MD, PhD, FMedSci, FSB, FRCP, FRCPEd

conflict of interest

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Homeopathy must be effective! It is used extensively throughout the world, not least India! If it were ineffective, as all these nasty sceptics insist, Indians would not use it in such large numbers.

How often have we heard this argument?

Take, for instance, statements from the ‘peer-reviewed’ literature such as this one: “At present, in India, homeopathy is the third most popular method of medical treatment after allopathy and Ayurveda. There are over 200,000 registered homeopathic doctors currently, with approximately 12,000 more being added every year.” Or take statements from UK homeopaths like this one: “It seems clear that homeopathy is there to stay in India. So next time you see or read some condescending and patronising rubbish about homeopathy in the media, know that in India, a country with a population of 1.2 billion people (that’s more than 20x the population of the UK) homeopathy is an integral part of the healthcare system and deeply respected by the people of that country.”

Yes, homeopaths have always loved to mislead the public with fallacies!

The appeal to popularity is, of course, a classic fallacy – but, in the case of homeopathy’s popularity in India, it is not just that; here is an intriguing aspect to the use of homeopathy in that country that shines a different light on the whole story.

Epidemiologists from Canada conducted semi-structured interviews of 175 Mumbai slum-based practitioners holding degrees in Ayurveda, homeopathy and Unani. Most providers gave multiple interviews. The researchers also observed 10 providers in clinical interactions, documenting clinical examinations, symptoms, history taking, prescriptions and diagnostic tests.

No practitioners exclusively used his or her system of training. The practice of biomedicine was frequent, with practitioners often using biomedical disease categories and diagnostics. The use of homeopathy was rare; only 4% of consultations with homeopaths resulted in the prescription of homeopathic remedies.

The authors concluded that important sources of health care in Mumbai’s slums, AYUSH physicians frequently use biomedical therapies and most refer patients with TB to chest physicians or the public sector. They are integral to TB care and control.

These data seem to suggest that the use of homeopathic remedies in India is far, far less than often claimed by apologists. Indian homeopaths seem to have much more sense than to use homeopathy for serious conditions. This is good news for Indian public health, in my view.

The story also shows how the ‘appeal to popularity’ is being misused for the promotion of homeopathy: not only is it based on poor logic but often also on false information.

I am sure that most of us have had enough of the endless discussions, information and foremost disinformation about Brexit; we truly had to endure them ad nauseam. And here I come with a post about the very subject.

Have I lost my senses?

Bear with me and find out for yourself.

There has been little mention of alternative medicine in the debates about last week’s referendum. For the Remain campaigners, there was perhaps no reason to go into this divisive topic because, in their view, all would stay as it is. And the ‘Brexiters’ obviously had other things on their minds. It seemed almost as though they were too busy inventing new lies on a daily basis. To me, it seems fairly obvious though that, in the realm of alternative medicine, quite a lot could change after disastrous vote to leave the EU .

My main fears are twofold;

  1. Politicians who are short-sighted enough to campaign for Brexit might also be sufficiently stupid to go for unproven medicine. This fear seems to be confirmed by Nigel Farage who once claimed that BIG HARMA was lobbying in Brussels to put alternative medicine producers out of business. But we should take that with a pinch of salt, of course; anything this man says is hardly worth taking any notice of, in my view.
  2. Consumers who are gullible enough to believe the false arguments of the Brexiters might also be sufficiently naïve to believe the fallacies and falsehoods of alternative medicine promoters.

So, are there reasonable predictions as to how Brexit might impact on the alternative medicine scene in Britain? I searched for some evidence on this question and was surprised how little there was to be found.

Dr Jan Knight from Knight Scientific, a medical research company, was quoted saying: “A lot of the complementary/alternative medicine lobby are rubbing their hands because they think they’ll be able to do anything, but I don’t think the regulations will change.”

The excellent QUACKOMETER published an entire article on the subject which is well worth reading and essentially agrees with this view. Here are its conclusions: “EU laws about alternative medicine are not that great in number. The UK is free to choose who it licenses as a medical practitioner. It can allow chiropractors and osteopaths to have statutory regulation and does so. It can fund any such treatment publicly if it so wished without EU interference. It can police the sale of products on the High Street by funding Trading Standards and training them (but it chooses not to.) The UK government can come up with its own schemes to register herbalists and homeopaths and in doing so misleads the public about them. In short, it is possible to suggest that the UK governments do indeed exercise sovereignty over how alternative medicine manifests itself, how well the public is protected and how much public money is spent on it. Leaving the EU is not going to make much difference that way. Although I do suspect that staying might indeed over the years steadily increase the level of regulation around the matter. Successive UK governments have not done a lot. The EU just a little more.”

Perhaps the regulatory framework might not change a lot. But what about the prevalence of alternative medicine usage? It seems difficult to predict in which direction it will go. The reason is that I see influences in both directions.

FACTORS THAT COULD INCREASE THE USE OF ALTERNATIVE MEDICINE

The Brexiters managed to style themselves as the anti-establishment. It is obvious that much of alternative medicine understands itself as an anti-establishment movement within healthcare. This means there could be a natural affinity between the two. On second thought, however, I think we can reject this possibility. The reason is that the Brexiters’ anti-establishment stance was nothing but a campaign ploy; in truth it is as genuine as a 4£ note.

What is much more real, in my view, is the well-documented inability of the Brexiters to correctly interpret the evidence (one could put this more simply by pointing out their ability to twist and turn the truth such that it suits their aims). These are qualities which I have often observed in promoters of alternative medicine, and it is this type of affinity that eventually might stimulate a general upwards trend of alternative medicine in the UK.

In a similar vein, we have to account for the influence of our future king. Prince Charles clearly has an alternative bee under his bonnet. Once we are outside the EU, it is likely that his influence on health politicians and other decision makers will be felt more powerfully. The Prince of Wales might even revive the ‘Smallwood Report’ which he commissioned to convince politicians that money could be saved by using more alternative therapies in the NHS. Charles and his views usually generate bewilderment on the EU-level, while here in the UK we still have many who take him seriously. His influence in a post-Brexit Britain is likely to be strengthened and will therefore be a factor that has the potential to boost alternative medicine in the UK.

FACTORS THAT COULD DECREASE THE USE OF ALTERNATIVE MEDICINE

It has been reported that our suicidal move out of the EU has led to a contraction of wealth in Britain which is bigger than anything seen since 1921. Apparently, £ 120 billion have been wiped off the value of the stock market within just a few hours. To assume that this will hit only those who are rich enough to own shares, is more than naïve. It will hit all Brits and might even drive us into another recession.

