Acupuncture does not improve IVF success! No surprise, but why did they move the goalposts! Isn’t that unethical?

Acupuncture does not improve IVF success! No surprise, but why did they move the goalposts! Isn’t that unethical?

A negative result! And this coming from acupuncturists – not something that happens very often. And what’s more, it’s published in a very prestigious journal, the ‘Journal of the American Medical Association’ (JAMA), impact factor = 44. So, all I can say is, wow, did not see this one coming. Because usually they will spin the result into a positive using various techniques and various media platforms, and yet, here we have a very clear negative, even their (social) media platforms proudly proclaims; “Fertility study finds acupuncture ineffective for IVF birth rates”.  Sure, they still tried their best to give it some sort of positive spin by stating:

“We examined the effects of a short course of acupuncture administered during an IVF cycle….. However, in clinical practice, acupuncture may include more sessions prior to an IVF cycle starting.”

“Stress is thought to play a role in infertility…..In our earlier research, acupuncture was shown to reduce the emotional stress and burden experienced by women during IVF treatment.”

Conflicts of interests

Now I have some history with this project. Back in 2012 when the NHMRC announced that they have approved $630 000 dollars for this study, it was promptly called “universities in a wacky waste of cash” in the media. Why? Because even back then acupuncture was known to be ineffective for IVF (and pretty much everything else) so why spend so much money which could have been spent on doing useful research, on something that is known not to work? Well, if you can mislead people into using acupuncture and all sorts of other ineffective remedies, then surely, you’ll be able to fool funding bodies as well. That is after all their job – to fool people, that is what promotional researchers do!

But I did notice a couple of years ago that the ‘academics’ (Prof Caroline Smith and Alan Bensoussan) from the National Institute of Complementary Medicine (NICM) almost never declare their conflicts of interests. In other words, they received some sort of financial incentive (cash or in-kind) from acupuncture clinics which went undeclared, in clear violation of research ethics. They also failed to declare their conflicts of interests when they published their original trial design back in 2012 for this current acupuncture IVF study. After highlighting this issue with the journal, Trials, they eventually published a correction (erratum) in 2017 which simply state that the authors did not receive any financial compensation. Sure, she did not get any payments into her personal bank account but the NICM did receive substantial donations (evidence was send to the journal, but yes, what can I say, scientific journals nowadays, pfff). You can read more about it here, here and here.

Moving the goalposts!

But overall, publishing a negative result is so unlike the NICM, the winners of the Bent Spoon award for quackery in 2017.  Or is there more to this than meets the eye? Indeed, there is something fishy and it is strange that the reviewers of such a prestigious journal did not pick up on this. To explain the issue let’s have a look at the abstract (my underlining).

Importance:  Acupuncture is widely used by women undergoing in vitro fertilization (IVF), although the evidence for efficacy is conflicting.

Objective:  To determine the efficacy of acupuncture compared with a sham acupuncture control performed during IVF on live births.

Design, Setting, and Participants:  A single-blind, parallel-group randomized clinical trial including 848 women undergoing a fresh IVF cycle was conducted at 16 IVF centers in Australia and New Zealand between June 29, 2011, and October 23, 2015, with 10 months of pregnancy follow-up until August 2016.

Interventions:  Women received either acupuncture (n = 424) or a sham acupuncture control (n = 424). The first treatment was administered between days 6 to 8 of follicle stimulation, and 2 treatments were administered prior to and following embryo transfer. The sham control used a noninvasive needle placed away from the true acupuncture points.

Main Outcomes and Measures:  The primary outcome was live birth, defined as the delivery of 1 or more living infants at greater than 20 weeks’ gestation or birth weight of at least 400 g.

Results:  Among 848 randomized women, 24 withdrew consent, 824 were included in the study (mean [SD] age, 35.4 [4.3] years); 371 [45.0%] had undergone more than 2 previous IVF cycles), 607 proceeded to an embryo transfer, and 809 (98.2%) had data available on live birth outcomes. Live births occurred among 74 of 405 women (18.3%) receiving acupuncture compared with 72 of 404 women (17.8%) receiving sham control (risk difference, 0.5% [95% CI, −4.9% to 5.8%]; relative risk, 1.02 [95% CI, 0.76 to 1.38]).

Conclusions and Relevance:  Among women undergoing IVF, administration of acupuncture vs sham acupuncture at the time of ovarian stimulation and embryo transfer resulted in no significant difference in live birth rates. These findings do not support the use of acupuncture to improve the rate of live births among women undergoing IVF.

So, clearly this study was conducted in order to see if acupuncture is effective and they found it to be ineffective – or at least that is what they want us to think. This negative result was also widely covered in newspapers around the world and yet almost all of them got it wrong. Here are a couple of examples (my underlining):

Having acupuncture to increase IVF chances might be waste of time, study suggests” ABC news (Aus)

Acupuncture no better than placebo for improving IVF success, trial finds” The Independent (UK)

Study finds no evidence acupuncture boosts fertility treatment” Chicago Tribune (US)

So, what did they all get wrong? There are a number of issues with these results, not with the results per se, but with the results that they did not publish. So, I decided to write an email to the authors (and the journal editor) asking them a number of questions (this email was also undersigned by Prof Edzard Ernst). This email should explain the issue at hand. Here it is:

Dear Prof Smith et al.,

Congratulations to you and your team on the publication ‘Effect of acupuncture vs sham acupuncture on live births among women undergoing IVF’ in JAMA recently. 

You are probably aware that the outcome of this project has been widely reported and is currently being discussed on numerous blog sites (here and here are two examples). During these discussions a number of questions were raised and we were hoping that you, or any of your co-authors, can provide answers or some sort of explanation for these questions.

1.Why did it take so long after the completion of this study to publish the results.

2.There is a consensus that a trial of this nature would be far more expensive than the NHMRC’s funding of $630 000 – was there a lot of in-kind support or other sources of funding? 

3.The live birth rate of around 18% reported in this study seems to be low when compared to the overall success rate of IVF. According to IVF Australia women between the age of 30.0-34.9 can expect a success rate of just above 35% while women in the age category 35.0-39.9 have a success rate of just above 25%. (On Repromed’s website, who co-authored this publication, similar success rates are reported).  In your study the median age was 35.4 and 35.5 in the 2 groups, and yet, a success rate of around 18% was reported. If true, does this mean that acupuncture reduce your chances on IVF success?

4.Both the ANZCTR registry and your publication in Trials where the trial design was published, included a study group 3. This group was meant to receive only IVF and it was supposed to serve as a baseline comparison. This is of course a very important aspect and yet the results were not reported nor was it mentioned or discussed – could you clarify what the reason for this omission is?

5.In various newspaper reports it is mentioned that a further two publications will flow from these results. A cost effectiveness study and a paper on the psycho-social benefits of acupuncture. But when something is shown to be ineffective (as in this study) it cannot possibly be cost effective and when no 3rd group, receiving only IVF, was included in this study, how can the psycho-social benefits be determined?   

We would appreciate any answers or comments. Thank you in advance.

Needles to say (pun intended), no response has been received – yet. Now if we carefully look at the design of this study you will notice that the original study had a different title and design. On the trial registry the title is;

“Acupuncture compared to sham acupuncture and standard care to improve live birth rates for women undergoing IVF: a randomised controlled trial”

In the journal Trials the title is;

”Acupuncture to improve live birth rates for women undergoing in vitro fertilization: a protocol for a randomized controlled trial”

So clearly this study had three groups including the important baseline comparison of women receiving only IVF – because this is the only way that you can determine if acupuncture actually improve pregnancy or live birth rates. This is what they wanted to determine, and they were in effect supposed to investigate two questions;

  1. Does acupuncture and/or sham acupuncture have a negative, neutral (no effect), or positive effect on IVF compared to IVF alone? – this is the important efficacy question.
  2. Does acupuncture work better/equivalent/worse than sham acupuncture? – this is a secondary question focusing on the existence of the non-existent chi (energy) that flows through non-existent meridians.

But now they have intentionally dropped the baseline comparison (group 3) and only compared acupuncture with sham acupuncture. Therefore the only conclusion that can be drawn from this study is that there is no difference between acupuncture and sham acupuncture (no big surprise because chi and meridians do not exist). Nothing can be said about the efficacy of acupuncture because they left this important information out and did not report on it, even though they misleadingly claim acupuncture to be ‘neutral’ (no effect).

And the newspapers?

Most journalists get their information from the university’s press release and this is what the NICM published “Fertility study finds acupuncture ineffective for IVF birth rates”. It is completely wrong, it should have been something like; “Chi and Meridians again shown not to exist and acupuncture might even reduce your chances on IVF success” So, the journalists did not get it wrong per se, they just reported what they were told, which is strange, because any good journalist would surely check their facts before publishing. So, the question now is why did they do it? Why did they move the goal posts? Is it possible that this publication is simply a smokescreen to hide the fact that acupuncture might have a negative impact (nocebo effect) on IVF success rates?

They have omitted it intentionally!

