indications
according to the current legislation. Boots have since removed the product completely, however the Patient Guide to Homeopathy is still on the website. MHRA are now aware of this and so hopefully it too will disappear soon.

Not that it matters really, because Holland & Barrett are selling Nelson's Sulphur 30c pillules, complete with therapeutic indications, and completely contravening the law (original link to website here). The MHRA are now aware, and the offending site can be seen here.
Indeed, even Nelson's own site (original site here) deems itself above the law by claiming that the product is "known by homeopaths for its many skin benefits" which is woolly wording in my book, but we'll see what the MHRA do.
(Nelson's also promote the product with therapeutic indications on their Nelson's Homeopathy page here).



Friday, October 23, 2009

Totally Hypothetical Remedy? - MHRA introduce certification mark for herbal remedies.

This is the new Traditional Herbal Registration certification mark. Well, it is apart from the 'Warning', which is what I think it is lacking.

According to the MHRA, this
indicates that the herbal medicine has been registered with the MHRA under the Traditional Herbal Registration (THR) scheme and meets the required standards relating to its quality, safety, evidence of traditional use and other criteria as set out under the Traditional Herbal Medicinal Products Directive (THMPD) 2004/24/EC.
There have been 92 applications since the scheme began in March 06.

The most important line is this one:
Under this scheme, the permitted indications for the medicine are based on traditional usage and not on evidence of effectiveness of the product.
My bold. So, as I wrote before with homeopathy, as long as the seller can demonstrate safety of the product and a history of use for the particular therapeutic indication, then it can receive the THR stamp and be sold legitimately, despite there being no investigation into whether it works or not.

[The MHRA guidance states:
European Directive 2004/24/EC on traditional herbal medicinal products was brought forward specifically in recognition of the position that for many herbal medicines it was difficult for companies to meet the full requirements for a marketing authorisation, particularly in relation to efficacy.
So, because it was difficult to prove they had any efficacy, it was deemed best to create a class of 'pseudo-medicines' that could pretend to be effective, but didn't have to prove it.]

On a positive note, any product with this mark on it will single it out clearly and obviously to me as snakeoil - if it were a *real* medicine that, you know, actually had some effect, then it would be marketed as such and would have some evidence to back it up.

So, perhaps we should look at this stamp as a victory for evidence-based medicine, as it singles out products without any provable efficacy for all to see.


Monday, September 21, 2009

"We are all individuals!" - The Comedy of Homeopathy

Poking fun at homeopaths and those that follow the religion of homeopathy is an easy game: it's an 18th century quack medicine that requires laws of physics and chemistry to be binned in favour of a belief system based on anecdotes and a denial of evidence.

There is plenty to go at: the pills are nothing more than sugar and water, diluted to near infinity, the followers have an unwavering belief in the power of the magic pill and the theory of homeopathy is so topsy-turvy it requires a huge amount of hand-waving and circle-squaring to make any sense out of it.

Time and time again it has been shown to be no better than placebo, despite the homeopathic high priests trying to cure AIDS, malaria and other diseases, sometimes at the expense of proven medicines.

One of the huge paradoxes in the homeopathic theory is the need to offer the patient an individualised medicine - remember the Homepathic Mantra:
Homeopathy heals the person, not the dis-ease
and on the other hand, sell bottles of homepathic medicine for specific ailments.

The idea that the sugar pills need to be indivualised, but also can sold in a popular dilution for a specific ailment is one that I have yet to hear any homeopath explain coherently.

Take a look at the Alliance of Registered Homeopaths' website for instance:
Homeopathic medicines are chosen to treat the whole person, because homeopaths believe the mind and body operate as one, and you cannot treat one part of the body without affecting the whole
which is followed in the next paragraph by, and seemingly without a hint of cognitive dissonance,:
The onion - Allium cepa - can be used homeopathically to treat colds and hayfever where the main symptoms include runny eyes and nose.

Similarly, the Society of Homepaths' website gives the following mangled idea:
What can homeopathy treat?

Homeopathy treats the person, there is some evidence to suggest it can help a person manage the symptoms of acute fevers, sore throats and toothache, to chronic illnesses such as arthritis, eczema, asthma, anxiety and insomnia.
Note the modifiers "some evidence", "suggest", "help", "manage" and "symptoms" - even with these language modifiers in place, it's still stretching the truth.

The pinnacle of this confused comedy came last January, when Napiers Herb and Plant Remedies held a workshop called "Homeopathy for Families" workshop. The advert has since vanished but I blogged about it back in the day. The workshop cost £20, but delegates would receive
a complimentary bottle of the homeopathic remedy Arnica.
Imagine if Pfizer ran a similar scheme, giving away a bottle of Viagra to each delegate? It would be popular, sure, but wholly, wholly unethical, immoral, and illegal.

I made the MHRA aware of this - and was faced with another crazy dichotomy in the up-is-down world of homeopathy. MHRA decided that because the product isn't licensed as a medicine,
the restriction on the distribution of free samples therefore did not apply

Compare this with the Alliance of Homeopaths Website:
Homeopathy is one of the two most widely used forms of medicine in the world today
So it's a medicine but not registered as a medicine. Black is white.

There is a push from within the Church of Homeopathy to register some of these sugar pills under the EU Homeopathic Registration (MLX312) scheme.

This scheme allows specific homeopathic preparations to be licensed for sale for specific therapeutic indication - to a backdrop of "treat the person, not the disease".

After all, we are all individuals.


Wednesday, September 2, 2009

Update on Glasgow Chiropractic

Back in July, I blogged on Glasgow Chiropractic's claims to cure asthma, carpal tunnel syndrome, colic and period pains.

Following a complaint to the General Chiropractic council, Glasgow Chiropractic tweaked their website to remove some of their claims and to included a surprisingly truthful statement that "Chiropractic has never cured anyone of anything".

Since then, they have completely revamped their website, bringing in a ChiroMatrix, a "leader in Chiropractic website design" with the strapline "Raising healthier families".

This is quite a subtle but interesting shift happening within chiropractic - Chiropractors are salespeople, and as any sales guru will tell you , integrating your business with your client as much as possible makes repeat business more likely and therefore the business increases profitability. No longer are chiros happy to hand wave and back-crack, if they can peddle a philosophy of constant need, regular checkups, and a long-term 'wellness plan', they are on their way to the bank because:
Every person is unique, therefore everyone requires a customised wellness plan. The purpose of our wellness program is for you to achieve good spinal alignment, have a healthy diet, exercise, and maintain a positive mental state.
Long termism, think more of the model of the dentist, rather than the doctor.

Phase 1 of the Glasgow Chiropractic's "What to expect" is initial intensive care. Here we find the Humpty Dumpty language of what it means to cure:
Chiropractic does not 'cure' anything! If you are looking for a list of symptoms that Chiropractic has been shown to 'cure' then you will just end up more confused than when you started.
No, you'll end up realising that there is no real evidence that chiropractic has any effect over placebo or similarly administered therapy. But they wouldn't say that, now would they? They'd rather call you 'confused'. I can understand how someone would be confused - here they repeat the 'chiropractic has never cured anyone of anything' line then one paragraph later state
There are many 'conditions' that Chiropractic care has shown to provide assistance with.
- there's glory for you!

