MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

During Voltaire’s time, this famous quote was largely correct. But today, things are very different, and I often think this ‘bon mot’ ought to be re-phrased into ‘The art of alternative medicine consists in amusing the patient, while medics cure the disease’.

To illustrate this point, I shall schematically outline the story of a patient seeking care from a range of clinicians. The story is invented but nevertheless based on many real experiences of a similar nature.

Tom is in his mid 50s, happily married, mildly over-weight and under plenty of stress. In addition to holding a demanding job, he has recently moved home and, as a consequence of lots of heavy lifting, his whole body aches. He had previous episodes of back trouble and re-starts the exercises a physio once taught him. A few days later, the back-pain has improved and most other pains have subsided as well. Yet a dull and nagging pain around his left shoulder and arm persists.

He is tempted to see his GP, but his wife is fiercely alternative. She was also the one who dissuaded  Tom from taking Statins for his high cholesterol and put him on Garlic pills instead. Now she gives Tom a bottle of her Rescue Remedy, but after a week of taking it Tom’s condition is unchanged. His wife therefore persuades him to consult alternative practitioners for his ‘shoulder problem’. Thus he sees a succession of her favourite clinicians.

THE CHIROPRACTOR examines Tom’s spine and diagnoses subluxations to be the root cause of his problem. Tom thus receives a series of spinal manipulations and feels a little improved each time. But he is disappointed that the pain in the left shoulder and arm returns. His wife therefore makes another appointment for him.

THE ENERGY HEALER diagnoses a problem with Tom’s vital energy as the root cause of his persistent pain. Tom thus receives a series of healing sessions and feels a little improved each time. But he is disappointed that the pain in the left shoulder and arm returns. His wife therefore makes another appointment for him.

THE REFLEXOLOGIST examines Tom’s foot and diagnoses knots on the sole of his foot to cause energy blockages which are the root cause of his problem. Tom thus receives a series of most agreeable foot massages and feels a little improved each time. But he is disappointed that the pain in the left shoulder and arm returns. His wife therefore makes another appointment for him.

THE ACUPUNCTURIST examines Tom’s pulse and tongue and diagnoses a chi deficiency to be the root cause of his problem. Tom thus receives a series of acupuncture treatments and feels a little improved each time. But he is disappointed that the pain in the left shoulder and arm returns. His wife therefore makes another appointment for him.

THE NATUROPATH examines Tom and diagnoses some form of auto-intoxication as the root cause of his problem. Tom thus receives a full program of detox and feels a little improved each time. But he is disappointed that the pain in the left shoulder and arm returns. His wife therefore makes another appointment for him.

THE HOMEOPATH takes a long and detailed history and diagnoses a problem with Tom’s vital force to be the root cause of his pain. Tom thus receives a homeopathic remedy tailor-made for his needs and feels a little improved after taking it for a few days. But he is disappointed that the pain in the left shoulder and arm returns. His wife therefore tries to make another appointment for him.

But this time, Tom had enough. His pain has not really improved and he is increasingly feeling unwell.

At the risk of a marital dispute, he consults his GP. The doctor looks up Tom’s history, asks a few questions, conducts a brief physical examination, and arranges for Tom to see a specialist. A cardiologist diagnoses Tom to suffer from coronary heart disease due to a stenosis in one of his coronary arteries. She explains that Tom’s dull pain in the left shoulder and arm is a rather typical symptom of this condition.

Tom has to have a stent put into the affected coronary artery, receives several medications to lower his cholesterol and blood pressure, and is told to take up regular exercise, lose weight and make several other changes to his stressful life-style. Tom’s wife is told in no uncertain terms to stop dissuading her husband from taking his prescribed medicines, and the couple are both sent to see a dietician who offers advice and recommends a course on healthy cooking. Nobody leaves any doubt that not following this complex (holistic!) package of treatments and advice would be a serious risk to Tom’s life.

It has taken a while, but finally Tom is pain-free. More importantly, his prognosis has dramatically improved. The team who now look after him have no doubt that a major heart attack had been imminent, and Tom could easily have died had he continued to listen to the advice of multiple non-medically trained clinicians.

The root cause of his condition was misdiagnosed by all of them. In fact, the root cause was the atherosclerotic degeneration in his arteries. This may not be fully reversible, but even if the atherosclerotic process cannot be halted completely, it can be significantly slowed down such that he can live a full life.

My advice based on this invented and many real stories of a very similar nature is this:

  • alternative practitioners are often good at pampering their patients;
  • this may contribute to some perceived clinical improvements;
  • in turn, this perceived benefit can motivate patients to continue their treatment despite residual symptoms;
  • alternative practitioner’s claims about ‘root causes’ and holistic care are usually pure nonsense;
  • their pampering may be agreeable, but it can undoubtedly cost lives.

86 Responses to Alternative practitioners amuse the patient, while medics cure the disease

  • Excellent article.
    I believe a good way to describe most of complementary healthcare is; ‘misdiagnosis by default, coupled with ineffective/dangerous treatments’. I have made the statement before that CAM might possibly be the biggest killer, bigger than the combined deaths caused by cancer, malaria etc. It might even be topping the list of ‘deadliest diseases’. But unfortunately, there is simply no way of knowing what the true extend of the damage is, caused by these demented CAM practitioners.

  • Perfectly illustrated! Also, while totally unintended by the illustration, the example matches my prior experience that women tend to fall more passionately for this alternative decorated quackery of all sorts. The alt.med. practitioner base, of course, definitely provides equal opportunities for everyone… whether a patient or a trainee (although these days, courses cost a lot, I’m told).

    Hopefully, patients will get to understand the essence of the story and guard themselves. Practitioners, however, sadly, rarely do…

  • Today, François-Marie Arouet (Voltaire) would have said:
    “The art of medicine consists in curing the disease, whilst camists amuse the patient.”

