MD, PhD, FMedSci, FSB, FRCP, FRCPEd

medical ethics

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Last Sunday evening, the Syrian, Mohammad D., tried to enter an open air festival in Ansbach, Germany. As he had no ticket, he was barred from entering. Later he exploded his bomb in front of one of the entrances of the festival. It killed him and injured 15 others, 4 seriously.

According to a report published in German, the 27-year old suicide-bomber had been treated since about half a year in an institution in Lindau called ‘Exilio’ by alternative therapists (Heilpraktiker) who offer ‘holistic help’ for immigrants under the leadership of Gisela und Axel von Maltitz.

The German ‘Heilpraktiker’ is an oddity left over from the Third Reich. Today, a Heilpraktiker hardly needs any education or training at all. What is more, he/she can claim to practice psychotherapy without proper training in psychotherapy. The Heilpraktiker in charge of Exilio, Axel von Maltitz, for instance, calls himself ‘Primärtherapeut, Heilpraktiker, Traumatherapie and Psychotherapie.’ The debate in Germany about the usefulness or otherwise of the Heilpraktiker has recently been stimulated by the publication of a critical book on the subject and can be expected to get more intense after the events in Ansbach.

‘Exilio’ apparently has a dubious reputation in Lindau, and the local officials had stopped co-operating with this clinic already over a year ago. The therapeutic team of Exilio does not seem to include a single qualified doctor, psychologist or psychiatrist.

The treatments employed in ‘Exilio’ include such dubious methods as Rebirthing, a technique involving “specific breathing exercises which allow individuals to re-experience memories from the past and to release feelings and sentiments that are suppressed / contained within the emotional physical self.” I am not aware of good evidence to show that Rebirthing is effective for any condition.

It seems clear that the Syrian suicide-bomber was seriously disturbed; apparently he already had previously tried to commit suicide. Nobody will ever know whether the atrocity of last Sunday could have been prevented, if he had received proper psychiatric attention. With hindsight, however, it seems clear that the alternative therapies he did receive were not effective.

Acupuncture Today is a much-read online publication for people interested in acupuncture. It informs us that Chinese medicine is quite complex and can be difficult for some people to comprehend. This is because TCM is based, at least in part, on the Daoist belief that we live in a universe in which everything is interconnected. What happens to one part of the body affects every other part of the body. The mind and body are not viewed separately, but as part of an energetic system. Similarly, organs and organ systems are viewed as interconnected structures that work together to keep the body functioning.

To me, this sounds suspiciously woolly. Do they think that conventional healthcare professionals view the various body-parts as separate entities? Do they feel that conventional practitioners see the mind entirely separate from the body? Do they believe others fail to realize that what affects the brain does not affect the rest of the body? These common preconceptions have always puzzled me. Intrigued, I read on.

Elsewhere we learn that Acupuncture Today and acupuncturetoday.com are the only complete news sources in the profession and we don’t take this honor lightly. The acupuncture and Oriental medicine profession is a blend of ancient traditions, healing styles and modern therapies. We provide content that is comprehensive enough to appeal to each of the profession’s diverse groups. In addition, we provide a complete suite of additional products including newsletters, calendars and classifieds that provide our advertisers with the contextual platform they need to communicate with our readers, their customers.

Acupuncture Today seems to reflect a lot of what many acupuncturists want to hear – and thus it might provide us with an important insight into the mind-set of acupuncturists. On their website, I found an article which fascinated me:

START OF QUOTE

A more efficient method for diagnosis and treatment by remote medical dowsing has been found and used in acupuncture with great success. The procedure involves a pendulum, a picture of the patient, an anatomy book, a steel pointer, and a very thin bamboo pointer.

Being a dentist, orthodontist, acupuncturist and dowser, I like to take the liberty of treating a person affected with lockjaw or temporal-mandibular joint ailments via remote dowsing…

…When the mandible cannot open due to a spasm, the chief symptom is pain. Until energy is restored, the muscle cannot lengthen and pain cannot be eliminated. Acupuncture is a good way to correct this condition without the use of a dental appliance. Dentists specializing in treating TMJ use a computerized equipment scan (electrosonography), surface electromyography and the myomonitor to relax the muscles.

Another procedure to treat TMJ is using dowsing. At this point, I will talk about dowsing procedures and information needed to successfully carry out the procedures. Remote dowsing requires the use of the pendulum, a slender bamboo pointer, an anatomy book, a picture of the patient and a steel pointer.