Phase 2 is Corrective Care. Bearing in mind the push for repeat business, how does this sit with you:
In order to prevent a rapid recurrence of symptoms, it is often necessary to continue receiving care even though your symptoms are gone.
Nice little earner - a therapy which does nothing will continue to do nothing long after whatever it was it was supposed to do is not even needed! Taking a leaf out of the homeopaths book, they have the 'heads-I-win-tails-you-lose' argument -
Do not be discouraged if you have mild flare-ups in your symptoms on occasion. This is normal.
Homeopaths have a similar get-out clause - called aggravation. i.e. if the problem gets better it shows the sugar pill is working, if the problem gets worse, it still shows the sugar-pill is working. Similarly with Chiropractic, if the pain goes, it was due to chiropractic, if it doesn't that in no way means that the therapy is not beneficial - how can you lose! As sugar on top,
this phase of your care may last anywhere from a few months to a couple of years.

Phase 3 is Wellness Care

When you make routine chiropractic care a part of your lifestyle, you avoid many of the aches and pains that so many people suffer through, your joints will last longer and you will be able to engage in more of the activities you love.
A completely unfalsifiable statement, but a slick sales ploy nonetheless.

It turns out that
Some of our offices are equipped with the very latest in technology designed to non-invasively test your nervous system very accurately. This technology uses a number of cutting edge techniques to give you a very detailed report on the integrity of your spine and nerves. These systems are called the 'Discovery Insight' or the 'Neuro-Infiniti' - please ask at reception about what technologies apply to you.
Doesn't that all sound very sciencey and exciting! Here is a bit more information on the Discovery Insight Subluxation Station. (Bear in mind, subluxations are a very undefined woolly concept in chiropractic, with no real agreement about what they are, so how anything can 'detect' them is a mystery). From the ad, it was used by NASA - oooooh.

Except it wasn't, as they've distanced themselves from it. Indeed, the Chiropractic Journal has launched an investigation regarding the sales practices of the companies behind such machines. Without a hint of irony they state:
The Chiropractic Journal has 23- year history of representing doctors of chiropractic and watching their backs. We will not sit by and see doctors taken advantage of by charismatic salesmen concerned and motivated purely by profit.

One last bit on Glasgow Chiropractic, in case you had thought they had launched the "cure nothing/heal the person" Chiropractic 2.0 free of therapeutic indications, here is a photo of the Glasgow Chiropractic stand in an East Kilbride shopping centre, complete with old school (and removed from their website) claims of colic.

I'll be sure to let the Advertising Standards Authority know.

So either their stand or the website is talking rubbish. I reckon it's both.

H/t to Blue Wode and Zeno


Tuesday, August 11, 2009

Magic Smokescreen - homeopathy & cigarettes

Smoking is big business.

According to the Tobacco Manufacturers Association consumer spending on tobacco products in 2007 amounted to £12.6 billion. This led to tax revenue amounting to £9.9 billion - £8.0 billion in excise duty plus £1.9 billion in VAT.

Then there's the aftermath - according to Medical News Today, the global smoking cessation aids market is to reach $2.6 billion By 2010.

Quite the lucrative industry all in all.

There are all manner of products to try and wean the addict from the evil weed, with varying degrees of success, but surprise surprise, they all require will power and rely on the person concerned having a genuine desire to give up.

It shouldn't really come as a surprise for this to be a booming industry. It is notoriously hard to give up, compounded by the fact that people know it is notoriously hard to give up and that provides its own psychological barriers. To be cynical for one second, a product which relies on will-power (regardless of whether it is Big Pharma or Big Quacka), will help to ensure repeat sales from people who won't give up giving up, and keep the tills ringing for many a moon.

This is happy home turf for homeopathy - a placebo remedy that depends largely on the psychology of the person, and not at all on the sugar pill. Failure is due to lack of will-power, success is due to homeopathy. FTW!

Despite it being illegal to sell homeopathic products in the UK with therapeutic indications (unless licenced by the Medicine and Healthcare product Regulatory Agency), it is possible to buy homeopathic products marketed at the smoker.

How about a homeopathic anti-smoking spray from Smoker Stop Shop?
Spray away your cravings (for tobacco smoke or chewing tobacco) with Smoke Control homeopathic oral spray. It helps with nervousness, anxiety and irritability when quitting. It can also help with cough or shortness of breath, difficult breathing and the sensation of weight on your chest from smoking.
Or what about those homeopathic detox tablets and anti-craving lozenges further down the page
Drug Facts
Active Ingredients (per lozenge) Purpose
Caladium seguinum 4x, 12x, 30x Reduces tobacco cravings
Plantago major 4x Reduces tobacco cravings
Cinchona officinalis 6x, 12x, 30x Reduces tobacco cravings
Lobelia inflata 6x Reduces ill effects of nicotine
Nux vomica 6x, 12x, 30x Reduces tobacco cravings
Staphysagria 6x Reduces ill effects due to tobacco
Calcarea Phosphorica 12x Reduces tobacco cravings
Ignatia amara 12x Reduces nervous tension

Seems like pretty straightforward indications for homepathic products to me.

For the interested few, I'm led to believe that 4x dilution is equivalent to a 2c concentration. This means that 1 drop of the mother tincture has been diluted in 99 drops, hit against a magic board (succussed) and then a drop of that taken and diluted in another 99 drops and succussed again. This means that although the product is dilute, there is still some 'active' in the sugar pill. i.e it's not a homeopathic remedy in reality, it's only labelled that to pass US Food and Drug authority regulations. This crazy loophole which means that products containing 'actives' can be called homeopathic and thereby politely excuse themselves from the rigours of normal drug testing. This can mean that the untested pseudo-homeopathic products have massive unknown negative side effects and cause problems in the users - ZiCam is the most recent example. A pseudo-pseudoscience, if you will.

This can lead to all sorts of wacky products like homeopathic nicotine water being sold (I'm sure I can get hold of some bong-water and sell that?) - but only in US, right? Our strict laws wouldn't allow such quackery to be sold in UK?

As ever there are loopholes. Just because a site has got a '.co.uk' domain name doesn't mean it comes under UK law. As I found when I contacted my MP about a quack arthritis product called Artrosilium and put a written question to the Department of Health, the UK's position is that
The importation of medicines by individuals for their own personal use or for use by a family member is exempt from regulatory controls, and this includes purchases from the internet.
Dawn Primarolo signed the letter. Trading Standards have recently been warning people about false confidence in '.co.uk' websites with consumer goods - surely untested imported medicines with their uncontrolled, unregulated ingredients should be given higher priority than a few knocked-off hair-straighteners?

So who runs the Smoker Stop Shop (www.smokerstopshop.co.uk)? That is one Penelope Walford, who runs a private clinic in Harley Street and refers to herself as a 'smoking cessation specialist' using hypnotherapy as her main tool.

