MD, PhD, FMedSci, FSB, FRCP, FRCPEd

It almost goes without saying that alternative practitioners contribute importantly to the ‘sea of misinformation’ about alternative medicine. Again, I could write books about this subject but have to refrain myself and therefore will merely put quick spotlights on several types of practitioners, mostly drawing from my own research on these subjects.

Acupuncturists

A survey of more than 9000 patients of U.K. non-medically trained acupuncturists showed that a considerable number had received advice from their therapists about prescribed medicines. Since these acupuncturists hold no medical qualifications, they are not qualified to issue such advice. It is therefore clear to me that the advice given is likely to be misleading. In 2000, we directly asked the U.K. acupuncturists’ advice about electro-acupuncture treatment for smoking cessation, a treatment which we previously had identified to be ineffective. The advice we received was frequently not based on current best evidence and some of it also raised serious safety concerns (Schmidt, K., & Ernst, E. Internet advice by acupuncturists—a risk factor for cardiovascular patients? Perfusion,2002, 15: 44-50. Article not Medline-listed).

Chiropractors

Many chiropractors from the UK and other countries make unsustainable therapeutic claims on their websites. In 2002, at the height of the ‘‘MMR scare’’ in Britain, we conducted a study revealing that a sizable proportion of U.K. chiropractors advised mothers against having the measles-mumps-rubella (MMR) jab for their children. A survey of the U.K. chiropractors demonstrated that an alarming percentage of the U.K. chiropractors fail to provide advice about the risks of spinal manipulation before commencing treatment. As these risks are, in fact, considerable, this behaviour amounts to misinformation and is an obvious violation of medical ethics.

Osteopaths

With osteopaths, it is a very similar story; the main difference is that there are far less investigations than for chiropractors. This may be due to the fact that, in the US, osteopaths are not alternative but conventional clinicians with much the same training and skills as proper doctors. But in Europe, they are strictly alternative and make as many bogus claims as chiropractors. Systematic investigations are rare, but I only need to remind us of my recent blog-post where I pointed out that:

Most osteopaths treat children for a wide range of conditions and claim that their interventions are helpful. They believe that children are prone to structural problems which can be corrected by their interventions. Here is an example from just one of the numerous promotional websites on this topic:

STRUCTURAL  PROBLEMS, such as those affecting the proper mobility and function of the  body’s framework, can lead to a range of problems. These may include:

  • Postural – such as scoliosis
  • Respiratory  – such as asthma
  • Manifestations of brain  injury – such as cerebral palsy and spasticity
  • Developmental  – with delayed physical or intellectual progress, perhaps triggering learning  behaviour difficulties
  • Infections – such  as ear and throat infections or urinary disturbances, which may be recurrent.

OSTEOPATHY can assist in the prevention of health problems, helping children to make a smooth  transition into normal, healthy adult life.

Herbalists

Encouraging evidence exists for some specific herbs in the treatment of some specific conditions. Yet, virtually no good evidence exists to suggest that the prescriptions of individualized herbal mixtures by traditional herbalists across the globe generate more good than harm. Despite this lack of evidence, herbalists do not seem to offer this information voluntarily to his or her patients. When we directly asked the UK herbalists for advice on a clinical case, we found that it was ‘‘misleading at best and dangerous at worst’’ . In other words, herbalists misinform their patients and the public about the value of their treatments.

Homeopaths

Many non-medically trained homeopaths advise their clients against the immunization of children. Instead, these practitioners often recommend using ‘‘homeopathic vaccinations’’ for which no good evidence exists. For instance, the vice-chair of the board of directors of ‘‘The Society of Homeopaths’’ had a site with the following statements: ‘‘Homeopathic alternatives to children’s immunisation are now available.’’ ‘‘Our clinic offers alternative immunisation programmes for the whole family.’’ Such statements amounts to misinformation which puts children’s health at risk.

Other alternative practitioners

I have chosen the above-listed professions almost at random and could have selected any other type as well. Arguably, all alternative practitioners who employ unproven treatments – and that must be the vast majority – misinform their patients to some extend. The only way to avoid this is to say: ‘look, I am going to give you a therapy for which there is no good evidence – I hope you don’t mind’. If they did that, they would be out of business in a flash. It follows, I think, that being in business is tantamount to misleading patients.

And there is, of course, another way of misinforming patients which is often forgotten yet very important: withholding essential information. In all of health care, informed consent is a ‘sine qua non’. Alternative practitioners very rarely obtain informed consent from their patients. The reason seems obvious (see above). I would argue that not informing people when they should be informed is a form of misinformation.