To treat a TMJ patient, the picture of the patient is dowsed holding a pendulum in the right hand while the left hand uses a bamboo pointer to touch the closing and opening muscles individually in the anatomy book. The closing muscles will have good energy (as evidenced by the circular movement of the pendulum) while the lower head of the lateral pterygoid will have no energy (as evidenced by little or no movement of the pendulum). Having advance information on TMJ acupuncture points helps, but these points will have to be tested if needling will supply energy. Master Tong has suggested a point between Liver 2 and Liver 3. I find Spleen 2, a distal point related to the lower head of the lateral pterygoid, to be more effective. This can be checked by having the patient hold the point of the steel pointer so it touches Spleen 2 on the large toe.

To treat a TMJ patient, the picture of the patient is dowsed holding a pendulum in the right hand while the left hand uses a bamboo pointer to touch the closing and opening muscles individually in the anatomy book. The closing muscles will have good energy (as evidenced by the circular movement of the pendulum) while the lower head of the lateral pterygoid will have no energy (as evidenced by little or no movement of the pendulum). Having advance information on TMJ acupuncture points helps, but these points will have to be tested if needling will supply energy. Master Tong has suggested a point between Liver 2 and Liver 3. I find Spleen 2, a distal point related to the lower head of the lateral pterygoid, to be more effective. This can be checked by having the patient hold the point of the steel pointer so it touches Spleen 2 on the large toe.

By dowsing the picture of the patient with the right hand and using a bamboo pointer to touch the lower head of the pterygoid muscle in the anatomy book with the left hand, it will be evident by the circular movement of the pendulum that these muscles now have good energy. This is done before the needle is inserted. In this manner all points can be checked for ailments such as TMJ, stroke, backaches, and neck and shoulder problems before needling. When the needles are placed and after the needling procedure, energy can be checked using the pendulum. By being very accurate on the location of acupuncture points, less treatments will be needed to obtain results. Another point is Small Intestine 19, a local point which is also very effective. Good results are obtained by careful and accurate needling. Therefore, the number of visits are few…

Dowsing is a diagnostic aid that has been used for other situations and can be very helpful to acupuncturists. In conclusion, I feel that remote dowsing is a great approach to diagnosis and treatment.

END OF QUOTE

If I had not seen alternative practitioners doing this procedure with my own eyes, I might have thought the article is a hoax. Sadly, this is the ‘real world’ of alternative medicine.

I tried to find some acupuncturists who had objected to this intense nonsense, but I was not successful in this endeavour. The article was published 6 years ago (no, not on 1 April!), yet so far, nobody has objected.

I have also tried to see whether articles promoting quackery of this nature are rare exceptions in the realm of acupuncture, or whether they are regular occurrences. My impression is that the latter is the case.

What can be concluded from all this?

In a previous post about quackery in chiropractic, I have argued that the tolerance of quackery must be one of the most important hallmarks of a quack profession. As I still believe this to be true, I have to ask to which extend THE TOLERANCE OF SUCH EXTREME QUACKERY MAKES ACUPUNCTURISTS QUACKS?

[I would be most interested to have my readers’ views on this question]

A survey published in 2011 showed that one-third of Danish hospitals offered alternative therapies. In total, 38 hospitals offered acupuncture and one Eye Movement Desensitization and Reprocessing Light Therapy. The most commonly reported reason for offering CAM was “scientific evidence”.

Many readers of this blog might be amazed with both the high level of alternative medicine presence in Danish hospitals and the notion that this was due to ‘scientific evidence’. A recent article provides even more surprises about the Danish alternative medicine scene.

It revealed that 8 out of 10 Danes are interested in using some form of alternative medicine…Some 67 percent of Danes say the national healthcare system should be more open to alternative healing practices, such as homeopathy, acupuncture or chiropractic, and 60 percent would like to see these treatments covered by the public health insurance system. More than half of the 6,000 respondents believe alternative therapies can be just as effective as traditional medicine.