Such developments are, of course, most unwelcome but nevertheless important in relation to alternative medicine usage. Those who employ alternative treatments usually pay for them out of their own pocket. Alternative medicine has always been a bit of a luxury item for those who had more money than sense. The consequence is that financially hard times are almost automatically associated with a reduction of alternative medicine use.

CONCLUSION

All of this is, of course, akin to an exercise in reading tea leafs. But if I am correct, we will now see a significant decrease in the demand for alternative medicine in the ‘Disunited Kingdom’. Once the financial misery is over – and that could take many years – Prince Charles and other ‘irrationalists’ might succeed in bringing about a moderate increase in the use of unproven treatments.

It has been reported that ‘Boots the Chemist’ have filed several legal complaints against The Guardian in relation to articles published by the paper in relation to its April 2016 investigation. The Guardian articles in question alleged that Boots, the UK’s largest pharmacy chain, had placed undue pressure on its pharmacists to perform medicines use reviews so that it could claim the maximum payments possible from the NHS. In other words, The Guardian implied that Boots was trying to get more money from our NHS than might have been due.

Personally, I am always uneasy when I hear that someone takes legal action on such matters. I think that legal complaints of such a nature can turn out to be counter-productive, both in general and in this particular instance.

Why?

There could be several reasons. For instance, such actions might give someone the idea of filing complaints against Boots. I am sure it is not difficult to find reasons for that.

In the realm of alternative medicine, for example, someone might question whether selling homeopathic remedies in Boot’s section ‘pharmacy and health’ is not misleading. These remedies might be seen by a naïve customer as masquerading as medicines. As readers of this blog know all too well, they do not, in fact, contain anything (other than lactose) that has any pharmacological activity. Therefore Boots should best market them in the category of ‘confectionary’.

One might even suspect that Boots are fully aware of all this. After all, a spokesperson for the company stated years ago during a parliamentary inquiry: “I have no evidence to suggest that they [homeopathic remedies sold by Boots] are efficacious …”

And it is also not the first time that Boots have been challenged for selling products they know to be placebos. This is what The Guardian reported in 2008 about the issue: “Ernst accuses the company [Boots] of breaching ethical guidelines drawn up by the Royal Pharmaceutical Society of Great Britain, by failing to tell customers that its homeopathic medicines contain no active ingredients and are ineffective in clinical trials.”

A similar void of evidence also applies to Boot’s wide range of Bach Flower Remedies and aromatherapy oils.

Or am I wrong?

Perhaps Boots want to post links to the evidence in the  comment section below?

I am always keen to learn and only too happy to change my mind in view of new, compelling evidence!

Boots also sell a very wide range of herbal medicines, and here the situation is quite different: herbal medicines actually contain molecules that might have pharmacological effects, i. e. they might heal or might harm you. And many of these products imply indications for which they should be taken. I will pick just one example to explain: HERBAL SLIM AID.

Yes, you are absolutely correct – this product is (according to its name) not for gaining weight, it’s for reducing it. Each coated tablet contains 45 mg of extract (as dry extract) from Bladderwrack thallus (Fucus vesiculosus L.) (5:1) (equivalent to 225 mg of Fucus) Extraction solvent: water, ,30 mg Dandelion Root (Taraxacum officinale Weber ex Wigg), 27 mg of extract (as dry extract) from Boldo leaf (Peumus boldus Molina) (4-6:1) (equivalent to 108-162 mg of Boldo leaf) Extraction solvent: Methanol 70% v/v, 10 mg Butternut Bark (Juglans cinerea L.).

Now, I thought I know quite a bit about herbal slimming aids, after all, we had a research focus on this topic for several years and have published about a dozen papers on the subject. But oddly, I cannot remember that this mixture of herbs has been shown to reduce body weight.

Perhaps Boots want to post evidence for the efficacy and safety of this product as well?

I certainly hope so, and I would instantly withdraw any hint of a suspicion that Boots are selling unproven or disproven medicines.

Where is all this going?

I have to admit that am not entirely sure myself.

I suppose all I wanted to express was that it might be unwise to throw stones when one is sitting in a glass-house – a cliché, I know, but it’s true nevertheless.

 

 

 

CONFLICTS OF INTEREST:

None [except I don’t like those who easily take legal action against others]

Homeopaths assume lots of things; one of their main claims is, for instance, that the process of repeatedly diluting a remedy and vigorously shaking it at each step – they call this potentisation – renders it more potent. This is the famous MEMORY OF WATER’ theory of homeopathy. In Hahnemann’s own words: ‘…the power of a medicine in solution is much increased by intimate mixture with a large volume of fluid…’ And elsewhere he stated that ‘as the smallest quantity of medicine naturally disturbs the organism least, we should choose the very smallest doses, provided always that they are a match for the disease… hardly any dose of the homeopathically selected remedy can be so small as not to be stronger than the natural disease…’

Hahnemann’s explanation for this extraordinary assumption (which he claimed to have observed empirically) was that his remedies do not work through any material effects but via spirit-like energies. As this sounds a little silly in the light of modern science, homeopaths have been keen to find more rational support for their theories. Thus they have developed several ‘sciency’ concepts to explain the mode of action of their highly diluted homeopathic remedies. For instance that postulated that water can form secondary structures that hold some information of the original substance (stock), even if it has long been diluted out of the remedy. Alternatively, they claimed that the shaking of the remedy generates nano-particles or silicone-particles which, in turn, are the cause of the clinical effects.

Today, I want to assume for a minute, that one of these theories is correct – they cannot all be right, of course. Homeopaths regularly show us investigations that seem to support them, even though it only needs a real expert in the particular field of science to cast serious doubt on them. I will nevertheless assume that, after potentisation, the diluent retains information via nano-particles or some other phenomenon. For the purpose of this mind-experiment, I grant homeopaths that, in this respect, they are correct. In other words, let’s for a moment assume that the ‘memory of water’ theory is correct.

As I have been more than generous, I want homeopaths to return the favour and consider what this would really mean: information has been transferred from the stock to the diluent. Does that prove anything? Does it show that homeopathy is valid?

Could the homeopaths who make this assumption be equally generous and answer the following questions, please?