[A Cochrane Review asking "Does hypnotherapy help people who are trying to stop smoking" concluded that
We have not shown that hypnotherapy has a greater effect on six month quit rates than other interventions or no treatment.
So much for that, then. No doubt she has many positive testamonials - most placebo treatments do, and present them in place of real evidence]

So how can Penelope Walford sell homeopathic products in the UK with therapeutic indications, which is against the law? I've asked MHRA the same question - I'll let you know the response.

The idea that homeopathy can do something for smokers to help them kick the habit is quite widespread. Other UK-based companies that seem to be up against the law are The Body and Mind shop and i-Quit, with the media, helpful as ever, to give a hand to evidence-free nonsense. Yet surprisingly, few of them seem to require the major magic ingredient that known to give results - willpower.

H/t to Blue Wode


Wednesday, July 29, 2009

Beware The Spinal Trap - Lawyer-friendly reprint

Just in case you haven't been to your chiropractor in the last little while due to the recession, there has been a maelstrom.

Science writer Simon Singh wrote an article for the Guardian which the British Chiropractic Association claimed libelled them and so went the way of the courts. Justice Eady decided there were words used which conveyed a meaning which Singh had not intended, but that the case should go to trial nonetheless. Singh is appealing the decision.

In the meantime, the searchlight of skepticism was directed towards chiropractic. Hundreds of complaints were sent to the General Chiropractic Council meaning the GCC were unable to cope with the volume of complaints and causing some chiropractors to rapidly remove or rehash their websites, with some of them throwing in the towel and admitting that Chiropractic has never cured anyone of anything.

Sense about Science has been working with Singh to campaign to keep libel laws out of science.

As part of that, they have arranged for Singh's original article to be scanned by lawyers, have the few words removed that were called into question, so that the article can be reprinted without fear of libel. The important point of this article is that, the whole feel, meaning and impetus is unchanged by the removal of a few contentious words. The thrust of the article is the statement of fact that there is little/no evidence for most (all?) of the claims of chiropractic.

I am pleased to reprint the lawyer-friendly article below - it should also be noted that the BCA have no issue (and therefore tacitly agree with?) everything in the article below.

Beware the spinal trap

Some practitioners claim it is a cure-all, but the research suggests chiropractic therapy has mixed results – and can even be lethal, says Simon Singh.

You might be surprised to know that the founder of chiropractic therapy, Daniel David Palmer, wrote that “99% of all diseases are caused by displaced vertebrae”. In the 1860s, Palmer began to develop his theory that the spine was involved in almost every illness because the spinal cord connects the brain to the rest of the body. Therefore any misalignment could cause a problem in distant parts of the body.
In fact, Palmer’s first chiropractic intervention supposedly cured a man who had been profoundly deaf for 17 years. His second treatment was equally strange, because he claimed that he treated a patient with heart trouble by correcting a displaced vertebra.
You might think that modern chiropractors restrict themselves to treating back problems, but in fact some still possess quite wacky ideas. The fundamentalists argue that they can cure anything, including helping treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying – even though there is not a jot of evidence.
I can confidently label these assertions as utter nonsense because I have co-authored a book about alternative medicine with the world’s first professor of complementary medicine, Edzard Ernst. He learned chiropractic techniques himself and used them as a doctor. This is when he began to see the need for some critical evaluation. Among other projects, he examined the evidence from 70 trials exploring the benefits of chiropractic therapy in conditions unrelated to the back. He found no evidence to suggest that chiropractors could treat any such conditions.
But what about chiropractic in the context of treating back problems? Manipulating the spine can cure some problems, but results are mixed. To be fair, conventional approaches, such as physiotherapy, also struggle to treat back problems with any consistency. Nevertheless, conventional therapy is still preferable because of the serious dangers associated with chiropractic.
In 2001, a systematic review of five studies revealed that roughly half of all chiropractic patients experience temporary adverse effects, such as pain, numbness, stiffness, dizziness and headaches. These are relatively minor effects, but the frequency is very high, and this has to be weighed against the limited benefit offered by chiropractors.
More worryingly, the hallmark technique of the chiropractor, known as high-velocity, low-amplitude thrust, carries much more significant risks. This involves pushing joints beyond their natural range of motion by applying a short, sharp force. Although this is a safe procedure for most patients, others can suffer dislocations and fractures.
Worse still, manipulation of the neck can damage the vertebral arteries, which supply blood to the brain. So-called vertebral dissection can ultimately cut off the blood supply, which in turn can lead to a stroke and even death. Because there is usually a delay between the vertebral dissection and the blockage of blood to the brain, the link between chiropractic and strokes went unnoticed for many years. Recently, however, it has been possible to identify cases where spinal manipulation has certainly been the cause of vertebral dissection.
Laurie Mathiason was a 20-year-old Canadian waitress who visited a chiropractor 21 times between 1997 and 1998 to relieve her low-back pain. On her penultimate visit she complained of stiffness in her neck. That evening she began dropping plates at the restaurant, so she returned to the chiropractor. As the chiropractor manipulated her neck, Mathiason began to cry, her eyes started to roll, she foamed at the mouth and her body began to convulse. She was rushed to hospital, slipped into a coma and died three days later. At the inquest, the coroner declared: “Laurie died of a ruptured vertebral artery, which occurred in association with a chiropractic manipulation of the neck.”
This case is not unique. In Canada alone there have been several other women who have died after receiving chiropractic therapy, and Edzard Ernst has identified about 700 cases of serious complications among the medical literature. This should be a major concern for health officials, particularly as under-reporting will mean that the actual number of cases is much higher.
If spinal manipulation were a drug with such serious adverse effects and so little demonstrable benefit, then it would almost certainly have been taken off the market.

Simon Singh is a science writer in London and the co-author, with Edzard Ernst, of Trick or Treatment? Alternative Medicine on Trial. This is an edited version of an article published in The Guardian for which Singh is being personally sued for libel by the British Chiropractic Association.


Sunday, July 19, 2009

Acupuncture needles no good as toothpicks...

...yet funny enough toothpicks are just as good as acupuncture needles for providing relief of lower back pain.

The reference is
DC Cherkin et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Archives of Internal Medicine 2009 169: 858-866
but evidence-based healthcare knowledge collater, Bandolier has written a plain, easy-to-digest synopsis of the paper here.

The study looked at four therapies; individualised acupuncture, standardised acupuncture, simulated acupuncture with toothpicks and lastly, usual care. From Bandolier:

This large trial involved 638 adults, with follow up of 90% or above up to 52 weeks. Participants had an average age of about 47 years, with about 60% being women. About 70% had back pain for at least a year. The average initial RMDQ score was about 10.5 on a 0-24 scale, and average initial bothersomeness score 5 on a 0-10 scale.

