I have always wondered how pharmacists might justify using or recommending or selling homeopathic remedies. So far, I have not come across a pharmacist who would want to stick his/her neck out for homeopathy. Many pharmacists earn money by selling homeopathic preparations – but most seem to be embarrassed by this fact and don’t want to defend it.
Therefore, I was pleased when I found this interview with the pharmacist Christophe Merville. He got introduced to homeopathy as a 11 year old boy suffering from hay fewer; after using homeopathy, “the crises became less severe and less frequent”. Later, he studied to become a pharmacist in France and, in 1990, he joined Boiron, the world’s largest manufacturer of homeopathic remedies. The following is an extensive excerpt (I did not want to cite him ‘out of context’) from his interview about his views on homeopathy.
I remember attending the delivery of a woman and the contractions were very strong, and painful. She had some homeopathic medicine to take just at that time to make those contractions more regular and useful: less intense but longer and less brusque. I saw that happening within minutes, and I was thinking, “That’s very impressive.” That’s probably the time when I concluded that there is something to it.
I witnessed the action of homeopathic medicines on pets also, on young children. I had enough personal anecdotes that I could say there is something more than just suggestion, or placebo, or just the simple act of being cared for. My attitude is to say, “There are enough signs to say that it’s really worth exploring more why it works, how it works, when does it work.” We are past the stage where we can say, “No, there is nothing.” It has been around for a long time and if was just mere placebo effect, it would have gone away, as so many different techniques did.
If you look at the history of science, you find many instances where people first said, for example, “The theory of gravity explains everything.” And when some things are discovered that show it didn’t work in certain very narrow cases, there’s an understanding that we have to adjust. But every time you have to make that adjustment, there is a great body of people who say, “No, it cannot be.”
The main argument against homeopathy is that a remedy is very, very diluted, so it cannot work. My reaction to that is to examine what happens when you dilute something. The act of dilution is not very simple. Those molecules are interacting together, they are interacting with the walls of the container, they are interacting with the solvent, and this interaction does not adhere to a precise mathematical law. The skeptics say, “You divide the number of molecules by 100 each time, so after awhile, there is less than one chance to find one single molecule.” They have their math right, but they have their physics wrong.
Chemists try to use very pure substances. When you buy your reagent, you buy it at 99.999 percent pure. But you don’t have anything that’s 100 percent pure. It would take an infinite amount of energy to get rid of the last impurity. What I think we should explore is the fact that after a certain number of dilutions, the process is not very efficient at removing the last molecules. So there is always something that stays. That’s one thing.
The second thing is in pharmacology for years, we were interested in the ability of large quantities of substances. But what about small ones? I always use the example of butterflies that can sense pheromones at great distances, salmon finding their way back to their native creek from far away, to sharks being able to detect blood in a huge amount of water. Biology uses very small quantities. In cells, you have communication between cells using a few molecules of a certain substance—and it works.
I don’t pretend that I’ve put A and B and C together, and I’m able to provide you with a complete explanation. But I would say those are things to explore. Already the research that exists points to possible action of homeopathic dilution on activation or deactivation of genes. I won’t go into details, but I welcome the skepticism, I think it’s very constructive. But what I don’t really like is people whose mind is set on their misconception of what exactly a dilution is. Of course homeopathy doesn’t violate the laws of physics and chemistry, because that’s absurd.
My first role is pharmacy development. I look at what are the tools that allow pharmacists to know what homeopathy is and for a certain number of them, how to use homeopathy. I consider how to train them, how to have them integrate homeopathy in their practice, because the goal isn’t about replacing other medicines with homeopathy. My first role is to say to pharmacists, “You have to know what it is because these are drugs. If you don’t believe in them, you don’t have to use them, but at least you need to be able to answer customers, your patients.”
And the second thing is that for those who are interested in knowing more, I translate books from France, I design trainings, activities, interactions, so they are placed in a situation of recommending and deciding if it is appropriate to recommend homeopathy, and what treatment is adapted to that particular person.
“Before coming to the conference, I researched what homeopathy is, and you will have a hard time telling me that it can work.” I talk with them to explore a little bit more what it is. We speak the language of pharmacology together, and what strikes me is that very soon, they are into it. They say, “Okay, we see the logic of it.” They realize that they have a tool where they can relieve without doing any harm, without interactions, so their interest is piqued. And they recognize that the mode of action of conventional medicines is not as clear as we thought.
Pharmacists are very pragmatic people—you cannot tell them fairy tales. When they see it, explore it, and use it, then when I meet them later, they tell me, “That stuff works.” And I ask, “Yeah, but do you know how it works?” They don’t, but they see the patient coming back happy.
Of course, they are interested in the research and knowing how it works, but I just give them what we know in clinical research and we discuss it. They see that there is ongoing research and one day we’ll find more. But meanwhile, they are using the product.
You have two approaches. What I call “the user approach” is when people may not really completely understand how a medicine works, but they’re interested in taking it for stress or for allergies, whatever it might be, to see if it works for them. They’re interested in how this medicine will affect them, how should they take it. If it works for them, then great.
Then you have what I call the “intellectual approach”—which is concerned about more cultural, philosophical, and social questions: what is the place of homeopathic medicine in today’s medicine, what are its principles, its history, its perspective. Is it a philosophy, is it a cult, what is it? My role is to try to give context for what homeopathy is. It’s a simple tool in the toolbox—we don’t exactly know all the details of how it works. And this is what we know, and this is what we don’t know, and this is what we speculate might be the way it works. People educate themselves.