    (Camists being practitioners who practice camistry – CAM.)

  • Perhaps the emphasis on “alternatives” as province of (silly, emotional, irrational) women could be tweaked a little? Although I frequently witnessed with disgust the macho role-playing of “”she” looks after my health, I don’t fuss about that stuff” carried out at work, reinforcing the “caring/carer” traditional roles, one hope that these farces belonged to an older (our) generation and will pass away.

  • Ha, ha, ha…what an entertaining story. I feel better already with the laughter. No, I do not have dull ache and pain or any discomfort. I better not laugh too much over this story or a rib ache may happen.

    I am a great believer of Urine Therapy. God knows how may aches, potential cardiac ischemia, strokes or the myriads of illnesses I have have escaped or prevented. I am age 68 in fit condition but not taking it for granted. Each day I peruse the Obiturary page and see people dying at 28, 48, 58, 68, etc. There were not murdered or died from accidents. All died of something, most likely cancer and other diseases. So, I am thankful for each day. Will not shut out the GP completely..if an ache or pain persist, the GP is my first choice.

    • Like I mentioned when you posted this same message on another thread, I’m every bit as fit as you are (and a few years older), yet I’ve never drunk my urine. How on earth can you explain such fitness? Is it possible that I remain healthy because I get so many laughs out of people like you who are proud of their bizarre, pseudo-scientific, superstitious beliefs?

      No, I think I know the solution: I remain healthy because I don’t drink my urine. You can’t deny this. Assertions that are made without evidence can be dismissed without evidence.

    • Are you taking the piss, Eddie?

      • Yes I am taking urine for 17 years. In great health. Zero health supplements, not even Vit C. Actually no need to drink the urine, just put in the mouth, swish it around, flush the teeth, etc. then spit out. More important give the body a massage using the urine…great for the skin and the urine is absorbed too.

        Well, 17 years, looking 10 years younger than my age. In great health, never fall sick for many years. I do not need any GP or expert to tell me otherwise.

        • While it makes perfect sense why somebody might want to make such a statement, it actually begs for validation…

          You actuallyrinse your mouth with urine, rub yourself with urine and other quite fancy stuff?
          And… You think its value extends beyond being some liquid with dissolved salts, acids etc..

          If an ache persists, better not tell the GP about urine, because you will risk him not taking the ache seriously either…

          • To each his own. Prior to UT, I was taking large quantities of health supplements, still fell ill with severe flu three times a year with fever, aches, headache, cough. It has been 15 years since I last visted a doctor. Amazing. I do get a rare slight colds but a few Panadols will quickly solve the problem. I totally believe in the power of urine. I have no fever of an attack of cancer, AZ, stroke etc. Well, they can still occur but 15 years is enough proof that there is something powerful in using urine. Those never researched, keep a closed mind, are enttitled to their views too.

          • “…15 years is enough proof …”
            sorry, but this is not correct.

          • It is my body, my life, my enjoyment. I do not need to prove to anyone but myself. I am my own living, walking testimony on the power of urine.

          • ” I do not need to prove to anyone but myself.”
            I agree – but you are publishing nonsense on my blog and it is only legitimate to ask you for evidence. and anecdotes are NOT evidence!

          • Publishing nonsense? Your blog is nonsense itself with stories too. I am not here to provide medical evidence. My body, my long years of good health is evidence itself. How many time have you fallen ill in the past 15 years? That is evidence too. If you believe medical science is God-sent, enough to cure everyone and every disease, you are talking trash.

            Your blog is private and exclusive? That shut it down and take off the Internet. If you attack me, do not expect me to sit back and do nothing. You can delete my post. You want people to keep supporting your views? Then to the zoos and recruit the apes to help you. I am talking facts. You are mouthing nonsense yourself.

          • stop making a fool of yourself, please.

          • With all due respect, have you considered that you are potentially still at the amateur level, so it seems, Eddie? The toughest of your league have already upgraded to feces. Why not unlock the full potential of excrement?

            Still liquid…? Level up!

            Go solid!!!

          • Sounds like fetish behaviour.

          • It probably has become one, by now…I just cannot discern whether it is about the real deal or the make-believe health effects.

        • Eddie, contracting flu 3 times a years would be extraordinary. People often confuse flu symptoms with common cold or other viral illnesses. And from your own statement below you still suffer colds…….so maybe little has changed?

          Can I ask though what exactly is UT? What do you do with the urine? And who’s urine is it?

          • I live in the tropics. I work and sleep in aircon environment. Catching colds is common but no longer. It is normal to catch the cold or flu bugs. As I said, my immune foundation is so strong now. I have not got any episode of fever for 15 years at least since starting Urine Therapy.

            There is much about UT on Internet. It is an ancient treatment and monks living in the mountains use it to treat a variety of illnesses. Urine is called plasma ultrafiltrate medically. It is the fluid that bathes the womb. Urine is 95% pure water, 2.5% urea and 2.5% of other substances. It comes from the kidneys, the balancing organ. The liver gets rid of the waste. I am not a medical person and just quoting what is on Internet. Urine has not been extensively researched but people do not tell lies when they provide testimonies of cures. No one makes money by selling their urine.

            There research about extracting stem cells, urea and substances from urine and some have been used in commercial products. Millions use UT as a therapy and UT adherents like me do not need to see the doctor, no longer buys medicine nor supplements. How and why it works are not researched. The Big Pharma will not want to know. Non-believers can cast doubt. It is all right. The believers carry on and enjoy the benefits. Urine is not the miracle medical medicine. It is just one of so many traditional and alternative treatments. Nature is complex but will respond if treated wtih respect. Conventional medicine is not the only way to treat illnesses. Medical science has made tremendous advances and yet so many diseasaes are not cured, their origins and progression not understood. That is why people try out unconventional methods like urine, herbs, various alternative therapies. We need to be open-minded…there are alternative methods and they do work. But a sensible approach is required. See the GP and Specialist as appropriate. Help yourself as appropriate. The key point is…be broadly knowledgeable, do not be a fanatic in any one branch of treatment. Natures teaches us diversity. The body works well with a diversity of treatments and attention too.

