MD, PhD, FMedSci, FSB, FRCP, FRCPEd

fraud

WARNING: THIS MIGHT MAKE YOU LAUGH OUT LOUDLY AND UNCONTROLLABLY.

Deepak Chopra rarely publishes in medical journals (I suppose, he has better things to do). I was therefore intrigued when I saw a recent article of which he is a co-author.

The ‘study‘ in question allegedly examined the effects of a comprehensive residential mind–body program on well-being. The authors describe it as “a quasi-randomized trial comparing the effects of participation in a 6-day Ayurvedic system of medicine-based comprehensive residential program with a 6-day residential vacation at the same retreat location.” They included 69 healthy women and men who received the Ayurvedic intervention addressing physical and emotional well-being through group meditation and yoga, massage, diet, adaptogenic herbs, lectures, and journaling. Key components of the program include physical cleansing through ingestion of herbs, fiber, and oils that support the body’s natural detoxification pathways and facilitate healthy elimination; two Ayurvedic meals daily (breakfast and lunch) that provide a light plant-based diet; daily Ayurvedic oil massage treatments; and heating treatments through the use of sauna and/or steam. The program includes lectures on Ayurvedic principles and lifestyle as well as lectures on meditation and yoga philosophy. The study group also participated in twice-daily group meditation and daily yoga and practiced breathing exercises (pranayama) as well as emotional expression through a process of journaling and emotional support. During the program, participants received a 1-hour integrative medical consultation with a physician and follow-up with an Ayurvedic health educator.

The control group simply had a vacation without any of the above therapies in the same resort. They were asked to do what they would normally do on a resort vacation with the additional following restrictions: they were asked not to engage in more exercise than they would in their normal lifestyle and to refrain from using La Costa Resort spa services. They were also asked not to drink ginger tea or take Gingko biloba during the 2 days before and during the study week.

Recruitment was via email announcements on the University of California San Diego faculty and staff and Chopra Center for Wellbeing list-servers. Study flyers stated that the week-long Self-Directed Biological Transformation Initiative (SBTI) study would be conducted at the Chopra Center for Wellbeing, located at the La Costa Resort in Carlsbad, California, in order to learn more about the psychosocial and physiologic effects of the 6-day Perfect Health (PH) Program compared with a 6-day stay at the La Costa Resort. The study participants were not blinded, and site investigators and study personnel knew to which group participants were assigned.

Participants in the Ayurvedic program showed significant and sustained increases in ratings of spirituality and gratitude compared with the vacation group, which showed no change. The Ayurvedic participants also showed increased ratings for self-compassion as well as less anxiety at the 1-month follow-up.

The authors arrived at the following conclusion: Findings suggest that a short-term intensive program providing holistic instruction and experience in mind–body healing practices can lead to significant and sustained increases in perceived well-being and that relaxation alone is not enough to improve certain aspects of well-being.

This ‘study’ had ethical approval from the University of California San Diego and was supported by the Fred Foundation, the MCJ Amelior Foundation, the National Philanthropic Trust, the Walton Family Foundation, and the Chopra Foundation. The paper’s first author is director of research at the Chopra Foundation. Deepak Chopra is the co-founder of The Chopra Center for Wellbeing.

Did I promise too much?

Isn’t this paper hilarious?

Just for the record, let me formulate a short conclusion that actually fits the data from this ‘study’: Lots of TLC, attention and empathy does make some people feel better.

This is hardly something one needs to write home about; and certainly nothing to do a study on!

But which journal would publish such unadulterated advertising?

On this blog, I have mentioned the JACM several times before. Recently, I wrote about the new man in charge of it. I concluded stating WATCH THIS SPACE.

I think the wait is now over – this paper is from the latest issue of the JACM, and I am sure we all agree that the new editor has just shown us of what he is made and where he wants to take his journal.