In this context, it is worth mentioning an investigation we did in 2009: We obtained the ethical codes of the following bodies: Association of Naturopathic Practitioners, Association of Traditional Chinese Medicine (UK), Ayurvedic Practitioners Association, British Acupuncture Council, Complementary and Natural Healthcare Council, European Herbal Practitioners Association, General Chiropractic Council, General Osteopathic Council, General Regulatory Council for Complementary Therapies, National Institute of Medical Herbalists, Register of Chinese Herbal Medicine, Society of Homeopaths, UK Healers, Unified Register of Herbal Practitioners. We then extracted the statements from these codes referring to evidence-based practice (EBP). The results showed that only the General Chiropractic Council, the General Osteopathic Council and the General Regulatory Council for Complementary Therapies oblige their members to adopt EBP.

Conclusion

It seems that misinformation is an alternative practitioner’s daily bread. Without it, alternative therapists would need to confine their practice to the few treatments/conditions for which the evidence is positive. If they ever followed this strategy, they would hardly be able to earn a living.

11 Responses to Drowning in a sea of misinformation. Part 12: Alternative practitioners

  • Thank you for another informative article. If an alternative therapy results in great harm, wouldn’t a “patient” be able to sue the practitioner? Is there some sort of a loop-hole they are taking advantage of in order to stay out of lawsuits?

    • yes, of course!
      but in my experience cause and effect are often difficult to prove ‘beyond reasonable doubt’. I have been expert witness in cases where things seemed quite obvious but clever lawyers got the practitioner off the hook.

  • As I continued to study the best evidence about acupuncture and TCM herbal medicine (in addition to learning more about medical ethics), I found that there were fewer conditions I was willing to treat, that I was doing acupuncture in a more ‘defensive’ manner by using shorter, thinner needles which were inserted very shallowly, and that ultimately I could only say that acupuncture “reduces your perception of pain.”
    Even with those changes, I realized that some of my patients continued to have strong beliefs about what acupuncture/I could do for them. Often these beliefs were implausible and would only distract and deceive them from taking other healthcare and lifestyle options more seriously. For example, one older woman continually insisted I do her “blood sugar point” and “weight loss point” despite my telling her that the best evidence shows acupuncture doesn’t make a difference in those things other than increasing her resolve to exercise more and eat better.
    For a while, I kept doing acupuncture with the excuse that it was better for people who wanted acupuncture to come to me than go to some of the more sCAMmy people around. But as I continued to be disappointed with the anti-science and anti-sense even prominent members of the TCM profession demonstrate, I realized that doing acupuncture at all promotes the whole mess, no matter what I believe inside. That is not what I want to do for my life’s work.

  • Dr Ernst, it’s interesting that you choose to cherry pick one part of the acupuncture survey that fits your own perception of events. I suggest that anyone who hasn’t already made up their mind on the subject clicks on the link and reads the whole paper, which makes strong case for the safety of acupuncture as practised by non-NHS practitioners – in fact, ‘Patients not funded by the NHS were *less* [my emphasis] likely to report adverse events’:

    ‘Our secondary objective to establish whether patients are at risk because they are consulting acupuncturists was not supported by the evidence from this study. We received reports of adverse but non-serious consequences related to advice about conventional (prescribed) medication from only six patients and delayed conventional treatment from only two.’

    When you say ‘It is therefore clear to me that the advice given is likely to be misleading’, where is your evidence for this? You seem to be displaying just the sort of non-scientific, belief-based response that you criticize Peter Hain for. The evidence, as presented in the study to which you refer, suggests that the overwhelming majority of the advice given (to the 3% of patients who received it at all) produced absolutely no adverse effects, and not a single case of serious consequence. I’m speculating, but perhaps some/most of it was even useful?

    As an acupuncturist, I regularly give ‘advice’ to my patients about medication. For example, when their symptoms are improving, they sometimes ask whether they should discontinue or reduce their medication. I routinely advise them to discuss it with their GP – presumably this would result in those patients ticking the box saying they’d received advice on medication from me? It isn’t clear to me from the paper whether respondents were asked to differentiate between being told ‘Stop your medication’, and being told ‘You may be able to reduce your medication – talk to your GP’. The latter is certainly what is taught in accredited acupuncture schools in this country, during the solid grounding we are given as standard in Western medicine, and I suggest this may account for many of the 3% who received advice on medication. After all, 58% of this sub-group did also consult their GP – perhaps they were advised to?

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