The main results were these:

* There was no difference between individualised acupuncture, standardised acupuncture, or sham acupuncture.
* RMDQ scores fell from 11 to 6 for acupuncture of any sort by 52 weeks, compared with 7.9 for usual care. Any form of acupuncture was better than usual care.
* Bothersomeness scores fell from 5 to 3-5 to 4 for all four groups, with no difference between them.
* Use of medications (about 65% at baseline) fell to 47% with acupuncture, but remained at 59% with usual care.
* There was no difference in SF-36 mental and physical component scores.
* Cutting down on usual activities for more than seven days in the last month at 52 weeks was more common with usual care (18%) than with acupuncture.
* More participants with usual care missed work or school for more than a day (16%) than with acupuncture (5%-10%).
* There was no difference in total costs of back related health services between groups ($160-$221), though costs of acupuncture were not included.
* Adverse events occurred in 12/315 with real acupuncture, compared with 0/162 for simulated acupuncture, with one serious adverse event for real acupuncture.
* One patient in the usual care group went on to have back surgery.

There are a few interesting things that came out of the study.

The difference between standard care and intervention is significant, and confirms previous discussions suggesting the more theatrical the intervention the larger the placebo effect.

Secondy, the cost comparison is interesting - no real cost difference, and indeed acupuncture costs weren't included. So even the 'cost effective' argument is unfounded.

Thirdly, adverse effects - one serious adverse effect and 12 lesser, compared with zero for the toothpicks. This means about 4% of the patients had an adverse effect from a treatment which had absolutely no demonstrable benefit compared to toothpickery.

So let's see: there's no patient benefit, no cost benefit and increased risk of adverse effects. So why are NICE approving it for lower backpain?

Perhaps I'll drop them a line.

(How long do you reckon it'll be before a quackupuncturist declares that this proves acupuncture works, and the toothpicks were "accidently" letting the Qi energy move as it should?)


Monday, July 13, 2009

General Chiropractic Council unable to cope with complaints

According to a letter shown to this blog, the General Chiropractic Council has written to complainants and chiropractors saying that it can not cope with the number of complaints it has received (590 last month compared with 40 per year).

The GCC have stated that
it will be necessary to increase our regulatory staff capacity before we issue formal notification of any complaints relating to chiropractic websites.

The lack of staff will delay the commencement of the formal process until September 2009. The increase in complaints was due to the British Chiropractic Association's attempt to silence criticism about claims for chiropractic being an evidence-free zone.

If the BCA had been a bit less foolish, it could have avoided this whole debacle, but it appears that it was spoiling for a fight, and is looking pretty groggy.


Wednesday, July 8, 2009

Chiropractors admit "Chiropractic has never cured anyone of anything"

PLEASE NOTE Since writing this blog, Glasgow Chiro have revamped their webpage, hence some of the links may no longer work. A more recent article on Glasgow CHiro's website can be found here.

Recently, I blogged about Glasgow Chiropractic changing their website to remove references to colic.

Previous posts on this site have demonstrated that evidence-free claims about the ability of chiropractors to cure/treat period pains, carpal tunnel syndrome and asthma are routinely appearing on chiropractor's websites - in the blogposts above, I linked to Glasgow Chiropractic as an example.

A specific complaint about the contents of their website had been sent to the GCC and so, using www.changedetection.com, I was able to see how Glasgow Chiropractic would react.

As a pleasant surprise, the chiropractors seem they have come over all hand-wringy and repentant and have updated their website accordingly.

The change detection page for menstrual pain is here and the one for shoulder pain and carpal tunnel syndrome is here. You can see the changes made by clicking on " View changes: 2009-07-08 13:57" about half way down on the left hand side.

The new page on shoulder pain is here and contains the bold title
Chiropractic has never cured anyone of anything.

Quite an admission, although one that is completely backed up by research data.

The new addition to the website goes on to say:
If we go looking for the named condition that Chiropractic can be applied to and produce change in we will find ourselves in a merry-go-round of symptoms, loosing [sic] sight of the whole because of an obsession with the parts.

So the question of What can Chiropractic Cure should be changed to "How" can Chiropractic Assist? The answer is simple. A well functioning mind and body has a greater opportunity to heal, repair and function than a poorly functioning one. A well functioning mind and body depends to a significant degree on a well functioning spine and nerve system. This is Chiropractic's contribution.

People find that chiropractic's ability to produce better spine and nerve system function changes their life expression. There are thousands of symptoms and conditions that chiropractic has been associated with helping, however don't ask "Can Chiropractic Cure this or that condition" - instead ask "If my mind and body was functioning better through Chiropractic would I be better placed to handle this condition?"
Have you got that? Don't ask "can chiropractic cure". Just don't. Ask a different question if you must, but don't ask if it can cure.

The page on menstrual pain contains an almost identical admission along with postmodern flakery but has some interesting text manipulations further down (new text in bold, previous text in brackets/italics)

Chiropractic management of dysmenorrhoea

When helping (treating) women who suffer from dysmenorrhea, the majority of chiropractors address only problems located in the areas directly involved in causing the symptoms. In a study conducted to establish which styles of Chiropractic care (treatments) are most frequently used by chiropractors for dysmenorrhea, manipulation was used in 100% of the cases.
Read that last sentence again in its old and new forms - the meaning has been changed to the point of silliness. Although perhaps they are now referring to a different study? Who knows.
A chiropractor’s role is to normalise the functions of the body by correcting spinal problems. The rationale behind the chiropractic management (treatment) of women suffering from dysmenorrhea is to deal with (treat) its spinal and skeletal aspect.

Chiropractic provides the mechanisms through which dysmenorrheic women can be relieved of their pain in a drug-free environment and even go on to live a life free of period pain.

How (What) can Chiropractic assist with (a Chiropractor do for) menstrual pain?

Your chiropractor will perform a complete consult and examination and may take radiographs (x rays) if clinically required.). After review of the examination findings your chiropractor will recommend an appropriate and individual care program. Chiropractic care (Treatment) consists of specific manual adjustments, to the individual joints of the body and spine, which restore damaged neurologic function. As Grey’s Anatomy text states every single organ in the body is controlled by the nervous system. This includes the uterus and reproductive systems. Through the specific adjustment your chiropractor provides neurological input (imput) that allows your nervous system, and so your organs, to adapt to environmental stresses.

So by changing the word 'treat' to 'help' or similar, that makes it all ok. It's good to see that the X-rays are now only done 'if clinically required'.

Will that ever be the case if chiropractic has never cured anyone of anything?


Wednesday, July 1, 2009

MHRA publish public assessment of homeopathic arnica, admit it does nothing, but license it anyway

Just off so no time to blog this properly, but back in May I blogged about the Medicines and Healthcare Products Regulatory Agency giving their blessing to Nelson's selling homeopathic arnica with therapeutic indications.

The full report is now published and can be found here.

A few choice quotes for your discussion:

The homeopathic medicinal product consists of white to off-white spherical pillules
for oral administration, containing 30c (GHP) Arnica montana. It is used for the
symptomatic relief of sprains, muscular aches and bruising and swelling after
contusions. Two pillules should be taken every 2 hours for the first six doses, then
four times daily until symptoms improve for up to a maximum of 7 days.