Just as I thought that this cannot get any better, it did! It did so in the form of a second paper which is evidently reporting from the same ‘study’. Here is its abstract unaltered in its full beauty:

The effects of integrative medicine practices such as meditation and Ayurveda on human physiology are not fully understood. The aim of this study was to identify altered metabolomic profiles following an Ayurveda-based intervention. In the experimental group, 65 healthy male and female subjects participated in a 6-day Panchakarma-based Ayurvedic intervention which included herbs, vegetarian diet, meditation, yoga, and massage. A set of 12 plasma phosphatidylcholines decreased (adjusted p < 0.01) post-intervention in the experimental (n = 65) compared to control group (n = 54) after Bonferroni correction for multiple testing; within these compounds, the phosphatidylcholine with the greatest decrease in abundance was PC ae C36:4 (delta = -0.34). Application of a 10% FDR revealed an additional 57 metabolites that were differentially abundant between groups. Pathway analysis suggests that the intervention results in changes in metabolites across many pathways such as phospholipid biosynthesis, choline metabolism, and lipoprotein metabolism. The observed plasma metabolomic alterations may reflect a Panchakarma-induced modulation of metabotypes. Panchakarma promoted statistically significant changes in plasma levels of phosphatidylcholines, sphingomyelins and others in just 6 days. Forthcoming studies that integrate metabolomics with genomic, microbiome and physiological parameters may facilitate a broader systems-level understanding and mechanistic insights into these integrative practices that are employed to promote health and well-being.

Now that I managed to stop laughing about the first paper, I am not just amused but also puzzled by the amount of contradictions the second article seems to cause. Were there 65 or 69 individuals in the experimental group? Was the study randomised, quasi-randomised or not randomised? All of these versions are implied at different parts of the articles. It turns out that they randomised some patients, while allocating others without randomisation – and this clearly means the study was NOT randomised. Was the aim of the study ‘to identify altered metabolomic profiles following an Ayurveda-based intervention’ or ‘to examine the effects of a comprehensive residential mind–body program on well-being’?

I am sure that others will find further contradictions and implausibilites, if they look hard enough.

The funniest inconsistency, in my opinion, is that Deepak Chopra does not even seem to be sure to which university department he belongs. Is it the ‘Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA.’ as indicated in the 1st paper or is it the ‘Department of Family and Preventive Medicine, University of California San Diego, La Jolla, California, USA’ as listed in the 2nd article?

Does he know from which planet he is?

 

In alternative medicine, good evidence is like gold dust and good evidence showing that alternative therapies are efficacious is even rarer. Therefore, I was delighted to come across a brand-new article from an institution that should stand for reliable information: the NIH, no less.

According to its authors, this new article “examines the clinical trial evidence for the efficacy and safety of several specific approaches—acupuncture, manipulation, massage therapy, relaxation techniques including meditation, selected natural product supplements (chondroitin, glucosamine, methylsulfonylmethane, S-adenosylmethionine), tai chi, and yoga—as used to manage chronic pain and related disability associated with back pain, fibromyalgia, osteoarthritis, neck pain, and severe headaches or migraines.”

The results of this huge undertaking are complex, of course, but in a nutshell they are at least partly positive for alternative medicine. Specifically, the authors state that “based on a preponderance of positive trials vs negative trials, current evidence suggests that the following complementary approaches may help some patients manage their painful health conditions: acupuncture and yoga for back pain; acupuncture and tai chi for OA of the knee; massage therapy for neck pain with adequate doses and for short-term benefit; and relaxation techniques for severe headaches and migraine. Weaker evidence suggests that massage therapy, SM, and osteopathic manipulation might also be of some benefit to those with back pain, and relaxation approaches and tai chi might help those with fibromyalgia.”

This is excellent news! Finally, we have data from an authoritative source showing that some alternative treatments can be recommended for common pain conditions.

Hold on, not so fast! Yes, the NIH is a most respectable organisation, but we must not blindly accept anything of importance just because it appears to come form a reputable source. Let’s look a bit closer at the actual evidence provided by the authors of this paper.

Reading the article carefully, it is impossible not to get troubled. Here are a few points that concern me most:

  • the safety of a therapy cannot be evaluated on the basis of data from RCTs (particularly as it has been shown repeatedly that trials of alternative therapies often fail to report adverse effects); much larger samples are needed for that; any statements about safety in the aims of the paper are therefore misplaced;
  • the authors talk about efficacy but seem to mean effectiveness;
  • the authors only included RCTs from the US which must result in a skewed and incomplete picture;
  • the article is from the National Center for Complementary and Integrative Health which is part of the NIH but which has been criticised repeatedly for being biased in favour of alternative medicine;
  • not all of the authors seem to be NIH staff, and I cannot find a declaration of conflicts of interest;
  • the discussion of the paper totally lacks any critical thinking;
  • there is no assessment of the quality of the trials included in this review.

My last point is by far the most important. A summary of this nature that fails to take into account the numerous limitations of the primary data is, I think, as good as worthless. As I know most of the RCTs included in the analyses, I predict that the overall picture generated by this review would have changed substantially, if the risks of bias in the primary studies had been accounted for.

