Category Archives: Alternative Medicine

9/19/2020

I previously discussed an article from March 2020 by Drs. Eran Bendavid and Jay Bhattacharya titled Is the Coronavirus as Deadly as They Say? In this article, they wrote that,

If its true that the novel coronavirus would kill millions without shelter-in-place orders and quarantines, then the extraordinary measures being carried out in cities and states around the country are surely justified.

While Dr. Bhattacharya later tried to pretend these words dont mean exactly what they mean, he is not the sole author of the Great Barrington Declaration who has said things about these extraordinary measures that I agree with. On 9/19/2020, Dr. Martin Kulldorff said the following:

This seems eminently reasonable. For much of the pandemic, South Korea and New Zealand kept their COVID cases low through lockdowns to buy time for a vaccine.

On 10/4/2020 the The Great Barrington Declaration was published. It said,

Current lockdown policies are producing devastating effects on short and long-term public health. The results (to name a few) include lower childhood vaccination rates, worsening cardiovascular disease outcomes, fewer cancer screenings and deteriorating mental health leading to greater excess mortality in years to come, with the working class and younger members of society carrying the heaviest burden. Keeping students out of school is a grave injustice.

Keeping these measures in place until a vaccine is available will cause irreparable damage, with the underprivileged disproportionately harmed.

The Great Barrington Declaration said that those who are at minimal risk of death should live their lives normally to build up immunity to the virus through natural infection. Even though Dr. Kulldorff recognized that vaccines might be several months away, he wanted those at minimal risk to contract COVID before they were vaccinated. It falsely claimed that For children, the COVID-19 mortality riskis less than for theannual influenza, and said that,

We have seen only a handful of reinfections. If the virus is like other corona viruses in its immune response, recovery from infection will provide lasting protection against reinfection, either complete immunity or protection that makes a severe reinfection less likely.

Happily, Dr. Kulldorffs most optimistic projection about vaccines was spot on. Though the authors of the Great Barrington Declaration feared that Keeping these measures in place until a vaccine is available will cause irreparable damage, just two months later, something amazing happened. On 12/8/2020, 90-year-old Margaret Keenan stepped into history as the first person to receive a COVID vaccine outside of a clinical trial, and over the next several months, hundreds of millions of people were vaccinated in the fortunate parts of the world. The vaccines have since proven extremely effective at keeping people alive and out of the hospital.

Keep all this in mind when answering the question at the end of this article.

The tweet that opened this essay is one example amongst many where Dr. Kulldorff acknowledged that lockdowns drastically slowed the spread of the virus. Hes repeatedly said that lockdowns postponed the inevitable,and in January 2022, he acknowledged that many people had been able to avoid the virus for nearly two years, writing the laptop class is now getting infected with Covid. Dr. Kulldorff and I fully agree that interventions such as lockdowns helped postpone SARS-CoV-2 infections for millions of people until after vaccines were available and medical care improved. We just disagree on whether or not this was a bad thing.

While limiting COVID cases seemed to be an unambiguously good thing in the fall of 2020, when the population had negligible immunity and vaccines were plausibly just around the corner, the authors of the Great Barrington Declaration argued otherwise. Normal people feel the darkest days of the pandemic were immediately after vaccinations started in the winter of 2021, when 3,000 people were dying of COVID every day. However, proponents of infecting unvaccinated, young people reserve their outrage for the pandemics first months, when lockdowns prevented the virus from spreading. They wish more people had contracted the virus in 2020, and their pro-virus stance influenced politicians in many countries. For example, one headline from December 2020 declared,

We want them infected, Trump HHS Appointee Said in Email Pushing to Expose Infants, Kids and Teens to Covid to Reach Herd Immunity.

Though Dr. Kulldorff admits lockdowns helped postpone infections until vaccines were available, he views this a strike against them. Why is this?

Were he to admit that lockdowns were beneficial for this reason, hed be conceding that the arrival of vaccines in December 2020 rendered the Great Barrington Declaration utterly obsolete, which of course, they did. Vaccines meant that those who had avoided the virus thus far had a very attractive alternative to natural immunity. In order to maintain the illusion that his plan had any relevance in a post-vaccine world, Dr. Kulldorff has been forced to disparage vaccines, lockdowns, and all other measures that limit the spread of the virus. He even had the audacity to complain on 12/19/2020thatSpring #COVID19 #lockdowns simply delayed and postponed the pandemic to the fall. The very week that vaccinations began in the US, and as the deadliest part of the pandemic was starting, he argued that it was a mistake that hundreds of millions of people had postponed their infection. Think about how ridiculous that is.

As lockdowns interfered with his plan to infect unvaccinated, young people, Dr. Kulldorff now blames them for all sorts or maladies and issues unsubtle threats to decapitate those whom he deems responsible. He preposterously anointed himself as a spokesman for marginalized people and uses histrionic language to claim they continue to be harmed by lockdowns of varying stringency, that lasted several months, and ended nearly two years ago. For example, he wrote about the devastating lockdown carnage on children, workers and the poor and said lockdowns were the worst assault on the working class since segregation and the Vietnam War. He even blames lockdowns for variants, tweeting that they Generate more contagious variants, increasing herd immunity threshold needed for endemic stage, so more people infected. This is, of course, absurd, especially considering that in the same tweet he lamented that lockdowns postpone infections.

Even though 10 million children around the world lost a parent or caregiver to COVID, and 4 million Americans may be out of work due to long COVID, Dr. Kulldorff feels the children, workers and the poor would have been better off if the virus spread more freely among them before they were vaccinated. Hell never acknowledge what the virus has done to the people for whom he imagines himself an advocate.

Vaccines also interfered with Dr. Kulldorffs plan of herd immunity through mass infection, and to avoid recognizing their benefits, he now debases himself by consorting with anti-vaccine loons and fear mongering about vaccines based on a flawed study that misrepresents trial data. He absurdly argues that unvaccinated children should contract COVID because the flu is more dangerous. This is completely false, though even if it were true, this is not a valid argument against vaccinating children. With other viruses, Dr. Kulldorff recognizes its unacceptable for any child to suffer or die for lack of a vaccine. Its only with COVID that he argues such suffering is tolerable because the old have a thousand-fold higher mortality risk than the young. This too is a ludicrous reason to let unvaccinated children suffer.

If vaccines put the Great Barrington Declarations relevance on life support, the emergence of highly contagious variants capable of reinfecting people struck the fatal blow. To evade this obvious reality, Dr. Kulldorff been forced to fetishize natural immunity, claiming that The pandemic ends when enough people have natural immunity after Covid recovery. With herd immunity, we then enter the endemic stage. Even after the arrival of variants with immune escape, hes continued to act as a cheerleader for the virus. However, with reinfections now commonplace, its clear now that the only people who deny natural immunity are those who still claim it is robust and permanent. Even people with natural immunity benefit from vaccination, though Dr. Kulldorff wont admit this either.

Because his real goal has always been to generate outrage about measures that limited natural immunity, Dr. Kulldorff never bothered to formulate a workable plan as for how societies might actuallyprotect the vulnerable. Even even though this was the central aim of the Great Barrington Declaration, its entire plan consisted of the following four sentences:

By way of example, nursing homes should use staff with acquired immunity and perform frequent testing of other staff and all visitors. Staff rotation should be minimized. Retired people living at home should have groceries and other essentials delivered to their home. When possible, they should meet family members outside rather than inside. A comprehensive and detailed list of measures, including approaches to multi-generational households, can be implemented, and is well within the scope and capability of public health professionals.

Beyond this, the Frequently Asked Questions section of the Great Barrington Declarations website contains a handful of bland suggestions, such as saying an older family member might temporarily be able to live with an older friend or sibling, with whom they can self-isolate together during the height of community transmission. However, such statements are mostly inactionable pablum that look great on paper, but in reality have the same sophistication as my childhood plan to end crime by locking up all the bad guys. As Noah Louis-Ferdinand, who actually worked in a senior center at the pandemics start, wrote in a must-read critique, There was never any evidence that these flawed interventions could maintain zero COVID in one place despite rampant spread in the community.

Despite the complete absence of any real plan to protect the vulnerable, Dr. Kulldorff incredibly claims that without lockdowns, herd immunity would have arrived in 3-6 months. Even though the Great Barrington Declaration was published after lockdowns had ended in many parts of the world and after it became clear that natural immunity didnt lead to permanent immunity, Dr. Kulldorff insists he was proven correct, and the pandemic would have been over a year ago had we only listened to him.

This too is nonsense, and Dr. Kulldorff never provides any evidence for these grandiose claims. Its was always just a fantasy that not vulnerable people could be easily identified and then completely walled off from vulnerable people until herd immunity was reached. The pandemic would not have been over in 3-6 months had we let the virus rip through unvaccinated, young people. Some places tried that. They were falsely told they had protected the vulnerable, when in fact the vulnerable had been purposefully left defenseless and exposed. One country that hoped to achieve herd immunity through pediatric infections was instead rewarded headlines that read, Children Drive Britains Longest-Running Covid Surge and Twice as Many People Died With Covid in UK This Summer Compared With 2021.

