MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

The Swiss interior ministry has yesterday announced its intention to elevate quackery to the same level as conventional medicine.

The 5 therapies were named as

  • homeopathy,
  • holistic medicine,
  • herbal medicine,
  • acupuncture,
  • traditional Chinese medicine

No, this is not an early April fools joke! It might merely a sign that this country is in dire need of some critical thinking.

The 5 therapies will acquire the same status as conventional medicine by May 2017. After being rejected in 2005 by the authorities for lack of scientific proof of their efficacy, complementary and alternative medicines made a comeback in 2009 when two-thirds of Swiss backed their inclusion on the constitutional list of paid health services. As a result of the vote, these treatments are covered by basic compulsory insurance as part of six-year trial period from 2012-2017, during which their efficacy would be examined. The ministry has come to the conclusion that it is impossible to verify the efficacy of these therapies in their entirety. It has therefore opted to accept them on par with other medical disciplines. It plans to continue allowing reimbursements of treatment costs by compulsory health insurance, provided they are administered by certified medical professionals. However, as is the practice for conventional medicine, certain controversial practices under these complementary therapies will be subjected to further scrutiny. The ministry has initiated a consultation process – open until June 30, 2016 – on the proposed modification of the regulations.

There are a few interesting things here:

  1. What on earth is ‘holistic medicine’? It seems to be an umbrella term under which any type of quackery can be included.
  2. The lack of proof of efficacy – which since 20015 has only increased – is over-ruled by a popular vote.
  3. The ministry has come to the conclusion that it is impossible to verify the efficacy of these therapies in their entirety. What does that mean? From a scientific point of view, it means science cannot show that these treatment work, BECAUSE THEY DON’T! But I suspect they did not want to say that. What did they want to say then?
Personally, I wonder what the Swiss will vote into their health service next. Here are a few suggestions – but I am sure my readers have better ones:
  • holidays for citizens who feel ‘under the weather’,
  • clairvoyance,
  • distance healing,
  • botox therapy for wrinkled faces,
  • hair transplants,
  • pet ownership,
  • free champagne for low blood pressure,

Sorry, I just realized that all of the above are already included in the category of HOLISTIC MEDICINE.

72 Responses to It’s official: Switzerland is going holistically round the bend

  • Would be interesting to know what amount and nature of lobbyism has been delivered by the alternative crowd towards the Swiss ministry of interior during the years since the Swiss report scam.

  • It seems to me from the announcements about this that the decision is based on assiduous lobbying and the quacks pointing out that science cannot definitively refute their claims by proving a negative.

  • May be related to legal voluntary euthanasia in the same country 😉

  • Sounds like a politician has eyed that 75% vote and decided that staying in power is more important than the health of his nation.

  • Yet another arguement to leave the EU!
    (I know Swizerland is not in, but why let facts get in the way of opinion?)

    Argumentun ad populum has always been a logical fallacy.
    There was a time most people in Europe would have voted that the Earth is flat – for slavery etc.

    It’s a swiz – hence the country’s new name.

  • Most of it is nonsense but I’m irked by the derision of two things.

    “Holistic medicin”e is simply an umbrella term for medicinal practice that does not differentiate between mental and physical well-being, a division that is not scientifically feasible anyway, but practiced. So yes, that IS an evidence-based approach.
    Elements of psychotherapy must be included or information about mental effects simply not denied, withheld or derided. (Did you know that antibiotics can cause depression? There are groups at risk for it like children and female teenagers. NOBODY gets told this, ever, not as a child, teenager or adult. They get SSRIs later as if it is unrelated.)
    So I’d be careful to make fun of it in advance without knowing how it’s implemented. I see it as an instruction for doctors to not be an arse towards your patients.

    “Being under the weather” is a risk factor for people with chronic inflammation and pain. Amputees, people with huge scars, CFS patients, arthritic and rheumatic pain patients…All those could really use holidays for being under the weather because it really influences them. Some migraine and MS patients also have weather-related symptoms.

    • I have said and written it very often, but for you, I will do it again: ALL GOOD MEDICINE IS HOLISTIC.

      • Yes, IN THEORY. If you have the money for a private doctor, you might actually get it, even! And maybe there are SOME that even do it for normal insurance patients only. It’s a lottery!