Every day, I say, homeopathy doesn’t vaccinate, homeopathy doesn’t cure cancer, homeopathy doesn’t cure diabetes. It can relieve some of the symptoms or side effects of the treatments, but it has limits like every therapy. I fight against those outrageous claims and sometimes people that are really fanatical advocates for homeopathy do much worse for the cause. And I have to tell them: You cannot say that. It is untrue and it is dangerous. This is why I think pharmacists listen to me, because I’m not telling them to change their practice and their ethics. I’m telling them, this is another tool and this is how to use it properly. But there are fundamentals that are still there and will be there for a long time. You cannot replace vaccination by any other techniques—it’s unethical, it’s dangerous, it’s deadly. So we don’t do that. I’m completely against these kinds of claims.
Let’s explore that: a patient suffering with AIDS, advanced infection with HIV, with immunity that decreases. Or a patient treated with antiretroviral therapy, they still have sometimes diarrhea, because their immune system is not able to fight everything. They still have side effects or anxiety. We want their treatment to be as comfortable as possible, because we want them to keep using the treatment. The same thing with cancer. The patient says, “I don’t want to have chemotherapy because it’s hurting me, it’s very difficult and uncomfortable.” We have with homeopathy ways to reduce nausea, for instance, then we increase the comfort of the patient, and the outcome is always better. That’s the framework. Someone who would say, “Oh, you have AIDS, throw away your antiretrovirals, I’m going to treat you with homeopathy”—that person would be a murderer.
We develop tools to help people self-medicate. We say, “Okay, you’re stressed out, you need to sleep a little bit, you’re lacking sleep. Take this for a certain period of time—if it works for you, fine. If it doesn’t, doesn’t, stop it.” For people with what we call “self-limiting conditions”— a cold or a cough—we have good tools with warnings and precautions and things like that for them to self-medicate. And in the warnings, we tell them, “If you experience that kind of fever, if you have that symptom, see a doctor.” We don’t say see a homeopath, we say see a doctor. And among these doctors, there are doctors who have added in different techniques and some of them are using homeopathy when appropriate. For me, what is most important, is that a patient sees someone who is medically qualified.
For people who want to further explore the possibilities that homeopathy offers, I recommend that they see a physician who is skilled in homeopathy but will not use homeopathy for everything. And is able to diagnose. A physician will tell you, “In this case, I can do something with homeopathy, or, in that case, I cannot use homeopathy.”
As I have once worked as a junior doctor in a homeopathic hospital (the full story is here), I knew of course all these arguments and fallacies. Nevertheless, I still ask myself: HOW CAN PHARMACISTS GET CONVINCED IN THIS WAY? ARE THEY REALLY CONVINCED? OR DO THEY JUST DO IT FOR THE MONEY?
I do not feel like prejudging these questions just now. But I do hope to hear from my readers, particularly from the pharmacists amongst them, what they think.
If you talk to advocates of homeopathy, you are bound to hear claims that are false or misleading; in fact, you hear them so regularly that you might begin to doubt the truth. For those who have such doubts or are in need of some correct counter-arguments, I have listed here those 12 bogus claims which, in my experience, are most common together with short, suitable, and factual rebuttals.
1) THERE IS NOTHING MYSTERIOUS ABOUT HOMEOPATHY’S MODE OF ACTION, IT WORKS LIKE VACCINATIONS
This argument is used by enthusiasts in response the fact that most homeopathic remedies are too highly diluted to have pharmacological effects. Vaccines are also highly diluted and they are, of course, very effective; therefore, so the bogus notion, there is nothing odd about homeopathy.
The argument is wrong on several levels; the easiest way to refute, I think, it is to point out that vaccines contain measurable amounts of material and lead to measurable changes in the immune system. By contrast, the typical homeopathic remedy (beyond the C12 potency) contains not a single molecule of an active substance and leads to no measurable changes in any system.
2) SIGNIFICANTLY MORE CONTROLLED CLINICAL TRIALS OF HOMEOPATHY ARE POSITIVE THAN NEGATIVE
Several websites of homeopathic organisations make this claim and even provide simple statistics to back it up. Consequently, many homeopathy fans have adopted it.
The statistics they present show that x % of studies are positive, y % are negative and z % are neutral; the whole point is that x is larger than y. The percentage figures may even be correct but they rely on the spurious definitions used: positive = superior to placebo, negative = placebo superior to homeopathy, neutral = no difference between homeopathy and placebo. The latter category was created so that homeopathy comes out trumps.
For all intents and purposes, a study where the experimental treatment is no better than placebo is not a study neutral but a negative result. Thus the negative category in such statistics must be y + z which is, of course, larger than x. In other words, the majority of trials is, in truth, negative.
3) HOMEOPATHY IS SUPPORTED BY NOBEL PRIZE WINNERS
I don’t know of a single Nobel Prize winner who has stated or implied that homeopathy works better than a placebo. Some have tried to find a mechanism of action for homeopathy by doing some basic research and have published theories about it. None of those has been accepted by science.
And if there ever should be a Nobel Prize winner or similarly brilliant person who supports homeopathy, this would merely show that even bright individuals can make mistakes!
4) HOMEOPATHY IS SAFE
Tell that to the child that has just been reported to have died because her parents used homeopathy for an ear infection which (could have been easily treated with antibiotics but) degenerated into a brain abscess with homeopathic therapy. There are many more such tragic cases than I care to remember.
The risks of homeopathy are, of course, minor compared to many conventional treatments, but the risk/benefit balance of homeopathy can never be positive because, unlike those high risk conventional treatments, it has no benefit.
5) HOMEOPATHY DOES NOT LEND ITSELF TO BEING TESTED IN CLINICAL TRIALS
The best way to disprove this argument is to point out that ~ 250 controlled clinical trials are currently available. Every homeopath on the planet boasts about clinical trials – provided they are positive.