Of course its unambiguously good that measures to control the virus allowed countless millions of people to avoid it until after they were vaccinated and medical care had improved. A fully vaccinated person who contracts COVID today has much better odds of a good outcome than someone who contracted it in March of 2020. Although Dr. Kulldorff will never admit it, even children benefit from vaccination. Someone who contracts COVID in 2030 will be better off still. Its good to try to postpone the inevitable. Even Dr. Bhattacharya wisely chose to postpone the inevitable until August 2021 after he was vaccinated.

Perhaps my position reflects my experience working throughout the pandemic at Bellevue Hospital in New York City. I saw what the virus could do to unvaccinated people, even those deemed not vulnerable. While we all regret the toll the virus took on essential workers, like my co-workers, its good that measures were taken to shield everyone else. Its ridiculous to claim that essential workers would have been better off if only more hedge fund contracted COVID in 2020.

Had the laptop class been infected en masse then the catastrophe that befell us in New York City and elsewhere would have been much worse. No one had treated this virus before, hospitals were deluged as it was, and the morgues were literally overflowing with bodies. Giant refrigerated trucks were parked outside my hospital to store them all. The carnage was from the virus, not the lockdowns.

Dr. Kulldorff, himself an exemplar of the laptop class par excellance, witnessed this all from his living room, which is just where he should have been. We essential workers wanted everyone, even sheltered doctors like him, to avoid the virus. So hell have to take my word for it, but no one in the hospital at that time bemoaned the fact that lockdowns protected the laptop class. Ive still yet to hear anyone in my hospital make this complaint. Ironically, its only the laptop class that complains locksdowns prevented them from getting COVID before they were vaccinated.

Though Dr. Kulldorff disparages lockdowns by saying they merely postponed the inevitable, so do seat belts and smoking cessation programs. Beyond just not dying, there can be great value in postponing the inevitable. A core goal of medicine is to postpone the inevitable, and one analysis from May 2020 found that,

36,000 fewer people would have died if social distancing measures had been put in place across the U.S. just one week earlier.

Sadly, millions of people failed to take advantage of the gift of a few extra months before they contracted COVID. Doctors tricked them into believing they were not vulnerable and that getting the vaccine was therefore ill-advised. Some of these people turned out to be vulnerable after all, and many of them expressed regret about not getting vaccinated just before COVID killed them. Dr. Kulldorff treated exactly zero of these patients, some of whom reacted with outrage and violence towards healthcare workers who actually have real-world responsibility.

Comparisons between countries can be tricky. Countries with older, sicker populations will fare worse than countries with younger, healthier citizens. Cultural factors, such as the willingness to wear masks/get vaccinated, and the ability to stay home when sick matter tremendously. So do living arrangements, the availability of advanced healthcare, and the reliability of reporting metrics. The timing of lockdowns matters, and the word lockdown means different things in different countries. The lockdown in Florida was very different from the lockdown in China. Moreover, the pandemic is not over and its effects will take years to manifest and understand.

Nonetheless, enough time has elapsed that we can begin to get a sense of whether or not South Korea and New Zealand benefitted from their efforts to keep COVID cases low. Everyone agrees that South Korea and New Zealand acted aggressively to suppress COVID cases. Both countries had a negligible number of COVID cases the first two years of the pandemic, and Dr. Kulldorff has repeatedly acknowledged that lockdowns are the main reason why.

The numbers dont lie. South Korea and New Zealand couldnt keep the virus away forever, but, they suffered many fewer deaths per capita than the US and nearly every other country in the world. Over 800,000 Americans would be alive today if the US had their death rate.

Moreover, while no one pretends lockdowns were harmless, Im unaware of evidence that South Korea and New Zealand suffered irreparable damage from their COVID policies, at least compared to other countries. Students in all three countries (USA, South Korea, New Zealand) suffered from remote learning and school closures, which were often due to the virus, not overly-cautious politicians. Even Sweden had to close high schools for awhile. While its fashionable amongst the laptop class to blame lockdowns for everything bad that has happened since, neither South Korea nor New Zealand suffered enormous collateral damage on cancer, cardiovascular disease, diabetes, tuberculosis, mental health, education as far as I know.

So the real question is this: Did South Korea and New Zealand damage themselves by postponing the inevitable, or would the US have benefitted had it tried a bit harder to postpone the inevitable? You tell me.

Dr. Jonathan Howard is a neurologist and psychiatrist based in New York City who has been interested in vaccines since long before COVID-19.

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Lockdowns Postponed the Inevitable. Is That a Bad Thing? - Science Based Medicine

Insomnia is identified by difficulty in maintaining sleep and early morning awakenings [1]. Consequently, it further causes workplace absenteeism, accidents, and a declinein productivity which imparts tremendous societal and economic impact [2]. One-third of the general population encounter insomnia symptoms across their lifespan [3]. Insomnia should not be confused with sleep deprivation, the former being the inability to sleep adequately, either in length or quality[4]. Most studies suggested predominance rates of insomnia disorder from 5% to 15% [5-7]. Insomnia could be a persistent issue in 31% to 75% of patients, with more than two-thirds revealing side effects for at least one year [6-8]. Due to the increasing work pressure and social challenges in an advanced society, most of the masses cannot get adequate sleep and suffer from sleep disturbance [9-12]. A detailed study shows that around 30% of adults suffer from sleep disturbance [7]. It mainly affects females and is increasing with advancing age [8]. Insomnia may be acute or chronic, and primary or secondary [1]. Primary insomnia can be defined as an individual experiencing a sleep disorder due to stress or emotions, while secondary insomnia can be due to co-morbid conditions or prior illness [1]. Insomnia has been associated with many comorbidities such as hypertension, cardiovascular disease, depression, obesity, and diabetes [2]. It can also lead to alterations in attention with episodic memory, and these cognitive impairments are clinically significant [1,2].Hence, to maintain an individual's overall health, the treatment of insomnia is necessary [9, 10]. Conventional methods of treatinginsomnia generally involve either pharmacotherapies or psychological interventions [11]. The use of such kinds ofdrugs can cause serious adverse effects such as cognitive impairment, oversedation, daytime drowsiness,rebound discontinuation,and psychomotor disturbance [12].In recent years, benzodiazepines (diazepam and related drugs) or nonbenzodiazepine hypnotics (zolpidem or zopiclone} have been chosen over older barbiturates which can cause death in cases of overdose. In older patients, sedating antipsychotics, e.g., olanzapine or quetiapine, and sedating anti-depressants with older tricyclic drugs, are generally regarded as "off label" [11, 12]. The new treatment guidelines evolved for benzodiazepine include low doses of sedating antipsychotics, antidepressants, and mood stabilizers [11].Although pharmacotherapiesand psychological interventions remain essential for conventional treatment, due to various motivational factors, interest in using alternative therapies and products for insomnia has developed over the last two decades.

One common treatment group used by patients with insomnia is complementary and alternative medicine (CAM) [5-7]. Research on adult insomnia patients hasfound that 4.5% of them practised CAM to treat their condition [9]. CAM use can be seen extensively among patients with mental disorders, commonly for managing depression or insomnia. CAM generally includes extensive therapies based on different geographical regions from various schools of thought [8]. Common CAM therapies for insomnia include herbal and nutritional medicine, acupuncture, acupressure, yoga, tai chi, and mind-body practices [10]. Mind-body interventions such as yoga help manage stress and anxiety, improving sleep quality[10].Protein source herbal supplement L-tryptophan is also usedfor the treatment of insomnia [11]. Acupuncture and acupressure have been found to restore the normal sleep-wake process. They can also be employed to increase the -amino butyric acid content, enhancing sleep quality [12, 13]. Considering the growing public interest in CAM, these therapies and products have been researched over the past two decades to treat sleep disorders. Although few systematic reviews have been conducted on the use of acupuncture and valerian in treating insomnia, butcomprehensive study on all primary CAM treatments has not been conducted. The present systematic review comprehensively explored the effects of CAM on improving sleep quality to guide evidence-based clinical decision-making and inform future research. We have systematically searched and evaluated the evidence for the impact of CAM on insomnia.

Data Sources

Several electronic databases such as MEDLINE, PubMed, Scopus, EMBASE, Clinical key, Cochrane, and Research gate were explored to search the relevant articles. The references to the articles were also examined. The search strategy was only restricted to research studies in English.

The PubMed search strategy was :(((((((((((INSOMNIA) OR (insomnia[MeSH Terms])) AND (complementary medicine[MeSH Terms])) OR (alternative medicine[MeSH Terms]))) OR (complementary and alternative medicine[MeSH Terms]))) OR Natural practicesOR Manual practices OR Mind-body intervention practices OR Acupuncture ORAcupressure OR Yoga OR Tai ChiAND (The Pittsburgh Sleep Quality Index[MeSH Terms])) OR (PSQI[MeSH Terms])) OR (sleep quality[MeSH Terms])) OR (sleep latency[MeSH Terms])) OR (adjustment sleep disorder[MeSH Terms]) (((("insomnia s"[All Fields] OR "sleep initiation and maintenance disorders"[MeSH Terms] OR ("sleep"[All Fields] AND "initiation"[All Fields] AND "maintenance"[All Fields] AND "disorders"[All Fields]) OR "sleep initiation and maintenance disorders"[All Fields] OR "insomnia"[All Fields] OR "insomnias"[All Fields] OR "sleep initiation and maintenance disorders"[MeSH Terms]) AND "complementary therapies"[MeSH Terms]) OR "complementary therapies"[MeSH Terms] OR (("complementaries"[All Fields] OR "complementary"[All Fields]) AND "complementary therapies"[MeSH Terms])) AND (("Pittsburgh"[All Fields] AND ("sleep quality"[MeSH Terms] OR ("sleep"[All Fields] AND "quality"[All Fields]) OR "sleep quality"[All Fields])) AND OR "sleep quality"[MeSH Terms] OR "sleep latency"[MeSH Terms] OR "dyssomnias"[MeSH Terms]

Eligibility Criteria

Eligibility criteria have been described with the PICO framework. Inclusion and exclusion criteria for participants, intervention, comparison, and outcomes have been mentioned separately in other sections of the article.

