MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Nobody really likes to be criticised; it can be painful. Painful but often necessary! Criticism produces progress. Criticism is therefore important. So, let’s think about criticism for a moment.

Obviously I am not talking of criticism such as ‘YOU ARE AN IDIOT’. In fact, that’s not criticism at all; it’s an insult. I am also not thinking about criticism like ‘YOUR ARGUMENT IS IDIOTIC’. I prefer to focus on criticism that is constructive, well-argued and based on evidence.

In healthcare, there is plenty of that type of criticism – luckily, I hasten to add. Its aim is to improve healthcare of the future. We need criticism to make progress. Without it, things come to a standstill or regress. This is why all the major medical journals are full of it, and many medical conferences are entirely or partly focussed on such aspects . For instance, frequently-cited papers in the BMJ, Lancet, NEJM, etc. point out that:

  • much of the current medical research is unreliable,
  • many therapies in current use have severe adverse effects,
  • patients frequently do not get the optimal treatment in a timely fashion,
  • modern medicine is too often inhumane.

The hope is that by disclosing these and many other deficits, appropriate actions can be found and taken to improve the situation and make progress. This process is hardly ever straight forward. All too often it is slow, inadequate and impeded by logistic and other obstacles. Therefore, it is crucial that constructive criticism continues to be voiced. Many clinicians, researchers and other experts have dedicated their lives to this very task.

Now, let’s look at the realm of alternative medicine.

There is certainly not less to criticise here than in conventional medicine. So, are all the journals of alternative medicine full of criticism of alternative medicine? Are there regular conferences focussed on criticism? Are alternative practitioners keen to hear about the weaknesses of their beliefs, practice, etc.?

The short answer is, no!

Yet, advocates of alternative medicine are, of course, not adverse to voicing criticism. In fact, they criticise almost non stop – at least this is the impression I get from reading their comments on this blog and from continually discussing with them since 1993.

But there is a fundamental difference: they criticise (often rightly) conventional medicine, and they criticise those (sometimes rightly) who criticise alternative medicine. When it comes to criticising their own practices, however, there is an almost deafening silence.

In my view, these differences between alternative and conventional medicine are far from trivial. In conventional medicine:

  • There is a long tradition of criticism.
  • Criticism is published and discussed prominently.
  • Criticism is usually well-accepted.
  • Criticism is often taken on board and appropriate action follows.
  • Criticism thus can and often does lead to progress.

By contrast, in alternative medicine almost nothing of the above ever happens. Criticism is directed almost exclusively towards those who are outside the realm. Criticism from the inside is as good as non-existent.

The consequences of this situation are easy to see for everyone, and they can be dramatic:

  • The journals of alternative medicine publish nothing that could be perceived to be negative for the practice of alternative medicine.
  • Self-critical thinking has no tradition and has remained an almost alien concept.
  • The very few people from the ‘inside’ who dare to criticise alternative practices are ousted and/or declared to be incompetent or worse.
  • No action is taken to initiate change.
  • The assumptions of alternative medicine remain unaltered for centuries.
  • Progress is all but absent.

It is time that the world of alternative medicine finally understands that constructive criticism is a necessary step towards progress!

51 Responses to The role of criticism in the realm of alternative medicine

  • Noted and agree. Those who practice interventions that are not regulated should rise to the occasion and become members of the regulated professions or find a path to merge with them.

  • I am sure that camists who practice camistry are only too well aware of the veracity of the above criticisms.
    But camistry in its manifold guises represents a conglomerate of faiths.
    Faith in supernatural forces, paranormal influences, unidentified force field operations (UFFOs), imaginary non-existent anatomical constructs (INACs such as meridians, subluxations), spirits, gods etc.

    Faiths cannot be criticised as such – they would not be faith based if it was possible for them to be rationally and scientifically analysed.
    The really worrying trend is for camists (and those institutions and individuals who endorse them) to seek to have their faiths imposed on patients and practitioners of scientific evidence based medicine under the guise of ‘integrating’ the ‘best of both worlds’.
    Those policies most certainly must be criticised for the harm they are doing to scientific medicine.
    Cow pie with apple pie your Royal Highness, Mr Dean, College administrator, journal editor?