6) HOMEOPATHY WORKS VIA QUANTUM ENTANGLEMENT
I do not understand quantum mechanics and, I suspect, neither do the homeopaths who use this argument. But physicists who do understand this subject well are keen to stress that homeopathy cannot be explained in this way.
7) THERE IS NO PROOF THAT HOMEOPATHY DOES NOT WORK
The absence of evidence is not the same as evidence of absence, homeopaths like to exclaim. And they are, of course, correct! However, they forget that, science cannot prove a negative and that, in routine health care, we do not even look for a proof of ineffectiveness. We use those treatments that have a positive proof of effectiveness – everything else is irresponsible.
8) EVEN IF HOMEOPATHY WERE JUST A PLACEBO, IT STILL HELPS PATIENTS AND IS THEREFORE A USEFUL TREATMENT
It is true, of course, that placebo effects can help patients. But it is not true that, for generating a placebo response, we need a placebo. If a clinician administers an effective treatment with compassion, the patient will benefit from a placebo response plus from the specific effects of the treatment. Only giving placebos is therefore tantamount to cheating the patient.
9) THERE IS A WORLDWIDE CONSPIRACY AGAINST HOMEOPATHY
In a way, this argument merely suggests that homeopathic remedies are ineffective in treating paranoia. I have not ever seen a jot of evidence for it – and neither can anyone who uses this claim produce any.
10) YOU NEED TO BE A HOMEOPATH TO BE ABLE TO UNDERSTAND AND ADEQUATELY JUDGE THE VALUE OF HOMEOPATHY
With this notion, homeopaths want to claim that the critics of homeopathy are incompetent. It is like saying that only people who believe in god are allowed to criticise religion. By definition, homeopaths are believers, and therefore they are unlikely to be free of bias when judging the value of homeopathy. Homeopathy is a health technology that must be evaluated like all other health technologies: by independent scientists who know their job.
11) HOMEOPATHY HAS BEEN PROVEN TO WORK FOR LITTLE CHILDREN AND ANIMALS
The argument here is that animals and children cannot possibly respond to placebo. Therefore homeopathy must be more than a placebo.
This notion is twice wrong. Firstly, both animals and children can respond to placebo, if only ‘by proxy’, i.e. via their carers. Secondly, if we consider the totality of the reliable data, we find that neither for children nor for animals is the evidence convincingly positive.
12) HOMEOPATHY HAS BEEN USED VERY SUCCESSFULLY IN MAJOR EPIDEMICS, AND THAT FACT IS PROOF ENOUGH FOR ITS EFFICACY
Yes, there are some rather fascinating historical accounts which homeopaths interpret in this fashion. But if we look a little closer, we invariably find explanations which are much more plausible than the assumption of homeopathy’s effectiveness. Epidemiological observations of this nature can almost never establish cause and effect, and the clinical outcome could have been due to a myriad of confounders unrelated to homeopathy.
The Royal Australian College of General Practitioners (RACGP) just issued an important statement on homeopathy which, in several ways, goes beyond previous announcements on this subject. I take the liberty of reproducing it here in full:
The RACGP supports the use of evidence-based medicine, in which current research information is used as the basis for clinical decision-making. In light of strong evidence to confirm that homeopathy has no effect beyond that of placebo as a treatment for various clinical conditions, the position of the RACGP is:
1. Medical practitioners should not practice homeopathy, refer patients to homeopathic practitioners, or recommend homeopathic products to their patients.
2. Pharmacists should not sell, recommend, or support the use of homeopathic products.
3. Homeopathic alternatives should not be used in place of conventional immunisation.
4. Private health insurers should not supply rebates for or otherwise support homeopathic services or products.
The contention that homeopathy is an effective treatment is not supported by evidence from systematic literature reviews. The National Health and Medical Research Council (NHMRC) analysed the scientific evidence for the effectiveness of homeopathy in treating a range of clinical conditions and released a position statement  in March 2015. The NHMRC’s review concluded homeopathy does not produce health benefits over and above that of placebo, or equivalent to that of another treatment. Crucially, the report states that there are “no health conditions for which there is reliable evidence that homeopathy is effective” as a treatment.
While not covered in the NHMRC’s review, it is also the case that homeopathic alternatives to conventional vaccination do not prevent communicable diseases or increase protective antibodies to disease. The National Centre for Immunisation Research and Surveillance has advised that there are no studies of sufficient quality to demonstrate the safety or effectiveness of ‘homeopathic vaccines’ for protection against disease. Indeed, there is no plausible biological mechanism of action by which these products could prevent infection.
Harms associated with homeopathy
Homeopathic products are sometimes considered harmless as they are generally administered at a high dilution. Some may not even contain a single molecule of the original source material. However, there are a number of risks associated with the use of homeopathy.
Delaying or avoiding conventional medical care
When the use of homeopathy causes a person to delay or avoid consultation with a registered medical practitioner or reject conventional medical approaches, serious and sometimes fatal consequences can occur. As evidenced by recent Australian court findings, spurious claims made by homeopathic practitioners and retailers can mislead individuals about the effectiveness of conventional medicine. When homeopathic vaccines are used as an alternative to conventional immunisation, both the individual and the community are left exposed to preventable diseases.
Problems associated with unregulated products
Although homeopathic products manufactured in Australia are regulated as medicines under the Therapeutic Goods Act 1989, products sold on international websites may not meet Australian quality and safety standards. These products may be of particular concern when materials from problematic sources are employed in the preparation (e.g., pathogenic organs or tissues; causative agents such as bacteria, fungi, parasites, ova, yeast, and virus particles; disease products; excretions or secretions; heavy metals and toxins such as aconitum, kerosene and thallium). Impurities of source material and contamination associated with poor manufacturing processes also present threats to the quality and safety of these products.