Study Design

Randomized controlled trials reporting outcomes of the effects of CAM on insomnia and sleep quality were identified and included. Observational studies, case reports, case series, case presentations, and case-control studies were not included.

Study Participants

Regardless of health issues, adults (18 years or older) were included in the study, except for those working shifts and time zone travellers.

Interventions

For the systematic review, we have included CAM studies, classified under "manual practices," "natural practices," and "mind-body practices." All psychological and psycho-educational interventions were excluded from the review, e.g., cognitive behavioural therapy, relaxation therapy, or mindfulness (regarded as mainstream therapies). Bright-light treatment, exercise, music therapy, sensory art therapies, and aromatherapy were excluded from the study (as these therapies were not considered classical CAM interventions). Melatonin, too, was excluded from the review as the substance is a hormone, not an exogenous natural medicine. A total of eight CAM intervention RCTs met the inclusion criteria.

Comparison

For comparison, we have compared the intervention with a non-active placebo or control.

Outcome Measures

Subjective and objective sleep outcomes were evaluated, including, but not limited to, sleep quality, duration, and latency. The Pittsburgh Sleep Quality Index (PSQI) and Insomnia severity index (ISI) were used as the outcome measure in most of the studies. Duration of intervention should be 1 week.

Study Eligibility

The authors KVand AS independently screened all titles and abstracts per the inclusion and exclusion criteria. Only full-text articles that were published in English are included. Any discrepancy was resolved with discussion among other authors. The searched files were imported to the Zotero library after removing duplicate items and were freely available, and Rayyan (https:// rayyan.qcri.org), a free web-based software, was used to review articles. From the selected eligible articles, required data, including administration of intervention and control, author, year of publication, study design, follow-up, sample size, outcome measures, results, effect size and quality rating, and primary outcomes, were extracted from eligible studies.

Data Extraction

KV and AS prepared a narrative synthesis for relevant research articles, including their outcomes, variations on intervention, types, and outcomes measurement. The methodological quality assessment of the RCTs was performed using the modified Jadad scale, a scientific quality index of 5/10 (on the augmented Jadad scale) [14].

KV and DSsystematically searched the articles through different search engines, but as per inclusion and exclusion criteria mentioned previously, we have reviewed the articles through Rayyan (https:// rayyan.qcri.org), free web-based softwareto be more precise for the inclusion and exclusion criteria.As mentioned in the flow chart, among 621 identified potential studies in the field of CAM and insomnia. A total of 96 studies were removed, due to small sample size (5), different study design (7), insufficient reporting (7), only protocol/meeting abstract available (22), non-adequate control (11), different outcomes (17), non-English (19), short duration (8). This left 35 clinical trials for inclusion, primarily comprising adult samples (except for the tai chi and yoga studies, which used an older population). These CAM studies were grouped under "manual practices," "mind-body," and "natural practices." Eight CAM interventions had RCTs that met the inclusion criteria. DS and KV calculated and reported effect sizes (Cohens d) in all placebo-controlled studies with the available data(Figure 1).

Manual Practices

The systematic review revealed 11 RCTs with manual practice intervention [15-25]. These studies involved acupuncture (inserting fine needles to stimulate "acupoints") and acupressure (using digital or blunt pressure on "acupoints"). The trials were between two and 12 weeks, with an average sample size of 70 participants. Seven of the 11 studies measured the outcomes in the Pittsburgh sleep quality index (PSQI). The insomnia severity index (ISI) was adequate for the outcome measure in three of the 11 studies. The average quality score was 6.8 out of 10[15-18]. Out of the four acupressure studies, they all revealed positive results on the PSQI scale with large effect sizes ranging from 1.42 to 2.12 when measured on various PSQI subscales [15-18].

Among these four acupuncture studies, one was negative, equivalent to either placebo acupuncture or basic sleep hygiene. At the same time, one was positive, equal to the positive control (clonazepam), or more effective than placebo acupuncture or positive control (estazolam). Yin et al. stated a large effect size d = 1.14 on sleep quality outcomes [19-25](Table 1).

Mind-Body Practices

There were 12 mind-body intervention RCTs of sufficient methodological rigour in this review[26-37]. The trial length was between four and 24 weeks, with an average sample size of 90 participants. Five out of the seven studies used PSQI as the outcome measure. The average rating of the quality of the studies was eight out of 10. The yoga intervention studies revealed a positive effect on wait-list control. Manjunathet al. and Mustianet al.studies found large effect sizes (d = 1.52) and d = 2.56 on sleep quality outcome measures [31, 32]. One study (Ward et al.) found no significant difference between yoga and control groups [30].

All five tai chi trials were positive on various PSQI outcome measures compared with health education or low-impact exercise [33-37]. Large effect sizes prevailed in sleep duration d = 2.15 and sleep quality d = 1.05 in Li et al. [35]. At the same time, a marked divergence was observed in Irwin et al. with a large effect size on sleep severity (global score) d = 1.57 compared to small effect sizes on sleep duration d = 0.22, and sleep quality d = 0.44 [37] (Table 2).

Natural medicine practices

The review identified 12 RCTs of sufficient methodological rigour [38-48]. Three studies included kava and valerian interventions. Six studies included valerian intervention [38-40]. Three studies included tryptophan intervention [13,47,48]. The trials were from two to eight weeks (commonly two to four weeks) with an average sample size of 150 participants. The herbal medicine kava met the inclusion criteria compared to the placebo. The analysis of Lehrl et al.'s study showed a benefit for kava over placebo on the quality of sleep outcome [40]. The valerian studies exhibited diversified results, with three positive (more effective than placebo and equivalent to oxazepam) and three negative results (equal to placebo) [41-46]. For most of the studies, effect size calculations could not be available. For L-tryptophan trials, the average quality rating was seven out of 10, while herbal medicines studies showed a higher rating of 8 out of 10. Among the three L-tryptophan studies, two were positive on several outcomes. Hudson et al., in their analysis, mentioned a large effect size on increased sleep duration d = 1.16, and a small effect size on sleep quality d = 0.28 [13] (Table 3).

A review of all quality studies suggested that CAM may have the potential to improve sleep quality in a variety of patient populations. Although evidence is limited, this systematic review, which includes studies published till Jan. 2022, provides evidence that CAM may be useful for the treatment of both uncomplicated insomnias as well as insomnia co-morbid conditions.

Despite the substantial clinical trial literature, several studies were excluded due to methodological shortcomings. Only35 English language RCTs met the inclusion criteria. In various RCTs of herbal medicine, mostly involving valerian, researchers employed a short study duration and small sample size, restricting the study's statistical power. Moreover, several acupuncture studies had an 'active' control group, mostly involving another type of acupuncture.

Many studies could not calculate the effect size due to negative results or insufficient data (e.g., no standard deviation). As a result, the effect sizes noted in the positive studies (in natural medicine and manual practices) should be tempered concerning the negative studies. Quality grading of RCTs has been displayed in respective tables of manual, mind body and natural medicine practice. The majority of RCTs for manual practice scored 7/10 for quality of grading. Most RCTs for mind-body practices scored 6/10 while assessing quality grading. Mostly, RCTs with natural medicine practice scored 8/10 score for quality grading.

Findings revealed that the evidence for natural medicine practices in treating insomnia was also conflicting. Valerian was one of the most studied soporific natural medicines for its rich folkloric tradition of use in conditions of restlessness, hysteria, headache, nervousness, and mental depression. As detailed in Table 3, the evidence regarding valerian was quite mixed and did not support its use in treating insomnia. These results follow thesystematic reviews and meta-analyses done byBent et al. and Taibi et al. [49, 50]. The study of Bent et al., which included 16 eligible RCTs on valerian and valerian in combination with other herbal medicines, suggests that nine out of 16 studies did not have positive outcomes concerning the improvement of sleep quality [49]. The Taibi et al. review, which included 29 controlled studies, consistently stated that most studies lacked any significant difference between valerian and placebo. Valerian, combined withhopsor kava, did not seem to support the available data. Kava may provide a prospective alternative for managing insomnia [50]. However, Lehrl's studies had a different opinion, and presently as kava is withdrawn in several jurisdictions, further studies about its safety and efficacy are much needed [40].