Charlotte Yde, the chairwoman at Sundhedsrådet, which is the umbrella organisation for alternative practitioners in Denmark, contends many Danes feel frustrated because they cannot freely discuss alternative treatment with their doctors. Alternative treatment researcher Helle Johannessen agrees that Danish doctors should openly discuss alternative medicine options with patients. “In other European countries doctors use alternative treatment to a much greater extent than doctors in Denmark,” Johannessen told DR. “[International experience] shows that some forms of alternative therapy can improve quality of life and reduce anxiety and nausea in cancer patients.”

This, it seems to me, is little more than a bonanza of fallacious thinking and misleading information.

  • The notion that popularity of a therapy has anything to do with its usefulness is a classical fallacy.
  • The notion that belief determines efficacy (More than half of the 6,000 respondents believe alternative therapies can be just as effective as traditional medicine.) or vice versa is complete nonsense.
  • The notion that many Danes … cannot freely discuss alternative treatment with their doctors is misleading: patients can discuss what they feel like with whom they feel like.
  • The notion that in other European countries doctors use alternative treatment to a much greater extent than doctors in Denmark is also misleading: there are many European countries where LESS alternative therapies are being paid for via the public purse.
  • Finally, the notion that that some forms of alternative therapy can improve quality of life and reduce anxiety and nausea in cancer patients – even if it were correct – does not mean that ALL alternative therapies are efficacious, safe, or cost-effective.

Who cares about Denmark?

Why should this be important?

Well, the Danes might care, and it is important because it provides an excellent example of how promoters of bogus treatments tend to argue – not just in Denmark, but everywhere. Unfortunately, politicians all too often fall for such fallacious notions. For them, a popular issue is a potential vote-winner. Within medical systems that are notoriously strapped for money, the looser will inevitably be optimal healthcare.

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.

On a good day, I get several emails from complete strangers; some are complimentary, others are critical, and others again are just strange. Few are stranger than the exchange I am about to disclose.

The author asked me twice to treat his/her emails with ‘trust and confidence’; after the second email, I nevertheless felt that I should not respect this wish but needed to share this brief exchange with my readers. I have, however, erased all the details that would allow an identification of the author.

 

INITIAL EMAIL of 18/7/2016

I am responding to you latest post regarding “Informed Consent”. I have decided to do so because my instincts suggest that we may in fact have an empathy in our individual objective to establish an evidence base for complementary medicine. However, I do not have any empathy with many of the contributors to your blog and especially with those that have a desire to “grind homeopathic vets and feed them to the pigs” Given that you moderate the site, I am surprised that you allowed such a post.

As you are aware, I obtained a copy of your book “A Scientist in Wonderland” which I have read with considerable interest and as you know, I have posted extracts on your blog. In this respect I make the following observations:

1. Your early experiences of homeopathy were positive and on this basis I find great difficulty in accepting that you are as anti-homeopathy as you publically state. From my own experience, this is not logical.

2. I am of the opinion that the sad loss of your Hungarian friend and colleague is an influencing factor, particularly as you avoided any mention of him receiving any form of alternative medicine.

3. I can empathise with your frustration at the lack of support from the alternative medicine community, as I have experienced this in my own efforts.

4. I am inclined to accept the possibility that you are using the blog to deliberately provoke the homeopathic community into action from a long standing but understandable state of complacency. (If you know that something works, then why is there a need to prove it).

5. I find difficulty to believe that you are at home surrounded by such closed minded individuals, because, historically, you have always moved on from such situations. However, I am not sure that you know how you can escape from the trap that you now find yourself in. Is this what you want for the rest of your life?

For a variety of reasons, I embarked on this … venture as a means of finding evidence that these therapies do work and have found that the homeopathy community is somewhat less than supportive in my efforts, so I do understand your potential frustration.

I appreciate that my observations are assumption based and may be wishful thinking on my part; however, if my assumptions have validity, please contact me, otherwise ignore this message.

If you do choose to pursue this conversation, then it must take place under the strict condition of TRUST & CONFIDENCE.

 

MY REPLY of 18/7/2016

thank you for your email. you say you read my memoir; may I suggest you read it again – because the answers to your questions seem to be all in there. your assumptions about me are quite wrong, and I think my book explains why.

best regards
e ernst

 

THE RESPONSE of 21/7/2016

In Britain we have a saying “Don’t mention the war when speaking to a German”, so out of respect I refrained from mentioning the Nazi regime in my last message; however, as you have made an implied reference to it, I will now comment.