Direct adverse effects
Various direct harms associated with the use of homeopathic products have been noted in the literature, including allergic reaction, drug interactions, and complications related to the ingestion of toxic substances.
The importance of patient-centred practice
The RACGP supports the concept of patient-centred practice, in which the values, preferences, and personal healthcare philosophy of the patient are respected and individuals play an important role in their own healthcare. An estimated six per cent of Australians use homeopathy over the course of a year. It is important that these patients feel comfortable in discussing their use of complementary and alternative medicines with all members of their treatment team.
It is good practice for medical practitioners to initiate conversations with patients about their use of or intention to use homeopathy, and assist patients to think critically about the efficacy and safety of homeopathy so that they may make informed healthcare decisions.
Private health insurance and homeopathy
Many private health insurers provide ancillary (extras) cover that subsidises homeopathic treatment, and the individual’s costs in taking out this cover are subsidised under the Australian Government’s private health insurance rebate. The RACGP is concerned that health insurance premiums continue to rise as funds disburse significant sums for the use of homeopathy and other natural therapies lacking rigorous evidentiary support. In the 2013–14 financial year, health insurers paid out $164 million in benefits for natural therapies, up by almost 60 per cent from 2010–11.
The RACGP also notes that offering subsidies for the use of homeopathy sends a confusing message to consumers. Listing homeopathic treatments alongside evidence-based modalities in a list of member benefits lends legitimacy to a practice that is not supported by scientific data.
1. National Health and Medical Research Council. NHMRC Statement: Statement on Homeopathy. Canberra: NHMRC; 2015.
2. National Health and Medical Research Council. NHMRC Information Paper: Evidence on the effectiveness of homeopathy for treating health conditions. Canberra: NHMRC; 2015.
3. National Centre for Immunisation Research and Surveillance. Homeopathy and vaccination [fact sheet].2014 [cited 2015 April]. Available from http://www.ncirs.edu.au/immunisation/factsheets/homeopathyvaccination-
4. Commonwealth Department of Health and Ageing. Myths and realities: Responding to arguments against vaccination. A guide for providers. Canberra: DoHA; 2013.
5. Coronial inquest into the death of Penelope Dingle. State Coroner of Western Australia, 2010.
6. Australian Competition and Consumer Commission v Homeopathy Plus! Pty Ltd. FCA, 2014.
7. World Health Organization. Safety issues in the preparation of homeopathic medicines. Geneva: WHO; 2009.
8. Posadzki P, Alotaibi A, Ernst E. Adverse effects of homeopathy: a systematic review of published case reports and case series. International Journal of Clinical Practice 2012 Dec;66(12): 1178–88.
9. Xue CCL, Zhang AL, Lin V, Da Costa C, Story DF. Complementary and alternative medicine use in Australia: a national population-based survey. Journal of Alternative and Complementary Medicine 2007; 13(16):643–50.
10. Private Health Insurance Administration Council. Operations of the Private Health Insurers Annual Report 2013–14. Canberra: PHIAC; 2014.
I think this is a very good statement:
- it is based on the best evidence currently available,
- it is concise and to the point,
- it covers all the necessary ground,
- it provides valuable and practical recommendations.
Perhaps I should mention that it came as a complete surprise to me, and I was not involved in any way.
Finally, I would like to express my hope that this statement will be adopted in Australia and send a powerful signal to organisations across the world to issue similar recommendations for the benefit of vulnerable patients who still fall victim to bogus claims by homeopaths every day.
Chiropractors like to promote themselves as primary healthcare professionals. But are they? A recent survey might go some way towards addressing this question. It was based on a cross sectional online questionnaire distributed to 4 UK chiropractic associations. The responses were collected over a period of two months from March 26th 2012 to May 25th 2012.
Of the 2,448 members in the 4 participating associations, 509 chiropractors (~21%) completed the survey. The results of the survey show that the great majority of UK chiropractors surveyed reported evaluating and monitoring patients in regards to posture (97.1%), inactivity/overactivity (90.8%) and movement patterns (88.6%). Slightly fewer provided this type of care for psychosocial stress (82.3%), nutrition (74.1%) and disturbed sleep (72.9%). Still fewer did so for smoking (60.7%) and over-consumption of alcohol (56.4%). Verbal advice given by the chiropractor was reported as the most successful resource to encourage positive lifestyle changes as reported by 68.8% of respondents. Goal-setting was utilised by 70.7% to 80.4% of respondents concerning physical fitness issues. For all other lifestyle issues, goal-setting was used by approximately two-fifths (41.7%) or less. For smoking and over-consumption of alcohol, a mere one-fifth (20.0% and 20.6% respectively) of the responding chiropractors set goals.
The authors of this survey concluded that UK chiropractors are participating in promoting positive lifestyle changes in areas common to preventative healthcare and health promotion areas; however, more can be done, particularly in the areas of smoking and over-consumption of alcohol. In addition, goal-setting to support patient-provider relationships should be more widespread, potentially increasing the utility of such valuable advice and resources.
When I saw that a new UK-wide survey of chiropractic has become available, I had great expectations. Sadly, they were harshly disappointed. I had hoped that, after going to the considerable trouble of setting up a nationwide survey of this nature, we would have some answers to the most urgent questions that currently plague chiropractic and are amenable to study by survey. In my view, some of these questions include:
- How many chiropractors actually see themselves as primary care professionals?
- What conditions do chiropractors treat?
- Specifically how many of them believe they can treat non-spinal conditions effectively?
- How many chiropractors regularly treat children?
- For which conditions?
- How many patients get X-rayed by chiropractors?
- How many are in favour of vaccinations?
- How many are aware of adverse effects of spinal manipulation?
- How chiropractors obtain informed consent before starting treatment?
- What percentage of chiropractors use spinal manipulation?
- What other treatments are used how often?