  1. How does a nano-particle of coffee, for instance, affect the sleep centre in the brain to make the patient sleep? Or how does a nano-particle of the Berlin Wall or a duck liver affect anything at all in the human body? The claim that information has been retained by the diluent is no where near to an explanation of a rational mode of action, isn’t it?
  2. Most homeopathic remedies are consumed not as liquids but as ‘globuli’, i. e.  tiny little pills made of lactose. They are prepared by dropping the liquid remedy on to them. The liquid subsequently evaporates. How is it that the information retained in the liquid does not evaporate with the diluent?
  3. The diluent usually is a water-alcohol mixture which inevitably contains impurities. In fact, a liquid C12 remedy most certainly contains dimensions more impurities than stock. These impurities have, of course, also been vigorously shaken, i. e. potentised. How can we explain that their ‘potency’ has not been beefed up at each dilution step? Would this not necessitate a process where only some molecules in the diluent are agitated, while all the rest remain absolutely still? How can we explain this fantastic concept?
  4. Some stock used in homeopathy is insoluble (for instance Berlin Wall). Such stock is not diluted but its concentration in the remedy is initially lowered by a process called ‘trituration’, a process which consists in grinding the source material in another solid material, usually lactose. I have granted you that potentisation works in the way you think. But how is information transferred from one solid material to another?
  5. Everything we drink is based on water containing molecules that have been inadvertently potentised in nature a million times and therefore should have hugely powerful effects on our bodies. How is it that we experience none of these effects each time we drink?

Now, homeopaths, let me propose a deal.

If you can answer these questions satisfactorily, I will no longer doubt your memory of water theory. If you cannot do this, I think you ought to admit that all your ‘sciency’ theories about the mode of action of highly diluted homeopathic remedies are really quite silly – more silly even than Hahnemann’s idea of a ‘spirit-like’ effect.

 

Yes, yes, yes, I know: we have too few women in our ‘ALT MED HALL OF FAME’. This is not because I have anything against them (quite the contrary) but, in alternative medicine research, the boys by far outnumber the girls, I am afraid.

You do remember, of course, you has previously been admitted to this austere club of excellence; only two women so far. Here is the current list of members to remind you:

David Peters (osteopathy, homeopathy, UK)

Nicola Robinson (TCM, UK)

Peter Fisher (homeopathy, UK)

Simon Mills (herbal medicine, UK)

Gustav Dobos (various, Germany)

Claudia Witt (homeopathy, Germany and Switzerland)

George Lewith (acupuncture, UK)

John Licciardone (osteopathy, US)

If you study the list carefully, you will also notice that, until now, I have totally ignored the chiropractic profession. This is a truly embarrassing omission! When it comes to excellence in research, who could possibly bypass our friends, the chiropractors?

Today we are going to correct these mistakes. Specifically, we are going to increase the number of women by 50% (adding one more to the previous two) and, at the same time, admit a deserving chiropractor to the ALT MED HALL OF FAME.

Cheryl Hawk is currently the Executive Director of Northwest Center for Lifestyle and Functional Medicine, University of Western States, Portland, USA. Previously she worked as Director of Clinical Research at the Logan University College of Chiropractic, Chesterfield, USA, and prior to that she was employed at various other institutions. Since many years she has been a shining light of chiropractic research. She is certainly not ‘small fry’ when it comes to the promotion of chiropractic.

Cheryl seems to prefer surveys as a research tool over clinical trials, and it was therefore not always easy to identify those of her 67 Medline-listed articles that reported some kind of evaluation of the value of chiropractic. Here are, as always, the 10 most recent papers where I could extract something like a data-based conclusion (in bold) from the abstract.

Best Practices for Chiropractic Care of Children: A Consensus Update.

Hawk C, Schneider MJ, Vallone S, Hewitt EG.

J Manipulative Physiol Ther. 2016 Mar-Apr;39(3):158-68

All of the seed statements in this best practices document achieved a high level of consensus and thus represent a general framework for what constitutes an evidence-based and reasonable approach to the chiropractic management of infants, children, and adolescents.

Clinical Practice Guideline: Chiropractic Care for Low Back Pain.

Globe G, Farabaugh RJ, Hawk C, Morris CE, Baker G, Whalen WM, Walters S, Kaeser M, Dehen M, Augat T.

J Manipulative Physiol Ther. 2016 Jan;39(1):1-22

The evidence supports that doctors of chiropractic are well suited to diagnose, treat, co-manage, and manage the treatment of patients with low back pain disorders.

The Role of Chiropractic Care in the Treatment of Dizziness or Balance Disorders: Analysis of National Health Interview Survey Data.

Ndetan H, Hawk C, Sekhon VK, Chiusano M.

J Evid Based Complementary Altern Med. 2016 Apr;21(2):138-42.

The odds ratio for perceiving being helped by a chiropractor was 4.36 (95% CI, 1.17-16.31) for respondents aged 65 years or older; 9.5 (95% CI, 7.92-11.40) for respondents reporting head or neck trauma; and 13.78 (95% CI, 5.59-33.99) for those reporting neurological or muscular conditions as the cause of their balance or dizziness.

US chiropractors’ attitudes, skills and use of evidence-based practice: A cross-sectional national survey.

Schneider MJ, Evans R, Haas M, Leach M, Hawk C, Long C, Cramer GD, Walters O, Vihstadt C, Terhorst L.

Chiropr Man Therap. 2015 May 4;23:16.

American chiropractors appear similar to chiropractors in other countries, and other health professionals regarding their favorable attitudes towards EBP, while expressing barriers related to EBP skills such as research relevance and lack of time. This suggests that the design of future EBP educational interventions should capitalize on the growing body of EBP implementation research developing in other health disciplines. This will likely include broadening the approach beyond a sole focus on EBP education, and taking a multilevel approach that also targets professional, organizational and health policy domains.

Chiropractic identity, role and future: a survey of North American chiropractic students.

Gliedt JA, Hawk C, Anderson M, Ahmad K, Bunn D, Cambron J, Gleberzon B, Hart J, Kizhakkeveettil A, Perle SM, Ramcharan M, Sullivan S, Zhang L.

Chiropr Man Therap. 2015 Feb 2;23(1):4

The chiropractic students in this study showed a preference for participating in mainstream health care, report an exposure to evidence-based practice, and desire to hold to traditional chiropractic theories and practices. The majority of students would like to see an emphasis on correction of vertebral subluxation, while a larger percent found it is important to learn about evidence-based practice. These two key points may seem contradictory, suggesting cognitive dissonance. Or perhaps some students want to hold on to traditional theory (e.g., subluxation-centered practice) while recognizing the need for further research to fully explore these theories. Further research on this topic is needed.

Do informed consent documents for chiropractic clinical research studies meet readability level recommendations and contain required elements: a descriptive study.

Twist E, Lawrence DJ, Salsbury SA, Hawk C.

Chiropr Man Therap. 2014 Dec 10;22(1):40

These results strongly suggest that chiropractic clinical researchers are not developing ICDs at a readability level congruent with the national average acceptable level. The low number of elements in some of the informed consent documents raises concern that not all research participants were fully informed when given the informed consent, and it may suggest that some documents may not be in compliance with federal requirements. Risk varies among institutions and even within institutions for the same intervention.