I have some six years of close working experience with a large German organisation … so that I am fully aware of the significant differences between the German and British mentality and approach to life. I am therefore able to appreciate many of the difficulties that you will have encountered when arriving in this country to take up the Exeter post, which by definition was designed to advise the UK alternative therapy community how to do things properly!

The Anglo/Germanic axis is a significant challenge under normal circumstances but for you to arrive in this country and make direct comparisons between alternative medicine and the Third Reich in a country that spearheaded the fight against the Nazi’s at a cost of nearly half a million British lives was a fatal mistake on your part.

Having spent some forty years in and around the alternative health world here in Britain, India and the USA I don’t think your view point can be further from the truth. What amazes me is that you do not moderate Nazi type comments such as “grinding homeopaths and feeding them to pigs” from your blog which is a complete contradiction to your reasoning.

Your blog purports to provide cautionary advice to would be patients choosing alternative health options but your band of followers seem to have no understanding whatsoever as to the importance of respect for others. They seem to believe that from the offset, respect has to be earned, which implies judgement. Any doctor or therapist that starts from this view point when dealing with a patient, should not be treating patients at all. Empathy and respect are key factors in the healing process and those that automatically practice this naturally operate under and accept a moral code of ethics which forms part of all training within the main alternative treatments. The fundamental ethic behind all medicine is “first do no harm”. How can this be achieved if you do not respect the patient, regardless of his views?

At a personal level, I am concerned that your early experiences have distorted your views and unfortunately you have managed to alienate yourself from the very form of healthcare that would best resolve these issues without the need for suppressive drugs.

I suggest that you re-read your book and honestly ask yourself if the “peaceful vantage point” referred to on page 170, in any way measures up to the “peaceful, happy time” you mention on page 36.

I again extend my offer of an exploratory conversation in an atmosphere of “trust and confidence”.

END OF QUOTE

I do not feel like adding any comments just now… perhaps just a few questions:

How is it possible that someone who has obviously read quite a bit of what I have published misunderstands so much of it? Deluded? Demented? Or worse?

Informed consent is a basic ethical principle and a precondition for any medical or surgical procedure (e. g. a therapeutic intervention or a diagnostic test). Essentially, there are 4 facets of informed consent:

  1. the patient must have decision-making capacity,
  2. the patient’s decision must be free from coercion or manipulation,
  3. all relevant information must be disclosed to the patient,
  4. the patient must not merely be told but must understand what he/she has been told.

It seems to me that points 1, 2 and 4 are more or less the same in alternative as in conventional medicine. Point 3, however, has fundamentally different implications in the two types of healthcare.

What is meant by ‘all relevant information’? There seems to be general agreement that this should include the following elements:

  1. the indication,
  2. the nature of the procedure,
  3. its potential benefits,
  4. its risks,
  5. other options for the proposed procedure, including the option of doing nothing at all.

If we carefully consider these 5 elements of ‘all relevant information’, we soon realise why there might be profound differences between alternative and conventional medicine. These differences relate not so much to the nature of the procedures but to the competence of the clinicians.

At medical school, doctors-to-be learn the necessary facts that should enable them to adequately deal with the 5 elements listed above. (This does not necessarily mean that, in conventional medical or surgical practice, informed consent is always optimal. But there is little doubt that, in theory, it could be optimal.)

By contrast, alternative practitioners have not normally been to medical school and will have gone through an entirely different type of training. Therefore, the question arises whether – even in theory – they are able to transmit to their patients all essential information as outlined above.

Let’s try to address this question by looking at concrete cases: a patient with frequent headaches consults an alternative practitioner for help. For the sake of argument, the practitioner could be:

  • a chiropractor,
  • an acupuncturist,
  • a homeopath,
  • a naturopath,
  • a traditional herbalist.

Are these alternative practitioners able to convey all the relevant information to their patient before starting their respective treatments?

THE CHIROPRACTOR

  1. Can he provide full information on the indication? In all likelihood he would treat the headache as though it was caused by a spinal subluxation. If our patient were suffering from a brain tumour, for instance, this might dangerously delay the diagnosis.
  2. Can he explain the nature of the procedure? Yes.
  3. Can he explain its potential benefits? He is likely to have a too optimistic view on this.
  4. Can he explain its risks? Many chiropractors deny any risk of spinal manipulation.
  5. Can he provide details about the other options for the proposed procedure, including the option of doing nothing at all? Probably yes for cervicogenic headache. No for most other differential diagnoses.