- How often do chiropractors advise their patients about medications prescribed by real doctors?
- How often do they refer patients to other health care providers?
All of these questions are highly relevant and none of them has recently been studied. But, sadly, the new paper does not answer them. Why? As I see it, there are several possibilities:
- Chiropractors do not find these questions as relevant as I do.
- They do not want to know the answers.
- They do not like to research issues that might shine a bad light on them.
- They view research mostly as a promotional exercise.
- They did research (some of) these questions but do not dare to publish the results.
- They will publish the results in a separate paper.
It would be interesting to hear from the authors which possibility applies.
In many countries, consumers seem to be fond of consulting chiropractors – mostly for back pain, but also for other conditions. I therefore think it is might be a good and productive idea to give anyone who is tempted to see a chiropractor some simple, easy to follow advice. Here we go:
- Ask your chiropractor what he/she thinks about the chiropractic concept of subluxation. This is the chiropractors’ term (real doctors use the word too but understand something entirely different by it) for an imagined problem with your spine. Once they have diagnosed you to suffer from subluxation, they will persuade you that it needs correcting which is done by spinal manipulation which they tend to call ‘adjustments’. There are several important issues here: firstly subluxations do not exist outside the fantasy world of chiropractic; secondly chiropractors who believe in subluxation would diagnose subluxation in about 100% of the population – also in individuals who are completely healthy. My advice is to return straight back home as soon as the chiropractor admits he believes in the mystical concept of subluxation.
- Ask your chiropractor what he/she thinks of ‘maintenance care’. This is the term many chiropractors use for indefinite treatments which do little more than transfer lots of cash from your account to that of your chiropractor. There is no good evidence to show that maintenance care does, as chiropractors claim, prevent healthy individuals from falling ill. So, unless you have the irresistible urge to burn money, don’t fall for this nonsense. You should ask your chiropractor how long and frequent your treatment will be, what it will cost, and then ask yourself whether it is worth it.
- Run a mile, if the chiropractor wants to manipulate your neck (which most will do regardless of whether you have neck-pain, some even without informed consent). Neck manipulation is associated with very serious complications; they are usually caused by an injury to an artery that supplies parts of your brain. This can cause a stroke and even death. Several hundred such cases have been documented in the medical literature – but the true figure is almost certainly much larger (there is still no system in place to monitor such events).
- Run even faster, if the chiropractor wants to treat your children for common paediatric conditions. Many chiropractors believe that their manipulations are effective for a wide range of health problems that kids frequently suffer from. However, there is not a jot of evidence that these claims are true.
- Be aware that about 50% of all patients having chiropractic treatments will suffer from side effects like pain and stiffness. These symptoms usually last for 2-3 days and can be severe enough to impede your quality of life. Ask yourself whether the risk is outweighed by the benefit of chiropractic.
- Remember that there is no good evidence that chiropractors can treat any condition effectively other than lower back pain (and even for that condition the evidence is far from strong). Many chiropractors claim to be able to treat a plethora of non-spinal conditions like asthma, ear infection, gastrointestinal complaints, autism etc. etc. There is no good evidence that these claims are correct.
- Distrust the advice given by many chiropractors regarding prescribed medications, vaccinations or surgery. Chiropractic has a long history of warning their patients against all sorts of conventional treatments. Depending on the clinical situation, following such advice can cause very serious harm.
I am minded to write similar posts for all major alternative therapies (this will not make me more popular with alternative therapists, but I don’t mind all that much) – provided, of course, that my readers find this sort of article useful. So, please do give me some feedback.
Influenza kills thousands of people every year. Immunisation could prevent many of these deaths. Those at particularly high risk, e.g. young children, individuals aged 65 and older and people with severe diseases in their medical history, are therefore encouraged to get immunised. Nova Scotia health officials have just started their annual flu shot campaign. Now they are warning about some anti-flu vaccine literature being distributed by a chiropractor.
The leaflets from local chiropractic clinics suggest that flu shots increase the risk of a child ending up in hospital and link Alzheimer’s disease to flu shots. When questioned about this, the chair of the Nova Scotia College of Chiropractors defended this misinformation and claimed the author of the pamphlet did his homework. “Chiropractic is really pro information. Look at the positive, look at the negative, look at both sides, get your information and make the appropriate decision that’s right for you,” he said.
However, Dr. Robert Strang, Nova Scotia’s chief public health officer, said the message is wrong and added that the pamphlet is not based on medicine and is confusing to the public. “It’s discouraging, but unfortunately there are a range of what I call alternative-medicine practitioners who espouse a whole bunch of views which aren’t evidence based,” he said.
The stance of many chiropractors against immunisations is well known and has long historical roots. Campbell and colleagues expressed this clearly: Although there is overwhelming evidence to show that vaccination is a highly effective method of controlling infectious diseases, a vocal element of the chiropractic profession maintains a strongly antivaccination bias… The basis seems to lie in early chiropractic philosophy, which, eschewing both the germ theory of infectious disease and vaccination, considered disease the result of spinal nerve dysfunction caused by misplaced (subluxated) vertebrae. Although rejected by medical science, this concept is still accepted by a minority of chiropractors. Although more progressive, evidence-based chiropractors have embraced the concept of vaccination, the rejection of it by conservative chiropractors continues to have a negative influence on both public acceptance of vaccination and acceptance of the chiropractic profession by orthodox medicine.
No doubt, there will be comments following this post claiming that many chiropractors have now learnt their lesson and have considerably revised their stance on vaccination. This may well be true. But far too many chiropractors still post hair-raising nonsense about vaccination. Take this guy, for instance, who concludes his article (just one example of many) on the subject with this revealing paragraph: Our original blood was good enough. What a thing to say about one of the most sublime substances in the universe. Our original professional philosophy was also good enough. What a thing to say about the most evolved healing concept since we crawled out of the ocean. Perhaps we can arrive at a position of profound gratitude if we could finally appreciate the identity, the oneness, the nobility of an uncontaminated unrestricted nervous system and an inviolate bloodstream. In such a place, is not the chiropractic position on vaccines self-evident, crystal clear, and as plain as the sun in the sky?