Personally, I find it lamentable that such a potentially worthy exercise ended up employing such lousy methodology. Perhaps even more lamentable is the fact that the NIH (or one of its Centers) can descend that low; to mislead the public in this way borders on scientific misconduct and is, in my view, unethical and unacceptable.

Did you know that:

  • All diseases are really just psychological conflicts.
  • Conventional medicine is a conspiracy of Jews to decimate the non-Jewish population.
  • Microbes do not cause diseases.
  • AIDS is just a normal allergy.
  • Cancer is the result of a mental shock.

These are just some of the theories of RG Hamer realized in his Germanic (or German) New Medicine.

Hamer once had a medical licence; it was revoked after he was found guilty of malpractice. Subsequently, he continued treating patients as a ‘Heilpraktiker‘. He has been in court many times, sentenced repeatedly and imprisoned at least twice. There is an abundance of information about Hamer available on the Internet (for instance here), and I am therefore not attempting to repeat it here. Yet to give a quick impression of Hamer’s mind-set, I translate what he is quoted stating: ” … I do not even believe in the holocaust…I also do not believe that man was on the moon and, much worse, that the Twin Towers were brought down by Arabs, but hardly anybody believes that today…”

Hamer’s treatments have been associated with several deaths. The most recent case has only just been reported in this article from the Austrian newspaper ‘Der Standard’. As it is in German, I will summarize the essence here:

An Italian couple apparently had refused to let her daughter’s leukaemia be treated with conventional medicine (which usually is life-saving in this condition) but insisted that she receives Hamer’s methods of cancer therapy (which are not evidence-based). They therefore took her to a Swiss clinic where she apparently received cortisol and vitamins. After the interventions of Italian doctors, the parents were forbidden to take charge of their daughter’s care. Meanwhile, however, the daughter, Eleonora Bottaro from Padova, had reached the age of 18 and was therefore legally allowed to decide about her treatments. She opted to continue the treatment in the Swiss clinic and died of her leukaemia in mid August.

Some aspects of this new case are reminiscent of the one of the Austrian, Olivia Pilhar. In 1995, this girl, then aged 6, was diagnosed with a Wilms’ tumour. The parents withheld conventional treatments from her and opted for Hamer’s methods as an alternative. When the authorities intervened, the parents took their child to Malaga where she was treated according to Hamer’s weird ideas. Following a court order, the child eventually did receive proper medical treatment and survived her disease. Her parents received a suspended prison sentence of 8 months in Austria.

Sadly, alternative medicine hosts many miracle healers like Hamer. They have in common that

  • they create their own bizarre ideas about healthcare which are neither plausible nor evidence-based;
  • they mix them with a rich dose of conspiracy theory;
  • they tend to sue those who expose them for what they are;
  • they manage to amass a sizeable following of often quite fanatical believers;
  • they exploit them by selling false hope;
  • they manage to create some sort of cult;
  • they do financially very well with their quackery;
  • they endanger the health of consumers and patients who have the misfortune to come into contact with them;
  • they are undeterred by medical ethics, the law or the authorities.

These people disgust me beyond words. Yet, even in this company of rogues, Hamer is special  – not least because of his rampant racism. He claims, for instance, that conventional medicine is guilty of the “most hideous crime in the whole history of mankind” and alleges that Jews have killed around two billion people with morphine, chemotherapy and radiation.

Wouldn’t it be nice to be able to enjoy food and drink to one’s heart content and, once the pounds are piling up, simply swallow a pill and the weight goes down to normal? There are plenty of such pills on the market, but here I advise you to avoid them – mainly for two reasons.

The first is that they do not work. On this blog, we have discussed this before. The claims made for weight loss supplements are bogus. The manufacturers promise substantial body weight reductions not because their product is effective but because they want your money. So, unless you want to donate your cash to quacks, don’t buy such rubbish.

The second reason is probably even more compelling: weight-loss supplements endanger your health. A new paper tells us more about their risks. This investigation was aimed at identifying banned and discouraged-use ingredients, such as ephedra, 1,3-dimethylamylamine, and beta-methyl-phenylethylamine, in readily available weight loss dietary supplements within a 10-mile radius of Regis University.

A list of banned and discouraged-use ingredients was compiled with the use of the Food and Drug Administration (FDA) dietary supplement website which provides information on supplement ingredients that are no longer legal or are advised against owing to adverse event reporting. Investigators visited all retail outlet stores within a 10-mile radius of Regis University in Denver, Colorado. Retail chains were not duplicated and only one of each chain was evaluated.