THE TRADITIONAL ACUPUNCTURIST

  1. Can he provide full information on the indication? The patient might be treated for an assumed ‘energy blockage’; other diagnoses might not be given adequate consideration.
  2. Can he explain the nature of the procedure? Yes.
  3. Can he explain its potential benefits? He is likely to have a too optimistic view on this.
  4. Can he explain its risks? Perhaps.
  5. Can he provide details about the other options for the proposed procedure, including the option of doing nothing at all? No

THE CLASSICAL HOMEOPATH

  1. Can he provide full information on the indication? No, for a classical homeopath, the totality of the symptoms is the only valid diagnosis.
  2. Can he explain the nature of the procedure? Yes.
  3. Can he explain its potential benefits? Doubtful.
  4. Can he explain its risks? Doubtful.
  5. Can he provide details about the other options for the proposed procedure, including the option of doing nothing at all? No.

THE NATUROPATH

  1. Can he provide full information on the indication? Doubtful.
  2. Can he explain the nature of the procedure? Yes.
  3. Can he explain its potential benefits? He is likely to have a too optimistic view on this.
  4. Can he explain its risks? Doubtful.
  5. Can he provide details about the other options for the proposed procedure, including the option of doing nothing at all? No.

THE TRADITIONAL HERBALIST

  1. Can he provide full information on the indication? No.
  2. Can he explain the nature of the procedure? Yes.
  3. Can he explain its potential benefits? He is likely to have a too optimistic view on this.
  4. Can he explain its risks? He is likely to have a too optimistic view on this.
  5. Can he provide details about the other options for the proposed procedure, including the option of doing nothing at all? No.

The answers provided above are based on my experience of more than 20 years with alternative practitioners; I am aware of the degree of simplification required to give short, succinct replies. The answers are, of course, assumptions as well as generalisations. There may well be individual practitioners who would do better (or worse) than the fictitious average I had in mind when answering the questions. Moreover, one would expect important national differences.

If my experience-based assumptions are not totally incorrect, their implications could be most significant. In essence they suggest that, in alternative medicine, fully informed consent can rarely, if ever, be provided. In turn, this means that the current practice of alternative medicine cannot be in line with the most fundamental requirements of medical ethics.

There is very little research on any of these  issues, and thus hardly any reliable evidence. Therefore, this post is simply meant as a deliberately provocative essay to stimulate debate – debate which, in my view, is urgently required.

 

Medical ethics are central to any type of healthcare – and this includes, of course, alternative medicine. The American Medical Association (AMA) have just published their newly revised code of ethics, AMA Principles of Medical Ethics.

It has long been my impression that, in alternative medicine, ethics receive no or far too little attention. Some alternative practitioners thrive to be able to call themselves ‘physicians’. Therefore, it seems interesting to ask whether they would also be able to comply with the ethical duties of a physician as outlined by the AMA.

The following 9 points are taken without change from the new AMA code; in brackets I have put my own, very brief comments pertaining to alternative practitioners. There is much more to be said about each of these points, of course, and I encourage my readers to do so in the comments section.

  1. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights. [Most alternative practitioners use unproven treatments; I doubt whether this can be called ‘competent medical care’.]
  2. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities. [Treating patients with unproven therapies in the absence of fully informed consent is arguably unprofessional, dishonest and deceptive. Crucially, alternative practitioners never object to even the worst excesses of quackery that occur in their realm.]
  3. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient. [Treatment with unproven therapies can hardly be in the best interest of the patient.]
  4. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law. [The right of patients includes full informed consent which is, according to my impression, rare in alternative medicine.]
  5. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated. [Alternative medicine is frequently out of line with or even opposed to medical knowledge.]
  6. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.
  7. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health. [Some activities of some alternative practitioners are directly opposed to public health, for instance when they advise against immunising children.]
  8. A physician shall, while caring for a patient, regard responsibility to the patient as paramount. [Arguably this is not possible when using unproven therapies.]
  9. A physician shall support access to medical care for all people. [Some alternative practitioners advise their patients against accessing conventional healthcare.]

As I stated above, medical ethics are neglected in alternative medicine. The 9 points of the AMA together with my comments go some way towards explaining why this is so. If ethical principles were applied to alternative medicine, much of it would have to stop instantly.