This is now where it gets interesting. Back in 2006 a similar study with 228 participants was published by the same lead author from the NICM where a discussion was included about the reasons why acupuncture (28%) and sham acupuncture (18%) resulted in lower pregnancy rates as compared with the clinic’s baseline pregnancy rate of 30% (primary outcome was pregnancy and not live births).  Their current study with 848 participants published in 2018 had even lower pregnancy rates (live birth rates of around 18%) whereas the clinic’s baseline pregnancy rate/live birth rate has in all likelihood improved over the last 12 years (between 25-35%). So, just imagine a newspaper article stating that acupuncture might actually reduce your chances on IVF success. That would be a disaster for these people and the probable reason why they decided to keep quiet about it.

My opinion? The fact that infertility is a highly sensitive issue is simply ignored in order to protect acupuncture, and yes, they will spin this result into some sort of positive sometime in future. They have already started. Now, infertility can lead to broken relations, depression, and in extreme cases even suicide – so it is a very sensitive issue. If there is any suspicion that acupuncture might actually have a negative or even only a neutral influence on IVF then scientists should apply the ‘precautionary principle’  and advise people to stop using it. Promotional scientists on the other hand are well known to throw caution to the wind, and continue to try and convince vulnerable people to use their services or products.  This is completely unethical. These people could not care less about the well-being of the public and hence they just dropped this important information from their publication and did not even bother to discuss it, let alone, warn people about it.

Because of the size of this project they were probably forced to publish something and it took this long because they needed to come up with a way that will cause the least amount of damage to acupuncture. That it was published in JAMA is of concern and one can only question how this got pass the peer review process. Maybe the reviewers were so overwhelmed by the fact that these folks are publishing a negative result that they forgot to review the manuscript. (I will follow up on these issues with the editors)

It would however be interesting to see if the acupuncture clinics who donated money to the NICM, such as “The Acupuncture Pregnancy Clinic” will now put these ‘negative’, albeit misleading, results on their website. But how will they spin it? Acupuncture is their main, if not only, source of income with some of it flowing back to the NICM. (just read their rubbish declaration of interest in the JAMA article to see how they are getting away with it).

Will keep you posted on any further developments, I’m sure there is a lot more to come.

China Power and Influence! Part 1: TCM and the Aussie Academics who sold their souls!

China Power and Influence! Part 1: TCM and the Aussie Academics who sold their souls!

Is the Chinese Communist party currently exerting an influence on the Australian healthcare system? If so, how did they manage to get a foot in the door? Let’s have a look!

recent investigation by the award winning investigative journalism program, ‘Four Corners’, revealed that Chinese billionaires, with links to the Chinese communist party, have made substantial donations to various Australian politicians. Donations usually come with strings attached, and hence, there is some anxiety that this could have an impact on the Australian autonomy and international relations with historic partners (similar to Russia’s meddling with the US elections). The program also featured China’s influence at various academic campuses across Australia.

This prompted me to conduct my own investigation focusing on China’s influence, via these Chinese billionaires, on the Australian healthcare system. It is well known that China wants to internationalise their ancient, ineffective and dangerous traditional Chinese medicine (TCM). Australia could have, for example, decided to play a leading role and aid China in modernising their healthcare system in exchange for improved free trade arrangements – or anything that could have been mutually beneficial.  Unfortunately, a couple of Australian academics decided otherwise and made it extremely easy for China to obtain a strong foothold, with their TCM, in the Australian healthcare system.

This article will detail specifics regarding how these academics managed to get the job done, whilst a second article will describe how specific Australian politicians made all of this a walk in the park for China (all supporting documentation is available on request).  Please skip the next section if you understand TCM, but for those who don’t, below is some background information.

What is TCM and why is it so dangerous?

Imagine a healthcare system where no disease can be diagnosed and where the treatments on offer are mainly ineffective, while some are even outright dangerous. This is TCM in a nutshell; misdiagnosis by default and ineffective/dangerous treatments.  It is no wonder that many scientists are extremely concerned about the promotion and legitimisation, especially via universities, of TCM in Australia and around the world. A recent article in the Economist sums it up well; “State-sponsored quackery. China is ramping up its promotion of its ancient medical arts. That is dangerous for humans as well as rhinos”

To understand the issue at hand, here is one example;

The TCM nature of rhino horn is “salty, sour and cold” and hence its actions are to “clear heat, subdue Yang and cool blood, relieves fearfulness, detoxifying.” Rhino horn is therefore a treatment for “high fever, sun stroke, trauma, mania, convulsion, sore throat, epilepsy, febrile disease, infectious disease, macula, bad skin conditions, subcutaneous bleeding.” (rhino horn is in fact being promoted as medicine at Western Sydney University, but I believe for dementia. One of their collaborators was even sent to prison for importing rhino horn into Australia).

Some of these above mentioned conditions can be life-threatening, if left untreated. Because everybody knows that rhino horn is not an effective medicine for anything, prescribing and using it as a medicine, is equivalent to providing no treatment for these conditions. And this is indeed why TCM is dangerous for people, not even to speak about the needless slaughter of rhinos.

saddest-rhino-photo-yet-oscap-645x
It took this rhino calf a number of days to find its mother. Unfortunately the poachers got hold of her first -and all of this in order to fuel the insatiable and growing TCM market.

In TCM, disease is seen as an imbalance of a non-existent life-force (Chi) that flows through non-existent meridians, and in this pre-scientific world, bacteria, viruses, etc. do not exist.  By slapping yourself, or inserting needles (acupuncture), or taking herbs, or animal matter, your Chi will be ‘restored’ and you will be ‘cured’ of whatever ailment you might suffer from. Because TCM is a believe-based system, every treatment (and there are thousands) is believed to be effective for its intended purpose. This becomes very dangerous when this believe is so strong that they will advise patients to stop their conventional treatments, and rely solely on TCM. That this danger is real, was recently illustrated by the tragic death of a 6yo boy suffering from type-1 diabetes.

The fact that some herbs (very few) do contain beneficial compounds is, in effect, negated by the fact that TCM practitioners cannot correctly diagnose any medical condition. To try and ‘solve’ this problem, they will therefore prescribe a combination of up to 20 different herbs, because by doing this, it improves their chances of getting lucky! Most TCM proponents are fully aware of these problems, and therefore their current approach is to ‘integrate’ all of TCM with conventional diagnostics and treatments. They do this in order to continue to make money but also to promote TCM as ‘effective’ by piggy-backing on the successes of evidence-based modern healthcare.

So, yes, it is all about money with China trying to expand its $170 billion TCM industry by legitimising it in other countries. In Australia it turned out to be a very easy task, just ask the four blokes in the photo below. They have been warned, repeatedly, about the dangers of TCM, but apparently the big motivator, money, speaks louder than words.  So, this is where the Australian academics comes into play (more info regarding TCM can be found here and here).

Alan Benoussan Barney glover
FLTR: Proff. Alan Bensoussan (WSU), Barney Glover (WSU), Xu Anlong (BUCM) and Peter Shergold (WSU). Lobbying for political support of TCM at parliament house, Canberra (their trip paid for by the Aus public)

The Australian academics

One of the key players in Australia is Prof Alan Bensoussan, Director of the National Institute of Complementary Medicine (NICM), Western Sydney University (WSU). He completed a degree in physics and then, for some unknown reason, decided to continue with TCM. He studied at the Nanjing University of TCM in 1985/86, and this is where he was ‘converted’ or ‘recruited’ by the Chinese communist party.  And because Alan, like most people, cannot admit to have made a mistake, decided to continue down this path of pseudoscience. Once you are trapped, you are in it for life. And not only that, he became one of the biggest lobbyists of TCM in Australia. This is, of course, one way of ignoring your mistakes – you stubbornly continue to tell yourself, and everybody else, that you are right, even in the face of the most compelling scientific evidence! For Alan, TCM is an effective and safe healthcare system! Unfortunately, after 30 years of trying, he is not able to show that science was wrong about TCM, and hence, he still does not have anything to show for it (without cheating and misleading, that is).

But whatever happened, he became one of the biggest drivers of TCM in Australia. Since his return from China he has worked tirelessly to legitimise TCM with his main approach being; that the safety of patients will be assured by regulating TCM, and, that TCM should be ‘integrated’ within conventional healthcare. The fact that TCM is mainly ineffective and by regulating fake medicine, it can only lead to well-regulated fake medicine, didn’t bother him –  it simply doesn’t fit his delusion. Intense lobbying for many years resulted in TCM becoming a registered healthcare profession in Victoria in 2000, and Australia wide in 2012. Being ‘registered’, in this case, simply means that you must have a ‘real’ degree in fake medicine before you can practice fake medicine – how this will assure the safety of patients is beyond me! This was, however, a crucial turning point. Registering TCM as a ‘healthcare profession’ gave it an Australian government stamp of approval, and after this victory for TCM, everything went into top gear. Alan received a prestigious award for his intense lobbying in 2013 in the Great Hall of the People, Beijing China. This award was also celebrated at WSU and was attended by Eric Roozendaal, CEO of the Yuhu group (more about the YuHu group a bit later on).

