Summary of alternative therapies
These summaries are taken almost verbatim from the book Trick or Treatment by Simon Singh and Edzard Ernst [see above]. Their conclusions are based on the best reviews available [many from the Cochrane Collaboration]. Their Website is being developed at present.
General Advice on alternative therapies: [quoted verbatim]: Too many alternative therapists remain uninterested in determining the safety and efficacy of their interventions. these practioners also fail to see the importance of rigorous clinical trials in establishing proper evidence for or against their treatments. and where evidence already esists that treatments are ineffective or unsafe, alternative therapists will carry on regardless with their hands firmly over their ears.
     Despite this disturbing situation, the market for alternative treatments is booming and the public is being misled over and over again, often by misguided therapists, sometimes by exploitive charlatans,
     We argue that it is now time for the tricks to stop, and for the real treatments to take priority. In the name of honesty, progress and good healthcare, we call for scientific standards, evaluation and regulation to be applied to all types of medicine, so that patients can be confident that they are receiving treatements that demonstrably generate more good than harm.
     If such standards are not applied to the alternative medicine sector, then homeopaths, accupuncturists, chiropractors, herbalists and other alternative therapists witll continue to prey on the most desperate and vulnerable in society, raiding their wallets, offering false hope, and endangering their health.

Accupuncture
Accupuncture is an ancient system based on the noton that health and wellbeing react to the flow of a life force (Ch'i) through pathways (meridians) in the human body. Accupuncturists place fine needles into the skin at critical points along the meridians to remove blockages and to encourage a balanced flow of the life force. they claim to be able to treat a wide range of diseases and symptoms.
    Conclusions: The traditional principles are deeply flawed, as there is no evidence at all to demonstrate the existence of Ch'i or meridians. The reviews show that it is no more effective than placebo for any condition except possibly for some types of pain and nausea [and here the evidence is only borderline].

Chiropractic Therapy
A form of treatment developed at the end of the nineteenth century, which involves manual adjustments of the spine. Although some chiropracters focus on treating back pain, many others also treat a whole range of common illnesses, such asthma. The underlying theory claims that manipulating the spine is medically beneficial because it can influence the rest of the body via the nervous system.
    There are 2 groups of chiropracters: 'Straight' chiropracters are fundamentalists who believe in 'subluxations' and 'innate intelligence' and the ability of spinal manipulation to treat all diseases. 'Mixers' concentrate on problems directly related to the spine.
    Conclusions: In summary, the scientific evidence suggests that it is only worth seeing a chiropracter if you have a back problem. Even then, Singh and Ernst offer this important advice if considering a visit to a chiropracter:
1. Do not use a 'straight chiropracter' (identified by their claims with respect to anything other than back problems).
2. If the problem is not resolved (or no further improvement is obvious) within 6 sessions then stop and consult your doctor for advice. Chiropracters have a reputation for lengthy and expensive treatments.
3. Do not allow a chiropracter to become your primary healthcare provider. Note that many carry the title of Doctor but this does not mean they have graduated from medical school; it generally means Doctor of Chiropractic.
4. Avoid chiropractors who rely on unorthodox techniques for diagnosing patients, such as applied kinesiology [these practioners are usually 'straight' chiropractors].
5. Check the reputation of your chiropractor. They have been shown to be markedly more likely to be involved in malpractice, fraud and sexual transgressions than are medical doctors.
6. Try conventional treatments before turning to a chiropracter for back pain. they are likely to be cheaper and just as effective.
Risks associated with Chiropractic therapy: these can be considerable and should be considered very seriously especially if a child is involved. There is an excellent extensive discussion of these risks [and of other alternative therapies] in Trick or Treatment.