L-tryptophan, an exogenous amino acid converted into serotonin, has been widely studied in treating insomnia and depression [51].However, the results were encouraging but varied concerning different sleep outcomes. The studies on various animals and humans consistently suggest that L-tryptophan increases sleepiness and decreases sleep latency [51, 52]. It has been observed that the best results seem to occur in cases of mild insomnia with long sleep latency and the absence of any medical or psychiatric comorbidity [51, 52]. A study by Hudson et al. determined a large effect size on increased sleep duration and a negligible effect on sleep quality [13]. A survey by Irwin et al.consistently revealed a substantial effect size for tai chi in reducing insomnia severity. In contrast, sleep duration and quality effects had poor clinical outcomes [37]. The heterogeneous nature of samples throughout the studies made these effect size differences [37].

Acupuncture and acupressure seem to contribute to treating insomnia, probably by the neurochemical modulatory activity of serotonin, dopamine, and endogenous opioids [53]. The review by Cheuk et al.concluded with seven rigorous methodological trials that acupuncture and acupressure help improve sleep quality scores. Still, the evidence for acupuncture as a hypnotic intervention was inconsistent. Compared to control or no treatment, the efficacy of acupuncture and its variants was inconsistent among studies, including many sleep parameters, such as sleep onset latency, time to wake after sleep onset, and total sleep duration [53]. Further, Yeung et al. revealed that definitive conclusions could not be derived on acupuncture's efficacy for insomnia. This conclusion was reached due to the methodological quality of RCTs as the limitations of the study designs hampered studies. For instance, publications of such studies have also provided limited information about inclusion/exclusion criteria, outcomes measured, missing baseline data, randomization methods, and the specific acupuncture approach [54].

Mind-body practices such as yoga and tai chi in insomnia and different sleep disorders are enhancing popularity, particularly in the ageing population who might prefer low-effect exercises [35]. Comparatively, findings supported the benefits of exercise in improving sleep quality and reducing the severity of insomnia in older people. However, a Li et al. study compared tai chi to low-effect exercise and found it superior to low-effect exercises in all outcomes [35]. While Manjunath et al., the yoga study included older participants with sleep issues and noted yoga was superior to both wait-list and herbal medicine on sleep latency and total sleep [31]. Mind-body practices comprise multicomponent interventions, considered to give rise to similar physiological processes to traditional relaxation methods, which have been investigated as treatment options for insomnia [26-37]. Mechanistically, yoga acutely affects the activity of the autonomic nervous system and may decrease the gamma-aminobutyric acid levels and inflammatory markers. Probably by neurobiological pathways, yoga may improve sleep quality [28, 29]. Data from small RCTs suggested that yoga improves subjective and objective sleep quality, reducing insomnia symptoms in adults with chronic medical conditions [26, 28, 29, 31]. One of the largest RCTs of Yoga illustrated reduced hypnotic medication use in cancer survivors with sleep disturbance by 21% in the yoga group compared with 5% in the control group [32]. However, several emerging clinical trials on yoga found that most participants faced a general sleep disturbance. Moreover, yoga studies includingpranayama, breathing exercises, gentle hatha, restorative yoga asanas, and meditationassessing sleep outcomes showed common methodological limitations of sample sizes and limited use of objective outcome measures [27-32]. Further studies on yoga are encouraged with participants with a confirmed diagnosis of insomnia using validated sleep assessment scales.

Similarly, in studies for tai chi intervention, the focus was more on sleep quality rather than insomnia. Several RCTs suggested improvement in reported sleep quality, with tai chi intervention, particularly among older adults. Therefore,tai chimay improve sleep quality in different populations, specifically older adults [33-37]. Its impact on objective measures in chronic insomnia needs further explained.

In reference to data from the United States National Health Interview Survey, 17.4% of adults (n= 93 386) reported insomnia or regular sleep disturbance, and 4.5% used CAM therapies to improve their sleep quality. 56% of the individuals said that CAM was essential to maintaining their overall health and well-being, while 72% observed that CAM improved insomnia disorders significantly. Younger and highly qualified persons believe in CAM to improve insomnia symptoms [55]. It has been noticed that traditional Indo-Asian therapies such as acupuncture, acupressure, and yoga were morewidely studied compared to standard Western CAM therapies. The broadly researched herbal medicine is valerian in the form of monotherapy or combination with hops or kava [13, 15-48]. Future research in other herbal medications or Western CAM therapies with potential hypnotic effects is recommended as current research in these areas is insufficient.

The strengths of this systematic review included the search and synthesis of all relevant studies across several databases, the rigorous methodological inclusion criteria, and a quality assessment of all clinical trials with calculations of the effect size of studies.

This review also had some limitations. These were language constraints, as we excluded non-English publications; several valerian studies were published in German, and acupuncture studies were published in Chinese. Secondly, it lacks appropriate clinical trials with methodological weakness, for instance, adequate sample sizes. While reporting complete data, the long-term efficacy and safety of CAM interventions should have been employed.

The rest is here:

The Impact of Complementary and Alternative Medicine on Insomnia: A Systematic Review - Cureus

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Whenever we think about natural medical treatment, only one word clicks in our mind, i.e., India. Moreover, when it's about less toxic and unpainful treatment, Ayurveda treatment is one.

Ayurveda means the 'science of life'. 'Ayuh (r)' meaning life and 'Veda' as science. With its roots in India, Ayurveda is an old life system surviving for years and years in the world.

How effective is Ayurveda treatment?

Detailed research is required in the specific segments of Ayurveda, especially diagnostic principles. This way, Ayurveda diagnosis can be implemented as an effective treatment with effective strategies. Ayurveda is entirely science-based with solid explanations in a logical manner termed Darshana.

The world we are living in today is becoming toxic day by day. The stressful lifestyle disturbs the equilibrium of our mind and body, which further leads to health-related issues. The adverse effects can be seen physically and emotionally, making us seek medical intervention. This is the point where Ayurveda needs an adaption by us.

With Ayurveda, we learn how to live safely naturally based on principles. Following Ayurveda will help us stay away from costly medical treatments or prevent debilitating conditions. As a systematic approach, Ayurveda aims to boost vitality, longevity, and mental and physical strength, providing a balance of emotions and peace of mind.

Like other medical treatments, Ayurveda is a unique patient-oriented treatment where an Ayurvedic physician diagnoses and dispenses medicine to the patient. The essential principle forming the basis is a form of personalized medicine giving high safety, the maximum therapeutic efficacy of a particular person having a specific disorder, and and specified conditions dependent on the individual need.

Through Ayurveda, we don't just learn to live on medicines for years. Instead, we learn to live life following natural remedies. Natural remedies are available for the health conditions like thyroid, chronic kidney disease, or even complicated diseases. A vast paradigm is noticed amongst the patients willing to try Ayurveda.

The allopathic medication system has undergone various advancements and has been proven to save lives. But, there are some side effects related to allopathic medicine, as toxicity is seen in man-made drugs that make the body weak. Whereas Ayurveda has a natural approach that does not limit the healing of the disease but focuses on maintaining a balance in life and making the body energetic.

Ayurveda is founded in the belief that good health is based on a balance between the spirit, mind and body. The three most revitalising Ayurvedic forms are Ayurvedic massage, panchakarma Treatment and Ayurvedic therapy.

Another essential facet of Ayurveda is that everyone in the world is made up of five elements: air, fire, space, earth, and water. All these elements together form three different energies, also known as doshas. The three doshas are Vata Dosha, Pitta Dosha and Kapha Dosha. Vata Dosha represents air and space. Pitta Dosha represents water and fire. At the same time, Kapha Dosha means earth and water.

One of the best aspects about Ayurveda is it can be customised as per the individual. It's a kind of treatment designed differently for everyone. It considers the life force and the balance of the three doshas.

The specially customized treatment plan prioritises the body's cleansing first with a process termed panchkarma. Various tactics are designed to decrease the symptoms and restore balance and harmony.

In the present world, it's essential to look for an alternative medicine therapy as another choice available for the patients. For example, cancer patients should also have a variety of options. In the same manner, the other patients get a choice of treatment, either conventional or non-conventional; both should be available. Ayurveda as an alternative therapy or medicine is put into the light by the introduction of the Ayush Visa Indian Government. Ayurveda holding strong roots with its presence still requires a lot of introduction in the world and its benefits.

The initiative Heal in India focuses on the importance of Ayurveda as an alternate therapeutic medicine. The demand for various forms such as detoxification, stress management, and rejuvenation has been increasing since after COVID. The Ayurveda will emerge as one of the leading markets with a plan to provide more and more treatments for different ailments. Much research is required on the Ayurvedic aspects as alternative therapies with Heal in India and will track the study.

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Ayurveda As Alternative Medicine: Research And Development To Be Taken Ahead By Heal In India - Entrepreneur

French online medical platform Doctolib has been accused of promoting alternative medicines and practitioners after users found appointments on it for naturopaths offering leaf extracts as a cure.

Doctolib is available to health professionals whose activity is governed by the Code de la sant publique, and is also open to osteopaths and psychologists.

However, the platform can also be used by professionals whose activity falls into the wellbeing category. These practitioners may not be regulated or recognised by the state, and may be able to charge a wider range of fees for their care.

This wellbeing category has been disputed.

Tristan Mends-France, lecturer at the University of Paris, told Le Parisien that Doctolib has taken on an institutional [trustworthy] air since its participation in the Covid-19 vaccination appointment crisis. And yet, some alternative practitioners offer unproven or controversial services.