Other prominent Australian academics are Prof Charlie Xue from RMIT university who runs an accredited (again a government stamp of approval!) course in TCM and chairs the ‘Chinese Medicine Board of Australia’. He is therefore in charge of registering TCM practitioners, and he has also received millions from China to promote TCM in Australia (see under current grants). The University of Technology Sydney (UTS) also provides accredited courses in TCM and has accepted millions in gifts from Chinese businessmen – donations and gifts always comes with strings attached.

The Chinese businessman

The Yuhu group is owned by Chinese billionaire, Huang Xiangmo, who featured prominently in the ABC’s Four Corners investigation. Huang Xiangmo is the president of the ‘Australian Council for the Promotion of the Peaceful Reunification of China’ – an organisation considered to be the vanguard of lobbying for the Chinese communist party in Australia. It turns out that they do not only influence Australian politics, but also the healthcare system. The Yuhu group has ‘committed’ a $10 million donation to Alan Bensoussan for the internationalisation of TCM in Australia. This large donation was eventually withdrawn by Yuhu, due to WSU’s inability to get the necessary paper work done in time (maybe too many bureaucrats working at WSU?). Huang Xiangmo did eventually donate $3.5 million, to establish the Australia-China Institute for Arts and Culture at WSU. Alan is named as a key researcher which demonstrates that TCM is considered to be part of Chinese ‘arts and culture’ and not an evidence-based healthcare system.

Huang Xiangmo
Mr Huang Xiangmo, seated, before signing the $3.5 million agreement. Prof Glover, left, is looking on in greedy anticipation, mumbling ‘sign it, sign it, sign it….’

In the NICMs latest newsletter (under ‘Message from Director’) they thank their generous sponsors, which includes Josephine and Gary Lam. Unfortunately the value of these donations are not publicly available, but, Josephine Lam has donated substantial amounts of money to WSU/NICM before. She is also currently acting as a ‘specialist advisor‘ to the Vice Chancellor, Barney Glover (he has also accompanied Alan to China to lobby for support of their Australian TCM facilities). The Lam’s are part of the ‘Australian China Economic, Trade and Culture Association’, with Gary Lam being the Chairman and Josephine a Honorary Advisor.  Huang Xiangmo, of the Yuhu group is also a patron of this organisation.

Dr Ven Tan, who is the ‘Standing Deputy Chairman’ in this organisation, and the founder of ‘Tasly Healthpac’ is an important role player, claiming that; ‘Through his own practice he has come to realize the limitation of conventional Western medicine and to worship the merit of Traditional Chinese Medicine’. The photo below depicts the signing of a Memorandum of Understanding (MoU) between the Chinese and Australian governments ‘aimed at promoting TCM in Australia through a collaborative initiative’. (Alan Bensoussan is on the far left and Ven Tan third from the left.) So, again we have a Chinese ‘cultural’ organisation that wants to promote TCM in Australia.

Ven Tan Photo

Another separate MoU was signed between Tasly and the NICM (Alan Bensoussan is the director of the NICM) in 2011, which states that the NICM will provide “assistance in the development of an Integrative Care Model: to assist the Tasly Healthpac Centre of Excellence in Integrative medicine so that its structure aims to integrate TCM and western medical diagnostics and treatments in an integrated, patient centred way.” Some might now recall that the tragic ‘slapping therapy’ death of a 6yo boy recently occurred at Tasly Healthpac.  This illustrates what happens when your objective is to ‘integrate’ fake treatments with evidence-based treatments.

The NICM’s gifts register indicates that a huge amount of effort goes into cosying up to Chinese politicians, businessmen and (TCM) academics. There are documents demonstrating that they are actively targeting and engaging with specific Chinese businessman (Huang Xiangmo, Chau Chak Wing, etc) known to have links with the Chinese communist party. WSU even planned to provide scholarships to the children of Chinese consular staff members. The response from the Chinese consulate was, of course, a very big thank you to Alan Bensoussan and Barney Glover, for their hard work in legitimising TCM in Australia. To think that all their visits to China, the hosting of Chinese delegates, the huge amount of time it takes to lobby all of these role-players (in China and Australia), even the gifts are partially paid for by the Australian public. So, what do the Australian public get in return for their investment? The promotion and integration of a dangerous fake healthcare system. And this brings me to the Australia-China Free Trade Agreement.

Barney Glover FTA
Prof Barney Glover, right, after signing the agreement. Obviously smiling, because this means a lot of money.

Australia-China Free Trade Agreement

Alan has managed to get TCM included at the signing of the free trade agreement (FTA) between Australia and China (called a ‘tragedy‘ by an eminent Australian scientist – I tend to agree!). This inclusion will allow WSU and the Chinese government managed ‘Beijing University of Chinese Medicine’ (BUCM), to be used as vehicles for the communist party’s agenda to exert its influence via TCM on the Australian healthcare system. And all of this facilitated by Alan for which he is handsomely rewarded by the Chinese government. The inclusion of TCM in the FTA has paid off, and has resulted in a TCM hospital that is currently being established in Westmead, Sydney – opening in 2018. The BUCM will operate this ‘integrative’ TCM facility and it will be based on a similar 80-bed hospital which the BUCM is already operating in Germany. According to documents, this facility will be commercial (run by the BUCM) and the NICM will co-occupy this space to further their (or the Chinese communists party’s) agenda regarding the continued legitimisation and internationalisation of TCM.

Conclusions

In short; Alan Bensoussan, Barney Glover, and others, are colluding with the Chinese communist party, and as such, is making it extremely easy for them to exert their (not so soft) power in Australia. TCM is part and parcel of the international influence that China wants to exert. It is unfortunate that China, who has made rapid advances in science and technology, decided to stick with TCM and not on collaboration with Australia regarding modern evidence-based healthcare. It is even more unfortunate that these Australian universities decided to sell their souls for the sake of Chinese money. The $170 billion TCM industry therefore seems to be the main motivator for both WSU and the Chinese government and not improved health outcomes for Australians. The saying ‘give them an inch and they’ll take a mile’ comes to mind, and I have to ask; where will it all end?

It is interesting to note that serious medical conditions e.g. cancer, are being targeted by the NICM in order to legitimise ineffective TCM. In the NICMs own words “… the press/media would be reluctant to take a negative line on initiatives that are targeted at oncology…” This sentence says it all.

My next article will provide more details on the FTA and the Australian politicians (especially Andrew Robb and Jullian Skinner) who were successfully lobbied by Alan, and who made all of this possible. All this information has been sent to WSU, about 2 months ago, but as usual, there seems to be no interest in the adverse impact that their actions will have on science, on education and on the health of the public (and the poor rhinos, of course).

(The ‘controversial’ book ‘Silent Invasion: China’s influence in Australia’ by Prof Clive Hamilton is also worth a read)

Are the Gatekeepers of Science made of stone? The journals respond to the NICMs undeclared conflicts of interests.

Are the Gatekeepers of Science made of stone? The journals respond to the NICMs undeclared conflicts of interests.

Imposing figures, these gatekeepers pictured above. Problem is, they only give the appearance that they serve a purpose because they are made of stone, and hence, anyone, friend or foe, can easily pass. In the world of science we also have gatekeepers  (scientific journals, peer reviewers, university management etc.) who’s sole duty is to distinguish friend from foe. The former being ‘real scientists’ and the latter, ‘promotional scientists’ or ‘pseudoscientists’.  The gatekeepers’ duty is therefore to stop the promotional scientists in their tracks, and not allow them entrance into the scientific system. As soon as these people are allowed in, society will be engulfed with fictitious or alternative ‘facts’, and this can only lead to chaos (unfortunately this has already happened in many countries).

Real scientists understands social responsibility and impact, whereas promotional scientists ignores it, for the sake of more funding and increased sales for their sponsors. How to determine the difference between the two? Good place to start is to have a look at who funds a scientific study. Usually this information can be found within the conflicts of interests’ section, which has to be completed by all researchers. Being funded by industry does, of course, not necessarily mean that the research in question is biased. Consequently, it is not entirely fool-proof, but a good starting point nonetheless. It is, however, fool-proof when researchers intentionally fail to declare their obvious conflicts of interests, which implies that their research results are very likely to be biased, and geared towards promoting a specific product or service that their sponsors happen to sell.

Another way to tell the difference between the two, is if a research group always report positive results. These positive results doesn’t necessarily have to be reflected as such in their scientific articles, but more so when they use (social) media to ‘translate’ these results to the public. It is hard, but not impossible, to cheat in a scientific article and it is also risky business. You could lose your job, but then only if you have effective gatekeepers in place. To use (social) media to falsely promote ‘positive’ results is far safer because it is unregulated, it reaches the target audience better (the public), and hence it is far easier to get away with it. It basically circumvents the gatekeepers of science. This is an important aspect, because the public does not read scientific articles (it isn’t always available and it’s written in a scientific language that few people understand), but rather read someone’s interpretation of it on Facebook or in the newspaper.

Some of these promotional researchers have the ability to take a neutral or negative result and advertise it on social media as a clear positive. This is unethical, but unfortunately, there are no clear guidelines in place to prevent this from happening. Hence, another loophole in the academic system that unscrupulous promotional researchers exploit to the full. But let’s only look at the National Institute of Complementary Medicine’s (NICM) undeclared conflicts of interests, and I’ll get back to their advertising via social media prowess at a later stage.