A total of 51 weight loss supplement products from retail stores were found with banned or discouraged-use substances listed on their labels. At least one banned ingredient was found to be listed on the product labels in 17 of the 51 studied supplements (33%). At least one discouraged-use ingredient was found in 46 of the 51 products (90%). Retail outlet stores dedicated to supplements and sports nutrition alone were found to have the greatest number of weight loss supplements that included banned and discouraged-use ingredients.

The authors of this paper draw the following conclusions: the FDA has taken action to remove some weight loss supplements from the market that contain banned ingredients. Unfortunately, based on the findings of this study, it is evident that products containing these ingredients remain on the market today.

You might think that these findings apply only to the US, however, I am afraid, you would be mistaken. People buy such bogus supplements on the Internet where national regulations can easily be circumvented. Thus the trade in weight-loss supplements is thriving regardless of what the FDA or any other regulatory agency might do about them.

The solution is simple: avoid such products!

On this blog, I have discussed the lamentable quality of TCM products before (e. g. here, here and here). In a nutshell, far too high percentages of them are contaminated with toxic substances or adulterated with prescription drugs. It is no question: these deficits put many consumers at risk. Equally, there is no question that the problem has been known for decades.

For the Chinese exporters, such issues are a great embarrassment, not least because TCM-products are amongst the most profitable of all the Chinese exports. In the past, Chinese officials have tried to ignore or suppress the subject as much as possible. I presume they fear that their profits might be endangered by being open about the dubious quality of their TCM-exports.

Recently, however, I came across a website where unusually frank and honest statements of Chinese officials appeared about TCM-products. Here is the quote:

China is to unroll the fourth national survey of traditional Chinese medicine (TCM) resources to ensure a better development of the industry, said a senior health official…

With the public need for TCM therapies growing, the number of medicine resources has decreased and people have turned to the cultivated ones. However, due to a lack of standards, the cultivated TCM resources are sometimes less effective or even unsafe for human use, said Wang Guoqiang, director of the State Administration of TCM, at a TCM seminar held in Kunming, Yunnan Province in southwest China.

There is a pressing need to protect TCM resources, Wang said. “I’ve heard people saying that medicine quality will spell doom for the TCM industry, which I must admit, is no exaggeration,” he said.

The survey has been piloted in 922 counties in 31 provinces in China since 2011. According to its official website, it will draw a clear picture of the variety, distribution, storage and growth trends of TCM resources, including herbs, animals, minerals and synthetic materials.

TCM includes a range of traditional medical practices originating in China. It includes such treatments as herbal medicine, acupuncture, massage (tuina), exercise (qigong) and dietary therapy.

Although well accepted in the mainstream of medical care throughout East Asia, TCM is considered an alternative medical system in much of the western world and has been a source of controversy. A milestone in the recognition of TCM came when Chinese pharmaceutical chemist Tu Youyou won a Nobel Prize in 2015 for her discovery of Artemisinin, a medicinal herb, to help treat malaria.

END OF QUOTE

Surely, these are remarkable, perhaps even unprecedented statements by Chinese officials:

…cultivated TCM resources are sometimes less effective or even unsafe for human use…

…medicine quality will spell doom for the TCM industry…

Let’s hope that, after such words, there will be appropriate actions… finally.

It would be easy to continue this series on ‘tricks of the trade’ for quite a while. But this might get boring, and I have therefore decided to call it a day. So here is the last instalment (feel free to post further tricks that you may know of [in the comments section below]):

CRITICS DON’T UNDERSTAND

It is almost inevitable that, sooner or later, someone will object to some aspect of alternative medicine. In all likelihood, his or her arguments are rational and based on evidence. If that happens, the practitioner has several options to save his bacon (and income). One of the easiest and most popular is to claim that “of course, you cannot agree with me because you do not understand!”

The practitioner now needs to explain that, in order to achieve the level of expertise he has acquired, one has to do much more than to rationalise or know about science. In fact, one has to understand the subject on a much deeper level. One has to immerse oneself into it, open one’s mind completely and become a different human being altogether. This cannot be achieved by scientific study alone; it requires years of meditative work. And not everyone has the ability to go down this difficult path. It takes a lot of energy, insight and vision to become a true healer. A true Deepak Chopra is not born but trained through hard work, dedication and concentration.

