Bowen Therapy and the ASA

I have, for a little while, been taking a careful look at the claims made for a decidedly second-division CAM called variously ‘Bowen Therapy’, ‘Bowen Technique’ or ‘Bowenwork’.  It involves a potentially relaxing, gentle manipulation of soft tissue using fingers and thumbs; moving them over muscle, ligament, tendon and fascia.

Aside from the potential benefits of a sympathetic consultation, the psychological impact of physical contact with someone who wants to help you and simple relaxation, it would appear to have little to offer.

It’s certainly not at all a plausible treatment for serious conditions like asthma.

I had a look at the research literature a little while ago, and it provides decidedly slim pickings.  As far as I could tell the sum total of the published evidence for Bowen listed in PubMed amounts to:

• one or is it two (?) small uncontrolled trials for frozen shoulder from a single author (Carter 2001, 2002),
• an uncontrolled intervention to try and reduce staff absence (Dicker, 2005a),
• a small uncontrolled study on a range of issues with strong psychological components (Dicker, 2005b),
• an RCT^* showing improved hamstring flexibility in people with no hamstring problems (Marr et al 2011) and
• a tiny case series that doesn’t show that Bowen technique helps stroke rehabilitation (Duncan et al, 2011).

The Guardian and Dr Kase’s magic tape

Apparently, around 30 years ago a chiropractor called ‘Dr’ Kenzo Kase invented a ‘magic tape’ that can work all sorts of wonders on muscles and joints.  Rather than being a stiff, supportive, structure, it allegedly mimics the flexibility of skin.

Today, the science section of the guardian provided an extended advertorial for this product under the heading, “Dr Kenzo Kase: My magic tape can aid injured muscles.” (frozen page, change log)

It’s in the usually reliable science section of the Guardian, so I would hope that there is some pretty strong evidence to support the use of the word ‘magic’.

So, I thought that I would share the results of five minutes ‘googling’ and a bit of thought.  The sort of thing I’d expect from a proper professional journalist.  It’s not a happy story.

Any evidence cited?

Bowen Therapy – all fingers and thumbs

I stumbled across Bowen Therapy (aka Bowen Technique, Bowen Work) a few years ago when the other half decided to give it a try.  She found it relaxing and felt it provided a little immediate relief that was soon gone.  Essentially, it was worthless as a treatment for what was ailing her.

This therapy was invented by an Australian called Thomas Ambrose Bowen (1916 – 1982).  Apparently, he referred to himself as an osteopath before the title became regulated in the 1970s.  The therapy that now bears his name involves the gentle manipulation of soft tissue using fingers and thumbs; moving them over muscle, ligament, tendon and fascia.

It’s a fairly common, but definitely second division, complementary therapy.  In the UK, Bowen Therapists can register with the pointless Complementary and Natural Healthcare Council (CNHC).

After our experience of Bowen Technique, I decided to try and see what evidence is available for the effectiveness of this therapy.  I also decided that it was time to see what claims are being made for it.

A bare cupboard

After having a good look, I don’t think that there is really nothing resembling evidence to support the use of Bowen Therapy for anything.  A careful search of PubMed, The Cochrane Database and Google Scholar identified just six relevant references.

The King’s New Medicine: on the soporific effect of homeopathy

This is the story of the King’s new clothes.

Now there was once a king who was absolutely insane about

new clothes and one day, two swindlers came to sell him what

they said was a magic suit of clothes. Now, they held up this

particular garment and they said, “Your Majesty, this is a magic suit.”

Well, the truth of the matter is, there was no suit there at all.

But the swindlers were very smart, and they said,

“Your Majesty, to a wise man this is a beautiful raiment

but to a fool it is absolutely invisible.”

THE KING’S NEW CLOTHES, From the film “Hans Christian Andersen” (1952)

 It’s Homeopathy Awareness Week (HAW) again in the UK from the 14^th to 21^st June.  This is an annual publicity campaign run by homeopathy organizations and a potion maker.  It’s an attempt to convince potential customers that homeopathy is useful for something significant.  The two main problems are: there is no real evidence that homeopathy can help with any specific health issue, and they are peddling magic pills that typically contain no medicine.

This event always gives me a strong sense of déjà vu: after failing to produce any proper evidence for being able to help with women’s health (2010) and hay fever (2009), this year it’s sleeplessness (insomnia).