  • Not Voltaire. Ben Jonson.

    Please be aware that *no* quotation site is reliable. The least unreliable one (probably by far) is Wikiquote. I simply ignore all others, and I recommend you do too.

    http://www.emotionalintelligenceatwork.com/quote-unquote/

  • Here’s another story. Edwina was desperate for help with her debilitating migraines. Being a conventional type, she first consulted her GP. Over a series of years, her GP prescribed a number of medications. After beginning some of them, she felt a little initial improvement (the doctor was paying her attention after all), but others resulted in serious side-effects including gastric upset, which led to a separate PPI prescription. Not only were her migraines as bad as ever, but now her digestion and energy levels were getting worse and worse.

    Having run out of options, her GP suggested Botox injections. Edwina Googled this, and discovered that Botox was a toxin derived from the bacteria that causes botulism. She also read that there was a chance the toxin could spread to other parts of her body, and cause life-threatening complications. This didn’t sound good, so in desperation, she returned to Google, and found to her surprise that there was promising evidence that acupuncture can help with migraine, and that the best evidence suggested it was extremely safe when carried out by a properly trained practitioner. This lead her to wonder why her GP hadn’t suggested it before some of the other options, but she put that thought aside. She made a booking with a local member of the British Acupuncture Council.

    Julia the acupuncturist asked Edwina a lot of questions, and examined her thoroughly. She said that from the TCM (Traditional Chinese Medicine) perspective she may fall under a pattern called Liver Yang Rising, and that the tightness around her neck and shoulders was described as Qi and Blood stagnation. This sounded very strange to Edwina, but when Julia explained that these descriptions came from a culture which used metaphor to describe health and disease, and that the treatment mostly boiled down to inducing relaxation and increasing blood flow in a targeted way, she felt happy to proceed. In fact, Edwina found that this metaphorical approach helped her to re-frame the development of her current state in a helpful and refreshing way. She was also pleased to have the time for an in-depth discussion about how her diet and lifestyle may have contributed to her situation – although her GP had done his best and had touched on some of these aspects, Edwina could see how the time available to him for meaningful discussion had been woefully inadequate.

    After 5 weekly treatments, her migraines had decreased in intensity. After a further 10 weeks, she was pain-free for longer than she had been for years. She found that she only needed to return for top-up treatments about every 3 or 4 months after that to manage the condition, especially now that she’d joined a local Qigong class, which helped her learn to tune in to the signals her body was giving her, manage her stress, and improve her posture. She felt empowered that she had learned to manage her own health better, and reduce her need to visit her GP.

    This story is invented, but based on many real stories of a very similar nature.

    For the record, I do NOT mean to imply by this example that all doctors throw around potentially dangerous medications willy nilly, or that CAM is always the right choice. The reality of course is that my story and the one in the main post paint unrealistic pictures when told in isolation. Both these scenarios do happen, but to tell one story without the other is misleading.

    • so, the question is which scenario is more frequent, and who makes the most bogus claims about their treatments?
      I suggest you go on the Internet and do a little statistic for yourself – because if I supplied it, you would not believe me.

      • The CAM industry and many individuals within it make more bogus claims, no doubt. But your question invites an unhelpful black-and-white view in my opinion – it doesn’t mean there aren’t many good and honest CAM practitioners doing valuable work.

        • and my point is that even the “good and honest CAM practitioners doing valuable work” in pampering their patients might represent a danger to many.

        • One of the major problems with CAM practitioners is that no matter how honest and good they may be, they deceive people – and not in the last place themselves.
          This delusional belief in their own “insights” and “abilities” may be considered a mitigating factor, were it not for the fact that they can only uphold this belief by deliberately keeping blind and deaf, i.e. actively rejecting the truly massive amount of evidence telling them that what they believe in is wrong. For this reason alone, I consider CAM practitioners no better that scam artists. Simply said: they ask money in exchange for things they promise yet never deliver.

          Please note that I’d be happy to change my opinion about sCAM artists as soon as one of the following two conditions is met:
          They either
          – deliver convincing (scientifically validated, peer-reviewed and independently repeatable) proof that their treatments have an effect exceeding placebo effects,
          or
          – admit that their alternative treatments are nothing but placebo, and that they basically make people feel good by chatting with them while performing some ritual or other.
          There is nothing wrong with making people feel good. But it is wrong to make them falsely believe that you can heal them. As long as CAM practitioners portray themselves more or less as the equals of real doctors, people are deceived and cannot make a truly informed choice about their own health.

  • Man goes to the doctor, complains that his eye hurts every time he has a cup of tea.
    ‘Take the spoon out’, says the doctor.

  • Please Edzard, do some *research* to give your otherwise humorous posts a little bit of credibility.

    Edzard: how many people do you reckon go to ‘alternative practitioners’ as first point of call?

    I think that the vast majority of patients turn to other therapies AFTER years of conventional medicine has not provided satisfaction for them in terms of resolving/dealing with their health complaint.

    So your post is bollocks (but funny, as is usually the case, thank you).