As long as dangerous cranks are tolerated by the vast majority of chiropractors and their professional organisations to mislead the public, I have to agree with Dr Strang: “It’s discouraging, but unfortunately there are a range of what I call alternative-medicine practitioners who espouse a whole bunch of views which aren’t evidence based.”
If you think that homeopathy is risk-free, you should read what this US homeopath proclaims on his website. I have copied several sections from his lengthy article (everything that is in normal print is his writing; mine is in bold). The author first gives a general introduction into homeopathy and why he believes in it; then he continues:
…Now, on the surface, you might think that since there is some common ground between homeopathy and vaccinations, that homeopathic doctors would be, all-in, when it comes to vaccines. The fact is, most homeopaths today are against vaccinations. The main reason for that is not because of the underlying principle, but because the process have been perverted by eugenics. Today, the real purpose of vaccinations is to cause sterilization and early death. Bill Gates spends billions of dollars on global vaccination, admittedly, to reduce the population. All kinds of heavy metals like aluminum, mercury and other poisons and pathogens are put into vaccinations. People, especially children, are given many more times the amount of vaccinations today than they were decades gone by, when it can be argued, vaccinations were effective and were needed.Even cancer viruses have, on record, been put into vaccinations. There is no actual vaccine for cancer. The only reason to put cancer viruses in the mix is to create more cases of cancer. In this day and age, one of the most dangerous things you can do for your health is to get vaccinated…
With homeopathy, you never have to worry about heavy metals, cancer viruses or other poisons being mixed in with the natural ingredients. Even though some of the underlying foundations of homeopathy and vaccinations are similar, there are a number of differences. With vaccinations, the actual disease that they are allegedly trying to build up immunity to is in the injection. In homeopathy, that is not the case, except in rare exception, and due to the dilution process, there is never any risk. Another difference is that homeopathic remedies are taken orally, rather than injected…
Homeopathic remedies have no side effects. That’s a great thing. On the other hand, every drug comes with lots of side effects. And then, you can get in a vicious cycle where you keep taking (or being prescribed) more and more drugs to deal with more and more side effects. In time, this often leads to emergency “live saving” surgery. When they are successful and the patient doesn’t die on the operating table, everyone praises modern medicine for saving those millions of lives, all the while ignoring that the reason those millions of surgeries were needed in the first place, was due to those allegedly wonderful and so-called scientifically proven drugs. Plus, many times, these surgeries aren’t truly needed. If the patient would simply quit taking the drugs, the body could, often, heal itself from life threatening conditions…
Homeopathy is much more well known in Europe and various other nations than it is known in the United States. There is a huge medical conspiracy against the use of homeopathy and other medical modalities that threaten the financial dominance of the current medical industry. The conspiracy extends world-wide, but it is strongest in the USA…This conspiracy is being perpetrated on a conscious level, for going on 200 years. Then, on the heels of that, there is a massive amount of ignorance from ironically, highly educated people, who have been influenced by the conspirators. (Most of these people you might not be able to classify as conspirators, because they believe what they are saying.) Doctors who have never even tried a homeopathic remedy on themselves, or their patients, often say that there is no evidence that homeopathy works. When you point to the innumerable raving fans of homeopathy around the world, each of whom have testimonies of homeopathic remedies working extremely well, the detractors simply call those, anecdotal evidence, not worthy of consideration. When you point out some of the clinical case histories of undeniable healings that have come to patients of homeopathic doctors, the opponents of homeopathy chalk it all up to the placebo effect. They say they want scientific proof and that none exists, but the truth is, numerous studies have shown very positive results, and have outperformed drugs and/or placebo. There are more than 150 placebo controlled clinical studies, most of which have shown positive results, either compared with a placebo or compared with a conventional drug. Moreover, they did so with zero side effects, (unlike drugs, which often have that little side effect known as, death.) And yet, the detractors always have a Rolodex of never ending excuses, why those studies, “don’t count.” They range from, the studies are too small; they are conducted by people who believe in homeopathy – (I’m serious!); the doctors aren’t well known enough; there must have been some breakdown of the scientific procedure that has yet to come out, etc. These people are unable to deal with the conundrum, that homeopathic remedies become more potent, with dilution, instead of less potent, like you would assume. From there, they assume that it can’t work, and no matter how much healing is done with homeopathic remedies, it’s nothing more than mind of matter, (placebo effect.) …The evidence is overwhelming to anyone with an open mind that homeopathy is for real. Does everyone magically become well? Will you not have to die? You know the answers to that, and nobody is suggesting it.
What is undeniable is that the pharmaceutical industry peddles toxic drugs that do more harm than good, by far. Big pharma corporations get caught faking studies, bribing doctors and all kinds of dirty, illegal activity, for which they are fined billions of dollars. To call them purveyors of science is laughable. There are drugs like Vioxx, that have killed anywhere from tens of thousands to more than a million people (depending on whether you go by Merck and the FDA statistics, or outside investigators), which, shockingly, aren’t even pulled from the market by the government. The company finally quits peddling them once the lawsuits make it unprofitable…
I’ve finally come to the conclusion that these people aren’t interested in finding the truth. They only want to protect their status quo, and well as their paradigms of how the world works. They don’t have room for experiential evidence. When these type of people write research papers smearing homeopathy, they are being intellectually dishonest. They consciously obfuscate facts and mold findings to seem to conform to their beliefs – let the evidence be damned…
These medical mafia type of people, don’t even care about logic. They stopped making sense a long, long time ago. When you are done reading these two articles, if you have a modicum of an open mind, you will at the very least, not be able to deny that there really is a very genuine conspiracy against homeopathy…
Such utter nonsense speaks, I think, for itself. Therefore perhaps just this as my comment.