Herbal Medicine
Herbal medicine is one of the oldest and most widespread form of treatment; it involves the use of plants and plant extracts in the treatment and prevention of a whole range of diseases. Based on local plants and traditions, it continues to play a major role in healthcare in Asia and Africa. In recent decades, herbal medicine, (also called phytotherapy) has become one of the fastest growing forms of treatment in the rest of the world.
    Conclusions: By contrast with accupuncture, homeopathy and chiropractic manipulation, there is no doubt that some herbal medicine is effective. Much of modern pharmacology has evolved from the herbal tradition. Note that the word drug comes from the Swedish word druug meaning dried plant.
     What has to be considered here is the difference between scientific develpment of herbal extracts and what might be called 'alternative herbal medicine'. Alternative herbal therapists continue to believe that Mother Nature knows best and that the whole plant provides the ideal medicine, whereas scientists believe that nature is just a starting point and that the most potent medicines are derived from identifying and sometimes manipulating key components of a plant.
   Most alternative herbal medicines have not been tested for efficacy or safety to the same level as have conventional drugs. We have to ask: which herbal remedies work, and are they safe. There are valuable Tables summarising results of studies on 30 herbal remedies and aspects of their safety in Trick or Treatment [some are listed in the Table below].
    It should be noted that for many diseases and conditions there are no effective herbal remedies, including: cancer, diabetes, multiple sclerosis, osteoporosis, asthma, hangover and hepatitis.

Some myths unravelled
Vitamin C prevents colds; it does not.
The Cochrane plain language summary:  "Regular ingestion of vitamin C had no effect on common cold incidence in the ordinary population. However, it had a modest but consistent effect in reducing the duration and severity of common cold symptoms. In five trials with participants exposed to short periods of extreme physical stress (including marathon runners and skiers) vitamin C halved the common cold risk. Trials of high doses of vitamin C administered therapeutically, starting after the onset of symptoms, showed no consistent effect on either duration or severity of common cold symptoms. However, only a few therapeutic trials have been carried out, and none have examined children, although the effect of prophylactic vitamin C has been greater in children. One large trial with adults reported equivocal benefit from an 8 g therapeutic dose at the onset of symptoms, and two trials using five-day supplementation reported benefit. More trials are necessary to settle the possible role of therapeutic vitamin C, meaning administration immediately after the onset of symptoms".

Chondroitin and glucosamine for arthritis (From David Colquhoun's site : Chondroitin doesn’t work April 8th, 2007)·
"Sales of chondroitin and glucosamine are a worth billions of dollars, but the evidence that they work has never been good. A new meta-analysis of clinical trials now shows that chondroitin on the symptoms of osteoarthritis is “minimal or nonexistent”. (Reichenbach S and others. Meta-analysis: Chondroitin for osteoarthritis of the knee or hip. Annals of Internal Medicine 146:580-590, 2007]. It is the same old story. Early trials were small and badly-designed. They seemed to show some effect, which was wildly exaggerated by the supplement hucksters to push sales. Eventually somebody does the trials properly, and it is found that there is little or no benefit.
Glucosamine shows a similar trend. Glucosamine is a synthetic chemical, but it is not a licensed medicine in the UK. It is marketed as a “food supplement”, not as a drug. It is not approved for prescription on the NHS. The latest Cochrane review does not entirely rule out some benefit, but again the effects seem to get smaller as the trials get better.

Omega-3 PUFA (as in Fish oil and some vegetable oils) and cognitive function
The results of the available studies show no benefit for cognitive function with omega-3 PUFA supplementation among cognitively healthy older people. Omega-3 PUFA supplements may have other health benefits, and consumption of fish is recommended as part of a healthy diet.
Link to full Cochrane review.

Omega-3 PUFA for prevention of cardiovascular disease
The Cochrane review shows that it is not clear whether dietary or supplemental omega 3 fats (found in oily fish and some vegetable oils) alter total deaths, cardiovascular events (such as heart attacks and strokes) or cancers in the general population, or in people at risk of, or with, cardiovascular disease. When the analysis was limited to fish-based or plant-based, dietary or supplemental omega 3 fats there was still no evidence of reduction in deaths or cardiovascular events in any group.
Link to full Cochrane review.

Fish oil capsules and children’s IQ
No evidence of any effect. The possibility of an effect  has become part of general knowledge as a result of a so-called trial in which Durham school children were given capsules in periods before GCSE exams to see if their results were better than predicted. This was an uncontrolled and farcical experiment whose results were kept secret (no effect). This is described in full in Goldacre’s book and the subject well-aired on his website.