  • Senario #1.
    Chiropractor notes the major red flag and refers him to the GP.
    Immediately calls the GP to inform him of whats about to come through their door and discusses the patient.
    Chiropractor has a good referral relationship with the GP.
    Senario #2.
    Chiropractor sees a patient with atypical interscapular pain and due to red flags in the patients history informs the patient that he is potentially having a heart attack and he is calling an ambulance. Patient says no. Chiropractor says no option, sit down and relax. Ambulance arrives. Next day head of emergency at local teaching hospital calls the chiropractor to thank him.
    Senario #3.
    Chiropractor sees patient. Chiro informs him that its his heart and to see his doctor immediately who is just around the corner. Patient says its not his heart and all the doctor ill do is send him for a battery of unnecessary tests. Chiro informs the patient that he is calling the doctor to inform him that you are coming and if he does not turn up then the chiro will drive to his house and F%#@ing burn it down. Patient reluctantly goes to his doctor. One week later the patients daughter calls to thank the chiro.
    Senario #4.
    New patient presents to the chiropractor. Chiro informs patient following thorough history and examination that they are having a heart attach and he is calling an ambulance. Patient gets very angry says it is unnecessary and refuses. Chiro patiently explains his reasons for calling an ambulance. Again patient angrily refuses help. Finally the chiro, who has told the patient in no uncertain terms that he is not getting into his car and driving, gets the patient to agree to the chiro driving him to the local emergency department which is 8 mins drive away. As they walk into the emergency reception the patient collapses with a heart attack. Doctors rush to help the patient in seconds. Chiro informs the doctors that he has suspicions about the patients arteries in his neck. Next day the head of emergency calls the chiro to thank him for the warning.
    All these senario’s have occurred in my practice and many more . I also have a referral network of GP’s, Ortho’s, Neuro’s, physio’s, exercise physiologists etc. I also now work in a multidisciplinary medical centre.
    Identifying red flags and when to refer make up a large part of the chiropractic university degree’s here.

    • Nice story Edzard. You just missed adding at the end that Tom lived happily ever after.

    • The whole problem is that most chiropractors and other alternative practitioners will not notice many red flag symptoms.
      Diagnosing health conditions is often challenging enough already for real doctors, who spent at least seven years gathering the necessary knowledge and skills – and even then, they still get it wrong quite often.
      Even if accredited chiropractic education in the US involves quite a bit of general medicine, the simple fact that chiropractic is still based on a lot of antiscientific and pseudoscientific hogwash means that chiropractors are almost by definition incompetent to offer patients the best standard of care.
      The same goes for naturopathy. And if anecdotes are anything to go by: a friend of my parents consulted a naturopath for his lack of energy. The woman treated him with useless sugar pills (homeopathic ‘remedies’) for almost nine months, with the man’s condition slowly worsening after initial short-term improvement (no doubt as a result of the placebo effect). After a sudden collapse, he ended up in the ICU, where he was diagnosed with severe congestive heart failure as a result of a leaking valve — something that could have been fixed relatively easily early on. Unfortunately, the man died shortly thereafter.
      Note that a lack of energy is a very common health complaint and therefore not really a red flag. But any real doctor would (or at least should) have heard heart murmurs upon examination and found the true cause of this particular problem. Would a chiropractor even have listened to the man’s heart? I can’t find anything about this in chiropractic examination procedures…
      In all, I wouldn’t be surprised if the vast majority of diagnoses by CAM practitioners completely miss the mark, with their fantasy treatments leading even further away from what’s really wrong with patients. The two main reasons for their apparent success are a) the fact that most ailments resolve naturally (regression to the mean), and b) the fact that most CAM treatments are generally low-risk. Which brings us neatly on-topic: the practitioner simply gambles on nature doing the work while keeping the patient engaged (and paying for the privilege).

      • Your blog has one running theme…. you are critical of chiropractors. Provide facts and statistics. Obviously they are effective in many instances where the mainstream medical science did not solve the patient’s problems. Whether the patient is milked of his money should not be part of your blog…it implies that chiropractors are dishonest. You can extend your accusation to mainstream medicine too. So, stop harping about patients paying for ineffective treatment.

        Our bodies are incredibly complex. Nature defies all attempts to unravel its mysteries. Super bugs have emerged because Nature is much more powerful that what Man can throw at it. However, those super bugs do not kill normal folks who have not been medicating on endless rounds of antibiotics. Man has never been wiped out by any outbreak of diseases. How Nature copes, evolves and survive will be invested for hundreds more years to come.

        A balanced approach is to talked of being complementary. Mainstream medicine has its important role. So does many alternative approaches. The person also has to help himself. Exercise, diet, mental, etc. Just so many things are needed for a healthy system.

        • Provide facts and statistics

          If you mean facts and statistics to support the notion that chiropractic is based on nonsense: well, one only has to look at chiropractors’ Websites and compare their claims to what science has to say. At best, one can say that chiropractors offer physiotherapy, dressed up with a load of vacuous woo that serves as a placebo effect to enhance a customer’s well-being. But in fact the burden of evidence lies with you, as a proponent of this form of alternative treatment: I very much like to see peer-reviewed research where chiropractic interventions indeed have beneficial clinical effects on health conditions, in particular conditions that can’t be addressed by normal physiotherapy.

          Obviously they are effective in many instances where the mainstream medical science did not solve the patient’s problems

          The funny thing is that the Internet is full of statements and anecdotes like this, but that proper research doesn’t reflect this at all. Or in other words: cases like this, where CAM intervention provides relatively easy relief or healing where regular medicine failed for years, appear to be exceedingly rare.

          You can extend your accusation to mainstream medicine too

          This could not be further from the truth. Mainstream medicine, not CAM, has extended our life expectancy from perhaps 50 years only a century ago to at least 75 years now. Mainstream medicine, not CAM, has reduced child mortality from anywhere between 10% and 20% only a 150 years ago to some 0.5% now. Mainstream medicine, not CAM, has provided very effective and safe solutions for preventing and treating many infections (vaccination and antibiotics, respectively), saving countless lives over the years. Mainstream medicine, not CAM, is finding ever more effective ways to treat cancer, driving allround cancer mortality down, albeit slowly. Mainstream medicine, not CAM, has turned many incurable, previously fatal ailments into chronic ones. And mainstream medicine, not CAM, can often reduce suffering in cases of chronic ailments quite effectively. And I could go on an on…

          Nature defies all attempts to unravel its mysteries yada yada yada

          Here you are projecting your own lack of knowledge on those subjects onto the rest of the world. This doesn’t really make your point of view look any better, quite the contrary.