Read more: Record 1.2m appointments made for boosters as rules change in France

Read more: Frances favourite brands in 2021: Decathlon, Peugeot, and Leclerc

For example, users can currently book appointments for a hypnosis seance, a naturopath appointment, a sophrology appointment, a neurofeedback session (the latter is described as helping the user to control their neuron activity), or a naturopath appointment that invites you to drink your own urine.

In its defence, Doctolib said that it is not its place to "decide" or take sides in the debates that surround alternative medicine.

In a Tweet, it said that only 3% of its users practise an activity that comes under the wellbeing or medical-social umbrella. Their activity is legal, but they are of course not health professionals. Appointments with these practitioners represent just 0.3% of the appointments made with Doctolib.

It added: Society is evolving, andsome patient associations are promoting access to complementary therapies. We consider that it is not the role of Doctolib to decide on these debates.

It said that the website clearly states when the practitioner is exercising an unregulated profession and when their diploma is not recognised by the state.

The platform said that it would investigate reports made by users that claimed unscrupulous practitioners were operating on the site, including one Tweet that alleged a naturopath was offering treatments including barley grass juice and leaf extract.

On August 22, Doctolib said that it had banned the profiles of some naturopaths on its site who have alleged links with Irne Grosjean and Thierry Casasnovas, two influential personalities online who are accused of having sectarian and cult-like qualities, and whose practices have been widely discredited.

The platform confirmed that it had stopped users from being able to book with 17 such practitioners, whose training mentions these two highly-controversial names.

Irne Grosjean in particular has been accused of promoting non-scientific and even illegal practices, while Thierry Casasnovas is currently being criminally investigated for illegal practice of medicine.

Despite having no recognised medical training, he is alleged to have pushed some patients to give up their existing medication for severe illnesses, including some patients who were encouraged to give up their cancer treatment.

Doctolib is also inviting users to report any profile that appears to be promoting illegal practice of medicine.

Alternative medicine is controversial in France.

Judges investigated several cases in 2021, including the death of a 44-year-old woman who was paying 1,000 a week for a fasting treatment in a Loire chateau. She was found dead in her room after having drunk no water for several days.

The prefect ordered the course to be closed and a judge at Tours is investigating possible involuntary homicide.

The naturopath who ran the course denied involvement in the death and said the only explanation was her Covid vaccination.

Read more: Alternative medicine warning following two deaths in France

Participants told French media that they drank only water during the fast and one man had been taken to hospital after he stopped taking medicine for his diabetes.

In another case, the widow of a 41-year-old man who died from testicular cancer brought a criminal complaint against a naturopath who had advised the man to stop chemotherapy treatment and to rely on natural treatments such as fasts and purges.

The naturopath faced a Paris court on charges of illegally practising medicine and usurping a doctors work.

At the time, Claire Cavelier, spokeswoman for the LaFna, a federation of eight naturopath training schools that offers its own 1,200-hour course, said that trustworthy and ethical naturopaths would never encourage such practices.

She said: There is enormous interest in naturopathy at the moment, which unfortunately has attracted many charlatans or would-be gurus into the area because there are no regulations in France. You could buy a brass plate with your name and naturopath on it today, and be open for business tomorrow.

Charging 1,000 a week for a fasting treatment, or telling people to ignore a doctors prescription, is not something any naturopath should do and is an example of charlatan practice, and could even be classified as running a sect.

Naturopathy, which seeks to establish equilibrium in the body through natural means, is recognised as traditional medicine by the World Health Organisation, and is regulated in Germany, Portugal, and Switzerland. In France, naturopaths are forbidden from giving diagnoses or prescribing medicines.

Ms Cavelier said she would like to see similar regulation in France to other European countries, saying cases like the ones we have had this summer always slow down or reverse any progress we have made.

Naturopaths say that they encourage people to undertake treatments such as changing diet, fasting, phytotherapy (using plants, often in tisanes or tinctures), massages, yoga, or sport to improve health, and say illnesses can only be understood by looking for deep-rooted causes and treating them.

Homeopathy was previously reimbursed up to 30% by the French state, but in 2021 this was stopped.

The change was made after the health authority la Haute Autorit de sant (HAS) with then-Health Minister Agns Buzyn judged that homeopathic remedies were not proven to be sufficiently effective to be eligible for state medical reimbursement.

Alternative medicine warning following two deaths in France

Doctors attack alternative medicine

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French Doctolib platform accused of 'promoting alternative medicine' - The Connexion

Chronic fatigue syndrome (CFS) (also called myalgic encephalomyelitis) is a chronic illness that causes a broad range of symptoms.

Dont let the name fool you. The fatigue associated with CFS isnt simple tiredness. It can be life altering and make even the smallest routine tasks feel impossible, especially when sleep doesnt restore energy after each night.

Theres no cure for CFS. As a result, treatment is personalized and focused on relieving symptoms and restoring quality of life. Heres more about what treatments may be best for you.

CFS isnt common, as it affects roughly 0.7% of the U.S. population at most. Experts estimate that around 1 million people have CFS. But the actual number of people may sit anywhere between 836,000 and 2.5 million, including those who have yet to receive a clear diagnosis.

People assigned female at birth are two to four times more likely to have the condition than people assigned male at birth.

CFS is serious. The condition makes daily life difficult for people who deal with it.

Symptoms include:

People with CFS may need to spend much of the day in bed. At the very least, they may not be able to carry out their responsibilities or other desired activities without dealing with symptoms. This may eventually lead to missing work, being socially isolated, and dealing with depression.

Even small amounts of activity can trigger something called postexertional malaise (PEM), which can prolong symptoms, make symptoms worse, or both.

The median recovery rate for CFS is around 5%. Its important to know that many people can manage their condition and energy level by creating a personalized treatment plan with a doctor.

Beyond that, you may find that your symptoms change, get worse, or get better over time. Symptoms may even come and go somewhat unpredictably. Your experience will be unique and tied to your own triggers and coexisting health conditions.

Theres no one medication a person can take to treat CFS. Instead, treatment is highly individual and depends on what symptoms a person is experiencing.

The areas of treatment generally include:

You may start with treatment of these issues and progress to others in time. Many treatment options are available, ranging from over-the-counter (OTC) drugs to alternative therapies.

The most effective treatment for CFS is the one thats catered to you and your specific symptoms. A doctor may suggest a variety of treatments depending on what youre experiencing and what your treatment goals are.

Cognitive behavioral therapy (CBT) is a treatment that helps people understand and adjust the ways they think and respond to various situations. While CBT is a psychological treatment, its appropriate for chronic illnesses like CFS (and others).

This treatment may work best for people with mild to moderate CFS. It involves attending a set number of therapy sessions in which youll focus on things like unhelpful ways of thinking, unhelpful behaviors, coping mechanisms, and relaxation techniques.

Activity management can be an effective treatment for PEM. Another term you may be more familiar with for this type of energy management is pacing.

This treatment is usually carried out by a rehabilitation specialist or exercise physiologist. You may start by keeping a log of your usual activities and how they affect your energy levels. Some refer to this as the spoon theory in life with a chronic illness, where a spoon to represents a unit of energy.

From there, a healthcare professional will help you find ways to do these tasks in different ways to conserve energy. For example, you may try folding your laundry while seated or taking frequent breaks throughout the day.

Pacing is all about finding a balance between those activities that zap energy and those that may restore it.

An energy management plan may also include a personalized exercise plan.

Again, theres no one medication you can take to treat CFS as a condition.

Drugs that may help symptoms include:

Sleep is difficult with CFS. You may not get enough sleep, or even if you do, your sleep may not be restorative.

If OTC treatments dont help with sleep, a healthcare professional may refer you to a sleep specialist to determine if you have other conditions, such as sleep apnea or narcolepsy, that may be contributing to your sleep problems.

Treatment will depend on the diagnosis. With sleep apnea, for example, you may use a continuous positive airway pressure (CPAP) machine to help with breathing overnight.

There are a variety of alternative methods or changes to your lifestyle that may help with CFS as well:

A doctor may also suggest using certain supplements to address nutrition deficiencies, diet changes to support a balanced diet, or a combination of both traditional and alternative therapies to get you feeling better.

Researchers share that there are some newer treatments or trial treatments for CFS. A doctor may also know of newer treatments or other options available to you.

They include:

CFS does more than just make people tired. Its a potentially debilitating condition that causes both physical and psychological symptoms. Treatment plans vary from person to person and can include medications, therapy, complementary and alternative medicine, and more.

If youre struggling, speak with a doctor about your symptoms and your treatment goals. While CFS cant be cured, certain medications, pacing, and other treatments and lifestyle changes can help you get your life back.

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Chronic Fatigue Syndrome: Best Ways for Treating This Condition - Healthline

Ellen White has broken her silence on one of the main reasons why she decided to retire from professional football following Englands historic Euro 2022-winning summer.

Off the back of her emotional retirement statement, the Lionesses all-time top goalscorer has shed light on a traumatic incident that left her with a punctured lung last year.

White revealed the injury was a big factor in her decision to hang up her boots and look towards the next chapter in her career.

The former Manchester City star suffered a lung injury after receiving acupuncture for a back spasm issue following the 2020 Olympics.

Acupuncture is a form of alternative medicine, derived from traditional Chinese practice, where thin needles are inserted into the skin. It is most often used in attempt to aid pain relief.

