The Quacktitioner Royal and alternative therapies
Prince Charles, the Quacktitioner Royal, has been in the news again for his continuing advocacy for a variety of alternative so called therapies, the majority of which are wibble and possibly dangerous wibble if used instead of proper medical treatment. I had a quick glance at his "Complementary healthcare : a guide"
He has two categories of alternative therapy:
Utter wibbleAcupuntureAromatherapyBowen techniqueCranial therapyHomeopathyNaturopathyNutritional TherapyRelexologyReikiShiatsu
Relative wibbleChiropracticOsteopathyHerbal medicineAlexander TechniqueMassage therapyYoga
The relative wibble category needs a little explanation. The groping therapies such as chiropratic, osteopathy, Alexander Technique, massage therapy and yoga have good placebo effects and can be relaxing. But none of these "treatments" will cure serious illness. I am particularly uneasy about chiropractors who play with XRay machines.
Steer well clear of wibble, and be cautious of relative wibble, particularly if the fees are high or if the word "cure" is used by the practitioner. My main problem with the Prince's Foundation for Integrated Health website was that it is mind-numbingly dull. I tried to read it but I kept falling asleep.
I don't understand why the Quacktitioner Royal feels qualified even to discuss matters medical, let alone make recommendations. I wish he would stick to architecture.
Labels: alternative medicine, Prince Charles, Quacktitioner Royal
68 Comments:
Dear Dr Crippen,
Regarding wibble, have you seen this article?
http://news.bbc.co.uk/1/hi/magazine/7354089.stm
Best wishes.
A
No I hadn't.
What a JOY!
That made me very happy!
John
Dear Dr Crippen,
What do you think of Physiotherapy? it is not on either list but includes practices from both lists.
I am a Physiotherapist and i feel my profeesion also sometimes makes ridiculous statements, i like to think i am realistic; if it is stiff i can lossen it, if it is weak i can strengthen it. But that is probably about it.
Gentleben
Although Aphra Benn reckons that such gubbins is useful, in the same way prostitutes are useful, there can be more to it than that.
EBM and evidence of outcomes for your utter wibble list is woeful.
I'm concerned by anyone entertaining diagnosis who's not a doctor. A patient making a diagnosis and self-referring with their cheque book for wibble therapy worries me. His site talks of chiropracters and says, "You should not use chiropractic treatment if you have severe osteoporosis, malignant or inflammatory spine conditions or recent fractures, or if you are on anti-clotting drugs or some steroids."
How will people know these have been exluded if a medic hasn't sleuthed that out?
Ergo, his own site is advocating such therapies, predicated on the understanding a medic has done the proper stuff first, no?
"Professor" Patrick Holford was on BBC Radio 5 on Wednesday.
http://www.bbc.co.uk/radio/noscript.shtml?/radio/aod/fivelive_aod.shtml?fivelive/morning_wed
from about 8.00 mins into the programme
In case you missed it.
I'd much rather listen to the Quacktitioner Royal to be fair to him.
I have heard conflicting reports about whether acupuncture has any use. Some studies suggest it may possibly do some good. It might be better in the "relative wibble" category.
"There was moderate evidence that acupuncture was more effective than inactive, sham treatments measured immediately post-treatment and at short-term follow-up" -- http://www.ncbi.nlm.nih.gov/pubmed/16856065/
"We conclude there is limited evidence that acupuncture is more effective than no treatment for chronic pain; and inconclusive evidence that acupuncture is more effective than placebo, sham acupuncture or standard care." -- http://www.ncbi.nlm.nih.gov/sites/entrez/10812251/
I don't believe in Qi, or Yin and Yang.
Physio?
I think it is excellent - for certain thinks; mobilisation after strokes, sports injuries to name but two. I don't find that physios start making exotic diagnoses, unlike chiropractors who tend to spout serious wibble.
I don't know how valuable phsyio is for low back pain. You must get hundreds of them - bet it's real heartsink.
Physios are properly and reputably trained - serious lack of wibble there!
JOhn
My missus is a physio who specialises in musculo-skeletal problems. She’s about as unalternative as it’s possible to be, believing nearly of all of it to be mumbo-jumbo, or wibble as Dr C calls it.
However, she has found that acupuncture is the best treatment for tennis elbow. Scores of people at our tennis and squash club would happily bear testament to that…
Thanks for the reply, i agree, i get a lot of people who have seen the chiropracter / osteopath and 'have run out of money' and 'thought i would give the free NHS a try' however the chrio has often given them wanky some diagnosis like 'segmental shift' or 'misalignment' and usually said the patient will be 'cured' in 12-15 treatments! Personally i feel with any 'manual therapy' if you are not significantly better immediately or within a couple of treatments then it will not work. Patients do not like it when i say this. I do get plenty of heart sinks, but a lot get better to with the correct rehab, and lifestyle changes and (fundimentally) hard work and exercise. Keep up the good work Dr Crip. I may not always agree with you but it is nice to know you are still out there.
Gentleben
Dr C, my last post crossed with yours, but my missus would say that if 4-6 treatments don’t improve your problem, then you should be referred back to the GP for further investigations.
And yes, you’re right, can’t do much for lower back pain except for giving patient a series of exercises which may help strengthen and restore core stability.
western acupuncture works. come to one of the british medical acupuncture meetings. a gp practising acupuncture will knock £14000 of his analgesic drug budget. i dont know if it works by placebo, endorphin or gate control. dont knock it until you've tried it. you're beginning to sound like my old dad; hell he still believes in home visits (on horseback of course).