I have said and written it often: the homeopathic remedy might be harmless, however, many homeopaths are clearly not.
In a way, I should be thankful to the author of this truly amazing article enforcing my point.
My 2008 evaluation of chiropractic concluded that the concepts of chiropractic are not based on solid science and its therapeutic value has not been demonstrated beyond reasonable doubt. It also pointed out that the advice of chiropractors often is dangerous and not in the best interest of the patient: many chiropractors have a very disturbed attitude towards immunisation: anti-vaccination attitudes till abound within the chiropractic profession. Despite a growing body of evidence about the safety and efficacy of vaccination, many chiropractors do not believe in vaccination, will not recommend it to their patients, and place emphasis on risk rather than benefit.
In case you wonder where this odd behaviour comes from, you best look into the history of chiropractic. D. D. Palmer, the magnetic healer who ‘invented’ chiropractic about 120 years ago, left no doubt about his profound disgust for immunisation: “It is the very height of absurdity to strive to ‘protect’ any person from smallpox and other malady by inoculating them with a filthy animal poison… No one will ever pollute the blood of any member of my family unless he cares to walk over my dead body… ” (D. D. Palmer, 1910)
D. D. Palmer’s son, B. J. Palmer (after literally walking [actually it was driving] over his father’s body) provided a much more detailed explanation for chiropractors’ rejection of immunisation: “Chiropractors have found in every disease that is supposed to be contagious, a cause in the spine. In the spinal column we will find a subluxation that corresponds to every type of disease… If we had one hundred cases of small-pox, I can prove to you, in one, you will find a subluxation and you will find the same condition in the other ninety-nine. I adjust one and return his function to normal… There is no contagious disease… There is no infection…The idea of poisoning healthy people with vaccine virus… is irrational. People make a great ado if exposed to a contagious disease, but they submit to being inoculated with rotten pus, which if it takes, is warranted to give them a disease” (B. J. Palmer, 1909)
Such sentiments and opinions are still prevalent in the chiropractic profession – but today they are expressed in a far less abrupt, more politically correct language: The International Chiropractors Association recognizes that the use of vaccines is not without risk. The ICA supports each individual’s right to select his or her own health care and to be made aware of the possible adverse effects of vaccines upon a human body. In accordance with such principles and based upon the individual’s right to freedom of choice, the ICA is opposed to compulsory programs which infringe upon such rights. The International Chiropractors Association is supportive of a conscience clause or waiver in compulsory vaccination laws, providing an elective course of action for all regarding immunization, thereby allowing patients freedom of choice in matters affecting their bodies and health.
Not all chiropractors share such opinions. The chiropractic profession is currently divided over the issue of immunisation. Some chiropractors now realise that immunisations have been one of the most successful interventions ever for public health. Many others, however, do still vehemently adhere to the gospel of the Palmers. Statements like the following abound:
Vaccines. What are we taught? That vaccines came on the scene just in time to save civilization from the ravages of infectious diseases. That vaccines are scientifically formulated to confer immunity to certain diseases; that they are safe and effective. That if we stop vaccinating, epidemics will return…And then one day you’ll be shocked to discover that … your “medical” point of view is unscientific, according to many of the world’s top researchers and scientists. That many state and national legislatures all over the world are now passing laws to exclude compulsory vaccines….
Our original blood was good enough. What a thing to say about one of the most sublime substances in the universe. Our original professional philosophy was also good enough. What a thing to say about the most evolved healing concept since we crawled out of the ocean. Perhaps we can arrive at a position of profound gratitude if we could finally appreciate the identity, the oneness, the nobility of an uncontaminated unrestricted nervous system and an inviolate bloodstream. In such a place, is not the chiropractic position on vaccines self-evident, crystal clear, and as plain as the sun in the sky?
Yes, I do agree: the position of far too many chiropractors is ‘crystal clear’ – unfortunately it is also dangerously wrong.
A remarkable article about homeopathy and immunisation entitled THE IMMUNISATION DILEMMA came to my attention recently. Its abstract promised: “evidence quantifying the effectiveness of vaccination and HP (homeoprophylaxis) will be examined. New international research describing and analysing HP interventions will be reported. An evidence-based conclusion will be reached.”
Sounds interesting? Let’s see what the article really offers. Here is the relevant text:
…evidence does exist to support claims regarding the effectiveness of homeopathic immunisation is undeniable.
I was first invited to visit Cuba in December 2008 to present at an international conference hosted by the Finlay Institute, which is a W. H. O.-accredited vaccine manufacturer. The Cubans described their use of HP to control an outbreak of leptospirosis (Weilʼs syndrome – a potentially fatal, water-born bacterial disease) in 2007 among the residents of the three eastern provinces which were most severely damaged by a severe hurricane – over 2.2 million people . 2008 was an even worse year involving three hurricanes, and the countryʼs food production was only just recovering at the time of the conference. The HP program had been repeated in 2008, but data was not available at the conference regarding that intervention.
I revisited Cuba in 2010 and 2012, each time to work with the leader of the HP interventions, Dr. Bracho, to analyse the data available. Dr. Bracho is not a homeopath; he is a published and internationally recognised expert in the manufacture of vaccine adjuvants. He worked in Australia at Flinders University during 2004 with a team trying to develop an antimalarial vaccine.