The campaign’s website, ‘heal through homeopathy’, highlights the undoubted importance of the topic by claiming that, “… sleeplessness … affects an estimated 77% of people in GB.”  However, according to a National Health Service (NHS) publication, “Sleeplessness – A Self Help Guide” the figure is around 30%.  Perhaps the homeopaths are overstating the problem?

A summary of a recent YouGov poll^* put it this way:

“The majority of the British public need between six and nine hours’ sleep a night to feel fully rested, according to a recent survey. 43% claim they need 6-7 hours and another 33% of the population stated they require 8-9 hours to feel fresh the following day. This appears to be consistent with the hours of sleep the public normally get with a huge 79% claiming they get between 6-9 hours each night. However, almost one in five respondents (18%) state that they get a just a maximum of five hours of sleep a night and just seven percent claim that they feel fully rested with this amount.”

This seems to suggest that a smaller percentage of the population feel they are not getting enough sleep than the homeopaths are suggesting.

Measles, vaccination and homeopaths

Measles is in the news again.  Just to provide a little context, the graph above shows the number of confirmed measles cases in England and Wales since 1996^*. The impact of insufficient vaccine coverage is easy to see. This year is looking like being a good year for measles; not so good for vulnerable members of the community. According to the BBC, “The Health Protection Agency [HPA] reported 334 cases compared with 33 in the similar period last year.”  In fact, this is rapidly approaching the total of 374 cases reported for the whole of 2010.  It seems that this is related to “an epidemic in France, where 7,000 cases have been reported since January – more than in the whole of 2010.”

The HPA are advising “Whether you stay here in the UK or travel abroad, it is crucial that individuals who may be at risk are fully immunised.” Although the coverage with the MMR vaccine is improving in the UK, it is “still far from the 95% uptake rate needed to stop the spread of the disease in the community.”^** One reason for this is the damage done by the media^*** uncritically promoting the views of the disgraced Andrew Wakefield^† and other vaccine scaremongers.

Measles and MMR: the risks

It’s easy to forget just how dangerous measles is.  Those of us who grew up in times where it was more common may tend to look back on measles as an inconvenient rite of passage.  Generally, this is because we may not have had direct personal experience of the serious consequences that can arise from a measles infection.  In the years since, vaccination brought diseases like measles under control and people have, thankfully, become even less familiar with the dangers.

Quantumwave laser quackery

I’ve wanted to revisit the world of low level laser therapy (LLLT) for a while.^*.  Back in early 2009 I gave this therapy a look, after I came across the story of a woman in New Zealand who died from breast cancer after being ‘treated’ with a decidedly quackish variant of LLLT, called “Bioptron’.

I’ve been wondering if I missed anything when I was focusing on Bioptron and whether any more evidence has come to light since.

The Quantumwave Laser website^** has given me the push I needed.  The website was fantasy physics meets fantasy medicine; though it looks like some excellent ‘FishBarreling’ has taken care of most of the medical claims.

Still, there’s plenty of made up physics left to enjoy, along with the excuse to look at low level laser therapy again.

First, what is low level laser therapy?

Low level laser therapy refers to the therapeutic use of lasers, generally applied externally to the skin, delivering low doses of energy in an attempt to treat various conditions.

There are various hypotheses for how LLLT might work, but any mechanism of action remains unclear.

Typically, lasers are chosen that operate in the red to near infrared part of the electromagnetic spectrum, though there are exceptions as we shall see. Because the lasers are low-powered the therapy is sometimes called “soft” or “cold” lasers.

Red light redux

Three years ago I investigated claims that were being made for a red-light phototherapy device, marketed as a hay fever treatment by Lloydspharmacy.  The claims were based on a single, small, un-replicated trial with blinding problems (Neuman and Finkelstein, 1997).  Given that this is the hay fever season, I thought I’d revisit the topic and see if things have changed much.

The only new investigation of red-light devices phototherapy treatment for hay fever I am aware of was published in 2009.  Emberlin and Lewis (2009) reported “a double-blind, placebo-controlled grass pollen challenge conducted out of the pollen season, on 101 adult male and female hay fever sufferers. Subjects were assigned to placebo or active groups by stratified random sampling using responses to a baseline questionnaire. All subjects used active or placebo devices three times a day for 14 days before pollen challenge. Subjects were monitored for 2.5 h after challenge.”