White helped Great Britain reach the quarter-finals at the Tokyo Games before returning to City, who arranged for an external specialistto perform the treatment.

The club reportedly outsourced the acupuncture specialist due to a high amount of injuries in the Man City camp at the time.

Speaking to BBC Sport, White revealed the treatment had punctured her lung, which was a lot for me to have to go through and a big reason that accelerated my want to retire.

The 33-year-old admitted if someone had suggested two or three years ago that she would retire in 2022, she would not have believed it.

However, her injury hampered her fitness and it is something she is still trying to work out.

It punctured my lung which isnt something that happens normally, obviously, White said. It was a really traumatic time for me and something that Im still figuring out now, still working through.

The puncture left White unable to exercise due to being constantly short of breath.

She revealed she had a needle put into her chest to drag all the air out to help the lung inflate again.

White was able to return to the pitch and reach huge team and individual milestones, but she is still affected by the injury and admitted she feels a phantom pain as though it is still there.

Its important for me now to tell my story, and say it was a big factor in my year and leading up to the decision of wanting to retire. Obviously there are other factors that come into that as well.

I dont want it to happen to anybody else again is my main thing. I dont want to walk away from the sport having not told it and not say that I want things in place for it not to happen to anyone else.

SHOP OUR LEAH WILLIAMSON T-SHIRT TO CELEBRATE ENGLANDS EURO 2022 WIN

White leaves behind a magnificent legacy on the football pitch and bows out following a history-making summer at Euro 2022.

In November 2021, the striker earned her 100th cap for England and followed up in the next match by becoming the Lionesses top goalscorer.

She surpassed Kelly Smiths tally and came within two goals of beating Wayne Rooneys all-time record of 53 goals scored for England. She hangs up her boots with 52 goals scored in 113 appearances for her country.

The evergreen White also boasts the second highest goal return in Womens Super League history. With 61 goals in Englands top flight, she is behind only Vivianne Miedema, who leads the table with 74 goals for Arsenal.

On the international stage, White has represented England at three World Cups, including the bronze medal finish in 2015. She was also called up to Team GB for two Olympic Games. She was named England Womens Player of the Year in 2011, 2018 and 2021.

During her domestic career, the 33-year-old played for Chelsea, Leeds, Arsenal, Notts County, and Birmingham before joining Man City in 2019.

Throughout her 17 years as a senior player, White won two Womens Super League titles, four League Cups, and three FA Cups. She also won the 2017/18 WSL Golden Boot and holds the record for most goals scored by an England player at the Womens World Cup, as well as being Team GBs female all-time record goalscorer.

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Ellen White reveals "traumatic" incident that played huge role in her retirement - GIVEMESPORT

Non-Hodgkins lymphoma is the most common cancer of the immune system and one of the most common cancers in the United States.

Characterized by solid tumors that first develop in the lymph nodes, it is estimated that more than 80,000 Americans will receive a diagnosis of non-Hodgkins lymphoma in 2022.

In addition to its high prevalence, there are several subtypes of non-Hodgkins lymphoma that pose challenges for effective treatment and management.

For instance, diffuse large B-cell lymphoma is a common subtype of non-Hodgkins lymphoma that has shown resistance to current treatments, potentially increasing the risk of recurrence in some people.

Thus, researchers continue to explore new and alternative treatment options that are effective and safe. One such natural product is curcumin, an active compound found in the spice turmeric.

This article explains curcumin and its potential benefits and downsides for treating or preventing non-Hodgkins lymphoma.

Curcumin is not proven to prevent non-Hodgkins lymphoma, but it shows great potential as an alternative therapy in symptom management when taken in combination with conventional cancer treatments.

The anticancer potential of curcumin has been linked to its anti-inflammatory and antioxidant properties.

A 2017 research report suggests that curcumin disrupts cellular pathways between the lymphoma cancer cells responsible for its growth and spread.

Similarly, more recent test tube research found that curcumin suppressed the growth of diffuse large B-cell lymphoma the most common subtype of non-Hodgkins lymphoma and even induced death of the cancer cells.

A reduction of cancer-related inflammation via curcumin supplements was associated with an improvement in the quality of life of some people, including those with various lymphomas.

Taking curcumin at the same time as the cancer drug imatinib appeared to enhance the effectiveness of chemotherapy against non-Hodgkins lymphoma in test tube research.

The combined treatment, called rituximab, was more effective than the administration of the cancer drug alone.

This finding was consistent with other research that suggested curcumin could enhance the effects of chemotherapy and radiation cancer treatments.

Research also suggests that curcumin may reduce resistance to chemotherapy, or chemoresistance, which some people experience with non-Hodgkins lymphoma subtypes.

However, its still unclear whether these effects would be the same in humans, so we need more research.

The potential role of curcumin in cancer treatment continues to be recognized.

It may be capable of disrupting several cellular pathways related to the growth and spread of non-Hodgkins lymphoma. Plus, there are no reported side effects in doses as high as 8 to 12 grams per day.

Given that most of the research on curcumin and cancer has been in test tubes and animals, more clinical trials involving humans are needed to determine the long-term effects of curcumin for non-Hodgkins lymphoma.

Curcumin is a compound found in turmeric (Curcuma longa).

It forms part of the curcuminoids a group of compounds in turmeric with therapeutic properties and gives the traditional Indian curry spice its characteristic yellow-orange color.

It is generally recognized as safe (GRAS) by the Food and Drug Administration (FDA) and has been used extensively throughout traditional plant medicine systems for centuries.

Test tube, animal, and human research has demonstrated that curcumin has anti-inflammatory, antimicrobial, antibiotic, and antioxidant properties.

Thus, it has been the interest of scientific research for decades for its potential roles in the prevention and treatment of several inflammatory human diseases, including cancers, arthritis, and diabetes.

Curcumin can be consumed via turmeric root, spice powder, or a dietary supplement.

Check out Healthlines picks of the best turmeric supplements of 2022.

Though curcumin is considered safe, there are some potential downsides to consider.

Curcumin is a fat-soluble compound that is unstable in water-based mixtures with a low pH, such as stomach acid.

That means that when consumed alone, such as in supplement form, it is rapidly broken down and poorly absorbed. Therefore, it may not offer any benefits in this form.

Because its so unstable, curcumin has been labeled as an invalid metabolic panaceas (IMPS) candidate. IMPS refers to compounds that have been overstudied and whose benefits have been overpromised.

Some researchers even question whether test tube findings of curcumins benefits are false.

However, when combined into oil-based formulations or taken with other plant compounds like piperine from black pepper, the gut may be better able to absorb curcumin and perhaps benefit from its properties.

Learn more about the powerful combo of curcumin and piperine here.

The fact that curcumin needs to be combined with other compounds for human consumption makes it difficult to determine which health benefits observed in studies are related to curcumin alone.

Despite a few claims that curcumin may be toxic under some research conditions, doses of 8 to 12 grams per day were found safe in other research published between 2017 and 2019.

Furthermore, there may be several unsubstantiated beliefs about the use of curcumin for non-Hodgkins lymphoma and other cancers, based on test tube and animal research only.

Remember that clinical trials and long-term studies involving humans are warranted to determine safety, effective doses, and the best drug combinations for the combined treatment of non-Hodgkins lymphoma.

Non-Hodgkins lymphoma is the most common cancer of the immune system. Its characterized by solid tumors that first develop in the lymph nodes.

The many subtypes of non-Hodgkins lymphoma pose treatment challenges, so its important to explore alternative, safe, and effective treatments.

Curcumin is the yellow-orange pigment found in turmeric, and its shown to suppress the growth and spread of cancer cells while enhancing the effectiveness of chemotherapy and radiation in test tube research.

However, results of test tube research cant necessarily be applied to humans. Plus, curcumin is unstable and may not offer any benefits unless combined with oil-based formulations or with other compounds like piperine.

More research involving humans related to curcumin and non-Hodgkins lymphoma is needed.

If you want to try taking curcumin supplements, theyre generally considered safe with few to no side effects. Just be sure to talk with a healthcare professional first, as you would any supplement.

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Curcumin and Non-Hodgkin's Lymphoma: Does It Help? - Healthline

In June, Rebecca A. Shatsky, MD, a medical oncologist, turned to Twitter for advice:

"What do you do/say when a patient won't believe you that they have #CANCER. As an oncologist this comes up every now and then and proves very difficult, looking to hear how others have dealt and what works best to help patients here."

About a dozen people weighed in, offering various thoughts on how to approach these thorny situations. One oncologist suggested revisiting the conversation a few days later, after the patient has more time to process; others suggested sharing the pathology report or images with their patient.

Another person simply noted that "if a [patient] doesnt want to believe they have cancer, no amount of evidence will change that."

Based on the initial responses, "it appears there is a paucity of answers sadly," wrote Shatsky, a breast cancer specialist at University of California, San Diego.

But for Shatsky, these incidents spoke to another alarming trend: a rampant mistrust of the medical community that is "becoming MORE common instead of less."

Overall, experts say that situations like the one Shatsky described patients who don't believe their cancer diagnosis occur infrequently.

But denial comes in many forms, and complete disbelief is probably the most extreme. Patients may also downplay the severity of their disease, shy away from hearing bad news, or refuse standard treatment or their doctor's advice.