        That’s why the reimbursement is the interesting thing here, it allows it and makes doctors more likely to actually provide holistic medicine, anamnesis etc.
        Because if work is not reimbursed doctors cannot get the money for it and will not do it. You know that health insurances can refuse payment if they deem a treatment unreasonable or out of bounds and their catalogues of what to pay and what are patchy and often way outdated.

        • the thing is that what quacks tend to hide under the umbrella of ‘holistic medicine’ is a lot of compassion, time etc. plus quack remedies and treatments.

        • I am a family doctor at the Portuguese NHS. We practice solid, evidence-based, family medicine. We teach and practice a comprehensive, holistic approach to patients. You don’t have to be a private patient to have an holistic approach to your health. And we don’t buy into the woo of “integrated”, “complementary”, “alternative” practice. It is possible, yes.

    • I’m 37 with chronic pain related to 3 badly worn lumbar discs since I was 27. I can attest to that point, if I’m in a happy, contented, or even just ok, the pain running from my back down to my foot doesn’t seem to matter as much. If I’m anyway low the pain just multiplies that feeling.

      • isn’t there evidence from Damasio that if pain is disconnected from “mattering” to the sufferer it can continue with complete tolerance?

  • While working in Switzerland,I was told, that if i cut myself,there was someone I could ring who would stop the bleeding over the phone …so yes,colour me unsurprised !

  • Yes, it is easy to ridicule this decision. But this really shows a failure to communicate, educate and ultimately convince the Swiss people (or at least those who have voted). Switzerland is a well governed, direct democracy with a pragmatic and educated people. If you can’t convince those guys of the evidence, who can you convince? In my opinion you should be sad and do some soul searching to find out what went wrong here!

  • Please read the original article in German language https://www.news.admin.ch/message/index.html?lang=de&msg-id=61140

    Komplementärmedizin soll anderen Fachrichtungen gleichgestellt werden

    Bern, 29.03.2016 – Die obligatorische Krankenpflegeversicherung soll weiterhin komplementär-medizinische Leistungen übernehmen. Das Eidgenössische Departement des Innern (EDI) will die Komplementärmedizin den anderen medizinischen Fachrichtungen gleichstellen und schickt die entsprechenden Verordnungsanpassungen in die Anhörung.

    Volk und Stände haben im Mai 2009 den neuen Verfassungsartikel zur Berücksichtigung der Komplementärmedizin deutlich angenommen. Seit 2012 übernimmt die obligatorische Krankenpflegeversicherung (OKP, Grundversicherung) provisorisch bis 2017 die ärztlichen Leistungen der anthroposophischen Medizin, der traditionellen chinesischen Medizin, der Homöopathie und der Phytotherapie.

    Die Vergütung der Leistungen ist provisorisch und befristet, weil der Nachweis aussteht, dass die Leistungen der vier komplementärmedizinischen Fachrichtungen wirksam, zweckmässig und wirtschaftlich sind. Es hat sich nun gezeigt, dass dieser Nachweis für die Fachrichtungen als Ganzes nicht möglich sein wird. Unter Einbezug der betroffenen Kreise wurde daher ein abgestuftes Verfahren erarbeitet. Neu sollen Fachrichtungen der Komplementärmedizin den anderen von der OKP vergüteten medizinischen Fachrichtungen gleichgestellt werden. Somit sollen sie unter bestimmten Bedingungen (Anwendungs- und Forschungstradition, wissenschaftliche Evidenz und ärztliche Erfahrung, Weiterbildung) dem Vertrauensprinzip unterstellt und Leistungen grundsätzlich von der OKP vergütet werden. Analog zu den anderen medizinischen Fachrichtungen sollen lediglich einzelne, umstrittene Leistungen daraus überprüft werden.

    Zur Umsetzung dieser Zielsetzungen sind Verordnungsanpassungen notwendig, um einerseits zu bestimmen, ob für Leistungen einer bestimmten Fachrichtung das Vertrauensprinzip gelten soll, und andererseits im Umstrittenheitsfall einzelne Leistungen innerhalb einer Fachrichtung nach Kriterien von Wirksamkeit, Zweckmässigkeit und Wirtschaftlichkeit beurteilen zu können.

    Diese Gleichstellung soll neben den vier provisorisch vergüteten Bereichen auch die Akupunktur mit einbeziehen, welche bereits heute unbefristet von der OKP vergütet wird. Das EDI schickt die entsprechenden Verordnungsanpassungen bis am 30. Juni 2016 in die Anhörung.