    Professor Ernst helpfully provides us with a new, refreshed, definition of ‘alternative medicine’ (CAM/camistry):

    “‘Alternative medicine’ encompasses healthcare practices characterised by:
    Journals publishing nothing that could be perceived to be negative for the practice of alternative medicine; no tradition of self-critical thinking – which remains an almost alien concept; those few people from the ‘inside’ who dare to criticise alternative practices are ostracised instead of being encouraged to initiate rational inquiry; there is no action to initiate change in any of the practices; the assumptions of the domain of ‘alternative medicine’ remain unaltered for centuries, and scientific evidence-based progress is all but absent.”

    Let camists and their supporters criticise that definition if they can!

    (Setting aside the progress of the damaging insurgency represented by ‘integrative or integrated medicine’.)

  • It occurred to me on reading this post that the biggest problem faced by CAM practitioners is that, if they indulge in self-criticism, their raison d’être is likely to collapse. The prospect of losing everything a homeopath (say) has trained for by accepting the obvious criticism that homeopathic medicines contain nothing and don’t have any clinical effect makes it unlikely that self-criticism of homeopathy will ever occur.

    By contrast, a dermatologist, an audiologist or an orthopaedic surgeon (say) can freely criticize a medicine, a device or a procedure they use — even to the point of abandoning said medicine, device or procedure — without ceasing to be a dermatologist, an audiologist or a surgeon.

    Where we have seen (frequently on this blog) self-criticism is in the field of chiropractic. I’m sure ‘Critical_Chiro’ and ‘Logos-Bios’, among others, will post comments on this thread. They have told us repeatedly they accept ‘subluxations’, vitalism and anti-vaxx ideas promoted by some chiropractors are untenable concepts. Chiros often argue that their best procedures (whether rigorously proven or not) are even being adopted by physiotherapists, which seems to give them some legitimacy. But the minute someone asks them why then they don’t all become physios, they dissemble.

    Do we need two versions of physiotherapy? I think not. But the title ‘chiropractor’ is perceived as superior to ‘physiotherapist’ because the former permits the assumption of titles like ‘physician’ and ‘doctor’ — in some countries even with official government blessing — while the title of ‘physiotherapist’ ranks along with ‘nurse’, ‘midwife’ etc. as subordinate to physicians/doctors.

    My bottom line is that we can’t expect serious self-criticism of their central beliefs from any type of camist (practitioner of CAM; ©Richard Rawlins) because the act of self-criticism is suicidal to their status. Yet it is precisely those central beliefs that attract so much criticism from skeptics.

    • “It occurred to me on reading this post that the biggest problem faced by CAM practitioners is that, if they indulge in self-criticism, their raison d’être is likely to collapse,” stated Frank. Such may be true in some paramedical disciplines, but not in chiropractic. Myriad published studies have demonstrated dubious practices within chiropractice which have been largely eliminated from mainstream practice. Admittedly, there are pseudoscientific clinicians who simply won’t change their practice habits; but I suspect many of them will be retiring within the next 15-20 years, if not sooner.

      Note that in the US, physical therapists are now required to be doctors of Physical therapy to practice. Unfortunately, many in PT view the requirement as one of 1.trying to catch up with chiros and 2. trying, and succeeding, in bleeding more money from prospective PT grads by the colleges. Political PT is determined to improve its graduates’ public perceptions in its turf battle with organized chiropractic. BTW, my wife and others of her generation have been grandfathered into being able to continue to practice with 4 or 5 year degrees.

      PT’s and DC’s are not even close to being two versions of the same thing. Just today, I evaluated what I diagnosed, based on a neurological examination, as an action tremor in a 60 y.o. musician; not Parkinson’s, not a supra-nuclear palsy. Just today, I diagnosed osteopenia in a 65 y.o. African American patient and referred her for bone densitometry. Pending the expected confirmatory results, I will refer the patient to a primary-care physican since she currently has no PCP. PT’s don’t do these types of exams, not that they couldn’t be trained. However, the extra three years involved in acquiring their doctorates don’t really qualify them to do anything more than 4-year PT’s can do. The bottom line is that DC’s occupy a niche unlike that of PT’s, although there is some overlap in their treatments of NMS disorders.