Like Shatsky, these experts say they are also seeing a troubling increase in patients who don't believe their physicians or don't trust their recommendations.

"I think there's an erosion of trust in expertise, in general," saidys Ronald M. Epstein, MD, professor of family medicine and psychiatry & oncology at the University of Rochester School of Medicine, Rochester, New York. "People distrust science more than they did maybe 20 or 30 years ago, or at least that seems to be the case."

Denial and distrust in cancer care are not new. These responses along with wishful thinking, distraction, and minimization are long-established responses among oncology patients. In 1972, Avery D. Weisman, MD, a psychiatrist at Harvard Medical School, Boston, Massachusetts, wrote his book On Dying and Denying, and ever since, denial and similar responses have been explored in the oncology literature.

Much of this research has focused on the latter stages of illness, but denial can be present at diagnosis as well. One study of patients with breast cancer, carried out nearly 30 years ago, suggested that denial of diagnosis generally occurs early in a patient's course of illness and decreases over time, but may arise again in the terminal phase of cancer. Another analysis, evaluating this phenomenon across 13 studies, found that the prevalence of denial at diagnosis ranged from 4% to as high as 47%.

An oncologist delivers somewhere between 10,000 to 30,000 episodes of bad news over the course of a career, so there's always a chance that a patient will respond in a way that's on the "spectrum of disbelief," says Paul Helft, MD, professor of medicine and recently retired director of the ethics center at the Indiana School of Medicine, Indianapolis.

Diane Meier, MD, says denial and disbelief are natural, protective responses to difficult or frightening news.

When patients exhibit denial, Meier advises patience and time. Physicians can also ask the patient if there's a person they trust a family member or faith leader, for example who could speak on their behalf about possible next steps.

"The main thing is not to find ourselves in opposition to the patient or threaten them with what will happen if they don't listen to us," says Meier, a professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York City.

And physicians should be careful when they feel themselves wanting to argue with or lecture a patient.

"The minute we feel that urge coming on, that's a signal to us to stop and realize that something is going on inside the patient that we don't understand," she notes. "Forcing information on a person who is signaling in every way that they don't want it and can't handle it is not a recipe for trust or a high-quality relationship."

Jennifer Lycette, MD, has encountered a growing number of patients who don't believe their disease should be treated the way she or other oncologists recommend. Some patients remain adamant about sticking with alternative medicine or doing nothing, despite growing sicker.

"I've even had situations where the tumor might be visible, like growing through the skin, and people still double down that whatever they're doing is working," says Lycette, a hematologist and medical oncologist at the Providence Seaside Cancer Center in Seaside, Oregon.

She encourages these patients to get a second opinion and tries to keep an open mind about alternative approaches. If she's not familiar with something a patient is considering, she'll research it with them.

But she makes sure to point out any risks associated with these approaches. While some alternative therapies can support patients through standard treatment, she strongly cautions patients against using these therapies in place of standard treatment.

"The bottom line is to keep the lines of communication open," she says.

Like Lycette, Helft has been encountering more patients with alternative health beliefs who rely on people outside of the medical system for elements of their care.

In the past, he used to tell these patients that science is incomplete, and physicians don't know everything. But he's changed his tune.

"I've taken to just telling them what I believe, which is that the majority of things that they hear and are being sold are almost certainly ineffective and a waste of money," he says. "I've come to accept that people are adults, and they make their own decisions, and sometimes they make decisions that are not the ones that I would make or want them to make."

Helft often sees patients seeking a second or third opinion on their cancer. These patients may not all be in denial about having cancer, but they typically don't want to hear bad news, which can make treatment a challenge.

To handle these scenarios, Helft has developed a system of responses for engaging with patients. He borrows an approach described in 2008 where he acknowledges a patient's emotional distress and tries to understand why they may not want to know more.

For instance, he might tell a patient: "I have formulated an opinion about your situation, but it sounds as if you have heard many negative descriptions previously. I don't want to burden you with one more if you don't feel prepared to talk about it."

Trying to understand why a patient is resistant to hearing about their condition may also help build trust. "If you could help me understand your thinking about why you would rather not talk about prognosis, it will help me know more about how to discuss other serious issues," is one approach highlighted in the 2008 guide.

Behind the scenes, Helft will privately assess how much information about a patient's prognosis is salient to their decision making, especially if the patient appears to misunderstand their prognosis or if there are various options for treatment over the long-term.

Helft will also ask patients how much they want to know. Do they want to discuss no options? A few? All and in detail?

This approach implicitly recognizes that the information is highly stressful but avoids being overly blunt, he notes. It can also help steer patients on the right treatment track and minimize poor decision making.

Samantha Winemaker, MD, a palliative care physician in Hamilton, Ontario, Canada, finds patients often go through an adjustment period after learning about a new diagnosis. The reaction tends to range from needing time to accept the diagnosis as real to jumping in to understand as much as possible.

Winemaker, who cohosts The Waiting Room Revolution podcast that focuses on helping people deal with a serious illness, encourages physicians to be realistic with patients about their prognosis and deliver news with a dose of gentle truth from the start.

"We should invite patients 'into the know' as early as possible, while maintaining hope," she says.

She calls this approach of balancing hope and reality "walking two roads" and says it extends throughout the illness journey. This way, patients are less likely to be surprised if things make a turn for the worse.

"We should never wait until the 11thhour to give someone bad news," she says.

Epstein, the family physician at the University of Rochester, Rochester, New York, has listened to hundreds of hours of discussion between doctors and patients as part of his research on communication. He often hears doctors initiate difficult conversations by lecturing a patient.

Many physicians mistakenly believe that if they say something authoritatively, patients will believe it, he says. But the opposite often happens patients shut down and instinctively distrust the physician.

Epstein teaches doctors to establish trust before providing difficult information. Even when a patient expresses outlandish ideas about their illness, treat them with dignity and respect, he advises. "If people don't feel respected, you don't have a leg to stand on and there's no point in trying to convince them."

Patients and physicians often leave conversations with discordant views of what's ahead. In one study, two thirds of patients held wildly different views on their prognosis compared with their doctors, and most had no idea they were at odds with their physician.

In the past, Epstein has tried to close the gap between his understanding of a patient's prognosis and the patient's. But more recently he has become less convinced of the need to do so.

"What I try to do now is focus more on the uncertainty there," he says. He uses phrases like: "Given that we don't know how long you will live, I just need to know what you would want me to do if things took a turn for the worse" or "I'm worried that if you don't have the surgery, you might experience more pain in the future."

He urges doctors to pay attention to their word choices. Use care with the phrase "response rate" patients sometimes mistake this to mean that they are being cured. And, instead of telling patients they "must" do something, he says that he worries about consequences for them if they don't.

He asks patients what they're hearing from other people in their lives or online. Sometimes patients say that people close to them are encouraging them to stop medical treatment or pursue alternative therapies. When that happens, Epstein asks to meet with that person to talk to them about his concerns for their loved one.

He also acknowledges calculated uncertainty often exists in medicine. That, he says, leaves open the potential for exceptional circumstances.

"And we all want to hope," Epstein says.

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In Denial: When Patients Don't Want to Believe They Have Cancer - Medscape

In the early days of the COVID-19 pandemicPiotr Szyhalski became a strident, comforting voice of reason and truth. The interdisciplinary artist created a new drawing daily, using the aesthetics of propaganda posters to speak to living through the pandemic. Posted on social media each day, Szyhalskis pandemic images went viral.

Printed as posters, they were hung on street lamps and boarded up buildings in cities across the United States. They were also shown in exhibitions at the Minneapolis Institute of Art (which now owns digital files of the collection) and multiple institutions here in Minnesota and internationally.

The posters were part of a larger series called Labor Camp, where Szyhalski explores what he calls extreme historical phenomena. Also his Instagram handle, the term Labor Camp encompasses work Szyhalski began creating in 1998 in a multiplicity of mediums, including performance, musical scores, and media arts, as a way to respond to historical events of immense impact and change. A chapter of his Labor Camp project became COVID 19: Labor Camp Reports.

This is something that as a concept emerged for me in the late 90s, he tells a group of journalists about the larger Labor Camp milieu, at a recent media event at the Weisman Art Museum for a survey exhibition of his work called We Are Working All The Time!

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Born in Poland in 1967 when it was a satellite state of the Soviet Union, Szyhalski trained as an artist in Poland in a time when great change was at the cusp. He moved to the U.S. in 1990, in the wake of the fall of the Soviet Union. Since 1994, he has been a professor of media arts at the Minneapolis College of Art and Design. His work crosses genres, finding new ways to explore performance, mail art, digital media, printmaking, sound art, and installation, often in collaboration with other artists.

Courtesy of the Weisman Art Museum

"We Are Working All The Time!" book cover jacket image

When the COVID-19 emerged, I understood that we were living in one of those extreme historical phenomena, Szyhalski says. So the idea of responding to it through or processing that material was kind of a natural or obvious way to be in that moment.

He thought he was done with the project, completing the COVID 19: Labor Camp Report (2021) on Nov. 3, 2021. The posters often responded to the experience of living through COVID the trauma of mass death, the isolation, and the myopic response of the Donald Trump administration to the international emergency. Later, when Russia invaded Ukraine, he realized a new chapter of the Labor Camp series had begun.