    Die betroffenen Kreise haben bei den Arbeiten mitgewirkt. Es ist vorgesehen, dass die Verordnungsbestimmungen am 1. Mai 2017 in Kraft treten. Damit wird eine Weiterführung ohne Unterbruch der Vergütung von komplementärmedizinischen Leistungen durch die OKP ermöglicht.

    • Google Translation:

      Bern, 29.03.2016 – the mandatory basic health insurance is to assume remains complementary medical services. The Federal Department of Home Affairs (FDHA) wants to equate the complementary medicine to the other medical disciplines and sends the appropriate regulation adjustments in the hearing.

      Clearly, people and the cantons have adopted the new constitutional article to take account of the complementary medicine in May 2009. Since 2012 the mandatory nursing care insurance, basic health insurance is taking over medical services of anthroposophical medicine, traditional Chinese medicine, homeopathy and phytotherapy provisionally until 2017.

      The remuneration of the services is provisional and temporary, because evidence is, that the services of four complementary medical disciplines are effective, practical and economical. It has now shown that this proof of the disciplines as a whole will not be possible. Therefore a graduated procedure was drawn up with the involvement of interested parties. New fields of complementary medicine should be equated the other medical disciplines remunerated by the organiser. Thus they should be subordinate to the principle of trust and basically from the OKP remunerated services under certain conditions (application and research tradition, scientific evidence and medical experience, continuing education). To check only single, controversial services from analog to the other medical disciplines.

      To implement these objectives, regulation adjustments are necessary to determine whether the principle of trust should apply to services of a certain discipline on the one hand, and on the other hand in the Umstrittenheitsfall individual services within a field of study assessed according to criteria of efficacy, appropriateness and cost-effectiveness.

      This equality should involve also the acupuncture in addition to the four areas of temporarily quenched, which already today indefinitely is remunerated by the organiser. The EDI, please send the appropriate regulation adjustments until on 30 June 2016 at the hearing.

      Stakeholders have participated in the work. It is intended that the provisions of the regulation will enter into force on 1 may 2017. This enables the continuation without interruption of remuneration of complementary medical services by the organiser.

      • I have no idea how those links were embedded in my translation post. They weren’t in the text I copied from Google and I didn’t see them in the original German post yesterday. I apologize for any issues and if anyone can explain how they ended up in the post, PLEASE let me know.

        • It looks like an update to a plugin (JetPack) yesterday caused these videos to be injected randomly into comments. I’ve spent the last couple of hours trying to fix the same problem on another blog – you pointing it out here made me realise it wasn’t just one infected website. Deactivating the plugin has fixed it.

          Sorry about that.

          Admin

      • I am not sure that this autotranslation of the following phrase is correct.
        The phrase “Die Vergütung der Leistungen ist provisorisch und befristet, weil der Nachweis aussteht, dass die Leistungen der vier komplementärmedizinischen Fachrichtungen wirksam, zweckmässig und wirtschaftlich sind”
        To me it means that while evidence is pending that the four alternative disciplines are effective, practical and economical, remuneration of them is provisional and temporary.
        In the autotranslation it might be misunderstood that the “..evidence is that they are…”
        I am only self-learned in German as I chose French as fourth language in high school. (English is second and Danish third in our system)
        Perhaps prof. Ernst can provide a more exact translation?

        • “Die Vergütung der Leistungen ist provisorisch und befristet, weil der Nachweis aussteht, dass die Leistungen der vier komplementärmedizinischen Fachrichtungen wirksam, zweckmässig und wirtschaftlich sind”
          MY TRANSLATION:
          The reimbursement of the services is provisional and time-limited because the proof is lacking that the services of the 4 complementary fields are effective, utile and economical.

  • Herbal???? The majority of pharmaceutical drugs have a chemical backbone derived from a biological source. They have been tweaked to affect different properties, e.g. Salicylic acid, derived from the willow tree and used by people for hundreds of years in the treatment of pain but with the side effect of an upset tummy. Modern pharma comes along and adds an acetyl group and voila u have aspirin! And don’t get me started on cannabis!!