  • You have previously called for respect on this blog, I am sorry, but calling people liars and charlatans is neither respectful nor constructive. Show respect and encouraging Governments to support research would be constructive. As you well know, funding is not available other than by complimentary medicine sources which is never ever acceptable to you and your followers, so if you really want to see progress in this area then surprise us all and re-think your strategy!

    • “As you well know, funding is not available other than by complimentary [sic] medicine sources” How come? Do you ever submit a proposal to — for example — the Medical Research Council or the Wellcome Trust? If not, why not?

      • they reject applications where the applicant cannot even spell his/her subject correctly!

        • I coined ‘Condimentary Medicine’ in my book ‘Real Secrets of Alternative Medicine’ (Amazon) and on the associated web site http://www.placedo.co.uk.
          Condimentary Medicine: ‘Adds flavour and style but not substance, and has no functional effect on specific diseases. Mediated through placebo responses.’ (Harriet Hall says she will use the term!)

          All camists are in effect practising condimentary medicine – patients are comforted, and complimented.
          The techniques are also referred to a TLC or ‘bedside manner’. That’s how camistry works!

          • I coined “camedic” to describe biased ‘comedic critics’ of paramedical disciplines who proffer unsubstaniated opinions in subjects about which they know little. Camedics rightly criticize flaws within paramedical paradigms/professions, but they also withdraw from conversing about parallel flaws within “modern medicine.” That’s how camedics engage in discourse.

            Be well

          • I certainly use comedy to help camists face reality. It’s called catharsis.

            And in many roles during my career I have pursued the fault lines in conventional medicine (Chairman of the BMA’s Clinical Audit Committee; member of the management board of the National Centre for Clinical Audit; Chairman of the Advisory Council of the Health Quality Service etc.) – but the theme of this thread is ‘criticism of alternative medicine’ – dragging other concerns into the discussion is a red herring, a logical fallacy, and all too common amongst camists who are unable to face reality.

          • Simply introducing a new term to describe comedic critics of CAM disciplines, “camedics,” is not representative of a logical fallacy. The term simply injects some humor into sometimes dry conversations. I hoped that my humor might help camedics face their typically reductionist (and wrong!) beliefs about paramedical professionals in general.

          • Beliefs aren’t wrong – or right. They are beliefs.
            Some of which are shared by a large consensus of knowledgeable people.
            Some only by a few, often with vested interests.

            Inter alia, you must determine for yourself where you are on the spectrum; what has led you to any belief you hold; whether you are satisfied there is plausible reproducible evidence to support your belief; and whether or not you have been misled or even defrauded by your teachers and close colleagues.

            The application of scientific methods will help you, though not provide a guarantee.

            Best wishes.

          • In most cases and certainly in mine, a belief arises from personal experience which is far more reliable than pages of boring information in a research paper. At the end of the day, current medical research relies on the participants making a subjective judgements on whether the trial that they participated in gave them any benefit or not. Given that everyone is unique and has a different pain threshold and immune responses, how can that be relied on and what use is it to the man/woman on the street seeking answers? We need to encourage more personal experience and responsibility, rather than the state telling us what is right for us when clearly there are vested interests at play.

          • ” experience… is far more reliable than pages of boring information in a research paper”
            “…medical research relies on the participants making a subjective judgements…”
            thank you for these classical quotes – they show how far you are from understanding medicine.

          • Experience is real; whereas, a research paper is the work of others, who may have an agenda or fixed idea as to the outcome, that one can choose to read when undergoing their ‘experience journey’ assuming that they can understand and have the patience to read and understand it.

            Again you are using a derogative throw away comment to avoid proper debate.

          • “…derogative throw away comment…” no, my comment was the truth. your notions are erroneous to say the least.

          • Colin, you very clearly describe the essential need to set aside personal anecdotes; analyse a number of patients; have controls; and employ recognisable scientific methods.
            Welcome aboard!

      • Thank you for the information. I am not; however, personally seeking funding, I merely comment on the responses on this blog, that reject research undertaken by any organisation that is in any way CAM funded. In particular I recall some research funded by Bioron last year that was subject to heavy criticism simply because it was Bioron, which illustrates my point perfectly. I have previous suggested joint research to avoid time and money being wasted but that was rejected out of hand. One thing for sure, people are intelligent and can ultimately detect biased comments that are tainted with insults and ridicule and will ultimately make their own decisions.

