MD, PhD, FMedSci, FSB, FRCP, FRCPEd

To include conventional health care professionals amongst those who significantly contribute to the ‘sea of misinformation’ on alternative medicine might come as a surprise. But sadly, they do deserve quite a prominent place in the list of contributors. In fact, I could write one entire book about each of the various professions’ ways to mislead patients about alternative medicine.

There are, of course, considerable national differences and other peculiarities which render each specific profession quite complex to evaluate. The material is huge - far to big to fit in a short comment. All I will therefore try to do with this post is to throw a quick spotlight on some of the mainstream professions mentioning just one or two relevant aspects in each instant.

Nurses

Particularly in North America, many nurses seem to be besotted with ‘Therapeutic Touch’, an implausible and unproven ‘energy-therapy’. For instance, the College of Nurses of Ontario includes Therapeutic Touch as a therapy permitted for its members. In other regions, other alternative treatments might be more popular with nurses but, in general, many seem to have a weakness for this sector. Researchers from Aberdeen  recently conducted a survey to establish the use of alternative medicine by registered nurses, as well as their knowledge-base and attitudes towards it. They sent a questionnaire to 621 nurses and achieved a remarkable response rate of 86%. Eighty per cent of the responders admitted to employ alternative medicine and 41% were using it currently. Only five nurses believed that alternative medicine was not effective and 74% would recommend it to others. In other words, there is a strong likelihood of patients being misinformed by nurses.

Midwives

A recent article in the UK journal THE PRACTISING MIDWIFE (Sept 2013) by Valerie Smith (not Medline-listed) claimed that the Royal College of Midwives supports the use of homeopathic remedies during childbirth. This does come to no surprise to those who know that several surveys have suggested that midwives are particularly fond of un- or dis-proven therapies and that they employ them often without the knowledge of obstetricians. We investigated this question by conducting a systematic review of all surveys of alternative medicine use by midwives. In total,19 surveys met our inclusion criteria. Most were recent and many originated from the US. Prevalence data varied but were usually high, often close to 100%. Much of this practice was not supported by sound evidence for efficacy and some of the treatments employed had the potential to put patients at risk. It seems obvious that, in order to employ unproven treatment, midwives first need to misinform their patients.

Physiotherapists

Some physiotherapists promote and practise a range of unproven treatments, e.g. craniosacral therapy. I am not aware of statistics on this, but it is not difficult to find evidence on the Internet: One website boldly states that Physiotherapy & Craniosacral Therapy available with Charetred Physiotherapist with 20 years of experience in the NHS. Another one proudly announces:  Our main methods of treatment are through Physiotherapy and Craniosacral Therapy. A third site claims that Craniosacral Therapy is attracting increasing interest for its gentle yet effective approach, working directly with the body’s natural capacity for self-repair to treat a wide range of conditions. And a final example: Catherine is a registered Cranio-Sacral Therapist, a Physiotherapist, and is a tutor at the London College of Cranio-Sacral Therapy.  She is also qualified in acupuncture for pain relief and a member of the Craniosacral Therapy Association, the Chartered Society of Physiotherapy and Acupuncture Association for Chartered Physiotherapists.

Pharmacists

If you go into any pharmacy in the UK, you do not need to search for long to find shelves full of homeopathic remedies, Bach flower remedies, aromatherapy-oils or useless herbal slimming aids, to mention just 4 of the many different bogus treatments on offer. If you do the same in Germany, France, Switzerland or other countries, the amount of bogus remedies and devices for sale might even be greater. Pharmacists, it seems to me, have long settled to be shopkeepers who have few scruples misleading their customers into believing that these useless products are worth buying. Their code of ethics invariably forbids them such promotion and trade, but most pharmacists seem to pay no or very little attention. The concern for profit has clearly won over the concern for customers or patients.

Doctors

I have left my own profession for last – not because they are the least contributors to the ‘sea of misinformation, but because, in some respects, they are the most important ones. The general attitude amongst doctors today seems to be ‘I don’t care how it works, as long as it helps my patients’. I have dedicated a previous post on explaining that this is misleading nonsense; therefore there is no reason to not repeat myself. Instead, I might just mention how many doctors practice homeopathy thus misleading patients into believing that it is an effective therapy. Alternatively, I could refer to those charlatans with a medical degree who promote bogus cancer cures. In my view, misinformation by doctors is the most serious form of misinformation of them all: physicians involved in such activities violate their ethical code and betray patients who frequently trust doctors almost blindly.

Conclusion

It would be a misunderstanding to assume that, with this post, I am accusing all conventional health care professionals of misinforming us about alternative medicine. But some clearly do; and when they do abuse their positions of trust in this way, they do a serious disservice to us all. I hope that exposing this problem will contribute to conventional health care professionals behaving more responsibly in future.

7 Responses to Drowning in a sea of misinformation. Part 11: Conventional health care professionals

  • Andrew says:

    Dr Ernst

    thank you very much for this series. I am delighted to see you identify flaws in each profession and their potential mis-information. Although your primary concern is with mis-information in the public sphere in some respects my concern would be the extent of misinformation within the professions that remains hidden from public view but is perpetuated via delivery form those with perceived authority or eminence. All of the professions you site are vulnerable to this although some maybe more than others. However without critical comment demanding that a standard of some sort is upheld too much of this stuff is not challenged or the challenge is not sustained enough to engender change.

    Thank you for taking your time to do it

    Now may others read it

    ANdy

  • William says:

    I’ve got an idea for your next round of articles:
    List all or even examples of treatments that work every time, having numerous “robust” RCTs to support them. Then we can just pick from your list and be done with it.

    • Edzard says:

      good idea!
      i’ll do that; but first let me study pharmacology etc. then I might be able to speak authoratively on that. until then, I am merely an expert on alternative medicine.
      and why “every time”; did you not know about probabilities, statistics etc.?

      • George says:

        Dr. Ernst I m trying to really comprehend your comment :

        “The general attitude amongst doctors today seems to be ‘I don’t care how it works, as long as it helps my patients’. I have dedicated a previous post on explaining that this is misleading nonsense; ”

        Do you mean that if the mechanism of action is unknown MDs should not suggest an x therapy ,method , medication ?

        (In your previous comment you did not talk about mechanism of action but about evidence. )

          • George says:

            For instance, for depression, the mechanism of action of antidepressants is unknown.

            I would not imagine that you consider anti depressants as placebo therapy ——that’s why I m asking.

  • Irene says:

    Pharmacists often deplore the practices of their employers, who mostly these days are large corporate entities such as Walgreens, DVS, and all the box stores (Target, WalMart, Costco) that have pharmacies in their stores, but are fairly powerless to stop it. I speak of North America, but I imagine it’s similar in UK/Europe. I’d like to see pharmacists rise up, organize, and go out on strike until these practices stop, but I won’t hold my breath. Meanwhile, being the little old meddling lady that I am, I walk through the aisles and turn all the quack remedies around or push them behind others. It’s a tiny gesture, but it makes me feel better.:-)

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