    • According to friend of mine who specialized in organic chemistry, salicylic acid does not occur in the bark of willow. However, it does occur in the herb meadowsweet (Filipendula ulamaria), the bark of sweet birch (Betula papyrifera), and the leaves of wintergreen (Gaultheria procumbens). Formerly known as spiraeic acid, salicylic acid was first isolated from Spiraea sp. Whereas salicin shares in having analgesic effects with those of salicylates, it also occurs in popular (Populus spp.), including American aspen (P. tremuloides), as well as the bark of willow (Salix spp.). Salicylic acid is made by heating sodium phenolate with carbon dioxide under pressure. In turn, Aspirin is created by the treatment of salicylic acid with acetic anhydride.

  • This isn’t science, it’s self-interest. “Dear Swiss citizen, if you or any of your friends or family use or are likely ever to use in the future any of the treatments listed below would you like a/ to pay for it yourself, or b/ have the government pay for it instead?” I wonder how many nanoseconds it would take before most people ticked ‘b’? Science isn’t a democracy.

  • Switzerland is a top-medicine country. Novartis is there, Roche is there, the WHO is there, top hospitals are there.. they won a few nobel prizes, top bio/med research is done there.. while traveling to Switzerland I met highly-educated, tolerant people and saw great hospitals.

    If these guys say yes who on the world would say no?

    • david said:

      If these guys say yes who on the world would say no?

      Any who value science and evidence over quackery.

      But the usual cry from homeopathy fans is that Big Pharma actively suppress homeopathy because they’re frightened news of this ‘miracle’ will get out and put them out of business. If they can’t control it in their own country…

    • The referendum was won by a large middle class that has gotten used to all kinds of ‘natural healers’ and will happily see this included in the (for them) reasonably priced basic insurance packages.
      There is a small loophole in the wording that may allow the government to block the worst quackery but largely, they are caving in to the popular opinion.

      the only upside is that only homeopathy prescribed by actual medical doctors is reimbursed – quackery-inclined doctors perhaps but still with some idea of patients safety.

  • I have to say that I’m a bit surprised the list didn’t include Emmental cheese.

  • There is a strong drive in all of the pharmacies to go in first with homeopathy .. my wife often goes to the pharmacy in CH and comes back with packets of tablets that are usually ‘phytotherapy’ which is at best poorly QA’d allotherapy

  • Now you’re using ‘quackery’. Oh no, there’s no bias in your objective science based head. You just like to use meaningless, loaded, inherently biased terms instead. Do you have any insight? If all medicine either works or doesn’t, and if it doesn’t it is ‘quackery’ and I presume you want to save the NHS money and people unnecessary pain; then I look forward to an article on breast cancer screening. I’d hate to think that you were simply an ignorant or a hypocrite?

    • This might help you understand something that is really quite straightforward: Ernst is slagging off homeopathy, yet pharmaceuticals kill 100k a year.

      • Ernst expertise isn’t ‘alternative medicine’ (as he states to claim in that piece) he knows next to nothing about it. Can he tell me about any of the ancient texts of Chinese medicine… I doubt he can, let alone in any detail. His expertise(appears to be) in looking at statistical trials and giving his (rather jaded) opinion. Secondly, he claims there is only medicine that works ie no ‘alternative medicine’ therefore by his own admission he shouldn’t create any boundaries.

        Ernst is as much an ‘expert’ on alternative medicine as an armchair watcher of Match of the Day is an expert on football.

        • There is often the claim that somebody knows nothing about x, y or z because they may or may not be aware of some arcane and irrelevant detail. The promoter of this completely misses the point either deliberately or accidentally. Does the supposed remedy work?

          • Thank you for agreeing with my point, and this is what Edzard always says. Now, his claim to not want to investigate ‘conventional medicine’ whatever the **** that means; is as hollow as it sounds. (See post that I was referred to)

          • Lol, no, I was not agreeing with you. After all, you were the one who reckons that ancient Chinese texts have any revelance to modern methods of science and medicine. Do they have the concept of double blinding of clinical trials or do they have the detailed statistical analysis invented in the 20th century?

  • Yeah I thought you only accidentally agreed with me (you did). ‘It’s not I who claims to be an expert in ‘alternative medicine’ whatever the **** THAT means. Ernst does so he should know what he’s talking about. To claim they have no ‘relevance’ is frankly ridiculous. Oh, and do stop going on about effing statistics as though that’s the final word in medicine. Statistics is a VERY small part of the curriculum at medical school (and I’ve been there).
    Ps Ernst, I know you’re reading these.

  • Ps I successfully passed my membership exams for Emergency medicine and, from memory, statistics was worth 5 marks out of 100. There were NO questions on results of clinical trials in any of the exams. So stop making out its the be-all and end-all: it’s not. Only ‘statisticians think medicine is all DBRCT. Real practicing doctors know most of medicine works on risk vs potential benefit and maximising ‘placebo effect’ aka therapeutic encounter (be nice to patients, listen to them, empathise, etc etc)

    • No, ancient Chinese, Egyptian, Indian or indeed any other regions’ ideas of medicine have little relevance to modern medicine.

      If you do not understand that risk benefit ratios are derived by the very statistics you are ignorant of, I can quite understand why you feel the need to go to vague texts that are self contradictory such that almost anything goes.

      As you appear a little low in the comprehension stakes let me make it very plain.
      If homeopathy does not work in the highest quality clinical trials, then any knowledge of Hahnemann and his Organon is irrelevant. Professor Ernst has studied these modalities and is certainly an expert in them. He is aware of the most essential fact of any of them, they don’t work. Any hearkening back to some ludicrous text is just misdirection.

      • I’ll give you an example: most of medicine is actually ‘placebo effect’; what Voltaire described as ‘amusing the patient until time heals the patient’; or more accurately described as therapeutic encounter. Yet ‘statisticians’ disparage it, try to ‘eliminate’ it and generally see it as a nuisance. Therein lies a fundamental reason why no patient wants to see a statistician, why doctors spend little time studying it and why statistics is just 5% of medicine. Statistics is just an imperfect tool for measuring some of the effects of medicine. Stop elevating it above its station.

        • you seem to have indeed spent very little time studying anything – not even Voltaire!

        • Dan keown says “most of medicine is actually ‘placebo effect’”. Which shows how much he knows about medicine.

          Anaesthetics, antimicrobial agents, antiarryhthmics, antidiarrhoeals, antineoplastic agents, anticoagulants, and adrenocortical steroids certainly don’t work by placebo effects: and they’re just the drug classes that begin with ‘a’.

          The red herring garbage about statistics is just nonsense. Of course no patient wants to see a statistician and statistics is a minority component of medical training (I’m surprised it amounts to 5%!). But if you want to research medical outcomes you have to use statistics as a tool. “Stats is not medicine as if it was you’d need a stats degree for medicine.” Humbug. You don’t need a degree in anatomy, physiology, pathology or any other component of medical education for medicine

          • Yeah, what do I know? I’ve only got a degree in it, specialist qualifications in Emergency medicine, practiced it 20 years, degree in Chinese medicine, best selling book on acupuncture. But, yeah, what do I know compared to you, heh? You’re the armchair expert aren’t you. What would someone who’s lived breathed and changed medicine over the last 20 years know?

          • “Yeah, what do I know? I’ve only got a degree in it, specialist qualifications in Emergency medicine, practiced it 20 years, degree in Chinese medicine, best selling book on acupuncture.”

            Your immense wisdom just doesn’t show through your comments here. I guess you come here in your Mr Hyde persona.

  • Your comments (in context) are idiotic. They almost appear to have been written by an algorithm they are that stupid. Are you a doctor? I sincerely doubt it. Stop pretending you have the faintest idea you know anything about medicine, or ‘self-contradictory’ texts. Stats is not medicine as if it was you’d need a stats degree for medicine.

  • I notice Ernst is quiet. Is he on holiday? Or does he just accept that his language betrays an innate bias.

  • Bjorn, that link is broken.
    May I suggest if it makes no logical sense to you to ignore them. The fact you and others resort to that line of argument suggests you have none.
    The fact is, that, this entire forum can’t handle a little challenge to its comfortable hive-mind fanboy world. Instead of challenging my statements: Ernst doesn’t display bias and internal inconsistencies with the use of the words ‘quackery’ and ‘alternative medicine’ (original post) because…
    it just goes off on one.
    Meanwhile Edzard is conspicuous by his absence, and, oh, acupuncture gets more and more popular.

    • Edzard is not conspicuous by his absence! On the contrary, I am very active on my own blog. but the thing is that, as I stated before, I find it a waste of time to argue with people like you who insist on substituting reason with fallacies, smoke-screens and nonsense.

    • The link still works fine from here.
      If anyone is interested in seeing the self-aggrandizement of a science dropout and can’t use the link I gave, just type in this URL into your browser:

      http://www.getwell.space/about/

      • Works here.

        Strange how some people can get a medical qualification and never realise how all that knowledge they were taught was first obtained.

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