I've no idea if it was a placebo effect or not but acupuncture cured my husband's headaches. As soon as he stood up in the morning, the headache would hit and stayed all day. He very rarely takes painkillers and even more rarely goes to the doctors so when he did both with this headache I knew it must hurt. A year later and after various tests and scans organised by the GP he was no further forward so he decided to try acupuncture.
The accupuncturist told him that he was unbalanced after a crushing accident at work in which he had lost 2 fingers (Doh I hear you say! BTW, to give you some idea of how strong his work ethic is, the accident happened 2 days before Christmas and he was back at work with his hand in plaster straight after the New Year so only had 2 sick days.) The first acupuncturist tried to help for a while but failed so he arranged for them both to attend an appointment with his teacher. The second acupuncturist supplied him with a little hammer covered in pins and told him to hammer a certain point on his hand for 10 minutes a day for two weeks. It worked. After a year of headaches they gradually diminished and went. Placebo? Maybe, but why not with the first acupuncturist? It could have been a coincidence I suppose but what a coincidence!
My daughter was supposed to be having physio for neck pain and headaches but our GP told us that the wait was very long and we would probably do better with an Osteopath (and recommended on to us). The treatment appears to be working and also seems to be helping her low blood pressure/fainting episodes and fatigue too (she has had these problems for several years and has seen various specialists through the NHS during this time; neurology, endocrinology, etc.) Early days yet, but we have hopes that this is a permanent solution.
Re Alexander technique -
Agree no place for it in management of serious disease, but fabolous for posture and musculoskeletal symptoms related to stress. Also good for breathing and posture for singing.
I tooke lessons for a few months and only wish I had kept it up.
I thought acupuncture in randomised blind trials was shown to be effective in treating pain relief. I can't remember where I read about the trials but from memory patients were randomly assigned to 3 groups.
1. Those who had acupuncture
2 Those who had needles randonly stuck in to the body, rather than being put into the chinese pressure points
3. Those who had no needles inserted, but were given treatment to make them think they had had needles inserted. Can't remember how this was done.
Although a small number of people of people reported significant pain relief in group 3, groups 1 and 2 had a significantly larger number of people reporting significant relief from pain.
The conclusion of the study was that sticking needles in people does have an affect in reducing pain although no-one knows why, but the theory of chinese medicine that dictates where you should place the needles was mumbo jumbo.
This corresponds with my own experiences. I have neurological pain but am extremely sceptical of alternative medicine. However in desperation I decided to try acupuncture - I thought it wouldn't work but I was desperate enough to give it a try anyway. I was shocked when it did work. However, I have noticed over the years that different acupuncturists, although supposedly using the same points
actually put the needles in slightly different places.
Nothing particular to add to the serious debate here ... just had to compliment you on choice of the 'mot du jour' of Blackadder origin.
Makes me smile every time I hear it - so appropriate.
Bit confused as to why "Nutrional Therapy" is wibble (though possible also naive as to what it is).
Surely if somebody is malnourished then it's a good idea to have somebody look after their diet?
Mouse
(Not the mousethinks Mouse, a different one)
Rob Clark said...
My missus is a physio who specialises in musculo-skeletal problems. She’s about as unalternative as it’s possible to be, believing nearly of all of it to be mumbo-jumbo, or wibble as Dr C calls it.
However, she has found that acupuncture is the best treatment for tennis elbow. Scores of people at our tennis and squash club would happily bear testament to that…
Friday, April 18, 2008 4:34:00 PM
+++++
Interesting; my 15 year old daughter is a serious rower and has real problems with tennis elbow - tried acupuncture (I was that desperate) and it did nothing. Hard to see how it could really when you think of the pathology.
JOhn
Bit confused as to why "Nutrional Therapy" is wibble (though possible also naive as to what it is).
Surely if somebody is malnourished then it's a good idea to have somebody look after their diet?
Mouse
++++++
cause nutrition is nutrition, nothing more. Obviously if you have beri beri or something, then the right foot and vitamins will help, but the idea that food is THERAPY is ...er ... wibble. As promoted by Patrick Wibble, the famous wibbilist
John
...and this is the Heir Apparent!
Heaven help us all
Dr C writes "then the right foot and vitamins will help"
So why on earth do we have mllions spent on nutrition in hospitals and why do we have patiens needing TPN and enteral feeding if the right foot can be used? Why do the NHS employ dietitians? Suppose they are left footed and so need to keep the other foot as food on the latest menus in our wards? Explains why there are so many complaints about the food!!!!!
Also as a huge fan of a wonderful chiropractor who enabled me to move my head again without screaming in agony and taking hge levels of useless pain killers I would be careful what you say! They are "professionals" they are trained and one of these days they might right foot it over here and see your comments!
Did your daughter try 'NHS acupuncture' (available at NHS pain clinics), John?
I have an organic orchard. To keep my trees free of disease they are kept well-nourished and watered. If a tree is sick with say Honey fungus and its growing conditions have been less than ideal -then making sure that it is once more in good and healthy soil by maybe a bit of nutrient input (vitamins and minerals) and well-pruned (healthy weight!!!) it will often recover from the infection all by itself without "medication" from me.
Now if an apple tree can do that- I am sure humans can too............ nutritional therapy is not wibble.
..in fact it was a nutritional therapist who diagnosed my coeliac disease - later confirmed by the good ole NHS - having been dismissed as an hysterical woman.....
"Nutritional advice" from someone who :
(i) has a decent idea how the body actually works;
(ii) understands what consitutes "evidence";
(iii) doesn't have a vested interest in selling you their patented pills and
(iv) can get barred from working if they lie to you, give you bogus "treatments", or recommend pills they get cash for plugging
..might conceivably do you some good, though only if you actually need nutritional advice.