The UK petition to ban homeopathy for animals has so far achieved well over 3 000 signatures. Remarkably, it also prompted a reaction from the Faculty of Homeopathy which I reproduce here in full:

Response to petition calling on the RCVS to ban homeopathy

Homeopathy has a long history of being used successfully in veterinary practice for both domestic and farm animals. The EU recommends its use in its regulations on organic farms and is funding research into veterinary homeopathy as a way of reducing antibiotic use in livestock. It is nonsense to suggest that responsible pet owners and farmers are unable to distinguish between effective and ineffective medicines; they continue to use homeopathy because they see its benefits.

Membership of the Faculty of  Homeopathy (VetMFHom) is bestowed on qualified veterinary surgeons who have completed a minimum of three years study of homeopathy and after a rigorous examination procedure. It differentiates the qualified veterinary homeopath from an unlicensed healer.

In a statement, the Royal College of Veterinary Surgeons said “… homeopathy is currently accepted by society and recognised by UK medicines legislation, and does not, in itself, cause harm to animals”. Before going on to say it could see no justification for banning veterinary surgeons from practising homeopathy.

In an age when antibiotic resistance is such an important issue, veterinary surgeons and farmers who have found they can limit the use of these drugs by using homeopathy should be applauded and not attacked.


Peter Gregory
BVSc MRCVS VetFFHom
Veterinary Dean, Faculty of Homeopathy

 

Such sentiments resonate with those of the UK’s most influential supporter of homeopathy, Prince Charles. Speaking at a global leaders summit on antimicrobial resistance, Prince Charles  recently warned that Britain faced a “potentially disastrous scenario” because of the “overuse and abuse” of antibiotics. The Prince explained that he had switched to organic farming on his estates because of the growing threat from antibiotic resistance and now treats his cattle with homeopathic remedies rather than conventional medication. “As some of you may be aware, this issue has been a long-standing and acute concern to me,” he told delegates from 20 countries at The Royal Society in London. “I have enormous sympathy for those engaged in the vital task of ensuring that, as the world population continues to increase unsustainably and travel becomes easier, antibiotics retain their availability to overcome disease… It must be incredibly frustrating to witness the fact that antibiotics have too often simply acted as a substitute for basic hygiene, or as it would seem, a way of placating a patient who has a viral infection or who actually needs little more than patience to allow a minor bacterial infection to resolve itself.”

It seems that both Prince Charles and Peter Gregory believe that homeopathy can be employed to reduce the use of antibiotics in animals. So, let’s analyse this hypothesis a little closer.

The way I see it, the belief must be based on one of two assumptions:

  1. Homeopathic remedies are effective in treating or preventing bacterial infections.
  2. If farmers administer homeopathic remedies to their life-stock, they are less likely to administer unnecessary antibiotics.

Assumption No 1 can be rejected without much further debate; there is no evidence whatsoever that homeopathic remedies have antibiotic efficacy. In fact, the consensus today is that highly diluted homeopathic remedies are pure placebos.

Assumption No 2, however, might be more plausible and therefore deserves further scrutiny.  If we do not tell the farmers nor the vets that homeopathic remedies are placebos, if, in other words, we mislead them to think they are efficacious medicines, they might give them to their animals instead of antibiotics. Consequently, the usage of antibiotics in animals would decrease. This strategy sounds plausible but, on second thought, it has many serious drawbacks:

  1. The truth has a high value in itself which we would disregard at our peril.
  2. One might not be able to keep the truth from the farmers and even less able to hide it from vets.
  3. If we mislead farmers and vets, we must also mislead the rest of the population; this means lots of people might start using homeopathic placebos even for serious conditions.
  4. Misleading farmers, vets and the rest of the population is clearly unethical.
  5. Misleading farmers and vets in this way might not be necessary; if there is abuse of antibiotics in farming, we ought to tackle this phenomenon directly.
  6. Misleading farmers and vets might be dangerous for at least two reasons: firstly, animals who truly need antibiotics would not receive adequate treatment; secondly, farmers and vets might eventually become convinced that homeopathy is efficacious and would therefore use it in all sorts of situations, even for serious diseases of humans.

Whichever way I twist and turn the assumption No 2, I fail to arrive at anything remotely sensible. But this leaves me with a huge problem: I would have to conclude that both the Veterinary Dean, Faculty of Homeopathy and the heir to the throne are bonkers… and, surely, this cannot be right either!!!