The NICMs undeclared conflicts of interests

In a previous article I’ve written about the NICM and their intentional failure to declare their very obvious conflicts of interests in many of their acupuncture studies – and this has been going on for years. Currently, the most notable and largest study is an ‘acupuncture for infertility’ clinical trial (final results not available yet). When they published the trial design they ‘forgot’ to mention that Alan Bensoussan and Caroline Smith (both from the NICM) are consultants for commercial acupuncture-fertility clinics, the director of these clinics serve on the NICM’s advisory board, students of the NICM finds employment at these clinics, and that these clinics have donated money to the NICM (you can read about the details here and here).

I’ve also reported that Western Sydney University (WSU) who hosts the NICM, simply refused to even respond to this issue after I’ve raised it with their ethics committee.  One of the four journal editors who was contacted, also ignored this issue even though the journal, ‘European Journal of Integrative Medicine’ (EJIM) clearly states that;

All authors must disclose any financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work. Examples of potential conflicts of interest include employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, and grants or other funding. If there are no conflicts of interest then please state this: ‘Conflicts of interest: none.”

The reason why this editor ignored this issue, became clear when I looked at who she was.  Prof Nicola Robinson, happens to be an acupuncturist, she was also admitted to the  illustrious ‘ Alternative Medicine Hall of Fame’ (for ‘researchers’ that never publishes negative results),  and she has co-authored an acupuncture article with the NICM entitled; “Does acupuncture improve the outcome of in vitro fertilization? Guidance for future trials”. Needless to say, but even in this article under the heading ‘Conflict of interest’ they also declared to have ‘no competing financial interests’. Clearly, WSU and this editor has completely removed the role of gatekeepers and they are allowing everything to pass as ‘science’. This is also the reason why the NICM and WSU have again been nominated in 2017, for the Bent Spoon award, given to the best Australian pseudoscientist of the year.

The response from the British Medical Journal Open (BMJO) 

The BMJO published the NICMs article entitled “Complementary therapies for labour and birth study: a randomised controlled trial of antenatal integrative medicine for pain management in labour”. Here again we see that the NICM loves to combine or integrate acupressure (acupuncture without the needles) with interventions that in all likelihood will yield a positive result. In this study they combined six interventions (incl. acupressure to unblock your meridians so that your life-force or Chi can flow freely) and all interventions taken together gave them very good results. It also received a lot of (social) media attention. Now, any scientist will know that when you combine six interventions as a single treatment, there will be no way of telling which of these actually contributed to the positive outcome. And this is exactly what the NICM wants. And hence, although these overall results can be applauded, it again shows that the NICM have ulterior motives which, simply put, is to integrate fake treatments with real treatments and use these results to convince more people to use their commercial acupuncture clinics.

Although the journal did respond to this issue, and we have had a number of conversations, they eventually decided that “we do not feel that the authors have a competing interest”. Even though, BMJO clearly states that;

“A competing interest exists when professional judgement concerning a primary interest (such as patients’ welfare or the validity of research) may be influenced by a secondary interest (such as financial gain or personal relationship). There is nothing inherently unethical about a competing interest but it should be acknowledged and openly stated.”

Agreed, and this is exactly what the NICM intentionally did not do, but, unfortunately, this was also the last correspondence I had with BMJO.

Response from the journal ‘Trials’

Journal three was a bit more thorough. It concerns a publication in the journal ‘Trials’ entitled “Acupuncture to improve live birth rates for women undergoing in vitro fertilization: a protocol for a randomized controlled trial” (The media called this large and expensive study “Unis in a wacky waste of cash” at the time.) In this article, they again intentionally failed to declare their very obvious conflicts of interests, but eventually they were forced to publish a correction, which reads;

After publication of our article [1] we realised that our Competing Interests statement should have read as follows: Jane Lyttleton is the Clinical Director of The Acupuncture Pregnancy Clinic. Caroline Smith has had an association with The Acupuncture Pregnancy Clinic. She states that she has not received any financial compensation for this relationship at any time.”

Although a move in the right direction, not completely true, because Caroline Smith is/was clearly a consultant for these clinics (over an 8-year period, but this info was deleted from the clinic’s website after I published my first blog post on this issue), and it does not even mention the donations that the NICM received from these clinics – and this is the crux of the matter! Sure, Caroline Smith probably did not receive any money in her own bank account, but the NICM did accept donations for their research activities. All of this counts towards academic promotions, more students and she was even named WSU’s researcher of the year in 2015. So, she clearly benefited from it all.

Response from ‘Evidence-based Complementary and Alternative Medicine'(ECAM)

The fourth journal, ECAM (published by Hindawi) is still investigating this matter. But true to their nature, the NICM first tried to mislead the journal. The journal was even planning to publish a correction, but luckily, they decided to run this ‘correction’ past me first. And, knowing the NICM well, it was quite easy to point out how they were being misled with clever wordplay. After the NICMs failed attempt to mislead Hindawi, WSU also stopped responding to Hindawi’s further queries based on this new information. Only after Hindawi lodged a formal complaint with the university’s ‘independent conflicts resolution unit’ did they respond. Although I am not at all convinced regarding this unit’s independence (I’ve had some bad experiences with them), they even started to respond to my initial queries that I’ve emailed to them about 10 months ago.

Surprisingly, I am currently in contact with WSU’s department of Audit and Risk, who has now apparently forwarded this matter to an external investigator (I haven’t heard anything from them yet). It is surprising, because I am not in contact with scientists or ethics committees who are the best suited to deal with these matters – this is after all a simple case of scientific misconduct. As Alan Bensoussan publicly stated “We understand conflict of interest concerns, but this is why we have strict guidelines and ethics committees …..”

So, WSU is in all likelihood trying to mitigate the potential risks regarding this comparatively small issue, whereas they should start to address the far bigger underlying problem of allowing pseudoscientists a foot in the door.  Apparently, WSU’s gatekeepers will allow anyone in as long as you hand them a bit a cash – and this does not bode well. Promoting pseudoscientific healthcare systems, especially via universities, leads to a lot of people (and animals) getting hurt or even die, as was tragically illustrated with the 6yo boy who died after attending a ‘Slapping Therapy’ workshop at a clinic of one of the NICMs partners.

It is quite interesting to note the big difference between how the journals or ‘gatekeepers’ of science responded to this issue. From an absolute and resolute ‘let’s completely ignore the issue’, to a very thorough ongoing investigation, and everything in-between. It is at least good to see that some journals still understand the importance of fulfilling their gatekeeper role. This again shows that science might be factual, but human interpretations of factual observations is, or can be, strongly influenced by our diverse and many vested interests. And this leads to fiction becoming fact and vica versa.  Or put differently; science is simple, scientists are complex! And this is, unfortunately, a growing concern and danger to public safety and makes it increasingly difficult for the public, to make informed decisions regarding healthcare. Although this article only dealt with conflicts of interests, a rather ‘minor’ issue, a next article will deal with the ‘scientific’ content of the NICMs acupuncture articles. This will clearly illustrate how the NICM is intentionally promoting placebo treatments at the expense of science and public safety, and how WSU is not only allowing this to happen, but that they are even actively assisting the NICM to achieve their dubious objectives.

What can you do about this?

Unfortunately, if you fall for their trickery and you get hurt, then you will be all alone. The bureaucracy involved is extremely complex so the best thing to do is prevention. Stop believing that Chi is real, because it simply does not exist. Stop buying their products or using their treatments, and inform yourself and your family and friends about how these people play their sick game and what the dangers are regarding these ‘treatments’. ‘Friends of Science in Medicine’ provides valuable healthcare information as well as the website of Prof Edzard Ernst, where he discusses everything complementary medicine (what works and what doesn’t). If you are interested in receiving automatic updates regarding the NICM and what they are up to, you can always follow my Blog,  Twitter or connect on LinkedIn. Will keep you posted regarding the outcome of the 2017 Bent Spoon awards (the NICM has obviously been nominated), and please, ‘Like’ and share this article via FaceBook etc. – options below.

 

 

 

 

‘And the Bent Spoon Award goes to…?’ The NICM nominated for the second year running!!

‘And the Bent Spoon Award goes to…?’ The NICM nominated for the second year running!!

Reminiscent of Voldemort about to cast an evil spell, Prof Barney Glover (photo BL – resemblance is striking) is showing a packed auditorium his outstretched hand above which the mystical ‘life force’ or Chi hovers. Because no one, not even Barney, can see anything floating above his hand, Prof Alan Bensoussan (photo BR) comes to the rescue by explaining that if everyone just play along, and make as if they can see Chi, then they all stand to make a lot of money. His strenuous expression indicates that it is a hard sell, but he also knows that the money factor and quality of showmanship, usually attracts a crowd and also wins out over common sense. The photo on top is from Voldemort, the villain from the Harry Potter movies.  The reason why these three men looks so serious (excl. Voldemort because he is an actor, oh no, wait, all three are actors) is because they know damn well that what they are doing is ‘magic’. So, we are entering an era where all three these characters are real, or scientists should start to stand up for science!