The people I am referring to are doctors and dieticians.
In contrast, advice from a "nutritional therapist" - to whom NONE of (i)-(iv) apply - will simply relieve you of your unwanted cash.
And if you don't believe me, go and do some reading over at Holfordwatch.
Talking of "nutritionists", keen observers of the media will have spotted the supplement industry's Nuclear Strike response today to the recent Cochrane meta-analysis of data from a quarter of a million people that concluded that supplements did bugger all for you.
As Holfordwatch recounts, the supplements industry wheeled out Carole Caplin, Gloria Hunniford and - gasp - Sir Cliff Richard,to testify to the tremendous benefits they were sure they had got from vitamin pills. Fab.
Put another way:
Nutritionism: fighting science and evidence with Top-class Celebrity-Wibble.
Honestly, you couldn't make this stuff up.
When I was in hospital recently for a microdiscectomy, there were two of us in beds side by side who were diagnosed by "chiropractors who play with x-ray machines". My GP told me I had piriformis syndrome and gave me valium, whereas my osteopath suspected a slipped disc and recommended an MRI. In my neighbour's case the GP diagnosed tennis elbow, which her chiropractor and his x-ray machine discovered what turned out to be a myeloma.
Obviously wibblers haven't got the breadth of experience of a qualified doctor and I'd never trust my osteopath's view on a mole that looks a bit funny, but by the same token I don't think doctors can be entirely dismissive of what your relative wibblers have to say.
Give his Royal Wibbleness a break, he has to wait for his mother to die to get a job and all that in-breeding hasn't helped either. It is all wibble but some makes people feel better.
"the idea that food is THERAPY is ...er ... wibble" - tell that one to your local eating disorders service. Unless they're flouting all latest evidence they'll very much include nutrition as the vital part of their therapy. Good nutrition is vital to all of us . Of course someone unqualified trying to sell you quack pills shouldn't be calling themselves a nutritionist, but that doesn't make the art of getting people to eat well wibble.
There is plenty of "nutrition therapy" that goes beyond good dietary advice.
Helping someone with Coeliac disease avoid gluten, or helping someone use diet to control blood glucose is one thing. It is a bit different to think that aloe vera or barley grass will miraculously cure cancer.
Of course aloe vera and barley grass may have active ingredients that could either help, or cause side effects. But health professionals should use therapies that have proper evidence to back up their claims.
Ok, so let me get this right:
You complain that the Queen's hubby gets to see a doctor when he has a cold ... but the prince isn't allowed to be alternative.
You complain that your patients are too demanding ... and yet you dismiss alternative therapies (including homeopathy that's available on the NHS and is often practiced by doctors trained at least as well as you, Dr C) which could chill them out as "wibble".
You are very hard to please ...
Fx
Oh, yes ... and the introduction of milk to school children in order to solve the rickets problem ... food not a therapy?
Fx
Fx-that's NOT a therapy!!!! Food is not therapy! If people get rickets, they're not getting proper nutrition, which eating properly would give them. Fuck it, that means evey night when I have my dinner I'm "undergoing therapy". Hell, I don't feel like cooking tonight, might go out for some Indian "therapy". Decent food intake is supposed to be the norm, not a type of therapy. Dressing things up to call them a therapy so you can invent a job for yourself does not make you a "therapist". Food, air and water are not and never will be therapy.
Nutritional therapists are very distinct from dietitians.
Dietitians address nutritional deficiencies in abnormal situations, or prevent them in situations such as stroke where food intake may be compromised. They don't call this therapy.
Nutritional therapy, for the most part, advises crap like the "blood type diet" and macrobiotics and tells middle class people with bloating that they're intolerant of yeast without excluding more serious causes etc etc-I should know-a member of my extended family practises this crap.
I errr yeees....... and what is it do you do?
Of course when Daddy has finished arranging state sponsored assassinations with MI6, something he does quite regularly you know, there's nothing he likes better than an elderflower and rhubarb enema. Does a wonder for ones chakras don’t you know?
Oh, yes ... and the introduction of milk to school children in order to solve the rickets problem ... food not a therapy? Fx
+++++
to all of you who are mentioning vitamin deficiencies etc as an example of "nutritional therapy" - you are wrong. Replace vitamins is not food therapy, it is replacing vitamins. Similarly, avoiding food to which you are allergic (eg gluten in coeliac disease) is not nutritional therapy, it is avoiding allergens.
The nutritional therapists are either bonkers or fraudsters. They are promoters of scientific botty wipe
John
http://health.groups.yahoo.com/group/thyroidpatientadvocacy/
and this group practises the most dangerous wibble of them all -this is the advice dear doctors that many of your hypothyroid patients get from internet forums -read it and BE SCARED
oh -you have to join first to read this as the WIBBLE is so utterly utterly dangerous.
and having joined -just google Dr. Barry Durrant-Peatfield and then call Holford dangerous....
'Western acupuncture' utilises the paingate theory to explain why it works, the same reason you rub your elbow when you bang your funny bone (wikipedia has a very exensive explanation). So it should have a pain relieveing affect at least in the short term if correctly applied. 'Realigning' or 'restoring balance' is clearly bollocks (wibble if you are polite). I may be proved wrong in the future if 'chi' is found to exist but i don't think it will. 'Traditional acupuncture' predates any medical knowledge, at the time it began being used the Chinese didn't even know of the existence of muscles. Organs were grouped according to weight or there appearance not due to ant function, illness is thought to be caused by 'evil wind'. Now after a heavy night out i often have some pretty evil wind but it is what is cauing my head ache.