Critics who disagree are really to be pitied. They fail to exist on quite the same level as those who ‘are in the know’. Therefore one must not get annoyed with those who disagree, they cannot understand because they have not seen the light.

My advice is to start thinking critically and read up about the NO TRUE SCOTSMAN FALLACY; this will quickly enable you to look beyond the charisma of these gurus and expose their charlatanry to the full.

RESEARCH IS BEING SUPRESSED

Some critics stubbornly insist on evidence for the therapeutic claims made by quacks. That attitude can be awkward for the alternative practitioner – because usually there is no good evidence.

Cornered in this way, quacks often come up with a simple but effective conspiracy theory: the research has been done and it has produced fabulous results, but it has been supressed by… well, by whoever comes to mind. Usually BIG PHARMA or ‘the scientific establishment’ have to be dragged out into the frame again.

According to this theory, the pharmaceutical industry (or whoever comes in handy) was so shaken by the findings of the research that they decided to make it disappear. They had no choice, really; the alternative therapy in question was so very effective that it would have put BIG PHARMA straight out of business for ever. As we all know BIG PHARMA to be evil to the core, they had no ethical or moral qualms about committing such a crime to humanity. Profits must come before charity!

My advice is to explain to such charlatans that such conspiracy theories do, in fact, merely prove is that the quack’s treatment is not effective against their prosecution complex.

CRITICS ARE BOUGHT AND CORRUPT

If  critics of alternative medicine become threatening to the quackery trade, an easy and much-used method is to discredit them by spreading lies about them. If the above-mentioned ploy “they cannot understand” fails to silence the nasty critics, the next step must be to claim they are corrupt. Why else would they spend their time exposing quackery?

Many people – alternative practitioners included – can only think of financial motivations; the possibility that someone might do a job for altruistic reasons does not occur to them. Therefore, it sounds most plausible that the critics of alternative medicine are doing it for money – after all, the quacks also quack for money.

My advice to potential users of alternative medicine who are confused by such allegations: do your own research and find out for yourself who is bought by whom and who has a financial interest in quackery selling well.

EVEN NOBEL PRIZE WINNERS AGREE WITH US

It is true, there are some Nobel Prize winners who defend homeopathy or other bogus treatments. Whenever this happens, the apologists of alternative medicine have a field day. They then cite the Nobel laureate ad nauseam and imply that his or her views prove their quackery to be correct.

Little do they know that they are merely milking yet another classical fallacy and that such regrettable events merely demonstrate that even bright people can make mistakes.

My advice is to check what the Nobel laureate actually said – more often than not, it turns out that a much-publicised quote is, in fact, a misquote – and what his or her qualifications are for making such a statement; a Nobel Prize in literature, for instance, is not a sufficient qualification for commenting on healthcare issues.

AS I ALRADY SAID: IF YOU KNOW OF MORE ‘TRICKS OF THE QUACKARY TRADE’, PLEASE POST THEM BELOW.

This series of post is quite good fun – at least for me who is writing it.  But I also hope that it is useful to those readers who are tempted to consult alternative practitioners. My intention is to stimulate people’s ability to think critically and to provide some sort of guide for patients which might help them in deciding which practitioners to avoid.

In this spirit, I now offer you the next instalment of three ‘tricks of the trade’:

 

NATURAL IS GOOD

Everyone working in advertising will confirm: the ‘natural label’ is a great asset for boosting sales of all sorts of things. Practitioners of alternative medicine have long appreciated this fact and exploited it to the best of their abilities. They stress the ‘naturalness’ of their treatments ad nauseam, and more often than not they use the term misleadingly.

For instance, there is nothing natural to thrust a patients spine beyond the physiological range of motion [chiropractic]; there is nothing natural in endlessly diluting and shaking remedies which may or may not have their origin in a natural substance [homeopathy]; there is nothing natural in sticking needles into the skin of patients [acupuncture].

Moreover, the notion of a benign ‘mother nature’ is naïvely misleading. Ask those who have been at sea during a storm or who have been struck by lightning.

My advice is to see through transparent marketing slogans and to tell the anyone who goes on about the ‘naturalness’ of his therapy to buzz off.

ENERGY

When one goes to a meeting of alternative practitioners, the term ‘energy’ is mentioned more often than at a board meeting of EDF. The difference is that the alternative brigade does not mean really energy when they speak of energy; they mean ‘vital force’ or one of the many related terms from other traditions.