          Mainstream medicine has its important role. So does many alternative approaches.

          I beg to differ. As you can see in the point above, real medicine has arguably been hugely successful (and still is). Alternative approaches have not been successful at all, at least with regard to effectively treating well-defined medical conditions. The best one can say about them is that they sometimes make people feel better – but so does a visit to the beauty salon. To say it in an unfriendly way: CAM is parasitic medicine. It simply rides along on our natural healing faculties and on real medicine’s successes, claiming credit for things it doesn’t (and can’t) actually do. And perhaps worst of all, it often spreads untruths and misinformation about real medicine in attempts to make itself look better in contrast.
          There is a reason why alternative treatments are not a part of real medicine: they have not been proven to work (beyond a placebo effect, that is). Think about this, please.

        • Your blog has one running theme…. you are critical of chiropractors.

          Actually, Edzard is critical of demonstrated pseudoscience dressing up as medicine and/or health care.

          It’s not his fault that Chiro isn’t backed by the current medical and scientific consensus on their claims.

      • Richard, I agree, except that a chiro education in the US does not involve “quite a bit of general medicine,” but maybe some basic science and a lot of nonsense. They have minimal training and clinical experience with sick patients, especially very sick ones that need 24 hour care in hospitals.

        • Yes, I guess you’re right, I probably gave the chiropractic programs that I looked at(*) too much credit still; and I also saw that in particular clinical training is absolutely negligible compared to what real medical students have to do. My main point here is that belief in and application of pseudoscientific nonsense makes them incompetent by definition, regardless of any real medical training they may have received. Their belief in non-existent mechanisms and magical healing methods will more often than not lead to serious misdiagnoses and mistreatments.

          *: I’m not all that knowledgeable about CAM education in the US, and it appears to differ in several important aspects from the situation here in the Netherlands – e.g. our healthcare system doesn’t allow quacks to act as primary care physicians at all. If anything, CAM is increasingly marginalized here, with real doctors who dabble in quackery risking their license if they don’t spend enough working hours on real medicine.
          Nevertheless, we still have a serious quackery problem too, with CAM practitioners being allowed to swindle people out of their money offering the most egregious and sometimes dangerous nonsense as ‘alternative healthcare’, quite often lying that it is ‘scientifically proven’.

        • @S. Cox, MD
          Depends where you educated. National, Palmer, NY etc. No. Identifying camelions, mimics and red flags in regards to the MSk system and knowing when to refer is very important and is taught in these institutions. Sherman and Life in the US should be shut down for promoting BS and magical unicorn dust.
          Vitalist chiro’s who think that they are a cure all, foster a toxic dependency, don’t refer and make outrageous claims should be deregistered and/or have their license suspended. It should be a case of reform or take a walk.
          @RR
          “chiropractic is still based on a lot of antiscientific and pseudoscientific hogwash means that chiropractors are almost by definition incompetent to offer patients the best standard of care”.
          Time to be more targeted. Point out the BS but ALSO support reform, reformers and researchers. Carpet bombing the whole profession does not help reform.
          Question.
          When it comes to the MSK system what is the best standard of care?
          This is a very hot topic right now as many sacred cows have been led to slaughter by the research lately.

          • @cc: You pontificate as if you have-a-clue. As has been mentioned before you play logical trickery by subjugating all those “lesser chiros” that don’t have ‘your’ profound insights, judgements and fecund imagination as to what ‘real Chiropractic IS,,,’in to the box of sub-standard and disposable. Allowing you to stand alone on-high with your myriad of pointless anecdotes and treatment schemes. I suppose in a blind mans’ world the one-eyed man is king….
            But I fear you’ve been wearing the patch over your good eye.

          • As I said, I only have a limited view of what chiropractic education entails in the US, and I’m only starting to build a picture here. Yet what I see so far is not reassuring. Yes, many curricula at least give the appearance of focusing on scientifically sound principles, such as the courses offered at Northwestern Health Sciences University. This was also the basis of my remark that there appears to be quite a bit of real medicine there. (I checked out several more accredited chiro schools; this appears to be one of the more scientifically based ones I could find. No doubt there are more.)
            When diving into the details, however, it turns out that a lot of this ‘real medicine’ is in large part window dressing, and that at the very basis of it all, they’re still peddling utter nonsense such as subluxations, as presented under “Principles and Philosophy”, along with quite a few courses in useless ‘manipulations’ that are supposed to address problems that have nothing to do whatsoever with the body part being manipulated. Add to this that the total amount of time involved is less than half that of a typical regular medical curriculum, and that chiropractic clinical training is a joke, and you end up with practitioners who master only a small fraction of the knowledge, skills and experience that any real doctor has.
            This is also in evidence when looking at actual chiropractors’ websites, such as this one that really makes me cringe – an exemplary quote from the page on ‘Fatigue’:

            An unhealthy, unbalanced spine can interfere with the natural flow of energy through your body, creating blockages and imbalances that may cause physical and emotional fatigue.

            Anyone seriously basing their medical practice on this kind of fairytale medicine is – at least in my opinion – not competent at all to diagnose and treat real-world patients.

            Having said this, there are indeed more sensible chiropractors nowadays who abandoned the outright quackery, and focus on actual musculoskeletal disorders – but then again, this is not all that different from what physiotherapists do. And these people are by dint of their limited education still not competent to act as primary care physicians. It is a worrisome development that in the US, these people are allowed to diagnose and treat patients as if they were.

