MD, PhD, FMedSci, FSB, FRCP, FRCPEd

The WHO is one of the most respected organisations in all of health care. It therefore might come as a surprise that it features in my series of institutions contributing to the ‘sea of misinformation’ in the area of alternative medicine. I have deliberately selected the WHO from many other organisations engaging in similarly misleading activities in order to show that even the most respectable bodies can have little enclaves of quackery hidden in their midst.

In 2006, the WHO invited Prince Charles to elaborate on his most bizarre concepts in relation to ‘integrated medicine’. He told the World Health Assembly in Geneva: “The proper mix of proven complementary, traditional and modern remedies, which emphasises the active participation of the patient, can help to create a powerful healing force in the world…Many of today’s complementary therapies are rooted in ancient traditions that intuitively understood the need to maintain balance and harmony with our minds, bodies and the natural world…Much of this knowledge, often based on oral traditions, is sadly being lost, yet orthodox medicine has so much to learn from it.” He urged countries across the globe to improve the health of their  populations through a more integrated approach to health care. What he failed to mention is the fact that integrating disproven therapies into our clinical routine, as proponents of ‘integrated medicine’ demonstrably do, will not render medicine better or more compassionate but worse and less evidence-based. Or as my more brash US friends often point out: adding cow pie to apple pie is no improvement.

For many years during the early 2000s, the WHO had also been working on a document that would have promoted homeopathy worldwide. They had convened a panel of ‘experts’ including the Queen’s homeopath Peter Fisher. They advocated using this disproven treatment for potentially deadly diseases such as malaria, childhood diarrhoea, or TB as an alternative to conventional medicine. I had been invited to comment on a draft version of this document, but judging from the second draft, my criticism had been totally ignored. Fortunately, the publication of this disastrous advice could be stopped through a concerted initiative of concerned scientists who protested and pointed out that the implementation of this nonsense would kill millions.

In 2003, the WHO had already published a very similar report: a long consensus document on acupuncture. It includes the following list of diseases, symptoms or conditions for which acupuncture has been proved-through controlled trials-to be an effective treatment:

Adverse reactions to radiotherapy and/or chemotherapy
Allergic rhinitis (including hay fever)
Biliary colic
Depression (including depressive neurosis and depression following stroke)
Dysentery, acute bacillary
Dysmenorrhoea, primary
Epigastralgia, acute (in peptic ulcer, acute and chronic gastritis, and gastrospasm)
Facial pain (including craniomandibular disorders)
Headache
Hypertension, essential
Hypotension, primary
Induction of labour
Knee pain
Leukopenia
Low back pain
Malposition of fetus, correction of
Morning sickness
Nausea and vomiting
Neck pain
Pain in dentistry (including dental pain and temporomandibular dysfunction)
Periarthritis of shoulder
Postoperative pain
Renal colic
Rheumatoid arthritis
Sciatica
Sprain

If we compare these claims to the reliable evidence on the subject, we find that the vast majority of these indications is not supported by sound data (a fuller discussion on the WHO report and its history can be found in our book TRICK OR TREATMENT…). So, how can any organisation as well-respected globally as the WHO arrive at such outrageously misleading conclusions? The recipe for achieving this is relatively simple and time-tested by many similarly reputable institutions:

  • One convenes a panel of ‘experts’ all or most of whom have a known preconceived opinion in the direction on has decided to go.
  • One allows this panel to work out their own methodology for arriving at the conclusion they desire.
  • One encourages cherry-picking of the data.
  • One omits a meaningful evaluation of the quality of the reviewed studies.
  • One prevents any type of critical assessment of the report such as peer-review by sceptics.
  • If criticism does emerge nevertheless, one ignores it.

I should stress again that the WHO is, on the whole, a very good and useful organisation. This is precisely why I chose it for this post. As long as it is big enough, ANY such institution is likely to contain a little niche where woo and anti-science flourishes. There are far too many examples to mention, e.g. NICE, the NIH, UK and other governments. And this is the reason we must be watchful. It is all to human to assume that information is reliable simply because it originates from an authoritative source; the appeal to authority is appealing, of course, but it also is fallacious!

 

27 Responses to Drowning in a sea of misinformation. Part 6: The World Health Organisation, WHO

  • Interesting that you say the WHO stepped back; homeoquacks are still promoting work from the homeopathy debate as “proof” that the WHO recommends homeopathy (of course the paper they cite was written by a homeopath). Is there an official statement or position paper form the WHO that explicitly states that homeopathy is inappropriate for people with real diseases?

  • Edzard, great series, this latest one in particular. If you have the opportunity, please also take a look at the WHO’s stance on e-cigarettes: a minimally harmful technology which many smokers are currently switching to, but which the WHO is advising people not to use.

    This is in the face of an increasing body of science which underscores the safety of e-cigarettes relative to tobacco smoking (and in absolute terms). The WHO have obfuscated on this issue over and again, particularly over nicotine. In one particularly bizarre case they actually claimed that cigarettes are safer because “they have a filter so nicotine does not travel so deep into the lungs”.