In order to expose these ‘magicians’ and to create public awareness regarding their trickery, the Australian Skeptics Inc. annually presents the Bent Spoon Award for the top pseudoscientist of the year. It is in effect the Oscars for pseudoscientists, because both reward outstanding acting abilities. This year there are a number of nominees including the controversial National Institute of Complementary Medicine (NICM) hosted at Western Sydney University (WSU). Below is the full nomination:

Nominee: National Institute of Complementary Medicine and Western Sydney University

Nominated by: Australian Skeptics and others

Date: 20/09/2017

For continuing to promote unsupported and debunked ‘medical’ treatments, despite promises late last year, in response to a 2016 Bent Spoon nomination, that they are “intending to revise our website … and hope to address some of these issues you have raised”. It still promotes the following treatments under the Complementary Medicine banner: acupuncture, chiropractic, aromatherapy, naturopathy, spiritual healing, crystal therapy, reflexology, ‘energy therapies’ (reiki, qigong, electromagnetic field therapy), TCM, Ayurvedic medicine, anthroposophical medicine, healing touch, Rolfing, Feldenkrais, Alexander technique, and homeopathy. Secondly, NICM and UWS are nominated for planning to establish an on-campus TCM clinic for the general public.

Hopefully this year they will walk away with this coveted award, which is bestowed upon “the perpetrator of the most preposterous piece of paranormal or pseudo-scientific piffle.” In 2016, the NICM tried for some reason, but in vain, to remove their nomination, but their attempts backfired somewhat. You can read about their sorry attempts here. It is also notable that the 2016 nomination was done by one person, whilst the 2017 nomination was done by a group of people, indicating that more and more people are coming around to the fact that the NICM/WSU are indeed misleading the public.

Key people in this year’s nomination is again the director of the NICM, Prof Alan Bensoussan, and the Vice-Chancellor of WSU, Prof Barney Glover. Between these two men, they earn roughly $1.2 million AUD per year, dished out by the Australian public. In return for these vast sums of money, the Australian public are being misled into believing that all of the above therapies are useful, effective and safe. This is obviously not true as you can see in my previous article which dealt with the involvement of the NICM and WSU in the tragic case of the 6yo boy who died after attending a Traditional Chinese Medicine (TCM) based ‘slapping therapy’ workshop in Sydney. By slapping yourself you supposedly influence the flow of Chi through meridians and hence you will be cured of disease. Unfortunately, this boy suffered from diabetes and because many people belief that Chi is real, he was taken off his medication during the workshop – a life-threatening scenario. Clearly the ‘treatments’ that the NICM promote is not only ineffective, but it can also be quite dangerous.

But let us look at Alan Bensoussan. As a registered acupuncturist and herbal Chinese medicine man, he obviously falls within the category of delusional ‘healthcare’ practitioners. Because his livelihood depends on it, he will continue his unwavering support of debunked treatments, even in the face of overwhelming scientific evidence that these ‘treatments’ simply does not work. Ineffective treatments is quite dangerous, not only to people, but to wildlife as well. In his delusional world, all TCM therapies are effective and hence he will happily go to court to act as a character witness for his business partner (another TCM practitioner) who was send to jail for importing Rhino horn, and other endangered animal material, into Australia. This was followed by promoting rhino horn as a life-saving medicine in a thesis, approved by Alan and WSU (2012). And quite recently (2017) the NICM even had a link on their website where consumers could find information regarding the life-saving properties of rhino horn, and I guess they could even buy it online (link has since been removed).  Everything works in his delusional world.

There are many more examples such as his continued support for debunked treatments such as homeopathy, acupuncture etc. but this award is not only for supporting these treatments, it is also the way in which they mislead the public. For example: they fail to declare their many  conflicts of interest on many of their research papers (scientific misconduct), they design their experiments in such a way that it almost always gives a positive result (A+B vs B trial design), and even if the result is negative they will promote it as a big positive on WSU’s news site, or on social media (scientific misconduct and intentionally misleading the public). They even misled the Australian Research Council (info obtained after 2.5 years under a Freedom of Information request) who gave them a ranking of five, which stands for ‘research quality well above world standard’ in their ‘Excellence of Research for Australia’ program.  With this fraudulently obtained ranking, they lobby, but also mislead; UK royalty, ministers, regulators, foreign governments (specifically China) etc. in order to invest more money in the NICM.

But they also use this ranking to try and crush any negative reports, such as their 2016 Bent Spoon nomination – and this is where the excellent acting comes into play. Here is an excerpt from Alan’s letter to the Australian Skeptics “NICM conducts itself with the highest degree of integrity, ethics, scientific enquiry and social responsibility. Our research is independent, peer-reviewed, and is published in highly reputable, world-leading journals. NICM has been evaluated by Australia’s leading scientists under the Excellence in Research for Australia scheme and received the highest ranking of 5 for two consecutive periods, representing research that is deemed well above world standard.” None of this is true, and yet they can write these things without blushing. Their acting ability is so good, that they do not only fool the public, they actually have the acting ability to fool themselves. Any actor that can immerse themselves into a role to a point where they become the character deserves an Oscar, or in this case a bent spoon.

As for Prof Barney Glover. Well, he was warned about all of this, by myself and others, that by supporting the modus operandi of the NICM and hence these debunked treatments, including TCM, people will needlessly get hurt or even die (the Slapping therapy is a case in point). Unfortunately, Barney and the rest of WSU management decided to ignore all of these warnings and is fully supportive, and protects, the NICM at a cost of >$2 million AUD per year. I guess if you can’t beat them, join them; so, Barney has been actively involved in lobbying the Australian public that Chi exists and he has opened the door for China to use Australians as guinea pigs for their unproven and disproven TCM therapies.  It is well known that China wants to internationalise TCM, and via Alan and Barney the Australian public will now have to bear the brunt of ineffective therapies. Here is an excellent article in the ‘Economist’, explaining the dangers of doing just this – the title says it all; “State-funded Quackery. China is ramping up its promotion of its ancient medical arts. That is dangerous for humans as well as rhinos.”

Armed with this knowledge, Barney visited China on a number of occasions and together with Alan managed to get TCM in the Free Trade Agreement signed between China and Australia. This has given the impetus for Chinese companies to export more of their disproven and unproven ‘medicines’ to Australia, and it forms the cornerstone of a new TCM facility that will be built in Sydney. This facility will be co-managed by the Beijing University of Chinese Medicine (BUCM) and because it needs to be profitable within a couple of years, implies that it will be operated like a commercial clinic or hospital.  In the NICM’s own words during a industry sponsors meeting, the NICM will “lead the modernisation and integration of Chinese Medicine in the West through the
development of an effective Integrative Medicine Facility or TCM Hospital.” The BUCM has managed to start a similar 81-bed ‘hospital’ in Germany and this will likely be the model on which the Sydney facility will be based. So much for ‘evidence-based’ treatments, where evidence that a treatment does more good than harm comes first, before you start selling it to the public. But in their delusional world, all of TCM, and for that matter all of complementary medicine, works – so why should they provide any evidence?  You only have to belief that it works, and that is it!

At the heart of all of this, as usual, is money. The millions that Barney, Alan and the NICM cost the Australian public has to be recovered somehow, and hence these two men decided to destroy science, scientific education and put the public’s health at risk by allowing WSU to become the ‘scientific’ façade of a very dubious, and dangerous, complementary medicine industry. In exchange, they are handsomely rewarded with very big donations towards their ‘research efforts’, or rather, promotional research. Here they received $10 million from Blackmores, here is $4 million from the highly controversial Jacka Foundation (links with anti-vaccination activists), not to mention the millions from other complementary medicine companies, including Chinese companies and investors.

The list of misleading and false claims and statements constantly flowing from the NICM is unfortunately so long that it will require a series of books to be written in order to cover everything. It is however, quite remarkable, how similar their modus operandi is to the notorious gangster, Al Capone, who also had a ‘good guy’ public image, but beneath the surface had a somewhat more  sinister nature.  But the sad thing is that nobody can seemingly do anything about this. As long as they are in a position of power and they manage to bring in this kind of money; rules, ethics and morals simply do not apply anymore. As further evidence of their extremely good acting abilities, here is the title of Voldemort’s, oh sorry,  Barney’s speech given at the National Press club (photo) “universities must stand up for facts and the truth – if we don’t, who will?” This is acting at its best, and in my view, deserving of the Bent Spoon award.

Unfortunately, if you fall for their trickery and you get hurt, then you will be all alone. The bureaucracy involved is extremely complex so the best thing to do is prevention. Stop believing that Chi is real, because it simply does not exist. Stop buying their products or using their treatments, and inform yourself and your family and friends about how these people play their sick game and what the dangers are regarding these ‘treatments’. ‘Friends of Science in Medicine’ provides valuable healthcare information as well as the website of Prof Edzard Ernst, where he discusses everything complementary medicine (what works and what doesn’t). If you are interested in receiving automatic updates regarding the NICM and what they are up to, you can always follow my BlogTwitter or connect on LinkedIn. Will keep you posted regarding the outcome of the 2017 Bent Spoon awards, and please, ‘Like’ and share this article – options below.