            To put it succinctly: embracing CAM does not enrich real medicine; it dilutes it at best, and poisons it at worst. It is most definitely not in patients’ best interest.

          • @Michael Kenny
            You sound so similar to the vitalistic chiropractors. You both cling to subluxation like a religion, are resistant to reform and struggle to acknowledge that it even exists.
            @Richard R.
            Fairy Tale subluxation and philosophy is only taught here in its historical context.
            As for physiotherapy there are physio’s who I hold in high regard and are challenging the status quo and physio’s who are carrying on with BS as usual with myriad branches of their religion. When it comes to MSK the primary contact should be evidence based physio’s and chiro’s. If its medical then its referred and when to refer is a large part of the education here in Australia.
            Medicine is embracing the evidence, not CAM.
            That website is an embarrassment and he should be fined, suspended and deregistered. Unfortunately the US is a basket case for ALL health professions when it comes to advertising and BS claims.

          • Fairy Tale subluxation and philosophy is only taught here in its historical context.

            With ‘here’, you mean Northwestern? Then I’m sorry to inform you that subluxation is still very much alive and well here as a serious concept. The following is an excerpt from their course descriptions:
            “33120 : METHODS 2: SKILLS ANALYSIS 2
            2.00 credits: Development and integration of skills necessary to detect various manifestations of spinal subluxation and/or dysfunction …” (emphasis added)
            Or from this page:
            “22040 : PRINCIPLES AND PHILOSOPHY 4
            … Neuromusculoskeletal and visceral conditions are discussed with the subluxation model of facilitation and adaptation in mind. … The influences of subluxation and the effects of chiropractic care and the adjustment on the health of the entire body are also stressed.”
            This really doesn’t sound like they’re just mentioning Palmer’s invention for the sake of historical completeness…

            For all the rest it really doesn’t look all that different from extended physio curricula. And as already discussed earlier on, sorely lacking here are clinical experience and the development of diagnostic skills (which go hand in hand in real medicine).
            So even ignoring the whole fairytale medicine part of it: what does chiropractic have to offer that isn’t already offered by physiotherapy practitioners and general practitioners? What do patients stand to gain if they consult practitioners with rather shaky credentials and uncertain skills instead of doctors who received several years more training? Why would someone choose a chiro school over a traditional medical or even physiotherapy education? Why do you defend chiropractic, even though you obviously do not subscribe to the quackery part of it?
            Yes, I think I already know the answers to this (prejudice is a universal human trait, and I’m not immune either), but I’m still genuinely interested in the opinion of someone who makes a serious attempt at rationalizing this subject and appears capable of appreciating the other side’s point of view.

  • James, I’m afraid to say that Eddie will go rigidly solid if he were to follow your ‘recommendation’.

    Glad to see that you did not try the water test.

    Give him a break, he is still alive after God knows how many years. So he is living proof that drinking his urine has not killed him (yet?), and probably saved him a lot of cash on beer?

    • Drinking urine does not kill anyone. Go and search with an open mind. Those very close to death, just days from death ahve recovered from cancer by just taking urine and plenty of water (just normal tap or well water) for weeks. These are just claims and lies? People have survived.

      17 years on Urine and I know the difference. I am must more sensitive to my body condition. I know my foundation is much stronger. I take precautions when the slightest symptons appear and often that will be a slight tiredness, a slight ache..something that is not my normal self. It is not often. My body is not perfect. I live my normal diet, am in the crowds and do get my dose of other viruses and bacteria. But UT has created a very strong immunity.

      Time and again, I find that many just dismiss urine as nonsense, never even spend time to research. It took me three months to research before I started. I have accumulated over 15 years of patient reading and I still to. Knowledge is power even if it is not detailed medical research. To each his own.

    • What’s with that water test? What do you mean?

  • @AN Other

    Your comment may seem relevant and important to the subject but it is not. In reality it only reinforces the Professor’s point about the perils and futility of make believe medicine. The study you cite is very interesting and important. It is a very well designed and rigorously performed clinical trial giving very important information that needs to be confirmed in further, independent studies before one can say the data are reliable enough to change clinical guidelines. And they will be changed if the data can be confirmed. Clinical guidelines will then be revised to downgrade the recommendation for PCI in patients with stable angina despite use of medical therapy.
    This trial only deals with one problem, that of stable angina. Stents will still be used in other settings.

    Now tell us dear “AN Other”, whoever you are. Can the same be said for the different so-called alternative modalities? What reality based improvements have been made during the two centuries since Hahnemann invented homeopathy? How many remedies have been discarded by homeopaths? Of course many more substances have been added to the enormous list of remedy-fantasies. Like houseflies (Musca Domestica) or a morsel from the Berlin wall for example. Have these been proven to work or not? No, I didn’t think so. Still there are people selling the stuff with claims of health-efficacy.
    I am not aware of any truthful trial leading to the downgrading of a particular chiropractic manipulation because it did not prove better than placebo. And even less so any Craniosacral adjuster or belly fondler (Visceral manipulator) discarding a certain type of fondling after rigorous trials testing its effecacy.
    Make believe medicine may be multiply tested but not properly tried in the same way as real medicine. The only reason I have ever found that something “alternative” is not used is that it does not sell.

    • @ Bjorn

      No the same cannot be said for the different so-called alternative modalities.

      I am just wondering, why did you go to a chiropractor first and not a physiotherapist, when you had low back pain?

      • Out of ignorance. As I have previously said, it was because of recommendations from someone and references that said there was evidence it could help in uncomplicated LBP.
        When I realised the man was fleecing me and the only positive effect was on his income, I stopped going. Later I did a proper analysis of chiropractic, its history and its validity.