 

Nobody can doubt that, during the last 200 years, conventional medicine has made monumental progress. Homeopathy, however, has remained more or less like Hahnemann invented it. But now it seems as though homeopathy can celebrate an unprecedented step ahead. As so often in medicine, it originates from a commercial enterprise.

Genexa is a US firm that produces natural health products. On their website, they state that “At Genexa, we believe medicine should be free from unhealthy fillers and toxins”. They recently published a press-release introducing a line of homeopathic medicines certified organic by the U.S. Department of Agriculture and Non-GMO Project verified. They are keen to point out that these products “do not contain any genetically modified ingredients.” In fact, several of their remedies do not contain any active ingredients to speak of: they are homeopathic!

“We are extremely proud of our organic and non-GMO certifications – the seals are prominently featured on all our products and website for easy label reading and patient education,” stated David Johnson, CEO of Genexa, in their press-release. “Our quality standards are among the highest in the over-the-counter medicine industry.”

Genexa’s 11 homeopathic formulations are being advertised for the treatment of common health issues such as flu, cold, allergies, stress, pain, leg cramps, sleeplessness and jet lag. An entire line of products is, according to the press-release, specially formulated for children and includes treatments for cold, allergy and calming.

Genexa’s CMO proudly announced that “It’s important to us that our retail customers feel confident in the products and know they can trust they are purchasing medicines free from unhealthy fillers and toxins and simply focus on healing.” Presumably that trust must include the trust into the efficacy of the homeopathic remedies! Yes, I am pleased to report that, apparently it does; elsewhere they confirm this by stating that “Genexa holds itself to the highest standards in both quality and ethics.” The highest standards of ethics surely include that the remedies in question are demonstrably efficacious.

But how can we be sure? Are any of these homeopathic remedies supported by reasonably strong evidence? Oddly enough, despite all these affirmations, I did get my doubts when I tried to dig a bit deeper.

Take the homeopathic remedy called SLEEPOLOGY, for instance. The website informs us that “This homeopathic formulation consists of nine leading remedies designed to treat sleeplessness, inability to fall asleep, frequent waking, restless sleep and sleeplessness from stress, exhaustion, nervousness, excitability, restlessness, worries, irritability, and pain.” So, it’s a complex homeopathic remedy with 9 different ingredients. But is there any evidence of efficacy for this mixture? I am not aware of any clinical trials that have tested its efficacy. But I must be wrong, because on the website we are being told that “Clinical trials have demonstrated efficacy for treating sleeplessness for piper methysticum, and valeriana officinalis.” That may be so, but the trials were done with herbal extracts, not with homeopathic potencies! Could the statement therefore be more than a little misleading?

On the internet, I found all sorts of fascinating bits about the new homeopathic lines (my compliments to the PR firm that organised the launch!); for instance the revelation that: “The company’s proprietary medicines were created by and are regularly reviewed and enhanced by its chief medical officer, Dr. Todd Rowe*, a nationally respected physician with an expertise in homeopathic medicine formulation. Working with the Genexa team, Dr. Rowe and his team of chemists and pharmacists spent hundreds of hours meticulously formulating and testing the products. The result is a line of effective, potent medicines that are certified organic by the USDA and non-GMO verified by the Non-GMO Project. “Our formulations are based on tried and true principles for miasmatic and energetic balance, so that the remedies potentiate each other and promote the most positive patient outcomes,” said Dr. Rowe. “These powerful medicines work with your body to help it heal itself.”” However, I was unable to find out which potencies are being used for the Genexa homeopathic products. This information might not be that relevant: according to the homeopathic ‘like cures like’ principle, the effects of a substance are reversed through potentiation. This is why coffee, for instance, is potentised by homeopath to generate a sleeping remedy. Does it not follow then that, potentising two or more herbal ingredients that have hypnotic effects (as in SLEEPOLOGY), must generate a remedy for preventing sleep? A similarly puzzling lack of ‘homeopathic logic’ seems to apply to several other products in Genexa’s line of homeopathic remedies.

I have to admit, I am confused.

Could it be that the ‘breakthrough’ turns out to be a breakdown of ‘homeopathic logic’?

Let’s hope someone from Genexa reads these lines and can enlighten us.