The excipients used to manufacture the homeopathic medicinal product are lactose,
sucrose and purified water.
Oh, no arnica then?
This bit is utterly laughable:
Published scientific literature review
The applicant has provided a bibliographic reference documenting a summary of
clinical trials using arnica in homeopathic dilutions. The summary refers to studies
where Arnica had been administered in a number of clinical conditions.
The applicant has also provided further details of eleven published clinical studies
investigating the clinical effects of arnica. The studies were performed under
randomised, double blind conditions and were carried out to investigate the post
operative clinical actions of arnica, such as pain relief and bruising.
The results of the clinical trials and studies provided were not conclusive in
establishing the clinical effects of arnica but indicated that there may be a trend
towards demonstrating some beneficial effects of arnica in some situations.

I'll be contacting the MHRA as they seem to have omitted an important safety concern - how do I know that what is in the pack is what is on the label? Both you, I, MHRA and Nelson's know it is impossible to tell.

Friday, June 26, 2009

Say goodbye to colic the easy way!

.... by deleting it from your website, indeed.

Previous posts on this site have demonstrated that evidence-free claims about the ability of chiropractors to cure/treat period pains, carpal tunnel syndrome and asthma are routinely appearing on chiropractor's websites - in the blogposts above, I linked to Glasgow Chiropractic as an example.

[Many other bloggers are carrying out similar investigations into chiropractic claims, in light of the British Chiropractic Association's spectacularly bad decision to sue Simon Singh for stating there was no evidence for many of Chiropractic's claims of efficacy.

As a result, a number of complaints have been put to the General Chiropractic Council, and McTimoney Chiropractic, a professional body for a branch of chiropractic, sent out an edict to its members to shut down their websites, for fear of investigation.]

One of the complaints to GCC was about Glasgow Chiropractic's claims on their website and so, using the power of the intertubes, and changedetection.com, a page monitor for two of Glasgow Chiropractic's pages was set up.

This week, the first notice of change appeared. This provides a comparison of the old site with the changed one - click on 'View Changes' about half way down the page on the left hnd side.

Notice on the left hand side in the yellow box, the word 'Colic' with a line through it. (You'll see the new page has the word 'Colic' removed). They've decided that chiropractic is no longer useful for treating colic. No need to tell anyone though, just say goodbye by deleting it from your website in a wonderfully Orwellian way.

The internets never forget though.

[In a similar fashion, the Complementary and Natural Healthcare Council got caught playing a seemingly dishonest game, by editing old press releases to remove undesirable targets they had set themselves.]


Wednesday, June 10, 2009

"Before every action ask yourself - Will this bring more monkeys on my back?" - Chiropractors react to legal decision

So said Alfred A Montapert. The full quote is:
Before every action ask yourself - will this bring more monkeys on my back? Will the result of my action be a blessing or a heavy burden?

His words seem extremely relevant in light of the recent chiropractic debacle. In short, the British Chiropractic Association is suing science writer Simon Singh for remarks made about the lack of evidence for chiropractic. This has led to the searchlight of skepticism being shone in every corner of the chiro world. Their actions have lead to many more monkeys on their back and the result is a heavy burden for the chiropractic community.

In some astonishing developments brought to light by The Quackometer, Gimpyblog and The Lay Scientist via chiropracticlive.com, McTimoney Chiropractic Association (a chiro representation body) has issued an email telling all McTimoney Chiropractors to remove their websites, remove any claims of cure/help for which there is not evidence (i.e. practically of it), along with the following chiller:

The McTimoney website itself now only has a basic holding page.

A McTimoney Chiropractor, Jo Hanstead, used to have this page on her website (note the reference to period pains, debunked in this blogpost), the others have a similar lack of evidence:

It now reads like this.

Emails shown to this blog from Jo Hanstead regarding chiropractic help with arthritis included the following information:
I usually find that treatment can relieve some/all symptoms, depending of course exactly what is going on. Most people with hip problems have a pelvis that is way out of balance. Balancing the pelvis changes the dynamics at the hip joint, and improves the nerve supply.

I read this to be a strong endorsement of chiropractic for arthritis, for which there is no evidence. When questioned about the evidence, this was extremely telling response:
Trouble is, complementary medicine does not have the money pharmaceutical companies have, nor are theralpes [sic] amenable to double blind trials, hence going at it by research publiched [sic] may not get you a realistic viewpoint.
So the claim is that chiropractic can relieve the symptoms of arthritis, but evidence is not available because of lack of funds alog with special pleading that double blind trials are not suitable. Utter nonsense. There are many, many double-blind, sham-treatment controlled, research papers into chiropractic and other manipulation therapies. This reply is just a smokescreen to try and disguise the fact that the evidence is weak to non-existant.

The various chiropractic associations are now wishing they had thought more carefully about the fall-out of the BCA's decision to sue Simon Singh. The number of monkeys is increasing every day.

EDIT: Zeno has also covered the story here, DC is covering the story here, JDC's coverage is here and Frank @ SciencePunk has posted his post here.


Tuesday, June 9, 2009

Chiropractors take money for trying to relieve asthma, despite a lack of evidence. What a wheeze!

Previous blogposts on this site have demonstrated how a collation of published research, gathered by the independent body, The Cochrane Collaboration, has shown that there is no evidence that chiropractic can relieve menstrual pains or is any better than placebo or control at relieving carpal tunnel syndrome.

Another common claim by chiropractors is that chiropractic can relieve asthma. Asthma is a complex chronic clinical condition - airway inflammation contributes to airway hyperresponsiveness, airflow limitation,
respiratory symptoms, and disease chronicity. (National Heart, Lung and Blood Institute .pdf here)

There is no cure for asthma, but there are a number of treatments that can normally manage the condition. Treatment is based on two important goals:

* Relief of symptoms.
* Preventing future symptoms from developing.

Successful prevention can be achieved through a combination of medicines, lifestyle advice and identifying and then avoiding potential asthma triggers.
Taken from the NHS website. As with carpal tunnel syndrome and menstrual pain, asthma is a condition which can be difficult to treat, can cause pain and inconvenience and is reasonably common - the NHS website suggests about 5 million people suffer from it in the UK. These is a classic situation for complementary and alternative medicine to step in and offer relief. The barrier to success is laid so low, as the patient is ready to try anything (regardless of evidence or how 'creative' the therapy is) just to get some respite from the condition.

As with carpal tunnel syndrome and menstrual pain, the Cochrane Collaboration has published a review on the evidence available for asthma relief by chiropractic and can be found here. (The abstract and conclusions can be found here).

The Cochrane research published in 2005 came to the following conclusion:
There is insufficient evidence to support the use of manual therapies for patients with asthma. There is a need to conduct adequately-sized RCTs that examine the effects of manual therapies on clinically relevant outcomes. Future trials should maintain observer blinding for outcome assessments, and report on the costs of care and adverse events. Currently, there is insufficient evidence to support or refute the use of manual therapy for patients with asthma
The hesitance in the last line is due to poorly-run trial using massage therapy that indicated some benefit, however that is outwith of chiropractic. The author notes that the best run trial between chiropractic and sham treatment found no significant difference.