    • Had a chat with some cardiologists over here. Turns out the results of this trial were known ten years ago. I believe the previous study was called COURAGE. This small but well made and important study only confirmed what they are already following. Stenting is primarily of use in acute coronary syndrome and not in stable angina where medical therapy is the primary method.
      This study is however already being heavily misinterpreted and misrepresented by those who profit from diverting people away from real health care.

      • @ Bjorn

        So, would you say that Tom’s condition was stable angina?

        Is my previous comment (when I cited the study)now relevant and important?

        • obviously not, otherwise the cardiologist would not have put a stent.

          • @ Edzard

            What symptoms indicate unstable angina in Tom’s case?

          • @AN Other
            Why don’t you ask the cardiologist who evaluated Tom’s condition? I am sure she followed best evidence and current guidelines.

          • @AN Other
            Why don’t you ask the cardiologist who evaluated Tom’s condition? I am sure she takes a pride in being up to date and follow current guidelines and clinical recommendations. I am also sure that she gladly changes her practice when such guidelines are updated based on the best current evidence.
            Modern doctors take a pride in being up to date and base their practice on what is at any time considered best for the patient.

          • @ Bjorn

            You do know Tom’s case is a story invented by Prof Ernst?

          • :D. I was actually wondering when you would realise it yourself.

          • @ Bjorn

            I was thinking the same about you too 🙂

            So it is not a very accurate story regarding a patient with unstable angina? If it is an accurate reflection of a patient with unstable angina, what symptoms indicate unstable angina in Tom’s case?

          • how about this:
            “But this time, Tom had enough. His pain has not really improved and he is increasingly feeling unwell.”

          • @AN Other

            Perhaps it was some of the other incognito friends here but I seem to recall suggesting that you look up the term sarcasm and its little brother irony in a dictionary. Then reflect on how this relates to your attempts to pull the discussion into your little corner by asking silly questions. I believe this rather childish way of discussing can be classified as a fallacy called begging the question.

            If you are trying to make a point, then make it, for heavens sake. But for us to be able to respond it has to be supported by arguments that are refutable.

        • Of course Tom needed a stent, did you not read the case? Tom was evaluated by a cardiologist and they follow accepted clinical guidelines.l He was not evaluated by a quack who only follows the money.

  • Our bodies are incredibly complex.

    And you, Eddie, do not have even the vaguest clue about how they work.

    Nature defies all attempts to unravel its mysteries.

    That’s why we’ve never learned how to make fire, how to harness electricity, how to travel to the moon. That’s why we don’t know how to create computers or understand the way DNA encodes RNA, which dictates protein structure. That’s why we have no knowledge of micro-organisms and how they work to cause both benefits and harm.

    Super bugs have emerged because Nature is much more powerful that what Man can throw at it.

    No, we can’t possibly know about super bugs because “Nature defies all attempts to unravel its mysteries”.

    those super bugs do not kill normal folks who have not been medicating on endless rounds of antibiotics.

    OH YES, THEY DO. That’s the problem! But you wouldn’t begin to understand because you’re too ignorant about the complexities of nature and clearly unwilling ever to learn what we already do understand.

    You really are making a colossal fool of yourself in your comments, Eddie. I’m sure you mean well but you’re way out of your depth.

  • My mother had the same complaints in 1984. Stents not developed yet. Diagnosis = stable angina. Effective treatment: Nitrostat, a sublingual homeopathic preparation of Nitroglycerine. Still used today.

    https://www.webmd.com/drugs/2/drug-6929/nitrostat-sublingual/details

    http://circ.ahajournals.org/content/73/1/21

    • A homeopathic preparation of nitroglycerin? Now that’s something I’d like to see, especially the first succussion step – from a safe distance, mind you…

      • Nitrostat sublingual is emphatically NOT homeopathic. It “contains 0.3 mg, 0.4 mg , or 0.6 mg nitroglycerin” [https://www.rxlist.com/nitrostat-drug.htm]. Historically it was indeed promoted by homeopaths (in the 19th century) but homeopathic ritual nonsense and ‘provings’ became replaced with authentic medical research in the 20th century, which showed the compound was a vasodilator.

        The homeopathic formulation of nitroglycerine (it’s called ‘glonoine’ in homeopathy) is diluted at least to 6C (which means a dilution of 10^–12 or 1 part in 1 trillion and may be given at Hahnemann’s favourite dilution of 30C (10^–60) which effectively means there’s no nitroglycerine in the preparation. [http://www.homeoint.org/books/boericmm/g/glon.htm]

        • I distinctly recall that the label on the small amber colored glass Nitrostat bottle at that time included the words “a homeopathic preparation”. It has since been removed from the label. I am sure Professor Ernst recalls this. Perhaps he will comment.

          It is still an effective, safe and inexpensive vasodilating homeopathic preparation.

          • yes, it is a effective, safe and inexpensive vasodilating preparation.
            but homeopathic it ain’t!
            it does not follow the ‘like cures like’ principle nor is it potentised like practically all homeopathic remedies.

          • Sandra

            Here’s a collection of photos of Nitrostat bottles and packaging. Can you see any that mention homeopathy? What alternative explanations can you think of for your recollection, distinct or otherwise?

          • I distinctly recall that the label on the small amber colored glass Nitrostat bottle at that time included the words “a homeopathic preparation”.

            You “distinctly recall”? If you knew anything about memory at all you’d know that recalling anything from that far back is going to be dodgy at best.

            Also, you have had your posts and tweets corrected with reliable and conclusive data (with citations) consistently throughout your time online. You also consistently fail to recall these.

            Your recollection is incorrect.

        • Professor Odds, You don’t have a clue about homeopathy and your statement above is evidence of that.

          A homeopathic remedy is not contingent on its potency: it is contingent on the similarity of the symptoms produced by the medicine to the symptoms of the natural disease. 1gram of x substance could be a homeopathic remedy depending on case, one good example comes to my mind but you are so thick that it is not worth telling you.