Stick a needle in for sure, if it helps the pain it may enable you to exercise and/or live a normal life which will generally sort out the majority of muscular/skeletal complaints, but you might as well take a paracetamol.
gentleben
Intesting. Western and Chinese acutpuncture are totally different treatment modalities. I cannot buy into yin and yang and meridians, so that's wibble for me; pain gate theory, sure, I can buy into that. But that means that Western acupuncture is solely a method of providing analgesia and not a cure for anything. So if I have a headache, I can try Western acupuncture...or I could drop a lead weight on my toes, which will make me forget about my headache.
Hmmmm
John
"Stick a needle in for sure, if it helps the pain it may enable you to exercise and/or live a normal life which will generally sort out the majority of muscular/skeletal complaints, but you might as well take a paracetamol."
Great when it works of course, but when paracetamol and stronger prescription pain killers fail and a little pin covered hammer tapped on a nerve in amputation scar tissue for 10 minutes a day for a couple of weeks works (i.e. permanently ends headaches that began on standing in the morning and lasted all day for over a year), I think I know which I would prefer. Obviously, anything serious should be ruled out first by your GP and hospital.
I've just remembered that I have also benefited from acupuncture. During my first two pregnancies I was driven to distraction by a rash on my tummy. When it began to develop again in my third pregnancy my midwife referred me to a fellow midwife who provided acupuncture on the NHS. After two or three sessions the rash had gone. Again, positive help without risk of side effects, I don't really care if it's placebo. I'm sure western medicine also gains from the placebo effect. If it works and is safe, that's fine with me. I would never try an alternative therapy if I had any doubt about safety. Every time we have tried an alternative it has been recommended by a GP or other medical practitioner. I know, this will probably just confirm your opinion of midwives as madwives, but there you go, it worked for us, and if this is the case, you will also have to include GPs in the ranks of quacktioners.
Johns says:
"So if I have a headache, I can try Western acupuncture...or I could drop a lead weight on my toes, which will make me forget about my headache."
None of the acupuncture we have had has hurt so I'm not sure how why you say this? Massage helps me better as a distraction from pain. My husband massaged my shoulders throughout a painful medical procedure recently and it helped a lot. I've had the same procedure before so I'm reasonably sure it made a difference. The person carrying out the procedure might just have been better at it which is obviously why anecdotal evidence should only be used to suggest topics for research.
Research evidence appears to be mixed which suggests that more research is needed to determine if and when alternative therapies are effective.
http://www.ncbi.nlm.nih.gov/pubmed/18416793?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
"CONCLUSIONS: An experimental trial established the effects of using acupressure and meridian massage on increasing body weight in premature infants. Acupressure and meridian massage have a significant effect on weight gain in premature infants. RELEVANCE TO CLINICAL PRACTICE: Nurses could be trained in acupressure and meridian massage techniques to provide more effective level of clinical care for premature infants."
http://www.ncbi.nlm.nih.gov/pubmed/18346056?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
"Conclusions. Our results suggest that a broad range of self-management programs may provide benefits for older adults with chronic pain. Research is needed to establish the efficacy of the programs in diverse age and ethnic groups of older adults and identify strategies that maximize program reach, retention, and methods to ensure continued use of the strategies over time."
http://www.ncbi.nlm.nih.gov/pubmed/18275361?ordinalpos=9&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
"CONCLUSIONS: The addition of compressed air massage to standard medical and surgical management of diabetic ulcers appears to enhance ulcer healing. Further studies with this new treatment modality are warranted."
http://www.ncbi.nlm.nih.gov/pubmed/18081800?ordinalpos=19&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
"CONCLUSIONS: Despite previous research suggesting that MT may be an effective treatment for depression, there is currently a lack of evidence to support this assertion from RCTs that have selected participants for depression or SSD."
http://www.ncbi.nlm.nih.gov/pubmed/18088435?ordinalpos=18&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
"CONCLUSION: The frequent use of CAM for LBP demonstrates that CAM is popular in patients and doctors alike. The observed association with a treatment in a rehabilitation facility or with specialist consultations rather reflects professional preferences of the physicians than a clear medical indication. The observed dependence on providers and provider related services, as well as a significant proportion receiving CAM that did not meet the so far established selection criteria suggests some arbitrary use of CAM."
http://www.ncbi.nlm.nih.gov/pubmed/17983334?ordinalpos=27&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
"CONCLUSIONS: This the first known study to define the rate of side-effects after massage therapy treatment. These data are important for risk-benefit analyses of massage care. Larger studies are needed to verify these data and to assess effects of different massage types and durations."
http://www.ncbi.nlm.nih.gov/pubmed/17920972?ordinalpos=30&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
"CONCLUSION: Acupressure in the prehospital setting effectively reduces pain and anxiety in patients with distal radial trauma."
http://www.ncbi.nlm.nih.gov/pubmed/18410363?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
"Discussion: In this retrospective study, the ketogenic diet stopped spasms in nearly two-thirds of cases, and had fewer side effects and relapses than ACT H. ACTH normalized the EEG more rapidly, however. Further prospective study of the ketogenic diet as, with a 2-week time limit if unsuccesful, first-line therapy for infantile spasms is warranted."
Thanks, jane_t. Perhaps Dr C will now keep his silly ranting gob shut now that research evidence has been produced which suggests that alternative therapies aren't just "wibble", as he likes to call it.
Thank you, jane_t.