At least at the very beginning, we were literally talking about looking at the potential of World War III happening, he said. So this edge of something much larger than it appears on the surface was always there.

Ive been referring to these as War Reports, Szyhalski says of the new drawings. Part of my thinking about this new body of work was how to pay attention to this event, both as a very specific, localized tragedy, but how to also talk about it in a way where we are engaged in a more direct, emotional way.

One drawing depicts Ukrainian victims that were found on the streets of Bucha. Szyhalski studied natural landscapes of Ukraine, in order to directly connect to Ukraines geographical place in the world. As an example, he includes chestnut trees in the image. Another work speaks to the refugee experience of Ukrainians fleeing their country. Thats a direct connection to the experience of my family in Poland, Szyhalski says.

MinnPost photo by Sheila Regan

"Alternative Medicine," 1990

The exhibition was supposed to open in the summer of 2020, but got postponed because of COVID. According to Diane Mullin, senior curator for the Weisman, the exhibition was put together in time for the original opening in 2020, before the COVID-19 works were created. The catalog was not meant necessarily to be before the show, but ends up being this monument before it, she said.

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Working with Szyhalski on how to organize the survey, Mullin says, was a practice of criss crossing and overlapping themes and ideas from across time. Not chronological, nor biographically organized, its instead structured around objects, materials, and thematics.

Courtesy of the Weisman Art Museum

"Plan Your Work"

Often in the exhibition, works made many years ago resonate with the newer works. Looking at a set of postcards he made in Poland in the late 1990s, Szyhalski says he was struck by how much visual language, ideas, and sentiments are shared between his older works and newer works.

For roughly half of my life, I lived in what we described as a communist state. And half my life Ive lived in a capitalist society, Szyhalski said. One of the threads in the exhibition as a whole is acknowledging the complexities of both of those systemic structures, and how similar in many ways they are, especially in the way that they tend to polarize us, tend to dehumanize us, and tend to paint the other as less than us.

Courtesy of the Weisman Art Museum

"You Work, You Eat," 2019, enamel paint on found ceramic plates

Szyhalskis merciless satirical voice emerges from the works. In one linoleum cut print, Alternative Medicine, (1990), a tag that reads alternative medicine pokes through a slit in an old persons throat. His series We Are Working All The Time! (2007-21), repeats the same phrase across multiple screen prints, mocking the notion of tireless overproduction in the series itself.

Perhaps the most chilling work is made of surgical drapes sewn together. At first, the work looks abstract, until you look at it as some kind of mass surgery. The piece evokes the mass carnage of war.

In the exhibition there are giant rollers, sound pieces, and ephemera from Szyhalskis performance art pieces. Whether through objects, imagery or text, Szyhalski sifts through the artifice, calling out with clarity his visceral response to the world.

Piotr Szyhalski: We Are Working All the Time! runs through December 31 at the Weisman Art Museum (free). More information here.

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Piotr Szyhalski depicts living through COVID-19 and other extreme historical phenomena - MinnPost

Chemotherapy is a painful experience. The treatments in general have terrible side effects and it's no secret that the medications used are frequently hazardous to both the patient and the tumour. Because tumours spread so quickly, the theory is that chemotherapy will kill the disease before its side effects kill the patient. That is why, scientists and doctors are always looking for more effective treatments. The findings of the study were published in the Journal of Medicinal Chemistry.

A team led by researchers at UC Santa Barbara, including collaborators from UC San Francisco and Baylor College of Medicine, has identified two compounds that are more potent and less toxic than current leukemia therapies. The molecules work in a different way than standard cancer treatments and could form the basis of an entirely new class of drugs. What's more, the compounds are already used for treating other diseases, which drastically cuts the amount of red tape involved in tailoring them toward leukemia or even prescribing them off-label. "Our work on an enzyme that is mutated in leukemia patients has led to the discovery of an entirely new way of regulating this enzyme, as well as new molecules that are more effective and less toxic to human cells," said UC Santa Barbara Distinguished Professor Norbert Reich, the study's corresponding author.

The epigenome All cells in your body contain the same DNA, or genome, but each one uses a different part of this blueprint based on what type of cell it is. This enables different cells to carry out their specialized functions while still using the same instruction manual; essentially, they just use different parts of the manual. The epigenome tells cells how to use these instructions. For instance, chemical markers determine which parts get read, dictating a cell's actual fate.

A cell's epigenome is copied and preserved by an enzyme (a type of protein) called DNMT1. This enzyme ensures, for example, that a dividing liver cell turns into two liver cells and not a brain cell. However, even in adults, some cells do need to differentiate into different kinds of cells than they were before. For example, bone marrow stem cells are capable of forming all the different blood cell types, which don't reproduce on their own. This is controlled by another enzyme, DNMT3A.

This is all well and good until something goes wrong with DNMT3A, causing the bone marrow to turn into abnormal blood cells. This is a primary event leading to various forms of leukaemia, as well as other cancers. Toxic treatments

Most cancer drugs are designed to selectively kill cancer cells while leaving healthy cells alone. But this is extremely challenging, which is why so many of them are extremely toxic. Current leukemia treatments, like Decitabine, bind to DNMT3A in a way that disables it, thereby slowing the progression of the disease. They do this by clogging up the enzyme's active site (essentially, its business end) to prevent it from carrying out its function. Unfortunately, DNMT3A's active site is virtually identical to that of DNMT1, so the drug shuts down epigenetic regulation in all of the patient's 30 to 40 trillion cells. This leads to one of the drug industry's biggest bottlenecks: off-target toxicity.

Clogging a protein's active site is a straightforward way to take it offline. That's why the active site is often the first place drug designers look when designing new drugs, Reich explained. However, about eight years ago he decided to investigate compounds that could bind to other sites in an effort to avoid off-target effects. Working together

As the group was investigating DNMT3A, they noticed something peculiar. While most of these epigenetic-related enzymes work on their own, DNMT3A always formed complexes, either with itself or with partner proteins. These complexes can involve more than 60 different partners, and interestingly, they act as homing devices to direct DNMT3A to control particular genes. Early work in the Reich lab, led by former graduate student Celeste Holz-Schietinger, showed that disrupting the complex through mutations did not interfere with its ability to add chemical markers to the DNA. However, the DNMT3A behaved differently when it was on its own or in a simple pair; it wasn't to stay on the DNA and mark one site after another, which is essential for its normal cellular function.

Around the same time, the New England Journal of Medicine ran a deep dive into the mutations present in leukemia patients. The authors of that study discovered that the most frequent mutations in acute myeloid leukemia patients are in the DNMT3A gene. Surprisingly, Holz-Schietinger had studied the exact same mutations. The team now had a direct link between DNMT3A and the epigenetic changes leading to acute myeloid leukemia. Discovering a new treatment

Reich and his group became interested in identifying drugs that could interfere with the formation of DNMT3A complexes that occur in cancer cells. They obtained a chemical library containing 1,500 previously studied drugs and identified two that disrupt DNMT3A interactions with partner proteins (protein-protein inhibitors, or PPIs). What's more, these two drugs do not bind to the protein's active site, so they don't affect the DNMT1 at work in all of the body's other cells. "This selectivity is exactly what I was hoping to discover with the students on this project," Reich said.

These drugs are more than merely a potential breakthrough in leukemia treatment. They are a completely new class of drugs: protein-protein inhibitors that target a part of the enzyme away from its active site. "An allosteric PPI has never been done before, at least not for an epigenetic drug target," Reich said. "It really put a smile on my face when we got the result." This achievement is no mean feat. "Developing small molecules that disrupt protein-protein interactions has proven challenging," noted lead author Jonathan Sandoval of UC San Francisco, a former doctoral student in Reich's lab. "These are the first reported inhibitors of DNMT3A that disrupt protein-protein interactions."

The two compounds the team identified have already been used clinically for other diseases. This eliminates a lot of cost, testing and bureaucracy involved in developing them into leukemia therapies. In fact, oncologists could prescribe these drugs to patients off-label right now. Building on success

There's still more to understand about this new approach, though. The team wants to learn more about how protein-protein inhibitors affect DNMT3A complexes in healthy bone marrow cells. Reich is collaborating with UC Santa Barbara chemistry professor Tom Pettus and a joint doctoral student of theirs, Ivan Hernandez. "We are making changes in the drugs to see if we can improve the selectivity and potency even more," Reich said. There's also more to learn about the drugs' long-term effects. Because the compounds work directly on the enzymes, they might not change the underlying mutations causing cancer. This caveat affects how doctors can use these drugs. "One approach is that a patient would continue to receive low doses," Reich said. "Alternatively, our approach could be used with other treatments, perhaps to bring the tumor burden down to a point where stopping treatment is an option."

Reich also admits the team has yet to learn what effect the PPIs have on bone marrow differentiation in the long term. They're curious if the drugs can elicit some type of cellular memory that could mitigate problems at the epigenetic or genetic level. That said, Reich is buoyed by their discovery. "By not targeting DNMT3A's active site, we are already leagues beyond the currently used drug, Decitabine, which is definitely cytotoxic," he said, adding that this type of approach could be tailored to other cancers as well. (ANI)

(This story has not been edited by Devdiscourse staff and is auto-generated from a syndicated feed.)

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