Practitioners do prefer to use ‘energy’ because this sounds modern and impressive to many consumers. Crucially, it avoids disclosing how deeply steeped the therapists are in vitalism and vitalistic ideas. Whereas rational thinkers have discarded such concepts more than a century ago, alternative medicine advocates find it hard to do the same – if they did, there would be little else to underpin their various ‘philosophies’.

My advice is to avoid clinicians who are ‘vitalists’ because adhering to long obsolete concepts is a sure sign of dangerous backward thinking.

STIMULATING THE IMMUNE SYSTEM

‘Your immune system need stimulating!’ – how often have we heard that from practitioners of alternative medicine? By contrast, conventional clinicians are most reserved about such aims; they might try to stimulate the immune system in certain, rare circumstances. Quite often they need to achieve the opposite effect and use powerful drugs to suppress the immune system. But even when they aim at stimulating the immune system of a patient, they would not use any of the treatments alternative practitioners swear by.

How come? There are several reasons:

  1. The alternative ‘immune stimulants’ do not really stimulate the immune system.
  2. Stimulating the immune system is rarely a desirable therapeutic aim.
  3. Stimulating a normal immune system is hardly possible.
  4. For many of us, stimulating the immune system might even be a very risky business (if it were at all achievable).

My advice is to ask your practitioner precisely why he wants to stimulate your immune system. If he can give you a good reason, ask him to try stimulating his own immune system first and to show you the proof that his therapy can do such a thing.

In part one and part two of this series of posts, we have discussed altogether six ‘tricks of the trade’:

TREAT A NON-EXISTING CONDITION

MAINTENANCE TREATMENT

IT MUST GET WORSE BEFORE IT GETS BETTER

THINK HOLISTICALLY

IT’S DUE TO THE POISONS YOUR DOCTOR GAVE YOU

A CURE TAKES A LONG TIME

Now it is time to disclose three more.

DETOX

Alternative therapies are hugely diverse, but they nevertheless have a few characteristics in common. One is that many of their practitioners try to persuade their patients that they are being poisoned. This sounds odd, however, it is true.

Most alternative therapists tell their patients sooner or later that they need to ‘detox’ and, as it happens, their type of treatment is ideally suited to achieve this aim. Detox is short for detoxification which, in real medicine, is the term used for weaning addicts off their drugs. In alternative medicine, it is used as a marketing slogan.

Yes, detox, as used in alternative medicine, is nothing but a marketing slogan. I have several reasons for this statement:

  • The poisons in question are never accurately defined. Instead, we hear only vague terminologies such as metabolic waste products or environmental toxins. The reason for that lack of precision is simple: once the poison is named, we could be able to measure it and test the efficacy of the treatment in  question in eliminating it from the body. But this is the last thing these ‘detoxers’ want because we would soon establish how bogus their claims are.
  • None of the alternative therapies claimed to detox our body take any toxin from us; all they do take from us is our cash.
  • Our body has powerful organs and mechanisms to detoxify (skin, lungs, kidneys, liver). These take care of all the toxins we undoubtedly are exposed to. If any of these organs fail, we do not need homeopathic globoli or detoxifying diets, or electric foot baths or any other charlatanry; in this case, we are more likely to need an A&E department’s intensive care.

My advice is, as soon as you hear the word ‘detox’ from a quack, ask for your money back and go home.

THE TEST OF TIME

Another thing that many alternative therapies have in common is their age. They have almost all been around for hundreds, if not thousands of years. To the enthusiasts of alternative medicine, this means that these interventions have ‘stood the test of time’; they argue that acupuncture, for instance, would not be around any more, if it were not effective. They tell their patients, write in books and argue in debates that the age of their therapy is like a badge of approval from millions of people before us, a badge that surely weighs more that modern scientific studies (which tend to cast doubt on the effectiveness of the treatments in question).

This line of thinking has always puzzled me. We are talking of TECHNOLOGIES, health technologies, in fact. Would we argue that a hot air balloon is an older technology that an aeroplane and therefore better suited for transporting people from A to B? The fact that acupuncture was developed thousands of years ago might just mean that it was invented by relatively ignorant people who understood too little about the human body to create a truly effective intervention. And the fact that blood-letting was used for centuries (and thus killed millions), might teach us a lesson about the true value of ‘the test of time’ in medicine.

My advice is to offer leeches, blood-letting and mercury cures to those who try to persuade you that the test of time has meaningful therapeutic implications.

TREATING THE ROOT CAUSE OF THE DISEASE

Alternative practitioners often claim that, in conventional medicine, doctors only treat the symptoms of their patients, whereas they treat the root causes of the illness. I have often wondered where this assumption and the fierce conviction with which it is so often expressed come from. I have to conclude that the explanations are quite simple.