Death by ‘Slapping Therapy’. The role of the NICM, and others, in this tragedy.

It is always a terrible day when children die at the hands of fake medical practitioners or pseudoscientists. It is so unnecessary and preventable, and yet, it happens every day everywhere around the world. The proverbial snake-oil salesman is not a new phenomenon, it has always been with us, but it is becoming a global epidemic since some universities decided to elevate this type of quackery, to become state-funded and university-supported quackery. This turn of events lends undue credibility and legitimacy to these ineffective and dangerous ‘treatments’ and this translates into more people being fooled, while the snake-oil salesmen and those universities stand to make more money. It is always about money! But let’s have a look at how it works with the following tragic example, followed by some suggestions as to what you can do to help prevent these things from happening.

The controversial ‘Slapping Therapy’

This example involves a complementary therapy within the realm of Traditional Chinese Medicine (TCM), called ‘slapping therapy’ or ‘Paidalajin’. A 6yo boy suffering from type-1 diabetes attended a slapping therapy workshop in Sydney with his parents, but sadly, the boy died in his hotel room shortly afterwards. Although the case is still before the courts, it is believed that he was deprived of medication and food during the workshop. The parents and grandmother have been arrested and faces manslaughter charges while the TCM practitioner, Hongchi Xiao, was only quite recently extradited from the UK, where another person died at one of his workshops. He was not granted bail and faces a maximum sentence of 25 years imprisonment.

But what is this ‘slapping therapy’, and why is it called controversial? It involves the flow of ‘energy’ or a ‘life force’ (chi) through channels (meridians) and by slapping yourself, or being slapped by someone else, you restore the flow of chi and your body starts to expel ‘toxins’. These toxins become visible when your skin turns red, and I guess, purple and blue, depending on how hard you are being hit. The theory was, therefore, that by slapping this boy he would be cured from diabetes, and this belief is so strong, that he was also taken off his medication – a life threatening scenario. But what does science say? Chi does not exist, meridians do not exist, diabetes cannot be cured and especially not by slapping, and the so-called toxins that your body expel are called bruising (the slapping injury causes tiny blood vessels to burst and the blood gets trapped below the skin’s surface, which causes a bruise). Just imagine how many people get hurt or die, due to TCM practitioners using chi, meridians etc. to diagnose and treat disease. Because it does not exist, they cannot really diagnose anything, and hence cannot effectively treat anything!

Here is a photo of the type of bruising that you can expect, posted as a testimonial from a cancer sufferer and devout follower of Master Xiao (I always wonder how many of these testimonials are real). In addition, if you hit a young child to a point of severe bruising it is called child abuse, but in the pseudoscientific world it is apparently called ‘self-healing’.

All of TCM is controversial, or none of it is!

If you promote TCM, in whatever shape or form, you also promote its underlying pseudoscientific principles. Let’s look at acupuncture; You insert needles at specific points (acupoints) that supposedly manipulate the flow of chi through meridians – and this, according to practitioners, cures disease! This acupuncturist (at Western Sydney University – WSU) recently published a case study where she reported that her patient did not recover after receiving an acupuncture treatment. What was her conclusion? “Despite this, I found that my confidence was undermined by being out of touch with my own inner knowing or Yi.” So, what is Yi? It is your intent (yi 意 ), and when your intentions (to cure disease) becomes permanent, then it becomes your will (zhi 志 ). In other words, acupuncture works and nobody should argue with that, the problem, this time, was that her intention for it to work were insufficient. Solution: believe more deeply!  And to think that this was part of the ‘science’ that was reviewed by the Australian Research Council in their Excellence of Research for Australia scheme, which they rewarded with the highest possible ranking (5) “evidence of outstanding performance well above world standard (something is rotten, but more about this in a next article).

But the same goes for herbal TCM, which also aims to manipulate the flow of chi through meridians. As described by ‘Prof’ Alan Bensoussan (director of the NICM at WSU) in a radio interview; “The first patient would receive acupunctural herbs that disperse the accumulation of energy, the second patient would receive acupunctural herbs that strengthen and tonify the low back. It’s a tool like this concept of circulation of energy, that actually allows the Chinese Medicine practitioner to distinguish these patients, and allows the Chinese Medicine practitioner to treat the patients in a way that the patient themselves may understand better,”.

Disease is therefore seen as an imbalance of a non-existent energy that flows through non-existent meridians, and the ‘slapping therapist’ makes use of these ‘fake’ principles to mislead people. In their strange world, bacteria, viruses, pancreatic cells secreting insulin etc. do not exist, but rather disease is caused by your chi clogging your meridians and hence slapping yourself, or inserting needles, or taking herbs, will unclog your meridians and you will be cured of whatever ailment you might suffer from. They are continuing, to this day, to promote these false and dangerous ideas to the Australian public. And again, it is dangerous because if you cannot diagnose a disease, you cannot effectively treat it. Any successful TCM treatment (some herbs might be effective) is therefore purely based on luck. Ever wondered why a TCM practitioner will prescribe a patient a combination of 10-20 different herbs? Because it improves their chances of getting lucky, but also amplifies the many risks, 20-fold.

This is why scientists call TCM, and the many other forms of complementary medicine, belief-based healthcare systems. You only have to believe hard enough that it works and that’s it, there are more than enough gullible people who will fall for your trickery. Sure, you get true believers (delusional) and unscrupulous people (criminals) that only make as if they belief, for the sake of misleading you and to make money out of you. If you fall for them, then, unfortunately, you are on your own. Master Xiao’s comments after his arrest? “This has nothing to do with the workshop. This boy had a lot of diseases, more than we ever know.” It is never their fault.

But now a very unfortunate death has occurred, which means that many of the important role players in this tragedy will disavow the slapping therapy ‘treatment’ in order to absolve themselves of responsibility and to stay out of the news. They do not accept any negative reports because it tends to clash with their Yi and Zhi. And hence they continue to promote acupuncture and TCM, even though many deaths have occurred as a direct result of acupuncture and even more due to herbal TCM remedies. And to think that most deaths, by far, occur as an indirect result after using these pseudoscientific therapies by neglecting a treatable or manageable medical condition, such as malaria or diabetes. The total number of deaths? Nobody knows.

Either all of the above therapies and treatments are controversial and should be stopped, or none of it is. I am fully supportive of the former, but those ‘open-minded’ people whose brains have fallen out, albeit delusional or criminal people, will obviously choose the latter and they will continue to make money out of the misfortunes of others. And with the current support of some universities, this problem will only get bigger.

Who is now really to blame for these tragic events? The role of Tasly Healthpac and the NICM.

No real doctor or scientist or any decent person with ethics and morals would allow a slapping therapist to give a workshop on their premises. Especially not to children suffering from serious medical conditions. What you should do, especially if you are an evidence-based healthcare practitioner, is to explain to this person that what he does is dangerous and that he should please stop doing it. And then you report him to the police. But this did not happen. So, the workshop was held at the ‘Tasly Healthpac Centre of Excellence in Integrative Medicine’. According to a Tasly spokesperson, the slapping therapist “Mr Xiao rented a room from our centre to conduct what was described to us as a series of health seminars. The boy and his mother were participants in the seminar.” Apparently, they did not know about the slapping therapy, but is this true?

It is telling that Tasly have deleted their website or they have changed their name to Medicentral, where they continue to provide TCM and acupuncture alongside conventional treatments. No information can be found on their new website regarding the workshop, but from the internet archives, it is clear that they themselves advertised this workshop. Their old website received up to 538 daily visitors, and hence their marketing efforts via their website reached many people in Australia (I would not be surprised if the parents of the deceased became aware of this workshop via Tasly’s website). On Master Xiao’s website he also states that his workshop was co-organised by an Australian medical institution. Therefore, Tasly’s statement is false. Slapping, acupuncture, herbal TCM – it is all the same thing, and that is why they allowed this workshop to be held on their premises.

A key person at Tasly is the founder, Dr Ven Tan, who started the practice more than 20 years ago and ‘through his own practice he has come to realise the limitations of conventional Western medicine and to worship the merit of Traditional Chinese Medicine’. Having a well-established practice and making statements such as above will draw the attention of pseudoscientists at some Australian Universities. WSU in Sydney (and they are by no means the only Australian university who have decided to put money before science and ethics) used public money to convert TCM practitioners into ‘Professors’ and hence, it is to be expected that they will seek funding from, or collaborate with Tasly in exchange for providing extra credibility and legitimacy for Tasly’s pseudoscientific services. ‘Integrating’ TCM with conventional therapies, with the involvement of WSU, creates trust and a sense of security in patients that all of the provided services at Tasly’s are underpinned by science, and thus more and more people will be misled.

Here (second photo on the left) is the signing of a Memorandum of Understanding between the Chinese and Australian governments ‘aimed at promoting TCM in Australia through a collaborative initiative’ witnessed by Dr Ven Tan (Tasly) and Prof Alan Bensoussan (NICM at WSU). Another MoU was signed between Tasly and the NICM in 2011 which states that the NICM will provide “Assistance in the development of an Integrative Care Model: to assist the Tasly Healthpac Centre of Excellence in Integrative medicine so that its structure aims to integrate TCM and western medical diagnostics and treatments in an integrated, patient centred way.” The result of doing just that, speaks tragically for itself.