Any chiropractor who keeps up to date with the research (as is required by General Chiropractic Council’s Code of Practice and Standard of Proficiency - .pdf here) would surely not advertise that chiropractic can help with asthma, or if they had been advertising it, would remove such a claim from their site. A quick search of Google shows that plenty of Chiropractors are seemingly happy to advertise asthma relief despite lack of evidence to back up the claims and therefore contravening their Code of Practice. (I mean, no-one would advertise asthma relief *knowing* that there was no evidence, right?)

As with the previous two ailments, Glasgow Chiropractic is forthright in its misguided belief of asthma help:
The chiropractor will make a detailed examination of the spine, which may include x-ray. He will then decide which misalignment of the spine requires manipulation in order to correct the problem. Correcting the misalignment can halt the chain of events which lead to closing of the airways and asthma attacks, resulting in symptomatic relief and a reduction in frequency of attacks
Fulham Wellness Chiropractic Clinic has decided that:
Chiropractic care can help improve the patient's neurological status and respiratory function through stress management, lifestyle and dietary advise together with specific joint adjustments and exercises.
I wonder how much is down to the chiropractic - the evidence suggests not a jot.
Chiropractors Brighton think:
Chiropractic care can help children with asthma
Chiropractic Health Centres, based in London reckon:
Most common symptoms helped by Chiropractic are asthma, colic and repetitive ear infections.
Many other chiropractic practices like Emerson's Green Chiropractic near Bristol also claim asthma as a treatable condition.

How can the GCC claim to be regulating chiropractic when the treatments offered for specific ailments are not backed up by any worthwhile evidence?

As discussed prevously, the Cochrane Collaboration has reviewed the available research on menstrual research and carpal tunnel syndrome and found the evidence lacking compared with placebo or control. In many cases, Chiropractic practices are claiming to be able to treat these conditions despite a complete lack of evidence. This post has demonstrated that asthma can be added to that list.

Three strikes and you're out.


Thursday, June 4, 2009

The Law Has No Place in Scientific Disputes

free debateSimon Singh has decided to appeal the illiberal ruling of Justice Eady, in the nonsensical libel case brought by the British Chiropractic Association, over his use of the word 'bogus'.

David Colquhoun's blog DC Science and Andy Lewis' Quackometer are leading the charge, along with science charity Sense About Science, who have launched the "Keep Libel Laws Out of Science" campaign. Click here to get the SaS button for your website.

Simon's Facebook page is here and Simon writes in his own words here. Jack of Kent has been following this story in full here.

Anyone in the midlands area free on Mon 8th June 2009, should make their way to the The Chequers Inn in Oxford, where Simon is the guest speaker at Skeptics in the Pub (Oxford)

I'll see you there!


Monday, June 1, 2009

Chiropractors claim wrist action, but evidence states no happy ending.

I'm talking about Carpal Tunnel Syndrome(CTS) of course.

CTS is a relatively common ailment, which causes a pins and needles sensation in the fingers and hands. The NHS website linked to above, estimates that almost 5% of women and 3% of men have CTS. Most cases of CTS develop in people who are between 45-64 years of age. People with mild to moderate symptoms usually respond well to non-surgical treatment, such as wrist splints and corticosteroids injections. However, more severe cases usually require surgery to reduce the pressure on the median nerve. Left untreated, CTS may lead to permanent nerve damage.

So this is a common problem, ranging from very mild to severe, but at the painful end of the scale, surgery is the only option. As with menstrual pain, the parameters are nicely set for quack therapies to offer hope of relief.

Also like menstrual problems, the Cochrane Collaboration, an international not-for-profit and independent organization, dedicated to making up-to-date, accurate information about the effects of healthcare readily available worldwide, has published a review on Carpal Tunnel Syndrome. In this case, it has looked at all the non-surgical therapies that have been discussed in the scientific literature, analysed the data and come up with some evidence-based conclusions:
Trials of magnet therapy, laser acupuncture, exercise or chiropractic care did not demonstrate symptom benefit when compared to placebo (or control).
So the evidence gathered so far seems to be fairly clear and there is no reason why any self-respecting chiropractor would advertise that they could help CTS - it would be surely foolish?

Surprisingly (or perhaps not), the deja vu continues - CTS, like menstrual problems, is a prime complaint for alternative medicine; Like menstrual problems, it has a Cochrane Review which concludes that, based on published evidence, chiropractic is no better than placebo or control; and lastly and incredibly, like menstrual problems, appears on numerous chiropractic websites as a condition that they are able to successfully treat.

For instance, see Dr (not medical) Chris Pickard of the Pain Relief Centres in Finchley and Hatfield, discussing carpal tunnel syndrome:
Dr (not medical) Chris doesn't seem to have read the evidence, but no doubt he has his 'own evidence' (anecdotes) as do homeopaths, faith healers, pendulum swingers, astrologers, mediums and any other branch of quackery and pseudoscience you can think of. (Incidentally, I haven't looked into Cold Laser treatment mentioned in the video, except to say that a review in 2007 said there was 'conflicting evidence' as to its effectiveness). I like the ice-cream van near the end of the video.

Glasgow Chiropractic, (once again) claim:
[if] it is definitely carpal tunnel syndrome [...] a chiropractor can help greatly.
Not according to the evidence, they can't.

Roundhay Chiropractic in Leeds claims
carpal tunnel syndrome [-] Chiropractic can help you recover quicker and with less pain.
The evidence suggests not.

Other offenders include The Healing Clinic in York, Health Hydro (Swindon Borough Council website, if you're interested in complaining) in Swindon, the Chiropractice in Cardiff, the Chiropractic Clinic in Chester, and of course the Pain Relief Centre in Finchley, which boasts Chris Pickard from the above video.

There are plenty more Chiropractors out there offering this quack treatment, despite the clear, available evidence that it is of no value over placebo or control. I have no idea whether these places are aware of the available evidence - if they are, then they are knowingly misleading and fraudulent (bogus, if you will), if they aren't, then their professional knowledge is questionable - would you want to be treated by someone who offers useless treatments, demonstrating their ignorance in their supposedly specialised field?

Needless to say, the GCC will be made aware of this situation - will they just get a slap on the wrist?


Thursday, May 28, 2009

"As part of our commitment to transparency, we are becoming less transparent" - Ofquack

This is how the CNHC website looked on May 21st 2009 and here's how it looks now - see the difference?

I had previously written to Ben Bradshaw MP regarding CNHC, got a largely unsatisfactory reply and have to-ed and fro-ed again since then.

One of my main issues was that the quack health lobby group, Prince Charles' Foundation for Integrated Health, had received £900,000 of Dept of Health funding (my and your taxes) to set up CNHC and yet, they were being opaque as to their operations. Seemingly by mistake, a CNHC staff member put the minutes of the Nov 08 meeting on the web, which contained discussions about 'misinformation on a blog' and infiltrating websites to promote CNHC. I should point out that the CNHC have stated the minutes were not OK-ed by the board and contained inaccuracies. At the time of writing, those minutes are still available on the CNHC website here(.doc file).