The first time I slipped disks I was really lucky: the GP who diagnosed the problem was also trained in osteopathy, and he used manipulation, and did not tell me to rest. Decades later most GPs were still telling people to lie down, dooming many of them to at best, a far slower recovery, at worse, a radically weakened back.
gentleben, NHS acupuncture worked for me (temporarily, yes; but 36 hours pain-free was great). TCA has though helped me too.
Stick a needle in for sure, if it helps the pain it may enable you to exercise and/or live a normal life which will generally sort out the majority of muscular/skeletal complaints, but you might as well take a paracetamol.
1. isn't that what CBT does really (makes people walk etc. thereby relieving their depression)? 2. I'm afraid paracetamol didn't have the same effect as the NHS acupuncture...
But that means that Western acupuncture is solely a method of providing analgesia and not a cure for anything.
some of us, John, need a cure for *pain*. Also, 'Western acupuncture' does not purport to be anything more than analgesic, so your 'solely' is unnecessary.
As you've accepted this -- it seems -- you might also consider accepting the complementary therapies' more restricted claims: of course some chiropractors and osteopaths make highly extravagant claims but the ones I've seen simply did my back a lot of good (physios have too).
Don't think so anon.
And why would he.
Most of the evidence there is pretty rubbish.
"http://www.ncbi.nlm.nih.gov/pubmed
/18088435?ordinalpos=18&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum"
So in the back pain one heat helped, in a pretty crap not very well performed analysis...not exactly news is it, not exactly really CAM either is it.
"http://www.ncbi.nlm.nih.gov/pubmed/18410363?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum"
Well here there was no control group.
The CAM was about half as successfull as the medical treatment (maybe the half who respoded would have resolved without treatment) and the subsequent findings were based on the fact that relapse (in a group who responded to the diet) was lower.
"http://www.ncbi.nlm.nih.gov/pubmed/17983334?ordinalpos=27&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum"
So only 10% of people have negative side effects from massage therapy. I would have thought it would be much lower.
What were the "unexpected positive benifits". Maybe feeling more relaxed or uplift in mood....wow a massage makes you feel better. Cooking with gas.
"http://www.ncbi.nlm.nih.gov/pubmed/18081800?ordinalpos=19&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum"
And this one just says that massage is not as good as acupuncture for treating depression!
So one wibble is not as good as another wibble. I would have thought they would all be as bad as each other.
So far not a wibble convert
Oh and at our medical school for the last few years students have had to go to private CAM clinics.
Sitting through this rubbish and going to the lectures made ecen form pro-cam students go right off it.
Hi Ellie
Actually, nutritionists point out where one needs to adjust one's diet ... it is therapeutic adjustment of the diet ie a therapy. Dr C in one of his posts mentioned zinc to counteract lactose intolerance - a therapeutic addition to the diet. I think the word "therapy" is subject to misinterpretation; or possibly in the process of changing its meaning. It is used both in medical training and in alternative treatments - oh look, there's another word that is open to misinterpretation - treatments.
Frankly, I would have thought medics generally would have been glad to find something that makes people feel better, even when it doesn't fit in with their world view. My mistake.
Fx
OK I should have followed those links.
So one wibble is not as good as another wibble. I would have thought they would all be as bad as each other.
Why? SSRIs -- for mild depression -- never score *exactly* the same as placebo. (E.g.)
Hi EllieActually, nutritionists point out where one needs to adjust one's diet ... it is therapeutic adjustment of the diet ie a therapy. Dr C in one of his posts mentioned zinc to counteract lactose intolerance - a therapeutic addition to the diet.
++++
Er..yes, I did metion zinc when I was talking about lactose intolerance. The former does not help the latter and most people who think they have lactose intolerance are mad. Mad as hatters.
Maybe they have mercury poisoning.
I was TAKING THE PISS
John
Now this really is wibble of the most dangerous kind.
A quote from this group that appeared today
http://health.groups.yahoo.com/group/thyroidpatientadvocacy/
"The reason you are unable to cope with your thyroxine (at any dose) is because from what you say, and the list of symptoms you are suffering, you are suffering with low adrenal reserve. Look on your Patient Information Leaflet in your thyroxine, and I bet it tells you there that "...if you have low adrenal reserve (or something similar) - tell your doctor". It tells you you should not take thyroxine if this is the case and that you should be treated with steroids. Doctors don't even know this - doctors will tell you this only means "...if you have Addison's disease...". All quite appalling, and this is the reason why you are feeling so awful.
First: Go to our FILES which you will find on the Home Page of this forum website. Scroll down until you find "Adrenal Questionnaire". Answer all the questions there and see how you score. That will give you a good indication of whether or not I am right. You can get the 24 hour adrenal salivary test to see where your cortisol and DHEA lie at four specific times during the day. If you do have low adrenals, you need to stop taking your Thyroxine for (if possible) a couple of weeks, and start on an adrenal supplement like Nutri Adrenal Extra. You will learn more about this by asking members. With low adrenal reserve, your body cannot utilise the thyroxine. No good asking your doctor about this, because they haven't been taught this."
Scary heh?
Funny Pseudonym said...
"Most of the evidence there is pretty rubbish."
As I said in my original post, "Research evidence appears to be mixed which suggests that more research is needed to determine if and when alternative therapies are effective."
I purposely listed all of the research I found, whether it agreed with my theory that some alternative therapies work for some patients in some situations, or not. It is too easy to cherry pick the research that agrees with your own current theories and ignore anything that disagrees. I purposely included the conclusions of the research so that people were not 'tricked' into thinking that it would all be positive because it was quoted by someone in favour of further research into alternative therapies. I do not have a blanket belief in alternative therapies but do think they should not be dismissed without further, more rigourous research (randomised clinical trials, control groups, double blind and larger numbers, etc.) into effectiveness and side effects.