    The WHO’s stance on this is contributing to a climate of fear which is deterring smokers from adopting these products. Further, it is causing governments to clamp down on them, stymying an innovation with huge potential to tackle the enormous harms of smoking. In this way the WHO and others are actively endangering smokers’ health.

    For a useful précis of the general issues, Peter Hajek’s recent Lancet article is a good place to start.

  • http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)67159-0/fulltext

    “The acupuncture report stated that acupuncture had been shown to be effective in controlled clinical trials for more than a score of conditions, including bacillary dysentery and leucopenia. The evidence does not support such claims, said Betz. The acupuncture report and now the homoeopathy report are evidence that “WHO has been infiltrated by missionaries for alternative medicine”, Betz said.
    The 40-page draft on homoeopathy, entitled Homoeopathy: review and analysis of reports on controlled clinical trials, states that the “majority” of peer-reviewed scientific papers published over the past 40 years “have demonstrated that homoeopathy is superior to placebo in placebo-controlled trials and is equivalent to conventional medicines in the treatment of illnesses, in both humans and animals.”
    The report describes the findings of a selected group of systematic reviews, meta-analysis, controlled trials, cost-effectiveness and outcome studies, observational studies. Almost all of the studies cited support the practice of homoeopathy.
    Edzard Ernst, professor of complementary medicine at the Peninsula Medical School (Exeter, UK), said the draft “seems overtly biased, ie, it is based on data that are positive while ‘forgetting’ the negative studies and systematic reviews.”
    The randomised clinical trials cited, he said, “all happen to be positive; they are not the most rigorous ones, not the most recent. This does not inspire the reader to think the WHO report was even intended to be objective.”
    “I find it terribly worrying”, he added, “because WHO shouldn’t be promoting homoeopathy as it did acupuncture.””

    This is what I found…It also mentions you Dr. Ernst.

    • Yes, that draft is discussed in the blog post you were replying to. Did you also notice that the WHO has not published it?

      • They have not published anything as WHO – not as individuals about homeopathy to the best of my knowledge – it is a controversial matter among WHO – so it is not easy to say something definite –

        I know you are fantasizing that all scientists regard alt medicine as crap – but this is not the case – so far ..

        • homeopathy “is a controversial matter among WHO” ??? how do you know that?
          evidence please!

        • George, what do you think of the statement made on behalf of the director of the WHO Department of Child and Adolescent Health and Development (a statement that the WHO director-general’s office says “clearly express[es] the WHO’s position”) that they “have found no evidence to date that homeopathy would bring any benefit to the treatment of diarrhoea in children…Homeopathy does not focus on the treatment and prevention of dehydration – in total contradiction with the scientific basis and our recommendations for the management of diarrhoea”?

          • Is s/he the organization WHO or a person? It is a personal statement with some weight – you don’t believe the lancet ?

          • If a statement “clearly express[es] the WHO’s position”, then, clearly, it is clearly expressing the position of the organisation.

            So, where does this leave your much-vaunted paper about childhood diarrhoea?

          • As for what was written in the [i]Lancet[/i], you do realise that a statement that “WHO has been infiltrated by missionaries for alternative medicine” doesn’t actually support your cause, don’t you?

        • George: Homeopathy is nonsense, that is not remotely controversial!

  • George, somehow you are a moving target. I would be very interested to have your comments on my posting in the sea of misinformation #2 thread about homeopathy.

    • I replied but I will duplicate my response to this thread – things got messed up…

      Mojo – I have no ……cause – it is it really hard to believe – if you have a cause –the lancet comment just shows the diversity of the opinions in the WHO. One might call these different views whatever name – but they exist – according to the Lancet…

      • George, I suggest you look up the definitions of the words “infiltrate” and “missionary”.

        • Whatever name you call them – the journal says they exist (-ed) in the WHO and that.s why they created this “biased” draft..

          I think you have to accept this fact – denying it does not help – you still can regard your views as valid – no matter what…After all it does not prove Homeopathy- it shows only a diversity of opinions in the WHO..

          At that time,,

          ,maybe by now they have fired all and there is no problem.

          • OK George. If we accept your assertion that the WHO has been infiltrated by significant numbers of “missionaries for alternative medicine”, what does this say about the 2003 paper about homoeopathy for the treatment of diarrhoea in children you have been pushing, given that in 2009 the WHO’s position was that they “have found no evidence to date that homeopathy would bring any benefit to the treatment of diarrhoea in children”?

  • This is an opinion and its weight is really limited. S/he is not the pope.

  • Currently I’m a Health and Wellness Psychology doctoral student writing my dissertation on health literacy in acupuncture. I’m having a very hard time explaining how the public can be literate on the decision to adopt acupuncture into their life. So, I’m looking at the acupuncture practitioner’s insights on this matter. I’m doing a Delphi study to see what their “expert” consensus is on what’s needed for literacy. It troubles me that I’m using research on something that is quackery. Too late to pull away from the time and work invested thus far, I also have one more migraine in which much of my data from WHO is junk, which is the backbone to knowing the existing research out there. While all this troubles me, I do appreciate this and it’s helping, if nothing more, to make the case that there’s no such thing as literacy for acupuncture.