The website (shown above) continued to state until May 21st 09 that
In order to meet our commitment to transparency, CNHC will make the minutes of board meetings appear here.
Rubbish. The Nov 08 minutes (and previous) never 'officially' appeared, nor did the Feb 09. From a letter I've seen from the Dept of Health, it appears that at the Feb 09 meeting, a decision was made not to put the minutes on the website, but instead
a synopsis of items for discussion and decision would be put on the website.
Seemingly, no need to update the website though.

It's also interesting to note how many therapists are registered. Or it would be, if you could find out. Ever since a public spat (pdf) with the General Regulatory Council of Complimetary Therapies (splitters....), even the potential number of sign-ups was always going to be difficult to establish. The CNHC also seem unable to provide an answer because they allow industry bodies to upload blocks of therapists - despite an FoI request response from the Dept of Health, which stated
the [Professional Associations]cannot register their members with the CNHC. Rather, individual practitioners have to apply to the CNHC if they wish to be admitted to the
More muddle and confusion. One of the CNHC key objectives is to register 10,000 therapists by end of 2009, although I'm lead to believe the number is currently around 2,000.

So it seems the commitment to transparency has been discreetly removed - the new webpage on the CNHC website has dropped its 'commitment to transparency' tag (along with the word 'minutes') and replaced it with heavily edited meeting notes which contain such salacious gems as
Various amendments and changes were agreed.
How useful.

I never did find out what they did with that £900,000.


Wednesday, May 27, 2009

The Guardian brings all the nerds to the Yard, and they're like "it's quackery, yeah?"

With apologies to Kelis, and it doesn't even scan.

Anyway, not even a badly constructed blog title could take away from a funny little PR-disaster which happened today to Neal's Yard, courtesy of the Guardian and an internetful of geeks (that's the collective noun, surely? - feel free to provide suggestions below).

Neal's Yard Remedies, the super-ethical, eco-aware health and cosmetics company, had agreed to take part in a Guardian series called "You ask, they answer". In this feature, in the Ethical Living section of the Guardian, internetians were offered the chance to ask Neal's Yard Remedies any question they wanted, although they were generally supposed to be regarding organics and beauty.

By finishing the article with the comment
This is your chance to grill them: from the controversy surrounding the chain's removal of a homeopathic malaria remedy to the benefits and reasons to switch to organic beauty products.
it nicely teed up a complete pwning of Neal's Yards' quackery division.

Now perhaps you haven't been taking your Co-Enzyme Q10 pills (this link may be more useful) or your 100% Organic Pre-Sprouted Aktivated Barley Powder so perhaps you've forgotten that Neal's Yard was the subject of a BBC documentary, investigating the sale of homeopathic prophylaxis for malaria. Unsurprisingly, they were concerned that Neal's Yard were selling an evidence-free sugar pill to protect people from a potentially fatal disease (doesn't seem very ethical to me). There is a transcript of the article here and the YouTube version of it is here. It includes the bit where Susan Curtis, Neal's Yard's Medicines Director storms off in a huff after being made to look extremely foolish. The BBC investigation reported Neal's Yard to the regulatory authorities (MHRA), who promptly spanked their bottoms and forced them to remove the product from sale.

When it came to the Guardian article, the Nerds did not disappoint - after 5 pages of questions along the lines of
Do you see no problem with trying to be 'ethical' while at the same time selling snake oil for a living? (SaltyCDogg)
Surely you don't view it as ethical to sell products which are of unproven benefit and which you don't even know are safe? (Puzzlebobble)
I'll buy the relief of stress and tension, especially if combined with massage, but what evidence is there for the elimination of toxins held in the body? What evidence is there that these toxins exist in the first place?(Peter Sterling)
what is "healing energy"? What units is it measured in and where does it come from?(Tristanod)
Adam Vaughan from the Guardian came on to say
have just had a chat with [Neal's Yard Remedies].

Unfortunately, despite previous assurances that they would be participating in this blog post, I've now been told they 'will not be taking part in the debate'.

So yes, as several people have pointed out, this has become something of 'You Ask', rather than a 'You Ask, They Answer'. I'm still hoping NYR will reconsider.
(They have a habit of pulling out of PR events - apparently they were supposed to be sponsoring a garden at Chelsea Flower Show). An hour later, James Randerson from the Guardian stated that
We have tried again to convince NYR to respond to your comments but they have reiterated their position that they do not wish to enter the debate.

We will keep trying to change their mind, but if they stick to that we will be closing this thread in a hour at 15.00 BST.
Which they did.

Neal's Yard have scored a massive own goal - an epic fail and a prime case study for "How Not To Do PR". They've cried off, seemingly unable to salvage anything from the situation and deciding the bunker was the best place to be. HolfordWatch is contacting Neal's Yard to see if they would like to continue the conversation there - seems unlikely, but we'll see.

I wouldn't like to be the one explaining this cock-up to the Neal's Yard board.......


Tuesday, May 26, 2009

Chiropractic for menstrual pains? No evidence. Period.

I'll hopefully convince you by the end of this blogpost, that there are bogus chiropractors in the UK.

Menstrual pain (or to give it its posh name, dysmenorrhoea) is estimated to affect between 45 - 95% of women at some point. (Bit of a rubbish estimation, if you ask me, but it gives an idea of its occurrence).

Here we have a condition which is widespread, can be debilitating, can be chronic, and the main respite from which is through painkillers. A perfect combination for a theatrical placebo. (And a cynic would add it was a regular monthly income).

It takes a leap and jump in the logic to imagineer how chiropractic could assist in the alleviation of dysmenorrhoeaic pain, but it goes something like this, courtesy of Pringle Chiropractic, Belfast:
[Pringle Chiropractic] are aware that many women who suffer from menstrual cramps also experience frequent back pain. Is there a connection? Both may be related to subluxation in the lower spine that affects the nerves that serve the female anatomy.
More hand waving than the Queen on a walkabout. Subluxations are interesting little chaps - it seems they are impossible to x-ray, and the definition of what they are has changed over time - they used to be a considered a disruption in innate intelligence but that has been dropped for obvious reasons and replaced with something along the woolly lines of
a loss of function in the spine and nervous system due to a reduction in its normal motion or alignment.
- from Pringle Chiropractic, Belfast again. And what, amongst other things do Pringle recommend for menstrual pain?
Good, old fashioned chiropractic adjustments.
Glasgow Chiropractic also are keen to espouse the amazing ability of chiropractic to deal with menstrual pain, by starting off by talking about chiropractic for menopausal symptoms, using this paper from Obstetrics and Gynaecology. Which is interesting because dysmenorrhoea and menopause are completely different beasties. I guess Glasgow Chiro just lumped them together in a sort of hand-wavy "women's problems"-type way. In fact, according to Latthe et al., the predisposition factors for dysmenorrhoea are as follows:
Age < 30 years, low body mass index, smoking, earlier menarche (< 12 years), longer cycles, heavy menstrual flow, nulliparity, premenstrual syndrome, sterilisation, clinically suspected pelvic inflammatory disease, sexual abuse, and psychological symptoms.