        I have previously posted this amusing video link before and can only repeat that it depicts a visit by any CAM supporter to this Blog and in my view it brilliantly predicts the ultimate outcome.

        https://www.youtube.com/watch?v=k2PJ6T7U2eU

        • No, Colin, responses on this blog don’t reject “research undertaken by any organisation that is in any way CAM funded”. CAM funding merely raises an alert that the research may be biased. If one or more authors of a research publication fail to mention their CAM funding as a possible conflict of interest, which happens sometimes, the suspicion of bias becomes stronger.

          Exactly the same applies to research in mainstream medicine. Pharmaceutical clinical trials are typically sponsored by a company manufacturing one of the test drugs, and that potential conflict of interest raises readers’ awareness of conflicts of interest. And even in mainstream medical publications authors sometimes attempt to camouflage their sponsorship conflicts of interest, with the result that the work will possibly become discounted when the author is ‘outed’. If you think CAM critics are hypersensitive to funding conflicts of interest you have obviously never even scratched the surface of medical literature.

          No, it’s not commercial sponsorship that’s the problem with CAM research. (And, by the way, the company you refer to is Boiron, not Bioron — you seem to have great difficulty today in spelling the vocabulary of the CAM you claim to admire!). It’s also the fact that the research is typically published in CAM-specialized journals. Now, of course, specialists in a field need to talk to one another about specialized minutiae that won’t particularly interest non-specialists, but there are very general journals: Science, Nature and Cell are among the top-ranked for biological science, The Lancet, British Medical Journal (BMJ), New England Journal of Medicine and JAMA for medical research. Specialists submit their research studies to these journals when they think they have discovered something ground-breaking or ‘paradigm-shifting’. Yet we hardly ever see any CAM research appearing in these journals. (The BMJ seems to bend over backwards to accommodate CAM papers, but they are still remarkably few and far between.)

          Why do you think this is? Because the general biomedical journals of quality are biased against CAM? No, it’s because the research is typically of extremely poor quality. It therefore finds its way into what professional scientists refer to as ‘journals of last resort’; the landfills of low-quality research.

          I recall you previously told us you think videos are the best way to communicate the CAM message. Yet even a cursory glance at the hilariously dumb efforts at pseudo-medicine that get posted on YouTube is likely to reinforce the skepticism of CAM critics, even if it were remotely possible to make a case for videos as a formal medium for research presentation.

          That you don’t even seem to begin to appreciate all this speaks volumes.

    • Colin said:

      As you well know, funding is not available other than by complimentary medicine sources

      Why don’t those who profit for alt med pay from whatever research is necessary to back up the claims they make?

  • If something sounds too good to be true it usually is, and this is never more true than in the world of “alternative” medicine; now re-branded as “integrative” medicine.

    The fact is that there is no conventional medicine; no alternative medicine; no integrative medicine. There is only medicine that has been subjected to honest or dishonest scientific scrutiny; and medicine which has not.

    Pseudo-researchers do not do constructive criticism. They perform evasive maneuvers.

  • The author of the homeopathic blog:
    http://homeopathyofhahnemann.blogspot.co.uk/2013/03/materia-medica-pura-by-dr-samuel.html

    states that the homeopathic materia medica is, in his opinion, still subject to scientific verification, and retesting homeopathic medicines using today’s scientific standards is required in order to establish credibility and improved accuracy of the descriptions of the remedies.

    A number of readers of the blog page seem to agree with this homeopathic critique of its evidence base.

    Therefore, your view that there is a lack of homeopathic self-critique is contradicted here.

    • NOT REALLY! this ‘critique’ has not led homeopaths to abandon their ridiculous material medica.
      critique must have consequences to qualify as such, in my view.

      • It is ‘materia medica’ and not ‘material medica’, and isn’t ‘ridiculous’ part of the lexicon of one of the emotive forms of logic that you like to mention when others use these words (nonsense, idiotic, ridiculous, foolish etc)?

        • “materia medica’” I know but my spell-checker seems to dislike quackery. if you study how it was derived by Hahnemann et al, you might agree: IT IS RIDICULOUS!

  • I disagree with your view that Hahnemann’s Materia Medica is ‘ridiculous’. I wonder how many people would agree with you instantaneously (albeit that many of them have never looked at one page in the book)? Probably most would. ‘It is ridiculous!’ This is precisely where the credibility of your critique crumbles.