[*he is the President of the American Medical College of Homeopathy]

“When orthodox medicine has nothing more to offer” is the title of an article by Dr Elizabeth Thompson, a UK medical homeopath. The article was written years ago, but it is still an excellent example for disclosing the dangerously false and deeply unethical reasoning used by many alternative practitioners. The notion that all sorts of disproven treatments like homeopathy are justified when orthodox medicine has nothing more to offer is so very prevalent that I decided to do this post analysing it.

In the following, you see the most relevant sections of Dr Thompson’s original article (in normal print) and my brief comments (in brackets and in bold):

…Some people come when conventional treatments can no longer offer them anything to save their lives. This is a frightening time for them and although the homeopathic approach may not offer a cure at this late stage of their illness (Is she implying that, in some cases, homeopathy can cure cancer?), it can often offer hope of a different kind. (Surely, one does not need homeopathy for giving patients hope). Sometimes it helps people to outlive the prognosis given to them by months or even years. (A prognosis is not a precise time of death; it is based on statistics and therefore depicts a likelihood, not a certainty. Thus patients outlive their prognosis all the time regardless of treatments.) Sometimes it helps them need less (less than what? there is no control group and therefore the statement seems nonsensical) in the way of conventional medicine including pain killers and offers them continuing support despite progressive disease (is she trying to say that in conventional medicine patients with progressive disease do not get continuing support?).

As a doctor working in both conventional and complementary cancer care I have learned the importance of integrating these two perspectives (the integration of unproven therapies into EBM can only render the latter less effective). Ideally the doctor practising homeopathy would work as an integral part of a much wider team which would include family members, nurses, general practitioners, oncologists, surgeons, palliative physicians and other complementary therapists (the concept of a multi-disciplinary team for cancer is one from conventional medicine where it has long been routine). It is disappointing sometimes to see that other healthcare professionals can be unsupportive of a person’s desire to use complementary therapies and for some people the knowledge that the team is not working together can cause doubt and insecurity (for the majority of patients, however, it might be reassuring to know that their oncology-team is evidence-based).

Some patients come at the beginning of their diagnosis wanting to support their bodies with gentler (homeopathic remedies are not gentler, they are ineffective) approaches and help themselves recover from some difficult and powerful treatments such as chemotherapy and radiotherapy (Why are they being told that alternative therapies are effective in achieving these aims when there is no good evidence to show that this is true? Isn’t that unethical?). As well as using homeopathic medicines (no good evidence of effectiveness!!!), the GHH also has experience in using Mistletoe which is given by injection and has been shown to stimulate the group of white cells whose numbers can be depleted during chemotherapy and radiotherapy (also no good evidence that it works clinically!!!).

Other patients come when they have finished most of their treatments but may still not be feeling well despite being given the all clear by their doctors (same again: no good evidence!!!)…

One wonderful aspect of the homeopathic approach is that it can be a very important opportunity to help someone re-evaluate their life and their health (We don’t need to prescribe placebos for that, this aim is better reached by employing a clinical psychologist).

Sometimes hurts in the past have never been healed and sitting with someone as they describe difficult experiences can be itself therapeutic. Combining this therapeutic listening time with substances from nature that gently stimulate the body’s own healing potential (where is the evidence for that claim?) can be an approach that through patient demand and research (what research?) we can demonstrate is really worth offering to many more people…

END OF QUOTE

 

This text shows in an exemplary fashion how desperate patients can be convinced to make dramatically wrong choices. If you read Dr Thompson’s text without my comments, it probably sounds fairly reasonable to many people. I can understand why patients and carers end up thinking that homeopathy or other disproven therapies are reasonable options WHEN ORTHODOX MEDICINE HAS NOTHING MORE TO OFFER.

But the claim of homeopaths and others that mainstream medicine has, in certain cases, nothing more to offer is demonstrably wrong. Supportive and palliative care are established and important parts of conventional medicine. To deny this fact amounts to a lie! The implied scenario where a patient is told by her oncology team: “sorry but we cannot do anything else for you”, does quite simply not exist. The argument is nothing else but a straw-man – and a vicious one at that.

Moreover, the subsequent argument of homeopaths, “as ‘they’ have given you up, we now offer you our effective homeopathic remedies”, is not supported by good evidence. In other words, one lie is added to another. To call this unethical, would be the understatement of the year, I think.

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