Glasgow Chiro claim:
Chiropractic provides the mechanisms through which dysmenorrheic women can be relieved of their pain in a drug-free environment and even go on to live a life free of period pain.
which is pretty much a statement of cure.

It's a fairly widespread chiropractic claim to be able to assist in menstrual pain - a quick squizz on Google shows that alongside Pringle Chiropractic, Belfast and Glasgow Chiropractic, Tooting Chiropractic, Townhill Total Health, Bank Chambers Clinic in Chipping Sodbury and Newcastle Chiropractic to name a few, also insist that chiropractic can assist in some way with menstrual pain.

So, given that there is a widespread belief within chiropractic circles that it can cure or relieve dysmenorrhoea, what decent evidence exists to back this up?

It should come as no surprise to anyone who knows anything about chiropractic that the answer is "not a jot".

A Cochrane Review in 2006 titled Spinal manipulation for primary and secondary dysmenorrhoea concluded that:
Overall there is no evidence to suggest that spinal manipulation is effective in the treatment of primary and secondary dysmenorrhoea. There is no greater risk of adverse effects with spinal manipulation than there is with sham manipulation.

The Clinical Evidence section of the BMJ places Chiropractic in the "Unlikely to be beneficial" category for dysmenorrhoea.

BUPA's page on chiropractic categorically states
Currently, there is no evidence that spinal manipulation helps to relieve period pain.

The NHS page quotes the Cochrane review above and follows its conclusion.

What about the General Chiropractic Council? Does it recommend chiropractic for menstrual pain?

It used to. In this letter (.doc) written in 2004 to the GCC on behalf of Actions for Victims of Chiropractic, Frances Denoon happens to quote from the GCC's document "What Can I Expect When I See A Chiropractor?" which states:
benefit may also be seen for some types of asthma, digestive disorders, migraine, infant colic and menstrual pains.
The current version of this document can be found on the GCC website here (.pdf), dated Sept 2007, and the same passage now reads:
You may also see an improvement in some types of asthma headaches (including migraine) and infant colic.
It seems clear that following the publishing of the Cochrane Review, in 2006 showing that chiropractic had no demonstrable effect on menstrual pain, the GCC (in an attempt to show it was evidence-based) removed menstrual pain from its list of treatable disorders.

That means the GCC, the UK regulator of chiropractics, is fully aware that dysmenorrhoea cannot be treated successfully with chiropractic. No doubt it will have made every effort to communicate this to its members and ensure that no-one was claiming otherwise. I'll be arranging for complaints to be made to the GCC regarding the above chiropractor's claims.

I now suggest to you that, given the evidence above, any chiropractor that suggests that chiropractic is a worthwhile therapy for menstrual pain is bogus. Period.


Tuesday, May 19, 2009

Chiropractic - totally bogus, dude?

The word 'bogus' is back in vogue - and not before time. It's been 18 years since Bill & Ted's Bogus Journey hit the big screen and had all teh kidz talking like west coast surfer dudes.

The word 'bogus' has been thrust back into the limelight for a much more serious reason - just over a year ago, Simon Singh wrote a piece for the Guardian entitled "Beware of the Spinal Trap" (you can read the full article on Gimpy's excellent website here) which contained the line:
The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.
In the usual manner of Complementary & Alternative Medicine, the BCA decided to sue for libel rather than entering into a rational discourse regarding evidence or the lack thereof. At the time, it wasn't apparent what the offending part of the article was, just that it was happening, hot on the heels of another legal chill from New Zealand Chiropractors to David Colquhoun.

Blogger and legal eagle, Jack of Kent has been following this story meticulously - his round up of the preliminary hearing (which was on 7th May 2009) can be found here. From Jack of Kent's site:
[The Judge continued that] The word "bogus" meant deliberate and targeted dishonesty. So it did not mean that chiropractic for the six named children's ailments (including asthma) was simply wrong, or that it was contrary to established medical practice or research, or even that it completely lacked evidence. "Bogus" meant a lot more. The judge held that by the mere use of the word "bogus" Simon Singh was stating that, as a matter of fact, the BCA were being consciously dishonest in promoting chiropractic for those children's ailments.
[...]The ruling means that, as it stands, Simon Singh would have to prove at full trial that the BCA were being deliberately dishonest. This is not only extremely difficult but it was undoubtedly not Simon Singh's view in the first place. The BCA, as with many CAM practitioners, may well be deluded, irresponsible, and sometimes rather dangerous; but calling their promoted treatments "bogus" was not an express statement of their conscious dishonesty.
(My bold).

A Facebook site has been set up and on Monday 18th May in London, there was a collective show of support for Simon Singh, with Dave Gorman, Evan Harris MP, Nick Cohen and Brian Cox all speaking, as well as Simon himself. The Quackometer is setting up a Carnival of Bogus* Chiropractic to promote the fact that there really is little evidence for chiropractic at all, never mind the more exotic claims of colic, athsma and others.

So then, are chiropractics claiming all manner of curatives without the evidence to back it up? If so, then it's difficult to see how they aren't being consciously dishonest. Gimpy has already shown that the General Chiropractic Council appear to admit there may be bogus chiropractors. I suppose chiros could be deluded, well-meaning, possibly ignorant of the evidence, but I'm not sure how likely that is. I looked at one in the Wiltshire area at random to see what came up:

Step up Healthcare 2000 in Trowbridge and Chippenham - this is a one-stop shop for alternative quack-like things - clicking on the 'Select Treatment' icon downloads a pdf document which states the following:
This section lists alphabetically a number of conditions that may be alleviated by the therapeutic specialities shown. Many complementary therapies are not condition specific but treat the “whole person”, making it difficult to accurately list conditions alongside a therapeutic approach in this way.
Fairly weaselly - could be written as "by claiming a holistic approach, we can claim to help any disease in the whole wide world". And here is a list of the ones they claim chiropractic can 'alleviate' (I've put beside a few of them a link to a relevant Cochrane review if available and the conclusion from that review.)

Asthma - Various therapists use [...] chiropractic. The review found there is not enough evidence from trials to show whether any of these therapies can improve asthma symptoms, and more research is needed.
Bedwetting (childhood) - Complementary treatments such [...]chiropractic may help, but the evidence was weak.
Cancer (with a disclaimer that it may ease symptoms and enhance well-being)
Chronic Colds
Colic in infants - still at Protocol stage
Glue Ear
Hay Fever
Pregancy (well being during)

Remember this is chiropractic - mainly spine manipulation. Despite claiming all these diseases can be alleviated with chiropractic, there are few Cochrane reviews to confirm their claims and the ones that are available are not very positive.

How can Healthcare 2000 claim this? They must have some idea of evidence to show efficacy, I mean they wouldn't just make it up, not knowingly anyway, because that would mean their claims are bogus (according to Justice Eady).

This business with the BCA will undoubtedly have the same effect (known as the Streisand Effect) which is to blast the news round the world via the internets that BCA want to silence dissent about chiropractic. This will in turn shine a skeptic-ninja searchlight on the chiropractic industry and show that the evidence for any of it is weak to non-existant.

Roll on the Carnival!

* - deliberate deception not implied.