    Hahnemann’s Materia Medica is an extraordinary compendium of knowledge of a range of medicinal substances known to human beings for many years prior to Hahnemann; what he did was review these medicines through the prism of homeopathy. You have spent years reviewing contemporary research on ‘alt med’ but have you read Hahnemann’s ‘Materia Medica Pura’ and ‘The Chronic Diseases’? If so, please be specific and let us know exactly what is ‘ridiculous’ about it?

    Thank you for the time you have invested in this research

    • the symptoms listed there are generated by the most unreliable methods imaginable

      • Your comment suggests that you don’t have a clue on what you are writing about regarding this particular question.

        Have a look in the mentioned books and you will see that Hahnemann listed the ‘authorities’ that he referred to when he compiled the materia medica of each drug. His sources were based on hundreds of years of observation by astute observers and this is dismissed by you as ‘most unreliable methods imaginable’. He also detailed exactly how he prepared the drug for testing, so you should be able to see that he used low potencies for these trials.

        Belladonna 30 failed to produce a result when it was tested some years ago and this raises questions about the effectiveness of ‘high potency’ drugs. However, I can see how Hahnemann was able to produce his Materia Medica by combining the ‘ancient knowledge of medicine’ with his low potency provings. In my view, the toxicology of the drugs was known to the ‘authorities’ and his low potency provings supported those findings. The problematic zone is when the potency of the drug exceeds the threshold of containing molecules (as in the Belladonna trial). Do these drugs have a medicinal effect?

        Now, would you be more specific about what you mean by ‘most unreliable methods imaginable’? It seems like you are being emotive again on this topic. Given that you have just published a post detailing what to look out for in ‘good research’ and ‘bad research’, some quick pointers in the right direction could help homeopaths to see the ‘ridiculousness’ of their view.

        • before you patronise me, inform yourself about the way the provings were done

          • You have made an unsupported statement. I have provided additional clues for you to think about and asked you to clarify your statement. Instead you have reverted to emotional posturing ‘before you patronise me’. Strangely though, you don’t seem to see the contradiction between making unsupported emotive statements regarding views that others hold, and seem to take offense to the slightest suggestion of emotive criticism of yourself. (‘not having a clue’ is not ‘patronising’, saying that you are the world’s most esteemed genius in ‘alt med’ may be though)

            I think that there is more than enough information in my statement above for you to have responded to but perhaps you need more time to read up before replying to my question: what is ridiculous about Hahnemann’s Materia Medica?

          • very nice!
            you patronise me, and then you complain that I say so.

          • I don’t suppose you have my new book https://www.amazon.co.uk/Homeopathy-Undiluted-Including-Comprehensive-Z/dp/3319435906
            here is what it says about MM:
            In homeopathy, a materia medica is a collection of descriptions of the totality of the symptoms, signs, emotions etc. experienced by healthy volunteers after ingesting specific homeopathic remedies during provings. Homeopaths call the totality of these symptoms, signs etc. drug pictures.
            Hahnemann was the first to publish such a collection in 1811 which he extended numerous times up to the year 1833; he called it ‘Materia Medica Pura’. Subsequently many more such documents, often also referred to as a repertory, emerged. Kent’s materia medica became by far the most widely used of them all.

          • To describe the Materia Medica as “ridiculous” without discussing it in the context of its use in conjunction with a Repertory is suggestive of a serious lack of knowledge or inadequate training. As you well know, much of that information was compiled before conventional doctors had even thought of research!

          • oh dear!
            it may not have been ridiculous 200 years ago, but using the information today is ridiculous. can you see the difference?
            before you suggest ‘serious lack of knowledge or inadequate training’ on my part, try to just think a little bit before you comment.

          • In your book and in various interviews you have given, you say that you have successfully practiced homeopathy but make no mention of where you were trained and the extent of that training. Recently you posted a blog explaining misconceptions about Homeopathy and suggest that the success may be due to placebo and the time given to talking to the patient. If you were trained properly, surely you would have explained why the consultation takes so long and the skill involved in matching the totality of symptoms to a remedy picture using the Repertory and MM. On that basis you should have explained that if the practitioner gets that wrong, the remedy is unlikely to have any effect, whereas the correct remedy will have a positive healing effect which is likely to involve some form of early reaction. Under those circumstances, please explain the placebo effect and why you consider it be ridiculous!