Antioxidants. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases
This is a good example of a thorough Cochrane review. Its conclusion is: The current evidence does not support the use of antioxidant supplements in the general population or in patients with various diseases. Link to this Cochrane Review.
I have included the full summary of conclusions to illustrate the thoroughness of the Cochrane reviews.
     "The present systematic review included 78 randomised clinical trials. In total, 296,707 participants were randomised to antioxidant supplements (beta-carotene, vitamin A, vitamin C, vitamin E, and selenium) versus placebo or no intervention. Twenty-six trials included 215,900 healthy participants. Fifty-two trials included 80,807 participants with various diseases in a stable phase (including gastrointestinal, cardiovascular, neurological, ocular, dermatological, rheumatoid, renal, endocrinological, or unspecified diseases). A total of 21,484 of 183,749 participants (11.7%) randomised to antioxidant supplements and 11,479 of 112,958 participants (10.2%) randomised to placebo or no intervention died. The trials appeared to have enough statistical similarity that they could be combined. When all of the trials were combined, antioxidants may or may not have increased mortality depending on which statistical combination method was employed; the analysis that is typically used when similarity is present demonstrated that antioxidant use did slightly increase mortality (that is, the patients consuming the antioxidants were 1.03 times as likely to die as were the controls). When analyses were done to identify factors that were associated with this finding, the two factors identified were better methodology to prevent bias from being a factor in the trial (trials with ‘low risk of bias’) and the use of vitamin A. In fact, when the trials with low risks of bias were considered separately, the increased mortality was even more pronounced (1.04 times as likely to die as were the controls). The potential damage from vitamin A disappeared when only the low risks of bias trials were considered. The increased risk of mortality was associated with beta-carotene and possibly vitamin E and vitamin A, but was not associated with the use of vitamin C or selenium. The current evidence does not support the use of antioxidant supplements in the general population or in patients with various diseases".

PQQ as a nutritional supplement
History PQQ (Pyrroloquinoline Quinone) was first discovered as the prosthetic group (coenzyme) of enzymes oxidising sugars and alcohols in bacteria. As more enzymes that use PQQ in this way were discovered they become the subject of International Symposia. The first was in 1988. (I organised one in Southampton in 2002, published in Biochim. Biophys. Acta, Vol 1647, 2003).  
      Enzymes that use PQQ are called quinoproteins. These are analogous to flavoproteins in which riboflavin derivatives take the place of PQQ. Flavoproteins are essential oxidising enzymes in mammals which cannot make riboflavin; this is therefore a vitamin and must be present in the diet. If PQQ-containing enzymes occur in humans then PQQ is likely to be a water soluble B vitamin. However there is no evidence for such enzymes in humans and there is no evidence that PQQ is a vitamin.

Is PQQ a vitamin? In 2003 the Journal Nature published a paper claiming on wrongly interpretated data that PQQ is a new vitamin. This received wide publicity and led to hopeful development of PQQ as a vitamin (by, amongst others) Mitsubishi company. When I pointed out to Nature the completely false foundation (based on misinterpretation of molecular biology databases) they agreed that they must publish a rebuttal both of the molecular biology conclusions (by me) and the nutritional conclusions by Rucker. This led Mitsubishi to market PQQ as a nutritional supplement rather than a vitamin. The story of all this is described at length in my research pages, which include references and downloadable pdfs.

The marketing of PQQ as a nutritional supplement PQQ is now marketed widely as a supplement with claims for a wide range of benefits. These claims are based on many nutritional investigations of PQQ and many studies on the effect of PQQ in isolated cells or tissues or whole experimental animals (mice and rats). The website claims of the marketers are often factually incorrect, wildly exaggerated and have many misunderstandings about biochemistry and physiology.
       For unbiased examination of supplements I strongly recommend the website Examine.com which is an "independent organization that presents un-biased research on supplements and nutrition. We currently have over 25000 references to scientific papers". This is an excellent website that examines claims for nutritional supplements and has a lengthy valuable discussion of PQQ.

PQQ and health. Response to an article in Life Extension Magazine Feb 2011
"Generate Fresh Mitochondria with PQQ.  Scientists Discover the “Other CoQ10”.  By Perry Marcone
Link to the original article
     I am writing this response at some length. The same responses are relevant to many PQQ sellers

The article quotes important work by Rucker and colleagues. In early studies, he showed that germ-free mice fed chemically-defined diets thrived more if provided with PQQ. He has been at the forefront of this sort of work and his paper relating PQQ to mitochondrial genesis is the one quoted by the article in Life Extension. We should note that this paper studied the effect of PQQ on isolated cell cultures of mouse liver cells. It requires a lot of extrapolation to conclude that PQQ may have an effect on mitochondrial generation in humans and even more to conclude that PQQ as a nutritional supplement will have an effect on ageing. But of course it may achieve this.
     It should be remembered that even if PQQ does have such effects this is not evidence that it has a ‘normal’ role in human physiology – it is probably only acting as a ‘drug’. By its chemical nature it reacts powerfully with free radicals and so is an antioxidant. [Also note that there is no evidence that antioxidants in the diet have any benefit at all].