  • Every spring, when the cows are let out for the first time after a long winter, their joy and satisfaction is not to be mistaken. They run around hopping and dancing, throwing their behind about, waving their tails and kicking their hind legs into the air.

    Similarly the AltMed crowd is overcome with joy these days over The “WHO Traditional Medicine Strategy 2014 – 2023″ which was published in December 2013. They are touting this windfall as a clear attestation from the topmost medical authority that their peddling of potions and patient-prodding is to be taken seriously.
    The document is an interesting read, not the least from a public health perspective. It is, like the WHO definitions of the terms involved, obviously put together by people very very interested in alternative medicine and uncritical about the contents of what they choose to call “Traditional and complementary medicine (T&CM)”.

    There is abundant cherry-picking and many half truths in this overlong opus. For example their reporting (in Box 10) of the prevalent use, acceptance, and official ratification in Switzerland of certain alternative therapies is missing very important points thereby creating the false illusion that the so called PEK evaluation led to sanctioning of these methods, which it did not. As we know they were only temporarily reinstalled into the public health insurance scheme until 2015. Renewal was explicitly made conditional on the appearance of convincing evidence to support such expenditure.

    They fleetingly (Box 5) mention a list of problems with T&CM without any further discussion. In figure 6 one can see that almost all member states list the lack of research data as a problem. But nowhere do the authors acknowledge these as important problems and there is no inkling of this in the concluding proposals.
    The ease, low cost and lack of control of the new internet-medias have caused an explosive demand to fill the ever growing need for health miracles. This growing demand is repeatedly referred to by the authors at WHO, apparently to support the message they wish to confer.
    The last part, “Strategic objectives, strategic directions and strategic actions” contains no indication of critical thinking towards any of the methods of T&CM.
    The whole work is obviously based on lack of doubt that traditional medicine is full of useful and efficacious goods for the people of this world. None of the proposed objectives or strategies involve facilitation, promotion or financing of research into the applicability of different T&CM methods. The authors do not seem to have any reasonable restrictions as to what constitutes useful and efficacious methods. Even if they do not provide a comprehensive list, many are mentioned, even impossible constructions like homeopathy seem to be taken seriously.

    I believa this excerpt catches well the essence of this work (from part 4):

    Strategic actions for Member States:
    1. Recognize TM as a resource that could contribute to the improvement of
    health care services, particularly PHC, and that TM is relevant to improved
    health outcomes.
    2. Explore how T&CM might be integrated into the national health service
    delivery system based on national capacities, priorities, relevant legislation
    and circumstances, and on evidence of safety, quality and effectiveness.
    3. Encourage the development of appropriate health facilities for T&CM
    public health services by ensuring key health system elements are in place
    for integration.
    4. Ensure equitable consideration for safe and effective T&CM in existing
    insurance coverage and in national health reimbursement models.
    Strategic actions for partners and stakeholders:
    1. Promote mutual respect, collaboration and understanding between
    conventional and T&CM practitioners.
    2. Promote international communication among practitioner communities
    regarding integrative models.
    Strategic objectives, strategic directions and strategic actions 5
    WHO Traditional Medicine Strategy
    3. Promote research on the cost-effectiveness of integrating T&CM approaches.
    4. Promote continuing education, evaluation, evidence and research into
    T&CM practices.
    5. Involve nongovernmental organizations and the for-profit sector, including
    health reimbursement systems where appropriate, in the above objectives.
    Strategic actions for WHO:
    1. Develop or update WHO technical documents and tools on integrating
    T&CM into national health systems. This includes access to safe and
    qualified T&CM services, T&CM terminology and the inclusion of T&CM
    in the International Classification of Diseases. Support Member States in
    identifying models and approaches for integration of T&CM into health
    systems.
    2. Organize education and training workshops for policy makers and T&CM
    practitioners.
    3. Collect and disseminate information on integrating T&CM into national
    health systems.
    4. Bring together T&CM professional associations and conventional medicine
    groups to promote the safe and effective use of the former.

    This is yet another indication of the rising influence of the CAM industry in institutions and government.

    Something is rotten in the state of WHO.
    The aphorism from Hamlet, originally referring to the state of Denmark, seems fitting well to the questionable state of WHO.

    • Björn Geir said:

      As we know they were only temporarily reinstalled into the public health insurance scheme until 2015. Renewal was explicitly made conditional on the appearance of convincing evidence to support such expenditure.

      Not quite correct! Homeopaths have until the end of 2015 to provide good evidence that homeopathy meets the key criteria of ‘efficacy, appropriateness and cost-effectiveness’ or it will be removed form the State reimbursement scheme in 2017. For further details, see: That ‘neutral’ Swiss homeopathy report.

      The Swiss Government were looking to commission a well-respected international organisation to do the necessary research into this. I strongly suspect they now have no need. If my guess is correct, it’ll be interesting to see the homeopaths squirm in 2017!

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