It is well known that the Chinese government wants to internationalise TCM, it is, after all, a $170 billion industry. An excellent article about this issue, a real eye-opener, was recently published in the Economist “State-funded Quackery. China is ramping up its promotion of its ancient medical arts. That is dangerous for humans as well as rhinos.” The NICM has played a crucial role in the national registration of TCM practitioners in 2012, which elevated TCM to the same level as conventional healthcare, lending undue credibility to TCM. This extra legitimacy was used by the NICM to facilitate China’s plans for internationalisation of TCM via Australia. They lobbied various Ministers and managed to get TCM into the Australia-China Free Trade Agreement in 2015, shortly after the boy’s death from slapping. In 2016 a trade delegation of the Minister of Health (Jillian Skinner – now retired) visited China, accompanied by Dr Ven Tan and Prof Alan Bensoussan. Part of the mission was “To assist the University of Western Sydney’s National Institute of Complementary Medicine (NICM) secure investor and donor support for the NICM’s integrative Chinese medicine facility medicine/treatment on the Westmead Campus“.

Yes, they are building a large integrative TCM facility in Sydney, which will open in 2018. They will obviously sell this as a ‘research’ facility, but in truth, it will be operated like a commercial facility. All of this is good news for China, Tasly and the NICM, but it is definitely not good news for the Australian public.

Tasly and NICM should therefore also be held responsible for these tragic events.

The role of the regulator, the TGA, and the NICM’s influence

In Australia, this very important function to protect the public against the sort of quackery described above, is being done by the Therapeutic Goods Administration (TGA). Pseudoscientists also know that the TGA is a potential key hurdle that must be overcome. They therefore lobby intensely, and some infiltrate the TGA (Alan Bensoussan has served many years on the TGA panel for complementary medicines), where they actually managed to get the job done. Even though the golden rule is that you really do not need to be a pseudoscientist in order to know what pseudoscience is, or to adequately regulate it. And yet, there are a number of TCM practitioners currently involved with regulating TCM at the TGA.

The NICM, and others, have managed to convince the TGA that almost all of these products and services are ‘low risk’, meaning low direct risk. Unfortunately, the high indirect risk is being ignored. You are probably not going to die after being slapped, but if you stop taking your real medicine it can lead to your death (the possible cause of the boy’s death). And this is exactly what this slapping therapist says. Medicine is poison so let’s slap your medical condition out of you.  What is my evidence for the bold statement regarding the TGA? They recently published their draft list of ‘permitted indications’, or the ‘medical’ claim that manufacturers can make for their products. Included in this list is 140 TCM indications. For example: “Harmonise middle burner (Spleen and Stomach)”, “Unblock/open/relax meridians”, “Balance Yin and Yang”. When a regulator allows pseudoscientists a foot in the door, then the above is the only logical outcome and now the TGA accepts the notion that meridians, chi, Yin and Yang etc. is real. And here again, the NICM is assisting Chinese companies to help them get past the TGA bureaucracy in order for them to register and sell their products in Australia. Having a partner such as the NICM in Australia, obviously makes a lot of Chinese companies very happy. Shouldn’t the TGA also be blamed when people get hurt after using these pseudoscientific healthcare treatments?

In a nutshell. The bereaved parents of the deceased are in trouble, while the slapping therapist is in jail where he will hopefully stay for a long time. But what about Tasly’s which promoted and hosted this workshop as part of their integrative medicine approach, or the NICM who collaborated with this clinic and facilitated their ‘integrative’ approach and who promoted TCM for decades and probably have misled thousands of people over the years, or the regulators who have opened their doors for pseudoscientists and who are continuing to allow this to happen? (I’ve actually volunteered my services to the TGA, but they were not interested.) Not even to speak about the politicians who could actually do something about this, but apparently have little interest to go in against the zhi (will) of the industry.

I can only hope that the courts will also look at the other players in this scenario who are partly responsible for this boy’s death, because it is time that the underlying problems be addressed, otherwise more and more people, including children, will get hurt.

What can you do about all of this?

Unfortunately, if you fall for their trickery and you get hurt, then you will be all alone. The bureaucracy involved is extremely complex so the best thing to do is prevention. Stop buying complementary, alternative, traditional or integrative ‘medicines’ and stop  using their ‘treatments’. Inform yourself and your family and friends about how these people play their game and what the dangers are, regarding these ‘treatments’. ‘Friends of Science in Medicine’ provides valuable healthcare information as well as the website of Prof Edzard Ernst, where he discusses everything complementary medicine (what works and what doesn’t). If you are interested in receiving automatic updates regarding the NICM and how they continue to promote these ‘medicines’ and ‘treatments’, you can always follow my Blog,  Twitter or connect on LinkedIn. Will keep you posted regarding the outcome of the 2017 Bent Spoon Awards, for which the NICM has again been nominated. Please, ‘Like’ and share this article via FaceBook etc. – options below.

Stopping your support of these products and services, by informing yourself and by creating awareness about these issues, are pretty much the only things you can do in order to prevent these needless deaths. It is just such a pity that the VC’s, regulators and politicians (all funded by the taxpayer!) don’t have much interest in this, or just can’t seem to get the job done because of vested interests.  I’ll end with the wise, but somewhat empty, words of Prof Barney Glover (VC of WSU) “universities must stand up for facts and the truth – if we don’t, who will!” – Clearly Prof. Glover will not stand up for the truth, hopefully, the public will!

The NICMs undeclared conflicts of interest! The response from a journal editor.

The NICMs undeclared conflicts of interest! The response from a journal editor.

“We understand conflict of interest concerns, but this is why we have strict guidelines and ethics committees …..” – Prof Alan Bensoussan, director of the National Institute of Complementary Medicine (NICM), Western Sydney University (WSU). All academics, including Alan, are fully aware of the importance of research integrity, in which, potential or perceived conflicts of interests play an integral part. As such, WSU does indeed have many rules and regulations to safeguard research integrity in order to ensure that one thing remains intact – summed up in one word: trust.

These guidelines should ensure that the trust between taxpayer and scientist (or the scientific system) remains undamaged, because once it is broken or damaged it can have very serious consequences. We can notice all around us that the trust in the scientific system has been eroded over time. Just look at the number of people who do not ‘believe’ in vaccinations or climate change, then clearly, many people have grown a very healthy distrust in scientists and in the scientific system. It is therefore extremely important that universities act swiftly and decisively when a scientist endangers this trust, because the public does not necessarily look at the specific field of science where a transgression has occurred, they tend to distrust the whole academic system – and remember they keep the system afloat, financially.

So, what is this all about? About a year ago I noticed that in a large number of published peer-reviewed acupuncture papers, authored by the NICM, they failed to declare a conflict of interest. This was quite interesting because they clearly had, and probably still have, a glaring conflict of interest. For example; both Alan Bensoussan and Caroline Smith is (was) listed as consultants, for many years, of commercial acupuncture clinics (they deleted this information as soon as they became aware that I am investigating this issue – you can find an archived page here), the director of these clinics is part of the advisory board of the NICM, students of the NICM find employment at these clinics, the NICM is actively doing research where a positive outcome will clearly benefit these clinics, and the clinics have donated $20 000 to the NICM for the “IVF project” – clearly something that needed to be declared.  You can find more details about this very obvious conflict of interest here and here. But what is this IVF project? An independent journalist called it “Universities in a wacky waste of cash” whilst the NICM called it “Acupuncture to Improve Live Birth Rates for Women Undergoing IVF”, approved by a WSU ethics committee and funded to the tune of $600 000.

This is what an IVF expert had to say about this project: “IVF expert Professor Colin Matthews was outraged the National Health and Medical Research Council had allocated more than $600,000 for a study into acupuncture’s effect on IVF.” The WSU ethics committee that approved this study is fully aware that acupuncture has been shown to be nothing more than a placebo and that it is based on fake scientific principles – hence it is called a pseudoscience. This is now a problem because not only have they abandoned science but they also, seemingly, abandoned their ‘strict guidelines’ to ensure scientific integrity.

But let’s argue that the ethics committee simply did not know about this. Surely, when they are notified about this they will certainly take action to ensure that the trust between the public and academics do not further erode? So, I notified the WSU ethics committee, the advisors to the ethics committee and a number of other people at WSU regarding this issue over a number of months. And now I can reveal their response, and I will quote them; “………………………………..”. Nothing, they did not even acknowledge that they have received this information. After six months, it might be safe to assume that WSU do not plan to do anything about this issue. But then again, I am not at all surprised, as science adheres to the laws of nature (chemistry, physics, biology, etc.), pseudosciences are above those laws. Scientists are held accountable by enforcing these strict guidelines to ensure scientific integrity, sadly, these guidelines do not seem to apply to a pseudoscientist – they are just above it!