Feasibility of using a standardized patient encounter for training chiropractic students in tobacco cessation counseling.

Hawk C, Kaeser MA, Beavers DV.

J Chiropr Educ. 2013 Fall;27(2):135-40.

This active learning exercise appeared to be a feasible way to introduce tobacco counseling into the curriculum.

Consensus process to develop a best-practice document on the role of chiropractic care in health promotion, disease prevention, and wellness.

Hawk C, Schneider M, Evans MW Jr, Redwood D.

J Manipulative Physiol Ther. 2012 Sep;35(7):556-67

This living document provides a general framework for an evidence-based approach to chiropractic wellness care.

Chiropractic or osteopathic manipulation for children in the United States: an analysis of data from the 2007 National Health Interview Survey.

Ndetan H, Evans MW Jr, Hawk C, Walker C.

J Altern Complement Med. 2012 Apr;18(4):347-53.

C/OM is primarily used for back and neck pain, which is increasing in prevalence in children. Teens are more likely to use it than are younger children.

The role of chiropractic care in older adults.

Dougherty PE, Hawk C, Weiner DK, Gleberzon B, Andrew K, Killinger L.

Chiropr Man Therap. 2012 Feb 21;20(1):3.

Given the utilization of chiropractic services by the older adult, it is imperative that providers be familiar with the evidence for and the prudent use of different management strategies for older adults.

I am pleased to say that Prof Hawk gave me no problems at all; her case is clear: she is a champion of using research as a means for promoting chiropractic, has published many papers in this vein, clearly prefers the journals of chiropractic that nobody other than chiropractors ever access, and has an impeccable track record when it comes to avoiding negative conclusions which could harm chiropractic in any way.

Very well done indeed!

WELCOME, PROF HAWK, TO THE ‘ALT MED HALL OF FAME’.

 

Britt Marie Hermes is a most remarkable woman. She is an ex-naturopath who has the courage to speak out against all that is wrong with naturopathy. On her website she writes:

I used to be a naturopathic doctor. For 3 years, I practiced naturopathic medicine, licensed in Washington and Arizona. I earned my degree at Bastyr University and then completed a one-year naturopathic residency in a private clinic. I stayed at this clinic until I moved to Tucson.

Naturopathic medicine is not what I was led to believe. I discovered that the profession functions as a system of indoctrination based on discredited ideas about health and medicine, full of anti-science rhetoric with many ineffective and dangerous practices.

I left the profession of naturopathic medicine to pursue an education in biomedical research. Since my departure, I have been working to understand my former biases within naturopathic medicine. I am now exploring the ethics and evidence, or lack thereof, of naturopathic education and practice. I hope I can convey the message that naturopathy must be highly scrutinized, as its proponents have a seemingly on-going history of deceit, exploitation, and medical fraud.

Her articles are a rich source of fascinating material about naturopathy, and I warmly recommend you read her criticisms; you will not find better-informed comments easily. Recently, she went one step further and started a petition against US naturopaths’ plight to call themselves ‘doctors’. It seems that this was one step too far for the mighty ‘BIG NATUROPATHY’.

Forbes Magazine reported that, on May 26th, 5 days after Hermes launched her petition, the AANP retaliated [the AANP is the leading naturopaths’ organization in the U.S., the American Association of Naturopathic Physicians]. The subject line of an email sent to all AANP membership:  “AANP Needs Your Help – Stop Britt’s Change.org Petition.”

“We need your help to stop this petition… This petition violates these [Change.org] policies:

  • Breaks the law – this is defamatory and libelous content
  • Impersonates others;  Britt Marie Hermes is not from the United States
  • Terms of service – does not abide by the law or respect the rights of others

Naturopaths found Britt Marie so threatening that they started a website entitled ‘BRITT MARIE HERMES FACT CHECK. Here they indulge in blatant character assassination:

Britt Marie Hermes Fact Check was established to provide an unbiased analysis of the claims that Britt Marie Hermes (Britt Marie Deegan) has made, and is making, about Naturopathic Medicine, its educational system, and its practitioners. For the past year she promoted herself as an expert on Naturopathic Medicine, having left the profession because of her unsuccessful time as a practitioner. It’s clear that she has an agenda against the profession while claiming to be an expert. She has consistently lied, and left out important facts when discussing aspects of the Naturopathic Medicine, its educational system and its practitioners. Accusations have been made that she is being paid by the pharmaceutical industry, although they haven’t been substantiated. What is clear, is that she was unsuccessful during her short time as a practitioner and now has an agenda against the profession.

This looks suspiciously like the dirt some alternative medicine fans have been throwing at me, I thought, and I asked Britt Marie (who I once had the pleasure of meeting in person) to comment – and she very kindly did:

I find it amusing to be accused of being an unsuccessful practitioner of naturopathic medicine. I graduated with high grades from Bastyr. I landed a highly competitive naturopathic residency. Had I remained in practice, I would currently be eligible to take the naturopathic pediatrics “board-certification” exam offered by the American Association of Naturopathic Pediatrics.

I was making decent money at my practices in Seattle and Tucson. By all accounts, I was a successful naturopathic doctor. My bosses at the Tucson clinic had even asked me if I were interested in becoming their business partner!

I walked away from my practice because my boss was committing a federal crime by importing and administering a non-FDA approved medication to his cancer patients. I decided to leave naturopathic medicine for good after a former president of the American Association of Naturopathic Physicians urged me not to report my boss’s criminal activity to the authorities.

These wounds still hurt. I lost dozens of friends. I lost eight years of my life. I lost my livelihood. The ND degree does not have any value in the academic community. It is a tarnish on my permanent record. It would have been in my financial interest to move to another practice and continue being a “successful” naturopath.

The problem with naturopaths is that they measure success by how much money one collects from patients, yet they fail to understand that naturopathic services are quackery. So by their logic, being a successful naturopath is dependent upon profiting by fooling patients and fooling oneself. If others want to describe me as an unsuccessful naturopath, then the term “success” has no useful meaning.

I am not employed to write about anything in particular about naturopathic medicine or with any particular tone. I am an independent blogger who wants to share my insights. I created my own opinions on naturopathic medicine by looking at the profession critically. This kind of task is fundamental to the scientific process that I only learned after leaving naturopathy and engaging with the academic community.

Naturopaths want to be recognized as primary care physicians in the U.S. and Canada. This is a big deal, and we all should be skeptical. This profession is claiming to have established a comprehensive medical education that trains competent medical practitioners, who somehow predominately rely upon unproven methods at best and debunked ones at worst.