On the positive side, the authors found:

“Significant reductions in severity of symptom scores were found for sneezing, running nose, running eyes and itchy mouth/palate (p < or = 0.05).”

But, on the other hand:

“No significant differences were found in the results for itchy eyes, itchy nose, itchy throat, ECPs, PIFn and PEFn.”

The authors concluded:

“The results show that the device significantly reduced some hay fever symptoms. The study would have been improved if compliance was monitored electronically and if nasal congestion was monitored by report. The mode of action is unclear. The study does not consider long-term implications of the therapy.”

In December 2009 the ASA considered whether this study was sufficient to support the claims that Lloydspharmacy had made in a TV commercial.  (You can read the adjudication here.)  The decision went against them.  The ASA’s expert found a number of problems with using this study to support Lloydspharmacy’s claims:

Fantasy physics and energy medicine

I’ve heard it said that, unlike the medical world, there is no such beast as alternative physics.  Whilst it’s true that made up^* nonsense hasn’t penetrated physics education and practice in the same way as it has medicine, there is no shortage of people indulging in fantasy physics.  Perpetual-motion dreamers are prone to do this, as are advocates of so-called ‘energy medicine’.  In the case of the former, they are looking for excuses to support their claims for so-called ‘over-unity’ devices that are claimed to produce more energy than they consume.  The latter are looking for ‘explanations’ for how homeopathy, reiki etc. ‘work’.  Of course, neither of these communities actually have meaningful effects that require explanation.  This is about having some superficially ‘sciency’ prose to sell their wares, or reassure their devotees.

I’ve recently been pointed^** at a cracking example of ‘energy medicine’ advocates indulging in some fantasy physics.  It’s hosted on the PositiveHealthOnline website and is called, Spirals and Energy in Nature, attributed to Robert McCoy.   It’s worth a look as an exemplar of the desperate nonsense that elements of the ‘energy medicine’ community dabble in.  It’s so rich a vein of fantasy physics that I’m sure that I’ll end up overlooking some howlers.  If I do, please feel free to point them out in the comments.

From Academic to Quackademic

First, I’d like to start by looking at one of the key authorities cited in the article, one Dr Valerie Hunt.  She retired as Professor of Physiology at UCLA in 1980; to quote her web biography:

Editing reality

I really hope that this is the last post I write about the homeoprophylaxis campaign against Leptospirosis in Cuba during 2007 – 2008 (Bracho et al, 2010).  Deep down I know that this uncontrolled, un-randomised poorly-reported trial published in a terrible pseudojournal, dealing with a highly variable disease which is amenable to personal protective measures, a real vaccine and antibiotic treatment is going to get thrown at me again and again.

Homeopathic propagandists will not worry that real medicines were also used in the treatment region, a media campaign raised awareness of the disease and the homeopaths intervened at the peak of a multi-year problem.  Neither will it bother them that the net outcome was a return to the same infection rate as the rest of Cuba or the Intervention Region in 2004, or that the paper was rejected by proper journals.

However, before I move on I think that the accompanying guest editorial by Roniger and Jacobs (2010) deserves some additional scrutiny. It’s entitled, “Prophylaxis against Leptospirosis using a nosode: Can this large cohort study serve as a model for future replications?”

Here Is the News

These days scientific papers are often accompanied by a press release.  It gives the journal or institution at which the work was done a chance to highlight what they think the main message from the work is.  Some might even see it as applying some PR spin.  The recent paper on a trial of homeopathy on a Leptospirosis outbreak in Cuba (Bracho et al, 2010) has its own accompanying press release.  It’s from the Faculty of Homeopathy, the representative body for the UK’s medically qualified homeopaths, whose stated aim is to promote, “… the academic and scientific development of homeopathy. It ensures the highest standards in the education, training and practice of homeopathy”.

It’s instructive to see what message the UK medical homeopath’s representative body is trying to get into the minds of press and public.

First it’s no surprise that they welcome this apparently successful trial with open arms.  Homeopathy, is the journal of The Faculty of Homeopathy.  The paper appears to confirm the view of The Faculty and provide some justification for its work.  So what message do they want people to take away from this publication?  Is it an accurate reflection of the work?  Let’s have a look and see: