MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

A survey published in 2011 showed that one-third of Danish hospitals offered alternative therapies. In total, 38 hospitals offered acupuncture and one Eye Movement Desensitization and Reprocessing Light Therapy. The most commonly reported reason for offering CAM was “scientific evidence”.

Many readers of this blog might be amazed with both the high level of alternative medicine presence in Danish hospitals and the notion that this was due to ‘scientific evidence’. A recent article provides even more surprises about the Danish alternative medicine scene.

It revealed that 8 out of 10 Danes are interested in using some form of alternative medicine…Some 67 percent of Danes say the national healthcare system should be more open to alternative healing practices, such as homeopathy, acupuncture or chiropractic, and 60 percent would like to see these treatments covered by the public health insurance system. More than half of the 6,000 respondents believe alternative therapies can be just as effective as traditional medicine.

Charlotte Yde, the chairwoman at Sundhedsrådet, which is the umbrella organisation for alternative practitioners in Denmark, contends many Danes feel frustrated because they cannot freely discuss alternative treatment with their doctors. Alternative treatment researcher Helle Johannessen agrees that Danish doctors should openly discuss alternative medicine options with patients. “In other European countries doctors use alternative treatment to a much greater extent than doctors in Denmark,” Johannessen told DR. “[International experience] shows that some forms of alternative therapy can improve quality of life and reduce anxiety and nausea in cancer patients.”

This, it seems to me, is little more than a bonanza of fallacious thinking and misleading information.

  • The notion that popularity of a therapy has anything to do with its usefulness is a classical fallacy.
  • The notion that belief determines efficacy (More than half of the 6,000 respondents believe alternative therapies can be just as effective as traditional medicine.) or vice versa is complete nonsense.
  • The notion that many Danes … cannot freely discuss alternative treatment with their doctors is misleading: patients can discuss what they feel like with whom they feel like.
  • The notion that in other European countries doctors use alternative treatment to a much greater extent than doctors in Denmark is also misleading: there are many European countries where LESS alternative therapies are being paid for via the public purse.
  • Finally, the notion that that some forms of alternative therapy can improve quality of life and reduce anxiety and nausea in cancer patients – even if it were correct – does not mean that ALL alternative therapies are efficacious, safe, or cost-effective.

Who cares about Denmark?

Why should this be important?

Well, the Danes might care, and it is important because it provides an excellent example of how promoters of bogus treatments tend to argue – not just in Denmark, but everywhere. Unfortunately, politicians all too often fall for such fallacious notions. For them, a popular issue is a potential vote-winner. Within medical systems that are notoriously strapped for money, the looser will inevitably be optimal healthcare.

30 Responses to Is there something rotten in the state of Denmark?

  • The ‘cannot freely discuss’ phrase is a cop out. Yes, you can freely discuss and whomever you debate is free to rebut with evidence and logic. Just because you have a belief, does not make it inviolable from criticism.

  • In the UK, the GMC requires that doctors “must not express to your patients your personal beliefs, including political, religious or moral beliefs, in ways that exploit their vulnerability or that are likely to cause them distress.”
    (‘Good Medical Practice’ para 33.)

    Telling a gullible camee (one who uses CAMs) that any perceived benefit is due to placebo effects, not the pills, pricking, pummeling, plants or preternatural powers as they think, might well cause them distress.
    So might suggesting that they use such methods!

    Just what is wrong with intellectual honesty and professional probity?

    “There is no such thing as a free lunch”.
    Nor discussion.

    • So, telling a gullible camee (one who uses CAMs) that any perceived benefit is due to placebo effects. In your opinion, which would that be – a political, religious, or moral personal belief? Most (on this blog, anyway) would consider it fact, based on evidence.

      The GMC allows doctors to express facts, I hope.

      • I would call it theft.

      • Relax Frank, no theft involved. Richard is worried about docs not being able to express personal opinion. Perceived benefit being the result of placebo effects isn’t opinion, it would be fact. So docs should be totally free to say that to patients/camees. (assuming that the GMC allows docs to express facts, of course)

        • @ jm on Thursday 28 July 2016 at 16:29

          As always, cognitive dissonance. Doctors can’t lie to their patients but sCAMmers do it all the time, close to 100% (just to give some benefit of the doubt. it is just like you bruising people with your stick – deception and theft.

        • Frank,

          You’re an odd duck. Let me type it out differently.

          Richard said: docs can’t epxess personal opinion.
          I said: docs should be able to say that any perceived benefit from cam is placebo effect, since that is fact and not opionion. Docs are allowed to state facts.

          Your emotions are getting in the way of your reading again. Try to calm down. Maybe take a few deep breaths. I hear yoga helps, maybe you should give it a shot.

          • @ jm on Friday 29 July 2016 at 07:40

            It wouldn’t matter how many different ways you wrote it, it would still be bullshit by a delusional conman and thief.

          • I say (3 times now) any perceived benefit from CAM is placebo effect. You say bullshit. Prove it, Frank. Show us the evidence that CAM is more than placebo. So far, all you’ve shown is name calling, accusation, and general grumpy-pantsness. (You might need to find a new yoga teacher.)

          • Jm, Thank you for finally conceding that any perceived benefit from Gua Sha, acupuncture, TCM, homeopathy, reiki, et al. — CAM — is placebo effect.

          • Pete

            I’ve never said otherwise – not once have I said there’s any sort of scientific evidence for any of these therapies for treating any disease whatsoever. In fact, I argued against the post about evidence for massage/fibro.

          • @ jm on Friday 29 July 2016 at 15:56

            “I say (3 times now) any perceived benefit from CAM is placebo effect. You say bullshit. Prove it, Frank. Show us the evidence that CAM is more than placebo. So far, all you’ve shown is name calling, accusation, and general grumpy-pantsness. (You might need to find a new yoga teacher.)”

            That is a given; that you do it to fleece people means “it would still be bullshit by a delusional conman and thief”.

          • Frank

            You seem to be stuck on auto-repeat. Yoga doesn’t seem to be working for you. Maybe try a different kind?

            You never explained why a doc can’t tell a gullible camee (one who uses CAMs) that any perceived benefit is due to placebo effects. Since it’s the truth, why can’t they say that?

          • Jm, You have, at last, managed to concede Step 1: That any perceived benefit from Gua Sha, acupuncture, TCM, homeopathy, reiki, et al. — CAM — is placebo effect.

            You have yet to understand, then concede, Step 2: That the perceived benefit from a placebo might be statistically [epistemically] relevant, but clinically [ontologically] irrelevant; what is clinically [ontologically] relevant is both the risk-benefit ratio and the cost-benefit ratio of the placebo — and, of course, the ethics of charging patients for placebo ‘treatments’.

          • You’re wrong there, Pete – on both “steps” as you’re calling them.

            Step 1: In order to concede, I would have had to deny or resist in the first place. I never did. (I still “resist” Edzard’s conclusion that “Therefore the conclusion for those who suffer from FM might well be that massage therapy is worth a try.”)

            Step 2: I think benefit from placebo is both statistically and clinically irrelevant. The only way I think it’s relevant is the waste of money running those studies. There are better uses for money.

            And if you want to talk ethics, that will lead us back to surgeons claiming to know things they don’t have a clue about, the definition of “quack”, and Edzard’s post on AMA ethics guidelines. And the whole massage/FM thing. And a slew of fabricated, misused, or wildly contorted terms from other medical systems (like yin yang theory being a vitalistic concept, for example – there’s no way to even pretend that is accurate).

            So since Frank seems to be in an emotional tizzy and is reading what he wants to read rather than what I wrote – maybe you can answer the question: why a doc can’t tell a gullible camee (one who uses CAMs) that any perceived benefit is due to placebo effects. Since it’s the truth, why can’t they say that?

          • Jm, If the perceived benefits of CAM are due to placebo then what are the risks due to?

          • Pete

            In a recent post, Edzard said “the tolerance of quackery must be one of the most important hallmarks of a quack profession”. Docs that don’t tell a gullible camee (one who uses CAMs) the truth – how is that not tolerance of quackery? I see people all the time who are referred by their docs, and so do the acupuncturists I work with. That goes a bit beyond tolerance, don’t you think? What is that saying about the mainstream medical profession?

            Why can’t a doc tell a gullible camee (one who uses CAMs) that any perceived benefit is due to placebo effects? Richard seems to think that’s personal belief – but since it’s the truth, why can’t they say that? Wouldn’t docs be ethically bound to inform patients of the truth?

          • Jm, Your avoidance of answering my specific questions is telling; as is your years of relentless, pathetic, attempts on this website to discredit those who are fully qualified and licenced to practice [real, 21st Century] medicine.

            You exemplify the hallmarks of both, quack professions, and the apologetics for this quackery.

          • Pete

            Actually it was you who avoided answering a specific question. And you still are. Why can’t a doc tell a gullible camee (one who uses CAMs) that any perceived benefit is due to placebo effects?

            Answer that before we get into why someone qualified and licensed to practice 21st century medicine would think they could make up definitions of an existing therapy. And why you would defend that quackery.

          • @ jm on Sunday 31 July 2016 at 15:02

            “In a recent post, Edzard said “the tolerance of quackery must be one of the most important hallmarks of a quack profession”. Docs that don’t tell a gullible camee (one who uses CAMs) the truth – how is that not tolerance of quackery? I see people all the time who are referred by their docs, and so do the acupuncturists I work with. That goes a bit beyond tolerance, don’t you think? What is that saying about the mainstream medical profession?”

            Putting aside the poor grammar, this has been dealt with before, however, for the benefit of the resident chancroid, let’s do it again;

            Yes, there are some crackpot doctors who believe in this nonsense,
            No, it is not all of them, only a small percentage,
            Yes, it is acceptance of quackery and is unacceptable,
            No, it is not saying all of doctors tolerate that nonsense,
            Yes, all sCAMmers exhibit this trait so the prof is correct,
            Yes, you are trying to draw a very long bow to prove something which does not exist, and,
            Yes, you are still a deluded crackpot who steals from the gullible for bruising their skin while claiming it is efficacious for some illnesses.

            “Why can’t a doc tell a gullible camee (one who uses CAMs) that any perceived benefit is due to placebo effects? Richard seems to think that’s personal belief – but since it’s the truth, why can’t they say that?”

            A doctor should unless s/he is as deluded as you about the nonsense of sCAM.

            “Wouldn’t docs be ethically bound to inform patients of the truth?”

            See last answer.

            There is an expression for people like you, “The lights are on but nobody is home”.

          • Frank

            “A doctor should unless s/he is as deluded as you about the nonsense of sCAM.” Yes, a doctor should. No offense, but your opinions are steeped in a belief in witchraft, acupuncture is attempted murder, things like that. And you tend to read whatever you want into what’s written.

            Richard implied that there’s some actual reality based reason why docs can’t tell a gullible camee (one who uses CAMs) that any perceived benefit is due to placebo effects. So I’m actually looking for a reality based answer.

          • jm on Monday 01 August 2016 at 16:10

            “Yes, a doctor should. No offense, but your opinions are steeped in a belief in witchraft, acupuncture is attempted murder, things like that. And you tend to read whatever you want into what’s written.”

            Witchraft? A new form of water transportation?

            While you are fond of making assertions, may I remind you that you are using Tu Quoque repeatedly, as well regurgitating what others (including me) have said, also repeatedly. Is there any original thought in your head (another rhetorical question alert)? I wish Cognitive Dissonance could be materialised so it could be used to knock some sense into your thick head.

            “Richard implied that there’s some actual reality based reason why docs can’t tell a gullible camee (one who uses CAMs) that any perceived benefit is due to placebo effects. So I’m actually looking for a reality based answer.”

            No, he didn’t. You are taking out of context, as usual. He probably hasn’t responded because he doesn’t want to debate with an idiot. Sadly, I’m more foolhardy (pun intended) than him.

            Off you go now; sCAM some more poor delusional fools with your stick and cause some cosmetic bruising.

          • Frank

            Geez, knocking some sense into my thick head? ANOther threat of violence? What is that, 2 in the past 3 days? Your emotional thing seems to be getting worse. If you’re not ccareful, one of the blood tubes in your brainpan might spring a leack. I thought your yoga teacher would help. Maybe you should go back to that chiro you found so effective.

            Oh, I left you a couple of spare c’s, just in case you need to power up your raft. Use witchever one you want.

  • I am Danish, and I have read the report as well as the article on DR. It should be noted that the list of alternative treatments the repondents could choose from included som not-really-alternative-treatments (Massage, yoga and meditation).

    The 67 % were not 67% of the study population. It was 67 % of those who did not respond “Don’t know” (9-12%). But still a lot of people.

    The question wasn’t if we (Danish Health care providers) should be open to alternative treatment. It was if we should be more open to talk about alternative treatment, which is something completely different.

    I doubt (hope not) this reflects actual experience from patients who tried to speak to a physician about altmed. It is probably more some kind of prejudice.

    Doctors in Denmark as well as elsewhere have no problem with talking about alternative treatment with their patients. It is important to do so, particularly if the alternative treatment involves something that interferes with the conventional treatment being offered. But talking to patients doesn’t necessarily mean endorsement.

    Helle Johannesen makes a point that Danish doctors should familiarise themselves with research results concerning CAM. Even though she is a CAM proponent I agree with that. The books “Trick or Treatment” and “Snake Oil Science” are good starting points, but hardly what Helle Johannesen has in mind 😉

    A new blog on the website belonging to the Danish Medical Association has just been launched. The first post was about pseudoscience as basis of policymaking, and it was very well received, so I believe things are on the move.

    A post about the DR article has been submitted and hopefully will be up soon.

  • Sorry, I could not help digging up some memories.
    I remember Helle J as a very nice young lady, as a member of the COSTB4 EU action working group (European scientific collaboration on research in AltMed) some 20 years ago, time flies. She was a very motivated member from the start. Each country could send two delegates. From the start this COST action was dominated by believers, many of them without any medical degree: sociology, theology (yes! he was the then director of the London Homeopathic Hospital) and as founder and chair a businessman, financed by the Swiss pharma concern Roche, “to investigate the economic possibilities of CAM”.
    Some names have become famous in CAM-land, eg Klaus Linde of the homeopathy articles, and Mathiessen of the anthroposophic university” in Witte-Herdicke and the recent scandalous “Swiss report” on homeopathy.
    Most of them were very nice persons, but very little knowledge of medicine. Belgium delegated me and the chairman of the homeopaths. The first meeting I attended the chairman declared: ” we must investigate how we can promote the use of altmed” . My daring to propose “shouldn’t we first have a look if it works” was met with stunned silence, almost considered blasphemy.
    Helle then seemed totally convinced that CAM was effective, proven beyond doubt.
    She put a lot of work in compiling a database of the “practice and evidence”, gathering a lot of material but sadly omitting a critical evaluation of the quality of what she listed. Is she still working on this ?
    The COSTB4 end report with recommendations for action and was not so bad, considering that almost every line in the text was debated, or fought over. This report is mostly ignored by CAMmers, or very selectively cited. It states that in the future all medicine should be evidence based, though in the final version our theologist-chairman inserted the word “ideally”. 🙂
    The final report can be downloaded from http://bookshop.europa.eu/nl/eur-18420-unconventional-medicine-final-report-of-cost-b4-pbCGNA18420/

    • William

      That report looks quite interesting – I’ve filed it for later reading…

    • Fascinating comment. It appears that the original aim of COST for Unconventional Medicine included cost effectiveness but the effectiveness part is missing from the final report. This was pretty much the infamous Swiss report. I wonder how much work the authors of the Swiss report actually did or was it just a rip off from COST?

      http://cordis.europa.eu/project/rcn/21894_en.html

      In the above ref it states Total Cost 70 000 000 EUR, am I reading this right? Did this cost €70M?

      • Acleron said:

        Fascinating comment. It appears that the original aim of COST for Unconventional Medicine included cost effectiveness but the effectiveness part is missing from the final report. This was pretty much the infamous Swiss report. I wonder how much work the authors of the Swiss report actually did or was it just a rip off from COST?

        You may be interested in this from 2009: Assessing complementary practice. 2009 by Professor Dame Carol Black for the King’s Fund.

        In the above ref it states Total Cost 70 000 000 EUR, am I reading this right? Did this cost €70M?

        I think that means €70 million for all the COST projects together (I hope…).

    • Thank you for the link to the report. I wasn’t aware of its existence, but will definitely read it.

      It is my impression, that HJ understands that specific physiological effects of CAM cannot be demonstrated in properly conducted clinical trials. But from what she says now and then in the Danish media, she either believes that there are specific effects which are undetectable in clinical trials or she is a hard core believer in placedo (a telling term I learned of in Richard Rawlins’ book – Real Secrets of Alternative Medicine). The title of professor gives her some credibility in the eyes of the press.

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