Naturopaths essentially want to be allowed to take shortcuts in medical training. Instead of attending medical school, naturopaths attend naturopathic programs with low acceptance standards and faculty who are not qualified to teach medical topics. Instead of passing a standardized and peer-reviewed medical licensing exam, naturopaths have created their own secretive licensing exam that tests on homeopathy and other dubious treatments. What little real medical standards that seem to be tested on the exam have been botched, like the one question in which a child is gasping for air and the correct answer on how to treat is to give a homeopathic remedy.

Naturopaths have called me a liar, but have been unable to identify any specific fabrications. They say I am omitting facts and evidence, but they cannot show what information I allegedly missed. It seems that for naturopaths the only way to deal with legitimate criticism, is to undermine my integrity.

My blog harbors no hidden agenda. I write to prevent students from being duped into thinking they are being adequately trained as a primary care physicians in naturopathic programs. I write to protect patients from the poorly trained practitioners that these programs produce. I write because I have seen both worlds, and the naturopathic one is terrifying.

To this, I have nothing to add – except a big THANK YOU to Britt Marie for her courage, honesty and tenacity.

The queue outside my ‘ALT MED HALL OF FAME’ was getting restless because I did not admit any new members for some time. So, I better get cracking!

You remember, of course, who has been honoured so far; the list of members (main research interest, country) is as follows:

Nicola Robinson (TCM, UK)

Peter Fisher (homeopathy, UK)

Simon Mills (herbal medicine, UK)

Gustav Dobos (various, Germany)

Claudia Witt (homeopathy, Germany and Switzerland)

George Lewith (acupuncture, UK)

John Licciardone (osteopathy, US)

Today, we are going to have a look at Prof David Peters. This is what our friends from the ‘COLLEGE OF MEDICINE’ say about him:

“David Peters MB, ChB, DRCOG, DMSMed MFHom FLCOM trained as a GP, a musculoskeletal physician and also as a homeopathic and osteopathic practitioner. For fifteen years he directed the complementary therapies development programme at Marylebone Health Centre. Professor Peters is one of the founding faculty of the University of Westminster’s School of Life Sciences, where he is Clinical Director. Professor Peters is a member of the Council and former chair of the British Holistic Medical Association and Editor of its Journal of Holistic Healthcare. He has co-authored or edited six books about integrated healthcare. His research interests include the role of non-pharmaceutical treatments in mainstream medicine, wellbeing in long-term conditions and the development of integrated practitioners.”

I did my usual Medline search but found only 16 Medline-listed articles authored by David Peters. This is amazing because he has been involved in UK alt med much longer than I have. Even more amazing is that none of these papers seem to refer to clinical trials. Perhaps he is not convinced of this type of research?

In order to evaluate his output, I took the sentence that came nearest to a conclusion from the most recent 10 articles. Below you find first the titles of each paper (with the link to it), second the list of its authors and third the sentence that formulated a conclusion (in bold).

Patient outcomes and experiences of an acupuncture and self-care service for persistent low back pain in the NHS: a mixed methods approach.

Cheshire A, Polley M, Peters D, Ridge D.

BMC Complement Altern Med. 2013 Nov 1;13:300. doi: 10.1186/1472-6882-13-300.

The BBPS provided a MSK pain management service that many patients found effective and valuable. Combining self-management with acupuncture was found to be particularly effective, although further consideration is required regarding how best to engage patients in self-management.

Is it feasible and effective to provide osteopathy and acupuncture for patients with musculoskeletal problems in a GP setting? A service evaluation.

Cheshire A, Polley M, Peters D, Ridge D.

BMC Fam Pract. 2011 Jun 13;12:49. doi: 10.1186/1471-2296-12-49.

Provision of acupuncture and osteopathy for MSK pain is achievable in General Practice. A GP surgery can quickly adapt to incorporate complementary therapy provided key principles are followed.

Gatekeepers and the Gateway–a mixed-methods inquiry into practitioners’ referral behaviour to the Gateway Clinic.

Unwin J, Peters D.

Acupunct Med. 2009 Mar;27(1):21-5. doi: 10.1136/aim.2008.000083.

The Gateway Clinic has become an increasingly popular referral resource. The influences that drive referral to the clinic are multiple and follow “tacit guidelines”. GPs select patients on the basis of their individual clinical experience, informed by positive patient feedback and often only after more conventional medical treatment options have been exhausted.

Complementary medicine: evidence base, competence to practice and regulation.

Lewith GT, Breen A, Filshie J, Fisher P, McIntyre M, Mathie RT, Peters D.

Clin Med (Lond). 2003 May-Jun;3(3):235-40. Review.

This paper describes the current status and evidence base for acupuncture, homeopathy, herbal and manipulative medicine, as well as the regulatory framework within which these therapies are provided. It also explores the present role of the Royal College of Physicians’ Subcommittee on Complementary and Alternative Medicine (CAM) in relation to these developments. A number of CAM professions have encouraged the Royal College of Physicians Subcommittee to act as a reference point for their discussions with the conventional medical profession and the subcomittee believes that they are able to fulfil this function.

Using a computer-based clinical management system to improve effectiveness of a homeopathic service in a fundholding general practice.

Peters D, Pinto GJ, Harris G.

Br Homeopath J. 2000 Jul;89 Suppl 1:S14-9

It is possible to introduce rigour and reflectiveness when providing a homeopathic service in general practice by assessing the needs of patient and practitioners, agreeing intake guidelines, developing referral processes, implementing audit cycles. Clear lines of communication can be established and a patient-centred outcome measure can be introduced into the treatment cycle.

I could not find any further articles that I could classify as providing data; so I stopped well short of the envisaged 10 papers. I have to admit, I was hesitant: does David deserve to be in the ALT MED HALL OF FAME? In the end, I gave him the benefit of the doubt. Why? Mainly because I am impressed with his scope of practice. Here is what he himself wrote about this aspect:

“I use a range of approaches: osteopathy and medical acupuncture, as well as nutrition and mind-body medicine – meditation, relaxation techniques, breath-work, self-hypnosis, biofeedback, and simple yoga-based exercises.  Sometimes herbal medicines, complex homeopathy, nutritional supplements, trigger-point or joint injections can be a valuable too. Somatic Experiencing is a gentle form of body-centred psychotherapy for problems that have come on after traumatic incidents. When I want to assess the impact of stress on the body I use a painless approach involving computer-based heart rate variability testing and breath analysis; sometimes salivary cortisol profiling too. Where required I can prescribe conventional medicine and  were they are needed I might suggest scans, X-rays or blood tests.”