Some specific comments on the article:
The paragraphs in italics are taken direct from the article, given in the order in which they appeared.
  
1. The most exciting revelation on PQQ emerged early in 2010, when researchers found it not only protected mitochondria from oxidative damage—it stimulated growth of fresh mitochondria!
This refers to the Rucker study which used liver cells in tissue culture. This is important interesting work but it does not show that dietary supplementation with PQQ in animals/humans will lead to mitochondrial production.

2. Pre-clinical studies reveal that when deprived of dietary PQQ, animals exhibit stunted growth, compromised immunity, impaired reproductive capability, and most importantly, fewer mitochondria in their tissue. Rates of conception, the number of offspring, and survival rates in juvenile animals are also significantly reduced in the absence of PQQ. Introducing PQQ back into the diet reverses these effects, restoring systemic function while simultaneously increasing mitochondrial number and energetic efficiency.
     Note that to see these effects animals were often reared in extreme unnatural conditions [that is ok as this was the ‘cleanest’ way of showing effects]. Less effect is likely to be seen in animals if given PQQ in normal conditions. This is not surprising because there is a lot of PQQ in many foods, especially if bacteria have been involved in their production; for example vinegar has a lot of PQQ because it is made using bacteria that use a PQQ quinoprotein to oxidise alcohol to the active component of vinegar – acetic acid.

3. As the primary engines of almost all bioenergy production, the mitochondria rank among the physiological structures most vulnerable to destruction from oxidative damage. PQQ’s formidable free radical–scavenging capacity furnishes the mitochondria with superior antioxidant protection.
Firstly, we should not confuse mitochondrial activity with regeneration [the subject of Rucker’s paper].
      Free radicals are inescapable occasional products of reaction with oxygen in the final step in energy production. We have evolved thus far by avoiding damage by these free radicals which are happily mopped up by mitochondrial enzymes with that sole purpose. There is no reason to think that “superior antioxidant protection” is needed.

4. At the core of this capacity is an extraordinary molecular stability. As a bioactive coenzyme, PQQ actively participates in the energy transfer within the mitochondria that supplies the body with most of its bioenergy (like CoQ10).
      This is completely untrue. Although it is true that coenzyme Q actively participates in energy transfer within mitochondria, PQQ has not been shown to have any function whatsoever in mitochondria. In bacteria it does have this function.  During methanol oxidation for example the first step in energy production is catalysed by a PQQ containing enzyme that is so important that it constitutes 5-10% of the cell’s protein. PQQ enzymes have only been described in bacteria.
  
  5. Unlike other antioxidant compounds, PQQ’s exceptional stability allows it to carry out thousands of these electron transfers without undergoing molecular breakdown. It has been proven especially effective in neutralizing the ubiquitous superoxide and hydroxyl radicals…….. A consistent finding in the scientific literature is that nutrients like PQQ provide more wide-ranging benefits than conventional antioxidants the general public relies on.
      As mentioned above, PQQ is a powerful antioxidant and it is stable and so of course will ‘neutralise’ free radicals. But there is no evidence that this ability of PQQ can be relevant to health. There is good evidence that antioxidants in the diet have no positive health benefit and may have slight negative effect. This is published as a Cochrane Review.  

6. According to the most recent research, “PQQ is 30 to 5,000 times more efficient in sustaining redox cycling (mitochondrial energy production) . . . than other common [antioxidant compounds], e.g. ascorbic acid.”   
       This is terrible. Redox cycling is a chemical process that was proposed as a way of measuring PQQ in a test tube. It not relevant in any way to “mitochondrial energy production”.

7. In a revolutionary advance, an essential coenzyme called pyrroloquinoline quinone or PQQ has been shown to induce mitochondrial biogenesis—the growth of new mitochondria in aging cells!
     PQQ is not an essential coenzyme in animals [see above]. The studies of PQQ and mitochondrial genesis that stimulated this article were on liver cells in lab culture, NOT ageing cells, or whole animals or humans.