  • This notion is the mantra that is being taught over and over again during the practitioners’ training. It even constitutes a central message of most ‘textbooks’ for the aspiring alternative practitioner.
  • More importantly in the context of this post, the notion is a clever sales-trick. It sounds profound and logical to many consumers who lean towards alternative medicine. Crucially, it kills two flies with one stroke: it denigrates conventional healthcare and, at the same time, elevates alternative medicine.

The idea that alternative practitioners treat the root causes is  based on the practitioners’ understanding of aetiology. If a traditional acupuncturist, for instance, is convinced that all disease is the expression of an imbalance of life-forces, and that needling acupuncture points will re-balance these forces thus restoring health, he must automatically assume that he is treating the root causes of any condition. If a chiropractor believes that all diseases  are due to ‘subluxations’ of the spine, it must seem logical to him that spinal ‘adjustment’ is synonymous with treating the root cause of whatever complaint his patient is suffering from.

These are concepts that are deeply engrained into the minds of alternative practitioners. And they have one embarrassing feature in common: they are false! Some practitioners surely must know that; yet I have so far not met one who therefore would have stopped using it. The reason must be that, as a trick of the trade to increase his cash flow, it is invaluable.

My advice is to use your abilities for critical thinking, explain to the practitioner who tells you that he is going to treat the root causes of your condition that he is a quack, and look for a proper physician.

 

In part one, we have dealt with three common tricks used by quacks to convince the public to consult them and to keep coming back for more. It has been pointed out to me that some of these tricks are used not just by alternative practitioners but also by real physicians. This is, of course, absolutely true. A quack can be defined as “a person who dishonestly claims to have special knowledge and skill in some field, typically medicine.” Therefore real doctors can be real quacks, of course. I happen to have an interest mainly in alternative medicine; that’s why I write about these type of quacks (if it helps keeping you blood pressure within the limits of normal, I can tell you that I occasionally also published about quackery in mainstream medicine, for instance here).

Anyway, now it is time to continue this series of posts by discussing three further common deceptions used by quacks.

A CURE TAKES A LONG TIME

Imagine a scenario where, even after, several therapy sessions, a patient’s condition has not improved. Let’s assume the problem is back pain, and that it has not improved a  bit despite the treatments and the money spent on it. Surely, many patients in such a situation are sooner or later going to give up. They will have had enough! And this is, of course, a serious threat to the practitioner’s cash flow.

Luckily, there is a popular ploy to minimize the risk: the practitioner merely has to explain that the patient’s condition has been going on for a very long time (if, in the above scenario, this were not the case, the practitioner would explain that the pain might be relatively recent but the underlying condition is chronic). This means that a cure will also have to take a very long time – after all, Rome was not built in one day!

This plea to carry on with the ineffective treatments despite any improvement of symptoms is usually not justifiable on medical grounds. It is, however, entirely justifiable on the basis of financial considerations of the practitioners. They rely on their patients’ regular payments and will therefore think of all sorts of means to achieve this aim.

Take my advice and see a clinician who can help you within a reasonable and predictable amount of time.

IT’S DUE TO THE POISONS YOUR DOCTOR GAVE YOU

In the pursuit of a healthy cash-flow, almost all means seem to be allowed – even the fabrication of the bogus notion that the reasons for the patient’s problem were the poisonous drugs prescribed by her doctor who, of course, is in cahoots with BIG PHARMA. Alternative medicine thrives on conspiracy theories, and the one of the evil ‘medical mafia’ is one of the all-time favourites. It enables scrupulous practitioners to instil a good dose of fear into the minds of their patients, a fear that minimises the risk of them returning to real medicine.

My advice is that alternative practitioners who habitually use this or any other conspiracy theory should be avoided at all costs.

THINK HOLISTICALLY

The notion that alternative medicine takes care of the whole person is a most attractive and powerful ploy. Never mind that nothing could be further from being holistic than, for instance, diagnosing conditions by looking at a patient’s iris (iridology), or focussing on her spine (chiropractic, osteopathy), or massaging the soles of her feet (reflexology). And never mind that any type of good conventional medicine is by definition holistic. What counts is the label, and ‘holistic’ is a most desirable one, indeed. Nothing sells quackery better than holism.

Most alternative practitioners call themselves holistic and they rub the holism into the minds of their patients whenever and however they can. This insistence on holism has the added advantage that they have seemingly plausible excuses for their therapeutic failures.