Peter is perhaps not the most industrious researcher when it comes to publishing papers, but he fulfils the criterion of not ever publishing anything negative that might rock the boat or distract from the true value of alternative medicine.

LONG LIVE THE POSITIVE RESULT!

 

Seasonal allergic rhinitis (hay fever) is a common condition which can considerably reduce the quality of life of sufferers. Homeopathy is often advocated – but does it work?

A new study was meant to be an “assessment of the clinical effectiveness of homeopathic remedies in the alleviation of hay fever symptoms in a typical clinical setting.”

The investigator performed a ‘clinical observational study’ of eight patients from his private practice using Measure Yourself Medical Outcome Profile (MYMOP) self-evaluation questionnaires at baseline and again after two weeks and 4 weeks of individualized homeopathic treatment which was given as an add-on to conventional treatments.

The average MYMOP scores for the eyes, nose, activity and wellbeing had improved significantly after two and 4 weeks of homeopathic treatment. The overall average MYMOP profile score at baseline was 3.83 (standard deviation, SD, 0.78). After 14 and 28 days of treatment the average score had fallen to 1.14 (SD, 0.36; P<0.001) and 1.06 (SD, 0.25; P<0.001) respectively.

The author concluded as follows: Individualized homeopathic treatment was associated with significant alleviation of hay fever symptoms, enabling the reduction in use of conventional treatment. The results presented in this study can be considered as a step towards a pilot pragmatic study that would use more robust outcome measures and include a larger number of patients prescribed a single or a multiple homeopathic prescription on an individualized basis.

It is hard to name the things that are most offensively wrong here; the choice is too large. Let me just list three points:

  • The study design is not matched to the research question.
  • The implication that homeopathy had anything to do with the observed outcome is unwarranted.
  • The conclusion that the results might lend themselves to develop a pilot study is meaningless.

The question whether homeopathy is an effective therapy for hay fever has been tested before, even in RCTs. It seems therefore mysterious why one needs to revert to tiny observational studies in order to plan a pilot, and even less for an assessment of effectiveness.

There are few conditions which are more time-dependent than hay fever. Any attempt of testing the effectiveness of medical interventions without a control group seems therefore not just questionable but wasteful. Clinical studies absorb resources; even if the author was happy to waste his time, he should not assume that he can freely waste the time, effort and availability of his patients.

Two final points, if I may:

  • An observational study of homeopathy for hay-fever without a control group might be utterly useless but it is still an investigation that requires certain things. As far as I can see, this study did not even have ethics approval nor is there a mention of informed consent. Strictly speaking, this makes it an unethical study.
  • If we allow research of this nature to take place and be published, we give clinical research a bad name and undermine the confidence of the public in science.

I am puzzled how such a paper could pass peer review and how an Elsevier journal could even consider publishing it.

The question whether pharmacists should sell unproven alternative medicines will not go away. On this blog, we have discussed it repeatedly, for instance here, here and here. The Australian Journal of Pharmacy’s latest poll shows that readers have their suspicions about the validity of naturopathic medicines, with a whopping 544 voters choosing the option, “No, there’s no evidence they work” at the time of writing.

This constitutes 65% of readers who took part in the poll. A significant minority – 193 readers, with 23% of the vote – said that pharmacies should stock these medicines as they are legitimate products. Five per cent said that while they questioned their efficacy, pharmacy should stock them; and 3% said they were unsure, but the public wanted them.

Taree pharmacist and member of Friends in Science and Medicine Ian Carr, who has spoken to the AJP several times in the last couple of weeks as debate has continued about the subject of naturopathy in pharmacy, said he was surprised and pleased at the strength of the No vote. “I looked at [the poll] on the first day, and there was definitely a majority saying these things have no evidence, but there was still above 30% saying yes, they were legitimate products,” Carr told the AJP. “That’s been dwarfed by a lot of people who’ve looked in, and it’s interesting to have that many people vote. “I’m glad that it seems to be becoming recognised that there’s a need for the evidence base in these things, and the difference between having a naturopathic product or supplement on the shelf, and having somebody there charging for their time, as a naturopath, dispensing advice without knowing the patient’s background and without an intervention by a registered pharmacist.” He encouraged pharmacists concerned about the validity of naturopathy to consider what products and services they offer.

Where naturopaths are used, they should at least be expected to keep a record of products and advice dispensed, he says, similar to protocols around blood pressure and blood glucose monitoring. “If there’s going to be an insistence that naturopaths remain, that’s the way I’d like to see it: that the pharmacy has good records and oversight of what they’re doing. I think, given our connection to the PBS and the fact that we as pharmacists are looking for a more serious role as part of the health care team generally, and having a more active and integrative role, we would be silly to fritter it away on peripheries like naturopathy. I personally see the opportunities in evidence-based medicine and what flows from that, rather than trying to make up dollars. We’re more likely to lose control of pharmacy if we don’t guard it jealousy.”

One of the suppliers of CAM products to pharmacies responded to the article by stating the following:

“The complementary and alternative medicine (CAMs) sector and its role in healthcare management continues to be hotly debated by the media. Rather than dissuade this debate, we actively encourage this discussion, as it shines a light on many issues which need to be addressed. Of priority is the point that not all complementary and alternative medicine products are equal. As in many media articles, an incredibly wide spectrum of products are grouped under the label of ‘CAMs’. Products with specific clinical evidence, high-quality manufacturing processes and transparency on the sourcing of ingredients are not clearly identified from products without these qualities. Consumers and healthcare professionals are unable to distinguish this difference due to a lack of clear labelling. We agree with calls for CAMs products to be more thoroughly assessed, beyond being simply classified as ‘safe’. Healthcare professionals and consumers deserve this information and are indeed asking for it. Consumers are aware of the impact of their choices and that their demand drives industry change. History is littered with recent examples where consumer awareness has changed the marketplace for the better. Consumer-driven change in the CAMs industry IS possible, it just needs to be supported. The Australian CAMs industry needs to increase healthcare professional and consumer education on the importance of evidence-based CAM products; on what ‘evidence-based’ means and what this difference delivers… Healthcare professionals are key to helping their patients understand that not all CAMs or natural medicine products are equal… It takes time to change the way people see CAMs and natural medicines – but it is of inherent value for the consumer. Something, we believe, is integral to the future of the industry.”