Comments provoked by website of Dr Al Sears
"Vitamin by any other name"
  "Those diet dictocrats are at it again… We have strong evidence that there’s a nutrient that really should be classified as a vitamin. Why don’t you know about it and why isn’t it currently called a vitamin? Because they want to make a drug out of it so they can patent it and profit from it"
Really! His website is selling PQQ with claims for all sorts of medical effects. This would not be allowed if it were being marketed as a drug (as nothing has been properly tested or proven). As nutritional supplement he also cannot make his claims on the bottles but he does it on this website. He sells huge numbers of supplements and sells many books.

As with other websites the claims of the marketers are often factually incorrect, wildly exaggerated and have many misunderstandings about biochemistry and physiology.
The questions that must be considered:
Is there any evidence that PQQ is essential in the human diet?
Is the nutritional evidence on lab animals relevant?
Is there any evidence that PQQ has a ‘normal’ role in human metabolism?
To what extent can conclusion based on studies of isolated cells be used as a basis for nutritional supplementation. 
Some facts
There is a huge amount of information about the ‘natural’ role of PQQ in bacterial enzymes.
There is relatively little evidence for PQQ ever having a normal role in biochemistry or physiology of humans.
The concentrations of PQQ measured in humans are tiny.
Studies of rats with a low PQQ diet have a very special diet that contains tiny amounts of residual PQQ that is very much lower than in any normal diet without added PQQ (such as we would typically eat). The rats with added PQQ are given amounts of PQQ that are more than 100 times (g/Kg body mass) that are sold as supplements (typically 20mg).
PQQ is certainly a powerful anti-oxidant because it can remove free radicals. This is ‘merely’ a result of its orthoquinone structure. It does not mean that it has any normal function in this respect.
Mitochondria have their own antioxidant system for removing free radicals that might damage them.
There is no evidence that antioxidants in the diet are a good thing. In fact there is evidence that they may be harmful.
Much of the literature on PQQ as a potential supplement and as being important in normal metabolism is funded by those with a huge commercial interest as suppliers of PQQ (eg Mitsubishi); this is of course does not suggest the science is poorer for this (although the scientists may be richer).

There have been no controlled proper studies on effects (good or bad) of dietary PQQ supplements.
In my judgement
There is no reason to think that PQQ supplements will do good or harm.
Most effects seen in mammalian systems are using PQQ as an experimental ‘drug’ and do not prove that it has any physiological function.
The majority of claims for benefits in PQQ marketing were not made by those publishing the work that is quoted as evidence.

TOP    

QUACKWATCH (highly recommended)

Badscience.net Ben Goldacre's site, with text of his excellent Guardian column too.

Health Watch (UK)

Sense about Science an independent charitable trust to promote good science and evidence in public debates.

ebm-first.com:  A nice site about the follies of CAM run by an Edinburgh housewife who has suffered from it

The James Randi Educational Foundation

The Sceptical Preacher.  Sean Kehoe's site. It has had some good stuff recently

UK Skeptics' forum. A new UK forum

Little Atoms. Website of "Little Atoms" Radio show, broadcast fortnightly on Fridays from 16:30 to 17:30 on Resonance 104.4 FM . Little Atoms is a live discussion show, Produced and presented by Neil Denny and Richard Sanderson. Little Atoms explores the science of politics and the politics of science. Download their mp3s.

Skeptico  Critical thinking for an irrational world

The National Council Against Health Fraud (USA)

The Scientific Review of Alternative Medicine (SRAM) (Editor Wallace Sampson)

ADbusters (see especially the spoof adverts gallery)

Science Jokes

The world of Richard Dawkins

The skeptic's dictionary

The skeptics' society

CrankDotNet: cranks, crackpots, kooks and loons on the net

The skeptics annotated bible

Francis Wheen's Top 10 Delusions

The Toadstool Millionaires: A Social History of Patent Medicines in America before Federal Regulation, James Harvey Young

The Medical Messiahs: A Social History of Health Quackery in Twentieth-Century America James Harvey Young

Boffin productions  Greetings cards for Scientists, Mathematicians, Free-thinkers and Sceptics

REASON Rationalists, Empiricists And Skeptics Of Nebraska

Some links to delusional sites that illustrate how the far the CAM lobby has penetrated the National Health Service

The NHS Alliance A goldmine of misinformation

NHS Trusts Association

The NHS CAM library

The Research Council for Complementary Medicine

The Prince�s Foundation for Integrated Health Some of the wackiest views on the web.