Imagine a patient consulting a practitioner with depression and, even after prolonged treatment, her condition is unchanged. Even in such a situation, the holistic practitioner does not need to despair: he will point out that he never treats diagnostic labels but always the whole person. Therefore, the patient’s depression might not have changed, but surely other issues have improved… and, if the patient introspects a little, she might find that her appetite has improved, that her indigestion is better, or that her tennis elbow is less painful (some things always change given enough time). The holism of quacks may be a false pretence, but its benefits for the practitioner are obvious.

My advice: take holism from quacks with a pinch of salt.

We were recently informed that Americans spend more than US$ 30 billion per year on alternative medicine. This is a tidy sum by anyone’s standards, and we may well ask:

Why do so many people opt for alternative medicine?

The enthusiasts claim, of course, that this is because alternative medicine is effective and safe. As there is precious little data to support this claim, it is probably not the true answer. There must be other reasons, and I could name several. For instance, it could be due to consumers being conned by charlatans.

During the 25 years or so that I have been researching alternative medicine, I got the impression that there are certain ‘tricks of the trade’ which alternative practitioners use in order to convince the often all too gullible public. In this series of posts, I will present some of them.

Here are the first three:

TREAT A NON-EXISTING CONDITION

There is nothing better for committing a health fraud than to treat a condition that the patient in question does not have. Many alternative practitioners have made a true cult of this handy option. Go to a chiropractor and you will in all likelihood receive a diagnosis of ‘subluxation’. See a TCM practitioner and you might be diagnosed suffering from ‘chi deficiency’ or ‘chi blockage’ etc.

Each branch of alternative practitioners seem to have created their very own diagnoses, and they have one thing in common: they are figments of their imaginations. To arrive at such diagnoses, the practitioner would often use diagnostic techniques which have either been found to lack validity, or which have never been validated at all. Many practitioners appreciate all of this, of course, but it would be foolish of them to admit it – after all, these diagnoses earn them the bulk of their living!

The beauty of a non-existing diagnosis is that the practitioner can treat it, and treat it and treat it…until the client has run out of money or patience. Then, one day, the practitioner can proudly announce to his patient “you are completely healthy now”. This happens to be true, of course, because the patient has been healthy all along.

My advice for preventing to get fleeced in this way: make sure that the diagnosis given by an alternative practitioner firstly exists at all in the realm of real medicine and secondly is correct; if necessary ask a real healthcare professional.

MAINTENANCE TREATMENT

As I just stated, practitioners like to treat and treat and treat conditions which simply do not exist. When – for whatever reason – this strategy fails, the next ‘trick of the trade’ is often to convince the patient of the necessity of ‘maintenance’ treatment. This term describes the regular treatment of an individual who is entirely healthy but who, according to the practitioner, needs regular treatments in order not to fall ill in future. The best example here is chiropractic.

Many chiropractors proclaim that maintenance treatment is necessary for keeping a person’s spine aligned – and only a well-serviced spine will keep all of our body’s systems working perfectly. It is like with a car: if you don’t service it regularly, it will sooner or later break down. You don’t want this to happen to your body, do you? To many ‘worried well’, this sounds so convincing that they actually fall for this scam. It goes without saying that the value of maintenance treatment is unproven.

My advice is to start running as soon as a practitioner mentions maintenance treatments.

IT MUST GET WORSE BEFORE IT GETS BETTER

Many patients fail to experience an improvement of their condition or even feel worse after receiving alternative treatments. Practitioners of alternative medicine love to tell these patients that this is normal because things have to get worse before they get better. They tend to call this a ‘healing crisis’. Like so many notions of alternative practitioners, the healing crisis is a phenomenon for which no or very little compelling evidence was ever produced.

Imagine a patient with moderately severe symptoms consulting a practitioner and receiving treatment. There are only three things that can happen to her:

  • she can get better,
  • she might experience no change at all,
  • or she might get worse.

In the first scenario, the practitioner would obviously claim that his therapy is responsible for the improvement. In the second scenario, he might say that, without his therapy, things would have deteriorated. In the third scenario, he would tell his patient that the healing crisis is the reason for her experience. In other words,  the myth of the healing crisis is little more than a ‘trick of the trade’ to make even these patients continue supporting the practitioner’s livelihood.

My advice: when you hear the term ‘healing crisis’, go and find a real doctor to help you with your condition.

 

 

 

 

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