I notice you ignored the positive research examples quoted. The fourth quote I gave (the first one you criticised) suggests that when GPs provide these services they tend to use them indiscriminately and inappropriately when patients do not meet the currently established selection criteria so obviously more education is needed if alternative therapies are ever to be used effectively.
http://www.ncbi.nlm.nih.gov/pubmed/18410363?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
Well here there was no control group. The CAM was about half as successfull as the medical treatment (maybe the half who respoded would have resolved without treatment) and the subsequent findings were based on the fact that relapse (in a group who responded to the diet) was lower.
Here you ignore the 'significant side effects' caused by conventional ACTH therapy. In this study, http://adc.bmj.com/cgi/content/abstract/55/9/664, 37% of the children had pronounced side effects and mortality was 4.9% (8 out of 162 children died). The most common complications were infections: septic infections, pneumonias, and urinary and gastrointestinal infections. Other side effects were arterial hypertension (11), osteoporosis (2), hypokalaemic alkalosis (2), and other marked electrolyte disturbances (10). In children necropsy showed fresh intracerebral haemorrhages. Four children developed oliguria and hyperkalaemia during and after withdrawal of ACTH. One of them had tubular necrosis confirmed by renal biopsy. Infections were significantly more common with large doses (120 units) of ACTH than with small ones (40 units). It is concluded that side effects, even severe ones, are more common during treatment than had been assumed. Careful watch is important before and after treatment. The benefit of very high dosages should also be reconsidered.
Presumably the outcomes would be worse without the ACTH but it is obviously not ideal. So maybe the ketogenic diet is not the complete answer and a lot will depend on how long it is safe to try the diet before using ACTH. The specialists carrying out the research seem to believe that it would be safe to try for two weeks before reverting to conventional therapy. If the diet works for 62% of infants without putting them at increased risk of complications from the spasms and also pretects them from the dangerous side-effects of ACTH, it sounds like a 'good idea'. Maybe there would also be a place for the ketogenic diet in combination with lower doses of ACTH in an attempt to avoid the worst side effects and death. Obviously further research is needed.
""http://www.ncbi.nlm.nih.gov/pubmed/17983334?ordinalpos=27&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
"
So only 10% of people have negative side effects from massage therapy. I would have thought it would be much lower.
What were the "unexpected positive benifits". Maybe feeling more relaxed or uplift in mood....wow a massage makes you feel better. Cooking with gas.
Again you cherry pick the bits that support your case:
10% 'experienced some minor discomfort after the massage session','the majority of negative symptoms started less than 12 hours after the massage and lasted for 36 hours or less,' 'no major side-effects occurred during this study.'
However, '23% experienced unexpected, nonmusculoskeletal positive side-effects,' 'The majority of positive benefits began immediately after massage and lasted more than 48 hours.'
"http://www.ncbi.nlm.nih.gov/pubmed/18081800?ordinalpos=19&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum"
And this one just says that massage is not as good as acupuncture for treating depression!
So one wibble is not as good as another wibble. I would have thought they would all be as bad as each other."
Yes, one of the negative pieces of research I included. They found that most research in this area, 'provided insufficient data and analyses to contribute meaningfully to the evaluation of MT for depression', and they conclude that there is a lack of research evidence to support the use of massage therapy in depression. I have no idea if massage helps with depression and it does not sound as though anyone can be sure either way based on current research.
They're here! (The Alties, that is).
Jane_t writes:
"It is too easy to cherry pick the research that agrees with your own current theories and ignore anything that disagrees."
I totally agree - and that is precisely what the Alt Therapy lobbyists do all the time.
Numerous systematic reviews and meta-analyses offer minimal evidence for the effectiveness of most CAM interventions. Simon Singh and Prof Edzard Ernst have just written a popular book pointing this out (again) and highlighting the very few CAM interventions for which there is any meaningful evidence at all.
Incidentally, "equivocal" evidence does not always mean "we need more bigger trials". Sometimes it means:
"We would need more bigger trials to prove definitively that this doesn't work in the clinical setting, but as we already know that what it claims to do is scientifically impossible, and that it is all placebo effect, only a complete idiot - or an advocate with no scientific sense - would bother".
This applies quite clearly to homeopathy, and to some other idiotic CAM interventions like "crystal healing", reflexology, energy healing and Reiki etc etc.
all acupuncture reasearch is biased or wank. The vast amount just being shit nothing more nothing less. I practice it but only using the pain gate theory none of this chi ying yang shit. For those of you however that believe in ' traditional' acupuncture, please remember i still have a stone which keeps away tigers for purchase (remeber it only is licensed for use in Europe)
Gentleben
Dear Dr C
(grin) You clearly have not spent time in the States - my daughter spent the summer there last year as a counsellor at a summer camp and came back with lactose intolerance. This was pretty inconvenient since I didn't believe in it ether until she was curled up in pain and, um, some pretty non cosmetic other effects. The American diet is so processed that there is very little nutrient value left in the "food" when it arrives on the plate. Her problem required some pretty intensive dietary therapy to put right. Zinc helped, mainly because zinc is one of those things that the processing of food destroys ... as did live yoghurt, which contains a streptococcus bacteria known to release lactase when destroyed in the gut. It took about a month to put her right again.
The growing consumption of convenience food is a major cause of obesity in this country, as well as various other dietary imbalances resulting in, lets see ... obestity, diabetes, colon cancer, diverticulitis, heart disease, strokes, IBS etc etc.