          • a bit of circular argument here?
            if the patient responds, the remedy was correct. if not, the clinician chose the wrong remedy.
            one of the many reasons for the need of properly controlled trials.

          • But you have already labelled research into Homeopathy as automatically bad!

          • and where have I done that?
            please change your remedies urgently – you seem more and more deluded.

          • “If you were trained properly…”
            and you don’t find this sort of phraseology patronising?
            you seem to be taking the wrong remedies!

          • You like dishing out criticism but find difficulty in accepting it when it is returned but what do I expect from someone born with Mars placement in Virgo that makes little or no direct contact with any other planet. You may like to do some self analysis by reading the links below. Better still consult an experienced astrologer.

            According to you I am deluded so what do I know but at least I have been properly trained by a medical doctor who realised the importance of homeopathy many years ago.

            Yes sometimes I do sometimes prescribe the wrong remedy but know for sure when it is the correct one!

            You are welcome to explain your views and objections by way of an interview by me to camera!

            http://sasstrology.com/2014/08/primal-fire-unaspected-mars-in-relationships.html

            http://hniizato.com/unaspected-planets/

            https://books.google.co.uk/books?id=619UAvQdDZcC&pg=PA89&lpg=PA89&dq=mars+in+virgo+and+criticism&source=bl&ots=nMy1dMB7p3&sig=YpI3RjL9sWVN1QNpzeSTxkDmkqA&hl=en&sa=X&ved=0ahUKEwibuvOqhu_RAhXmLsAKHWjAAQgQ6AEIRzAI#v=onepage&q=mars%20in%20virgo%20and%20criticism&f=false

          • you are confirming my worst fears!!!

          • You accuse homeopaths of evading questions, is that not what you are doing in order to avoid a sensible conversation?

          • I am not at all sure that one can have a ‘sensible conversation’ with you!

          • All you need to do is to try and stop making meaningless throw away comments! As I have already stated, I am more than willing to conduct an interview with before a camera.

          • Colin said:

            But you have already labelled research into Homeopathy as automatically bad!

            TO WHICH I REPLIED: and where did I do that? TO WHICH YOU DID NOT REPLY!

            and you want a ‘serious conversation’ with me?
            get real!!!

          • “Ridiculous: deserving or inviting derision or mockery; absurd.

            synonyms: laughable, absurd, comical, funny, hilarious, humorous, risible, derisory, droll, amusing, entertaining, diverting, chucklesome, farcical, slapstick, silly, facetious, ludicrous, hysterical, riotous, side-splitting.”

            Hahnemann was personally much ridiculed in his lifetime. Now he has left the stage, we only have his Materia, and given he did not ‘prove’ any remedy (the German word he used, ‘pruefung’ – means ‘test or experiment’, not ‘prove’ in the sense of ‘demonstrate the validity of a premise’), that Materia is an imaginative account of highly subjective experiments and experiences, and as such is deserving of ridicule (unless declared as fiction). What other response would be rational? Be real.

  • The quote that you provided from your book Homeopathy – The Undiluted Facts is missing the point that I made earlier and so I am wondering whether you are reading the comments carefully.

    I wrote:
    ‘Hahnemann was able to produce his Materia Medica by combining the ‘ancient knowledge of medicine’ with his low potency provings. In my view, the toxicology of the drugs was known to the ‘authorities’ and his low potency provings supported those findings.’

    If you check any of the remedies listed in Hahnemann’s Materia Medica, you will see that he listed ‘authorities’ from whose works he obtained the information that he used to compile his drug descriptions. The low potency provings were in addition to the material obtained from the ‘authorities’ regarding a particular drug.

    Human beings have researched and formulated approaches to treating illness since ancient times. In Hahnemann’s time, drugs made from plants and minerals were commonly used but in larger doses. Hahnemann conceived the idea that perhaps smaller doses would also work but with less side effects. Medicine is not something that was discovered only recently and your dismissal of forms of medicine/therapy that have been known for centuries is something that I find interesting. How did human beings manage to survive for thousands of years until modern medicine was invented?

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