          Now, why don’t you go back to playing with your fungi?

        • Yes, I know it isn’t, it was just that I found the mental image of a homeopath vigorously shaking a bottle of nitroglycerin quite humorous.
          Apparently, the clinical effects of nitroglycerin were discovered by a homeopath, and this man created several different dilutions. No doubt, only the lowest potencies (up to 2C) had any real effect (although an active dose of only 0.6 mg makes it quite a potent substance; most pharmaceuticals are used in rather higher dosages).
          So indeed it is not correct to call Nitrostat a ‘homeopathic’ medicine, even if its medicinal effects were first described by a homeopath.

  • I appreciate your reply Professor Ernst. Your comment: “yes, it is a effective, safe and inexpensive vasodilating preparation but homeopathic it ain’t! it does not follow the ‘like cures like’ principle nor is it potentised like practically all homeopathic remedies.”

    My first husband (a German national I married while studying in Munich, Germany) was an Associate Professor of Pharmaceutical Chemistry at a major university’s medical school for 20 years. I edited and transcribed his PhD thesis (University of Michigan, Ann Arbor) Through him, I have a vast knowledge of pharmaceutical chemistry. Change the name, alter the description, change the label, do whatever suits the agenda, Nitrostat was and still is a homeopathic preparation and used in the same manner.

    I wonder if you, Professor Ernst, recall the labeling I have mentioned, containing the words noting that it was “a homeopathic preparation” ?

  • To Alan Henness who said:

    “Sandra Here’s a collection of photos of Nitrostat bottles and packaging. Can you see any that mention homeopathy? What alternative explanations can you think of for your recollection, distinct or otherwise?”

    Alan, I appreciate your contribution. However, the labels on the Nitrostat bottles would need to be on bottles dispensed in the 1980s. As I mentioned, the words “a homeopathic preparation” were removed from the label. A drug rep may be able to tell you when the decision to remove this notation was made.

    • Sandra

      It’s helpful if replies were underneath the comment you are attempting to respond to rather than elsewhere. It’s quite easy really.

      But you misunderstand, Sandra: those images include ones from many, many decades ago. Please let us know if you find one that says it’s homeopathic?

      However, unless and until you can provide some evidence for your claims, I think we can take them with a 30C dilution of NaCl.

    • Sandra, you’re on a hiding to nothing here. Nitrostat was first manufactured by Parke-Davis (a subsidiary of the Warner Lambert pharmaceutical company). It received FDA approval in 2000, so it didn’t even exist (under that brand name) in the 1980s.

      Here’s the problem for those of us who think homeopathy is unsupportable nonsense. A person like you — entirely pleasant and well-meaning — posts a comment that’s supposed to make us reflect we might be mistaken. But your recollections (a) have nothing to do with homeopathy — nitroglycerine was used as a pharmaceutical to treat angina long before the 1980s, (b) are demonstrably inaccurate in detail, and (c) don’t amount to a scientific proof of anything.

      You have now had explanations in several comments that, yes, we acknowledge the historical contribution of homeopaths to the discovery of the anti-angina effects of nitroglycerine (your original link) but that sublingual nitroglycerine with the brand name Nitrostat has zilch to do with homeopathy. (Niroglycerine was first used to treat angina in orthodox medicine in 1867 [https://www.britishhomeopathic.org/charity/how-we-can-help/articles/homeopathic-medicines/g/glonoine/]. Please note, that’s a reference from a homeopathist website.)

      Perhaps you’ll be interested to look over a list of effects of nitroglycerin in homeopathic ‘provings’ (I use the quotation marks because the word only means ‘testings’ in its original German). You’ll see a long list of ‘proving symptoms’, only one of which relates to the heart: “Laborious action. Fluttering. Palpitation with dyspnœa. Cannot go uphill. Any exertion brings on rush of blood to heart and fainting spells. Throbbing in the whole body to finger-tips.” You may say some of those relate to angina, but the main symptom of angina — chest pain — is missing. So, as Edzard already pointed out, nitroglycerin doesn’t even meet the standard homeopathic criterion of ‘like cures like’!

      • Here’s the problem for those of us who think homeopathy is unsupportable nonsense. A person like you — entirely pleasant and well-meaning[snip]

        Ah… I see you’ve never really interacted with Sandra before.

    • Like this one?

      It is from an appropriate era and was returned from a search for “Nitrostat historical bottles”

      Source;
      * Vintage Rexall GLYCERIN 4 FL OZ glass bottle ONE TEASPOON AS A DEMULCENT DRUG KING price sticker .33
      * https://kookykitsch.com/index.php/medicinal-advertising/vintage-rexall-glycerin-4-fl-oz-glass-bottle-one-teaspoon-as-a-demulcent-drug-king-price-sticker-33-detail

  • “Sandra” whoever that is, may well have seen the words “homeopathic preparation” printed on some bottles of something some time ago but that does not make nitroglycerine drugs “homeopathic” or substantiate homeopathy as anything more than a game of pretending to heal.

    It is difficult to find a substance that homeopaths have not played with and pretended to use as a drug in astronomically dilute preparations that contain literally (or next to) nothing at all of the named substance.
    The chemical substance Nitroglycerine is of course no exception as can be read in this article. But one can also read there how the homeopaths back then did not manage to make any sense of how to use it for real.

    Calling a potent drug like nitroglycerine a “homeopathic preparation” is plain pretentious, even if it is one of those drugs like nitroglycerine that works in very small amounts. The amount needed for even a mild effect of nitroglycerine is astronomically larger than what homeopaths use when they play doctor.
    “Homeopathic preparation” is something that contains no active amount of anything. If it has an effect, it by definition is a drug, not a remedy. Please don’t dilute the discussion with silly misconceptions.

  • Perhaps Sandra would like to tell us about how homeopathy saved her life when she was being poisoned by her fillings?

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