If it takes referring your patients with "dietry imbalances" to a dietician or nutritionist (who basically both address the same issues) to get them to eat properly - ie fresh food (preferably organic, but then I'm middle class so I would say that) prepared from scratch at home - then what is your problem? People like to be referred to those they consider specialists and are more likely to do what they're told by said specialists, particularly if said specialists give them a list of menus, than their family doctor - sorry - banging on about cutting out sugar and fat. You can't write a prescription for a decent diet. People go to their doctors for a prescription. Sad, but true. Or to be referred to a specialist. They are not under the impression that a nutritionist or dietician is a consultant any more then they are under the impression that a physitherapist is a consultant. They just want someone who will tell them what to eat, who isn't their family doctor. It's a no brainer, really.
Fx
dr aust, I'm not an altie, LOL. I very much doubt that any of the alternative therapies you list work too. As I've mentioned, we have had success with osteopathy and acupuncture in providing pain relief and both methods seem to have some acceptance within western medicine. The use of strong painkillers and muscle relaxants (which I assume are not without their disadvantages) were also avoided in our family.
BTW, the neck exercises my daughter was given by a consultant in an attempt to stop the headaches she suffered from (he thought they were caused by muscle tension) appeared to cause her neck and shoulder pain (the pain started during the exercises). He went on to prescribe a muscle relaxant to try and help with the neck, shoulder pain and headaches (which didn't help) and physiotherapy.
It was our GP who said that it would take more than 6 months for the physiotherapy appointment to come though and recommended a local osteopath. I doubt we would have considered osteopathy if it hadn't been recommended by our GP, it had certainly not crossed our mind before this.
What do you think about the research into massage and acupressure used with premature babies mentioned above?
http://www.ncbi.nlm.nih.gov/pubmed/18416793?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
"METHODS: Forty subjects were randomised into two groups. The 20 subjects in the experimental group were given a standard procedure of acupressure at Zhongwan, Zusanli, Yongquan, abdominal rubbing, spleen and stomach meridian massage, and kneading the points along the spine of the bladder meridian. These treatments were administered for 15 minutes per session, one hour before meals, three times daily over 10 days. The control group, also consisting of 20 subjects, underwent routine care and was observed. The infants' body weights and the volume of milk ingested were measured and recorded daily. RESULTS: The daily average weight gain of the infants in the experimental group was 32.7 g (SD = 8.1) compared with 27.3 g (SD = 7.7) in the control group. While in the first week there was no significant difference in weight gain between the two groups; in the second week, the weight gain observed in the experimental group was significantly higher than that observed in the control group."
I know it's a small sample but it fits with other research into physical contact and better outcomes in premature babies such as kangaroo care. The key component is probably the physical contact that helps whether it is given in the form of massage or constant carrying but some options will probably suit some patients or their carers better than others. For instance, a mother with a back problem would probably prefer to be taught how to massage their baby. And if massage helps babies, maybe it can also help adults?
http://www.ncbi.nlm.nih.gov/pubmed/18250500?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
"OBJECTIVE: To compare the effect of Kangaroo mother care (KMC) and conventional methods of care (CMC) on growth in LBW babies (> 2000 g). STUDY DESIGN: Randomized controlled trial. SETTING: Level III NICU of a teaching institution in western India. SUBJECTS: 206 neonates with birth weight < 2000 g. INTERVENTION: The subjects were randomized into two groups: the intervention group (KMC-103) received Kangaroo mother care. The control group (CMC: 103) received conventional care. OUTCOME MEASURES: Growth, as measured by average daily weight gain and by other anthropometrical parameters at 40 weeks postmenstrual age in preterm babies and at 2500 g in term SGA infants was assessed. RESULTS: The KMC babies had better average weight gain per day (KMC: 23.99 g vs CMC: 15.58 g, P< 0.0001). The weekly increments in head circumference (KMC: 0.75 cm vs CMC: 0.49 cm, P = 0.02) and length (KMC: 0.99 cm vs CMC: 0.7 cm, P = 0.008) were higher in the KMC group. A significantly higher number of babies in the CMC group suffered from hypothermia, hypoglycemia, and sepsis. There was no effect on time to discharge. More KMC babies were exclusively breastfed at the end of the study (98% vs 76%). KMC was acceptable to most mothers and families at home. CONCLUSION: Kangaroo mother care improves growth and reduces morbidities in low birth weight infants. It is simple, acceptable to mothers and can be continued at home."
It reminds me a bit of how traditional remedies have led to prescription medicines. Research is used to find the active ingredient which is then developed as a drug. Maybe the same will happen with some alternative therapies as in the massage example (where physical contact seems key).
The success of compressed air massage of diabetic foot patients may also point to another use for massage. In the study linked above, healing time was improved from an average of 82.7 days to 58.1 days without adverse effects. The researchers suggest that the massage may help to improve local tissue oxygenation around the ulcers. Maybe this knowledge can be transferred to other areas of care if further research supports this theory?
The danger with your approach to alternative therapy is that the baby is thrown out with the bath water. Yes, a lot, probably most of it is rubbish, but there are a few gems in the mix and it would be a shame to lose them.
The American diet is so processed that there is very little nutrient value left in the "food" when it arrives on the plate. Her problem required some pretty intensive dietary therapy to put right. Zinc helped, mainly because zinc is one of those things that the processing of food destroys ... as did live yoghurt, which contains a streptococcus bacteria known to release lactase when destroyed in the gut.
+++++
Oh dear.
With respect, this is complete wibble.
How can intelligent people fall for this guff?