The arguments are clearest, if we focus on a specific type of alternative medicine and spell out what precisely we are talking about. The one that comes to mind is, of course, homeopathy. In my view, there is no good reason why pharmacists should sell homeopathic remedies. It is comforting to know that the Chief Scientist of the UK Royal Pharmaceutical Society, Professor Jayne Lawrence, agrees; she stated about a year ago that “the public have a right to expect pharmacists and other health professionals to be open and honest about the effectiveness and limitations of treatments. Surely it is now the time for pharmacists to cast homeopathy from the shelves and focus on scientifically based treatments backed by clear clinical evidence.”

And what has changed since?

Nothing, as far as I can see – but please correct me, if I am wrong.

I think it is important that we remind the community pharmacists everywhere that they have their very own codes of ethics and that they need to adhere to them. If they don’t, they tacitly agree that they are not really healthcare professionals but mere shop-keepers.

I am editor in chief of a journal called FACT. It has a large editorial board, and I am always on the look-out for people who might be a good, productive and colourful addition to it. On 3 June, I sent an invitation to Mel Koppelman, who is by now well known to regular readers of this blog. Here is a copy:

Hi Mel,

can I ask you a question?

would you consider joining the ed-board of FACT [as you mentioned it in one of your comments, I assume you know this journal – but you are wrong in implying that it has anything to do with the pharmaceutical or any other industry]? if you agree, we would expect you to write 2-3 ‘summaries/commentaries’ per year. in return you get a free subscription and, of course, can submit other articles.

no, this is not a joke or a set-up. I like to have the full spectrum of opinion/expertise on my ed-board, and I do think you understand science quite well. our opinions differ but that’s what I think is good for the journal.

think about it – please.

cheers

edzard

On 6 June, she replied as follows:

Hi Edzard,

Great to hear from you, I hope you enjoyed your weekend.

Thank you very much for the kind offer, it’s something I would consider. I certainly have no problem with, and in fact embrace, people who have different opinions and views from my own, so long as I feel that they have integrity in their approach.

Just a few questions / comments:

1) Regarding FACT’s affiliations, what I said in my comment was that it was a publication of the Royal Pharmaceutical Society. According to Wiley’s website, Focus on Alternative and Complementary Medicine is copyright by Royal Pharmaceutical Society. It’s also listed on the Pharmaceutical Press website.

Are you telling me that’s incorrect? That I’m “wrong” in saying there’s a relationship? I obviously need to understand the nature of the publication whose editorial board I’m considering joining. Very confusing that you as editor say there’s no relationship to the RPS and yet they claim copyright over your publication. Incidentally, is FACT self-sufficient, earning all of its income from subscriptions? Or does any financial support come from the publishers?

2) As enticing as a free subscription to FACT is, I have access to more high quality peer-reviewed reading material than I could enjoy in many lifetimes. Because my skills seem to be in high demand and because I already spend 10-20 hours per week doing unpaid volunteer work, any additional projects that I take on at this time would need to be financially compensated. I understand that this may be a deal-breaker.   

3) While I have no issue with you having different views when it comes to medical research, in order to choose to work with your publication, it’s important to me that it’s run by people with a high level of academic integrity and put patient welfare at the forefront of it’s agenda.

In March, you came out in public support of the NICE draft guidelines. You were quoted in the Guardian as saying: “It is good to see that Nice have now caught up with the evidence. Neither spinal manipulation nor acupuncture are supported by good science when it comes to treating low back pain.”

Following this, it was brought to your attention that the recommendations were contrary to best evidence and that the conclusions were unsupportable. While you have the option of following this up to make sure that the record reflects best evidence, you have indicated that you have no interest in evaluating the situation and possibly admitting an error. This behaviour is concerning from the perspective of academic integrity, particularly when it directly leads to increased human suffering (policy in several countries has already been changed based on the draft), and I would be worried that by joining your board I could be associated with such unethical behaviour. 

Perhaps if I understood better your position, which seems to be to ignore the situation, not follow up on the concerns raised, and leave your comments uncorrected even though they may be inaccurate and backing guidelines that cause harm to patients, that might allay certain reservations.

Anyways, these are my initial thoughts. I hope you have an opportunity to enjoy the beautiful weather, and I look forward to hearing from you.

Best wishes,

Mel

At that stage, I began to fear that I had made a mistake. But, giving her the benefit of the doubt, I swallowed my pride and replied as politely as I could to her concerns which, in my view, were odd, to say the least. This is what I wrote on 7 June:

Hi Mel,

Thank you for your reply to my invitation. Let me address your points in turn:

  1. I said that FACT has nothing to do with the pharma industry which is true [when you state that “you as editor say there’s no relationship to the RPS” – it suggests to me that you did not read my email properly]. In their own words, the RPS is the professional membership body for pharmacists and pharmacy in Great Britain and an internationally renowned publisher of medicines information.” [http://www.rpharms.com/home/about-us.asp] They have a similar status as the Royal Colleges. In the 2 decades that I am running the journal, there has been not a single instance of interference of any kind. We use them simply as an excellent publishing house. And yes, FACT is to the best of my knowledge self-sufficient and survives without funds from 3rd parties.
  2. I am delighted to hear that your skills are in demand.
  3. I have stated my position regarding the draft NICE guideline ad nauseam: I prefer to wait until I see their next version of the draft before I make further comments on it. In my view, this is both reasonable and honourable. If you disagree, I can do little about it other than expressing my sincere regrets.

I hope these brief clarifications are helpful for you to arrive at a decision.

Regards

Edzard

On 8 June, I received Mel’s reply:

Hi Edzard,
 
Thanks for your reply.
 
After thinking about it, I’ve decided to pass on your offer for the time being. This is mainly because I’m moving house towards the end of the summer and I’m in the process of simplifying and reducing my responsibilities so I can focus on that and getting settled in. After the move, I plan to reassess what I’d like to be involved with and how I’d like to spend my time.
 
I’d be happy to write the odd article for FACT as and when, if something comes up that you think I can make a helpful contribution to. 
 
Thanks for thinking of me, I appreciate the opportunity.
 
Best wishes,
Mel
I have to admit, I was very relieved, mainly because meanwhile someone had alerted me to the fact that Mel had posted all the correspondence on facebook (I would otherwise not have re-published it here because I usually don’t consider this sort of thing to be very elegant) where her friends were making ample comments. Here are a few (I have omitted the most infantile ones):

How interesting! Is he trying to ‘keep his enemies closer’ or am I being too skeptical? He has recognised your talents and dedication and intellect so he is not altogether stupid after all! I eagerly await his response to your reply.

Those who have studied with Ernst say that he’s a genuine chap and misunderstood – which I know is almost unimaginable given his behaviour – but we always have to allow for the possibility that we have misjudged people however remote! Also, people can turn – especially when they get older and near retirement. Alternatively he may just fancy you!… 

I think it’s an impressive offer. If only we were so lucky to be asked!  
 