In 2012 we accessed the raw leptospirosis surveillance data, comprising weekly reports from 15 provinces over 9 years (2000 to 2008) reporting 21 variables. This yielded a matrix with 147 420 possible entries. This included data concerning possible confounders, such as vaccination and chemoprophylaxis, which allowed a careful examination of possible distorting effects. With the permission of the Cubans, I brought this data back to Australia and it is being examined by mathematicians at an Australian university to see what other information can be extracted. Clearly, there is objective data supporting claims regarding the effectiveness of HP.
The 2008 result was remarkable, and could only be explained by the effectiveness of the HP intervention. Whilst the three hurricanes caused immense damage throughout the country it was again worse in the east, yet the three homeopathically immunised provinces experienced a negligible increase in cases whilst the rest of the country showed significant increases until the dry season in January 2009 .
This is but one example – there are many more. It is cited to show that there is significant data available, and that orthodox scientists and doctors have driven the HP interventions, in the Cuban case. Many people internationally now know this, so once again claims by orthodox authorities that there is no evidence merely serves to show that either the authorities are making uninformed/unscientific statements, or that they are aware but are intentionally withholding information. Either way, confidence is destroyed and leads to groups of people questioning what they are told…
The attacks against homeopathy in general and HP in particular will almost certainly continue. If we can achieve a significant level of agreement then we would be able to answer challenges to HP with a single, cohesive, evidence-based, and generally united response. This would be a significant improvement to the existing situation.
Reference 7 is the following article: Bracho G, Varela E, Fernández R et al. Large-scale application of highly-diluted bacteria for Leptospirosis epidemic control. Homeopathy 2010; 99: 156-166. The crucial bit if this paper are as follows:
A homeoprophylactic formulation was prepared from dilutions of four circulating strains of Leptospirosis. This formulation was administered orally to 2.3 million persons at high risk in an epidemic in a region affected by natural disasters. The data from surveillance were used to measure the impact of the intervention by comparing with historical trends and non-intervention regions.
After the homeoprophylactic intervention a significant decrease of the disease incidence was observed in the intervention regions. No such modifications were observed in non-intervention regions. In the intervention region the incidence of Leptospirosis fell below the historic median. This observation was independent of rainfall.
The homeoprophylactic approach was associated with a large reduction of disease incidence and control of the epidemic. The results suggest the use of HP as a feasible tool for epidemic control, further research is warranted.
The paper thus describes little more than an observational study. It shows that one region was less affected than another. I think it is quite clear that this could have many reasons which are unrelated to the homeopathic immunisation. Even the authors are cautious and speak in their conclusions not of a causal effect but of an “association”.
The 2012 data cited in the text remains unpublished; until it is available for public scrutiny, it is impossible to confirm that it is sound and meaningful.
Reference 8 refers to this article: Golden I, Bracho G. Adaptability of homœoprophylaxis in endemic, epidemic and stable background conditions. Homœopathic Links 2009; 22: 211-213. I have no access to this paper (if someone does, please fill us in) but, judging from both its title and the way it is described in the text, it does not seem to show reliable data about the efficacy of homeopathic immunisation.
So, is it true that “evidence does exist to support claims regarding the effectiveness of homeopathic immunisation”?
I do not think so!
Immunisation is by no means a trivial matter; wrong decisions in this area have the potential to cost the lives of millions. Therefore proofs of efficacy need to be published in peer-reviewed journals of high standing. These findings need then be criticised, replicated and re-criticised and re-replicated. Only when there is a wide consensus about the efficacy/safety or lack of efficacy/safety of a new form of immunisation, can it be generally accepted and implemented into clinical practice.
The current consensus about homeopathic immunisation is that it is nothing less than dangerous phantasy. Those who promote this quackery should be publicly exposed as charlatans of the worst kind.
Steve Scrutton is a UK homeopath on a mission; he seems to want to promote homeopathy at all cost – so much so that he recently ran into trouble with the ASA for breaching CAP Code (Edition 12) rules 3.1 and 3.3 (Misleading advertising), 3.7 (Substantiation) and 12.1, 12.2 and 12.6 (Medicines, medical devices, health-related products and beauty products). Scrutton happens to be a Director of the ‘ALLIANCE OF REGISTERED HOMEOPATHS’ (ARH) which represents nearly 700 homeopaths in the UK. On one of his websites, he promotes homeopathy as a treatment and prevention for measles:
Many homeopaths feel that it is better for children, who are otherwise healthy, to contract measles naturally. Homeopathy is less concerned with doing this as it has remedies to treat measles, especially if it persists, or become severe.Other homeopaths will use the measles nosode, Morbillinum, for prevention.Homeopaths have been treating measles for over 200 years with success.
The main remedies used for the condition, according to Scrutton, are the following: Aconite, Belladonna, Gelsemium, Euphrasia, Bryonia, Pulsatilla, Kali Bich, Sulphur, Apis Mel or Arsenicum – depending on the exact set of presenting symptoms.
At the very end of this revealing post, Scrutton makes the following statement: To my knowledge, there have been no RCTs conducted on either the prevention or treatment of Measles with Homeopathy. However, homeopaths have been treating Measles safely and effectively since the early 19th Century, and through many serious epidemics throughout the world.
Why would anyone write such dangerous nonsense, particularly in the position of a director of the ARH? There can, in my view be only one answer: he must be seriously deluded and bar any knowledge what sound medical evidence looks like. One of his articles seems to confirm this suspicion; in 2008, Scrutton wrote: What ‘scientific’ medicine does not like about homeopathy is not the lack of an evidence base – it is the ability to help people get well – and perhaps even more important, we can do it safely.
Intriguingly, the ARH has a code of ethics which states that members must not claim or imply, orally or in writing, to be able to cure any named disease and that they should be aware of the extent and limits of their clinical skills.
Could it be that a director of the ARH violates his own code of ethics?