John
http://student.bmj.com/back_issues/1001/life/390.html
(the cited journals may be wibble)
jane_t
If some of the alt therapies encompass real and useful interventions, the systematic reviews of the evidence will show this. And then these things will become "treatments" - neither "mainstream" nor "alternative". Fine with me.
This is why someone like Edzard Ernst is such a treasure. He and his group have been, for a decade or so, working their way systematically through the alternative therapies, asking "what is the evidence" and weeding out the wheat (small bits of) from the chaff (absolutely loads of).
However... by doing this, Ernst, who set out being broadly sympathetic to complementary therapies, has become a hate figure for the complementary crew. Why? Because he quite justifiably asks them to meet normal scientific and medical standards of evidence, as applied to mainstream therapies. And when they don't do this he matter-of-factly points this out.
The reality is that the CAM lot systematically refuse to be judged on evidence-based standards, because the vast majority of CAM practitioners and enthusiasts start from a viewpoint of belief rather than science. And they then bluster and weasel about how it doesn't matter.
Sounds like Edzard Ernst is doing a great job and is to be applauded. At least he is taking the issue seriously enough to look into it closely and as you say, find the wheat amongst the chaff. I hope he continues despite opposition.
Dear Dr C
Thank you for the compliment (grin)
Lactose intolerance in common in Asian people - don't consume anything like the amount of dairy products we do here. Perhaps you don't have any Asian patients?
Fx
jane_t
If I were you I'd stop reading research studies. You simply haven't got the nous to know what's relevant and what isn't.
The fact that you're obviously only reading & quoting the abstracts says it all. To know if a study is valid you need to know the full detail, not the abstract. You don't even know this simple truth. It's an unknown unknown for you. Just give up.
Dr C - Our GP has an Accupunturist nad Osteopath visit the surgery weekly. I've had Accupunture from the NHS physios locally for nerve pain. Does it work? YES it does. Osteopathy also works in mobilising stiff joints. Some physios manipulate, some don't. I prefer the ones that do.
You may think something's utter twaddle, but if the patient reports a benefit then - so what?! If it works, don't knock it!
The fact that you're obviously only reading & quoting the abstracts says it all.
I'd say it says she hasn't got access to the full articles.
I certainly don't believe all the twaddle about Chi etc. in traditional acupuncture. But I have found acupuncture does help pain. I have trimigenal neuralgia which can't be cured, but the acupuncture provided by the NHS along with medication means that I can live with little pain.
Incidentally read in the Sunday Times at the weekend about the high percentage of patients (I think it was as high as 20%) who report negative effects after visiting a chiropracter.
Hard to see how it could really when you think of the pathology.
Western acupuncture is solely a method of providing analgesia and not a cure for anything. So if I have a headache, I can try Western acupuncture...or I could drop a lead weight on my toes, which will make me forget about my headache.
***
Dr C, sorry, can’t help with the pathology as I’m not medically trained myself.
I think you’re right to say that Western acupuncture is for providing analgesia rather than a cure – my (admittedly limited) understanding is that physiotherapy is primarily about speeding up the body’s own restorative powers, so maybe within that context, Western acupuncture is in some way doing something similar?
But you’re wrong to imply that it’s a distraction technique, from one pain to another – Western acupuncture does not cause any pain (unless it’s done badly).
My missus does not use acupuncture for knee, back, neck or shoulder injuries (her other main areas of expertise), only for tennis elbow. I have no idea why it works, but I suspect that the semi-professional players she has treated are grateful that it does.
Rob
This applies quite clearly to homeopathy, and to some other idiotic CAM interventions like "crystal healing", reflexology, energy healing and Reiki etc etc.
*****
Dr Aust, as regards Reiki a fellow guest at a dinner party a couple of years ago told my wife and I that she had a ‘qualification’ from the Reiki Association and could diagnose anyone’s medical problem.
Unfortunately she was unable to ‘diagnose’ that my wife has Type I diabetes (which she’s had for 32 years). I’m afraid I laughed – a lot – and the party went rapidly downhill…
Rob
Sounds like your Reiki practitioner had been at the claret. The Reiki people I've met wouldn't *dream* of diagnosing, what with them not being doctors and everything. And to be fair their association specifically regulates against it.
Rogue Reiki lady? Was she wearing a purple caftan - that usually provides a hint - Lol!
Fx
Fx, lol! No, she appeared to be quite normal. Indeed, I had spent quite a pleasant hour talking to her before she started with her nonsensical claims.
This woman claimed she could sense areas of the body in which there was a ‘weakness’ by laying her hands on someone, then singularly failed to demonstrate that she could, in fact, do that.
I doubt many doctors would fail to diagnose Type I diabetes given recourse to that standard diagnostic tools.
I know where I live there is a man who practices Reiki who "send out" healing signals on a Sunday night. For a price you can "tune into" these signals on a Monday night to help you heal a wide range of illnesses. Amazing what some people will believe!
Are you sure you’re not getting confused with Monday Night Football, where for a price you can tune into a signal which will beam into your home a wide range of rather rubbishy football matches…?
The wonderful arrogance of the medical profession. Your knowledge of The Alexander Technique would probably fit on to the back of a first class stamp. As for the rest of your list - they may well be utter wibble: I have no idea.
anonymous said...
The wonderful arrogance of the medical profession. Your knowledge of The Alexander Technique would probably fit on to the back of a first class stamp. As for the rest of your list - they may well be utter wibble: I have no idea.
Monday, April 21, 2008 9:45:00 PM
++++
Actually, I know quite a lot about it and one of my children, who is a serious musician, has done an Alexander Technique course
Its wibble
John
What do you find wibblish about it?
Homeopathy cures where Conventional Allopathic Medicine (CAM) fails
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