“…You understand science quite well”  What a backhanded compliment! Your response is so articulate and balanced. 
 
That’s a compliment. I quite like Edzard. If you go for it hope all goes well. It raises the voice of the profession just in a different way. Best wishes. 
 
“Keep your friends close and your enemies closer” – Michael Corleone.
 
Terrific response Mel!! We’re all proud of you!! 
 
This does bring a chortle. Well done Mel. He’ll be rolling over for you to tickle his tummy before you know it 
 
Wow, quite surprising! If you can, it might be a good idea? To see how the other half lives…? 
 
Wow, this guy is a piece of work!
 
Excellent response Mel.
 
wow the white flag. Maybe thats his way of trying to save face
 
Excellent reply Mel .. indeed a perfect reply. I’m glad to hear that Charlie things Ernst is a genuine guy but having read his blogs and communicated with him quite a bit I would say he’s on the margins of some kind of personality disorder. I would be very cautious of getting into bed with him (as it were)
 
Go For It. A chance to debate is a chance to influence. If you have this opportunity to engage in an INVITED platform this is goldust. 
 
You very much understand science and of course more than ‘quite well’! I would imagine it is a difficult decision to make: both Peter Jonathan and Jani White have made good comments and as long as you are allowed to maintain your integrity within the position (and you can also get out if you want to), it might be a great opportunity to make real changes from within and open up all sorts of possibilitie and closed minds.
 
Well done. Your mind is as sharp as a needle can be.
 
I’ve come to this saga quite late yet regardless of my lack of knowledge..I LOVE paragraph 2…the first sentence especially. Freakin’ brilliant and hilarious!!! 
 
If you can’t beat them, join them. And then beat them! 
 
Curiouser and curiouser and I’m with Sandro but on the other hand I think you can beat them. 

Mel Koppelman Really enjoying hearing y’all’s thoughts on this. I just want to say that If I had thought that the chances of me being able to create positive change by joining FACT were high, I would have tempered the tone of my reply. But the simple fact that EE can’t even be factual or forthright about whose journal it is suggests an irreparable break with reality. And surely there’s an issue (academic? ethical? legal?) with recruiting someone to your board and denying an industry tie when there is one? Not to mention that if the RSP does fund his journal, he’s been lying about his conflicts of interest. Is that someone I want to spend time adding value to that could be spent with family, patients, time in nature or really making positive change by supporting the ANF? I’ll be interested to read his reply if there is one and especially how he responds regarding the relationship between FACT and RSP. Will keep y’all posted. 

Mel, you are amazing! Can’t wait to read how this plays out. Understand your concerns and think the way you have dealt with him is very professional. Go Mel!!
 
Great reply Mel. I would very much share your concerns about getting into bed with EE, so to speak (sorry for that image!). One day Hollywood will make a movie about this…
END OF FIRST SET OF COMMENTS; THE FOLLOWING COMMENTS WERE POSTED AFTER MEL PUBLISHED MY REPLY

Max Forrester keep your friends close; keep your enemies closer…

Ooh. ..he’s not a happy bunny
Such a soap opera…
 
I’m loving all these updates, who needs a telly lol. Jokes aside, thank you Mel for fighting our battles so eloquently. I would definitely buy the book if you decided to write one
 
OK this is interesting. The two American editors of FACT are William M. London who “currently writes and teaches about scientifically implausible and fraudulent health care practices”, and Stephen Barrett of Quackwatch (see a devastating critique of him here: http://www.quackpotwatch.org/quackpots/quackpots/barrett.htm). 
 
De-licensed MD Stephen Barrett. What kind of man would drop out of the medical profession and dedicate his life to STOPPING advancement in the health sciences?> <title>De</title> <base target=
quackpotwatch.org

John McDonald Healthy skepticism! Healthy journal! And it’s 99% fact-free! 

I think your talents are better used elsewhere than being co-opted to the Ernst prejudice-engine, Mel!
END OF COMMENTS

I hope that you find these exchanges as amusing as I did – but are they important? Perhaps not exactly, but revealing certainly. They shed some light on the mind-set of acupuncturists and perhaps other alternative practitioners as well. Let me try to explain.

What struck me first was the degree of suspicion, even outright hostility from the acupuncturists. I had made it quite clear that I was asking Mel to join my Editorial-Board because of her views which vastly differ from mine. In science, differences of opinions and backgrounds can be stimulating and often generate progress. That is not something that seems to be wanted by alternative practitioners; they do not seem to tolerate criticism, different perspectives or views. One cannot help asking to what degree this attitude is immature or even dogmatic.

The next thing that baffled me was the speed with which conclusions are jumped upon. Everyone seemed to be instantly convinced that I was via my journal FACT in the pocket of the pharmaceutical industry. Nobody even bothered to look up what the Royal Pharmaceutical Society truly stand for and to verify that they do NOT represent ‘BIG PHARMA’. This blindness to the possibility of being wrong confirms my fear that alternative therapists are guided by strong beliefs which must not be questioned and are hard to influence, even with facts that take less than a minute to research.

And then there are, of course, the personal attacks which came quick, thick and fast. Its authors might think that such attacks get under my skin. If so, they are mistaken: if anything, they amuse me! I have long been of the opinion that they are important victories of reason. When an acupuncturist went as far as diagnosing me as being borderline psychopathic, I almost fell off my chair laughing! To me, this remark (which has emerged several times before) is emblematic, as it suggests several things at once:

  • The author is obviously rude
  • He/she is incompetent, even stupid
  • He/she lacks empathy – after all, one would expect from a healthcare professional to show some understanding, if I were truly ill! And if not, one would expect more respect towards mentally ill patients.
  • But, of course, he/she did not mean it like that; he/she merely meant to insult me. And employing mental health issues for this purpose shows a remarkable lack of professionalism, in my view.
[Whenever I or someone in a similar position point out such things, the ‘other side’ starts shouting “AD HOMINEM!” Do they not see that my analysis of their attempted insult is merely a reaction to their ad hominem?]

Am I making too much of all this? Perhaps – sorry, I am almost done.

But first I need to briefly address Mel’s doubts about my integrity. She can, of course, question what she likes as often as she wants. My point is that repeating nonsensical arguments ad nauseam does not render then sensical.

Finally, there is Mel’s public claim that I have been lying about my conflict of interests. To me, it suggests a degree of desperation, perhaps even fanaticism, that is only surpassed by her inability to apologize after the truth had become undeniable even to her.

I know that there are some people who would have sued for libel.

Not I!

For that I find all this far too hilarious.

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