Let me try to put all of this into perspective. Most people do not consider infertility to be a life threatening medical condition.  It does, however, have a severe impact on a person’s life, causing broken relationships, severe depression and in extreme cases, even suicide. The more treatment methods a person tries in order to conceive without a positive outcome, the more prone a person is to fall into severe depression (maybe it should be considered as a life threatening condition?). And this is where a pseudoscientist strike, they feed off desperation. If a researcher knows that the method that they recommend is only a placebo, then the project is unethical by default, and it should never have been approved. And oh boy, don’t they know this. There is a reason why they want to ‘integrate’ acupuncture with IVF (which has a success rate of around 45% at 35 years of age or younger, and around 5% when 42 or older), because they know acupuncture is nothing more than a theatrical placebo, and therefore they need to piggy back on something that actually works. If acupuncture worked that well, why don’t they use it as a standalone treatment option? Why did they start these commercial clinics in 2008 and only in 2013 are they doing a ‘scientific’ study to test if it is actually effective or not – wrong way round, maybe?  And if the study turns out to be negative, will they close their clinics? For some reason, I don’t think so!

Having said that, I do not expect to receive any response from WSU. In a previous article I have written about the dishonest type of people that you need at the NICM, this article illustrates that the WSU management themselves are not much better – they are just as dishonest. Hence, the Vice Chancellor, Prof Barney Glover, who is aware of this and many other issues at the NICM, was also nominated for the Bent Spoon award in 2016. Oh, and did they try to squash this nomination, but to no avail – you can read about their hilarious attempts here. But, maybe it is a good idea if a couple of readers can email the ethics committee at WSU, just to ask what is going on with this issue. This might even prompt them to respond (email Steve Hannan at  s.hannan@westernsydney.edu.au).

This brings me to their scientific publications. Journals are usually independent of universities, and as such, they might be able to perform the important job of being the ‘gatekeepers’ of scientific integrity. I have contacted the editors of four scientific journals regarding only five of the NICMs scientific publications, where they intentionally did not declare their obvious conflicts of interest. Here I will discuss the response that I got from one editor (I’ll report separately on the response from the other editors, and the other organisations investigating this issue).

Here is my original message to the editor of the ‘European Journal of Integrative Medicine’:

“Dear Prof. Robinson

 I am contacting you in regard to a recently published article in a special issue in the European Journal of Integrative Medicine of which you are the Editor, “Participation in a randomised controlled trial of acupuncture as an adjunct to in vitro fertilisation: the views of study patients and acupuncturists. Kylie Barr, Caroline A. Smith, Sheryl L. de Lacey. 8 (2016) 48–54”

The authors state under Conflicts of Interest that “There are no known conflicts of interest and no competing financial relationships exist”

 Senior author Caroline A. Smith is a Consultant for a chain of acupuncture fertility clinics in Australia who in turn has donated a substantial amount of money to her research group. The information regarding her consultant capacity for these acupuncture clinics has since been removed from their website but can still be found on the internet archive which you can access here. The reason for this removal appears to be based on an article that I’ve written regarding this matter.

This is not an isolated case, with four articles published in 2016 on acupuncture and fertility related issues where their conflict of interest is intentionally omitted. The editors of the other journals have also been contacted.

 I hereby request that this matter be investigated.

Thank you in advance.”

And here is her response dated 17/01/2017:

“Dear Dr Van der Kooy

I have contacted my Elsevier publisher and she is investigating as you requested and will get back to you in due course.

Regards

Prof Nicola Robinson”

This was unfortunately also the only response that I received from this editor and needless to say, nobody from Elsevier contacted me. As this is now more than 6 months ago, with all my subsequent follow-up emails being ignored, I believe it is safe to assume that this editor never intended to do anything about this issue. So, I had a look at this editor and it turns out that Prof Robinson happens to be an acupuncturist and that she has co-published with the research group in question – and the title of the research paper? “Does acupuncture improve the outcome of in vitro fertilization? Guidance for future trials”. So, she knows the people at the NICM quite well, she know the project quite well, and hence she is also aware that pseudoscience does not abide by the laws of nature nor does pseudoscientists abide by the laws that should ensure scientific integrity. They just need to remain quiet and ignore any complaints, and hopefully everything will blow over and they can happily continue to mislead the public. So, in this case, don’t expect anything from this ‘gatekeeper’ of science – she apparently has way too many vested interests.

In a next article, I will report on the feedback from the other editors, the NICMs attempts to mislead one editor and a couple of corrections to their ‘scientific’ publications that they have been forced to publish.

‘Take control of your health’, and we’ll take control of your wallet!

‘Take control of your health’, and we’ll take control of your wallet!

“Take charge of your health by being an informed consumer” or “….empowering patients to take control of their health and wellbeing” etc.

These are very common statements made by proponents of complementary, alternative and integrative medicine (CAIM), and it conveys a very clear message; you should take control of your health! But the question is; what do they really want to achieve with this message? If we look at this superficially, we might think that they refer to a healthy diet, physical exercise and other positive lifestyle changes, but then again, any medical doctor will give you this advice as well.  One might think that being an ‘informed’ consumer is clearly good advice, but then again, why do they continue to provide the public with misleading and false information regarding their CAIM products and therapies? So, it cannot be this either. So, what is it that these people really want to achieve with statements like this?

Well it’s simple, they want more people to buy their disproven and unproven products, and hence they aim to manipulate us, with using statements like this, in doing just that. One of their techniques is what I call, a soup kitchen approach, where they provide some good information for free, in order to lure us into their web of deceit. Because they do not make much money with their ‘good advice’ (e.g. lifestyle changes), they are thus hoping that we will also fall for their false and misleading information regarding the benefits and safety of a huge range of products, that they happen to sell.  To give you a rough idea of the sheer number of ‘products/services’ in their arsenal, please have a look at this table.

So, allow me to translate what they actually want to achieve with their ‘take control’ statement. There are two important aspects; creating distrust in conventional healthcare, and masterfully exploit a very common innate cognitive bias that we all suffer from, in order to increase their sales.

Let’s first look at creating distrust in conventional healthcare. With this message, they are implying that our health is currently in the hands of someone else, and that we should now take it back – it is our right. This is quite misleading. Lifestyle choices is indeed in our hands, but even people with the healthiest lifestyles, still get sick. And when you do get sick, you should go to a qualified medical doctor, get a proper diagnosis and a conventional medicine prescription – if needed (most people do not have the medical knowledge to do this themselves). In this conventional approach, we do not have much control and we put our trust in the hands of trained professionals.  According to the CAIM proponents this is not a good system because you need to be in full control.

So, with their ‘take control’ message they are actually creating distrust in conventional healthcare  with some even going as far as stating that very little of conventional healthcare has been proven to work, or that medicine just treats the symptoms and not the cause, or medicine doesn’t work at all, it is just toxic etc. Clearly, the real message here is that we should not really trust our doctor or conventional medicine, but we should trust ourselves and we should make our own healthcare decisions. The CAIM proponents only provide the ‘options’ that we can choose from, but unfortunately, they are notorious for making false and misleading claims about these ‘options’. And don’t they provide a massive range of products to choose from (and importantly, many pharmacies also benefit from this situation). In Australia, you have a choice of roughly 20 000 CAIM products. In South Africa, it is estimated that there are more than 155 000 products, and I have been informed that none of these products have had their quality, efficacy or safety verified!  But who cares, they want you to trust yourself and to decide which of these products will work for you.

The second aspect is exploiting an innate cognitive bias that we all struggle with. All of us are continuously performing risk-benefit analysis, usually, without us even knowing it.  Everything we do; getting out of bed, driving to work, going for a walk in the park etc. carries a risk and hence we will continuously perform a risk-benefit analysis. The CAIM proponents are skilfully exploiting the fact that we sometimes struggle to get this right, and in some cases, we just get it completely wrong. For example: we are far more likely (up to a thousand times) to downplay or ignore a risk if we perceive to be in control of a situation. A good example: we are far more likely to get into a car (we are in control) than getting into a plane (a trained professional is in control), even though the former is much riskier than the latter. Using false and misleading claims for their products and making their ‘take control’ statements, we are hoodwinked into perceiving that we can be in full control of our health, and hence we are far more likely to ignore the (in)direct risks associated with CAIM products.  And this is where they are really making a killing with their ‘take control’ message. Add to this the distrust that they are creating in trained professionals and conventional medicine, then it is no wonder that more and more people are consulting Dr Google and buying OTC CAIM products.

The CAIM proponents are quite happy with this situation because they can now use the explosive growth in sales figures as ‘evidence’ that their products work – the typical appeal to popularity fallacy (another weapon in their arsenal). So, what is the take home message? With their statement, they are trying to take healthcare out of the hands of professionals and they want to place it in your hands (and you don’t have the medical knowledge), knowing fully well that in such a situation we are much more prone to take a risk by dipping our toes into their disproven and unproven CAIM therapies and products – it is all about money!

But is there anything we can do about this? We are irrational beings, so trying to change or influence human nature is highly unlikely to succeed. The only thing we can do, is to continue to expose how the CAIM industry misleads the public, and hopefully, one day, politicians and regulators will start to impose very tight restrictions on this industry, which frankly speaking, should not have existed in the first place.