MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Prince Charles

Would you like to see a much broader range of approaches such as nutrition, mindfulness, complementary therapies and connecting people to green spaces become part of mainstream healthcare?

No?

Well, let me tell you about this exciting new venture anyway!

It is being promoted by Dr Dixon’s ‘College of Medicine’ and claims to be “the only accredited Integrative Medicine diploma currently available in the UK… [It] will provide you with an accredited qualification as an integrative medicine practitioner. The Diploma is certified by Crossfields Institute and supported by the College of Medicine and is the only one currently available in the UK. IM is a holistic, evidence-based approach which makes intelligent use of all available therapeutic choices to achieve optimal health and resilience for our patients. The model embraces conventional approaches as well as other modalities centred on lifestyle and mind-body techniques like mindfulness and nutrition.”

Dr Dixon? Yes, this Dr Michael Dixon.

College of Medicine? Yes, this College of Medicine.

Integrative medicine? Yes, this cunning plan to adopt quackery into real medicine which I have repeatedly written about, for instance here, here and here.

Crossfields Institute? Yes this Crossfields Institute which promotes the Steiner/’Waldorf quackery and has Simon Fielding as the chair of trustees.

Simon Fielding? Yes, the Simon Fielding who “devoted much of his professional life to securing the recognition of osteopathy as an independent primary contact healthcare profession and this culminated in the passing of the Osteopaths Act in 1993. He was appointed by ministers as the first chair of the General Osteopathic Council responsible for bringing the Osteopaths Act into force… He is currently vice-chair of the board of trustees of The College of Medicine… In addition Simon has… served as a long term trustee on the boards of The Prince of Wales’s Foundation for Integrated Health… and was the founder chair of the Council for Anthroposophical Health and Social Care.”

You must admit, this IS exciting!
Now you want to know what modules are within the Diploma? Here they are:

  • The Modern Context of IM: Philosophy, History and Changing Times in Medicine
  • IM Approaches and Management of Conditions (part 1)
  • Holistic Assessment: The Therapeutic Relationship, Motivational Interviewing & Clinical Decision Making in    Integrative Medicine
  • Critical Appraisal of Medicine and IM Research
  • Holistic assessment: Social prescribing, a Community Approach in Integrative Medicine
  • Managing a Dynamic IM Practice and Developing Leadership Skills
  • IM Approaches and Management of Conditions (part 2)
  • Independent Study on Innovation in Integrative Medicine

Sounds terrific, and it reminds me a lot of another course Michael Dixon tried to set up 13 years ago in Exeter. As it concerned me intimately, I wrote about this extraordinary experience in my memoir; here is a short excerpt:

…in July 2003… I saw an announcement published in the newsletter of the Prince of Wales’ Foundation for Integrated Health:

“The Peninsula Medical School aims to become the UK’s first medical school to include integrated medicine at postgraduate level. The school also plans to extend the current range and depth of programmes offered by including healthcare ethics and legislation. Professor John Tooke, dean of the Peninsula Medical School, said: ‘The inclusion of integrated medicine is a patient driven development. Increasingly the public is turning to the medical profession for information about complementary medicines. This programme will play an important role in developing critical understanding of a wide range of therapies’.”

When I stumbled on this announcement I was taken aback. Is Tooke envisaging a course for me to run? Has he forgotten to tell me about it? When I inquired, Tooke informed me that the medical school planned to offer a postgraduate “Pathway in Integrated Health” which had been initiated by Dr Michael Dixon, a general practitioner who had at that stage become one of the UK’s most outspoken proponents of spiritual healing and other dubious forms of alternative medicine, and for this reason was apparently very well regarded by Prince Charles.

A few days after I received this amazing news, Dr Dixon arrived at my office and explained with visible embarrassment that Prince Charles had expressed his desire to establish such a course in Exeter. His Royal Highness had already facilitated its funding which, in fact, came from Nelson’s, the manufacturer of homoeopathic remedies. The day-to-day running of the course was to be put into the hands of the ex-director of the Centre for Complementary Health Studies (CCHS), the very unit I had struggled – and even paid – to be separated from almost a decade ago because of its overtly anti-scientific agenda. The whole thing had been in the planning for several months. I was, it seemed, the last to know – but now that I had learnt about it, Dixon and Tooke urged me to contribute to this course by giving a few lectures.

I could no more comply with this request than fly. Apart from anything else, I was opposed in principle to the concept of “integration.” As I saw it, “integrating” quackery with genuine, science-based medicine was nothing less than a profound betrayal of the ethical basis of medical practice. By putting its imprimatur on this course, and by offering it under the auspices of a mainstream medical school, my institution would be encouraging the dangerous idea of equivalence – i.e., the notion that alternative and mainstream medicine were merely two parallel but equally valid and effective methods of treating illness.

To add insult to injury, the course was to be sponsored by a major manufacturer of homoeopathic remedies. In all conscience, this seemed to me to be the last straw. Study after study carried out by my unit had found homoeopathy to be not only conceptually absurd but also therapeutically worthless. If we did not take a stand on this issue, we might just as well all give up and go home…

END OF QUOTE FROM MY MEMOIR

Dixon’s Exeter course was not a brilliant success; I think it folded soon after it was started. Well, better luck up the road in Bristol, Michael – I am sure there must be a market for quackery somewhere!

As predicted, thanks to its high visibility in Rio, to the journalists, editors, photographers, numerous ‘experts’ crawling out of the woodwork, and last but not least the gullible public, cupping has fast become fashionable, ‘cool’ and ‘en vogue’.

Yes! Literally ‘en vogue’!

It has conquered the pages of ‘VOGUE’ (and any quackery that achieves this feast must have a bright future!) where Dr. Alex Moroz, director of the Integrative Sports Medicine program at NYU Langone Medical Center’s Rusk Rehabilitation, offers some extraordinary ‘explanations’. Dr Moroz (yes, he does exist; I looked him up) claims that he uses cupping at home on himself and his family. He believes there’s wisdom in the ancient practice, as well as common sense. Cupping’s effect, he says, is “mechanical, much like a massage,” and though Moroz has not treated professional athletes personally, he says, “It makes sense that it would work for that group of muscular skeletal injuries and problems.”

Moroz believes, furthermore, that cupping’s benefits reach far beyond sports. “For people with muscle-based pain, tightness, spasms, or chronic pain of any sort, it’s a great modality to use. Like other short-term modalities, there’s a curve where you have a small number of people who have rather dramatic results, and then you have a group of people who will not be helped at all,” he says. “Everyone else will fall somewhere in between.”

Dr Moroz has opinions but seems to be remarkably short on the ‘common sense’ he praises and a bit under-developed in the area of evidence.

This is regrettable!

Where on earth can we find some reliable information?

Surely, with all the hype about cupping, there must be someone who is just a trifle more science-based. Of course there is. The ‘London Cupping Clinic’ seems serious enough; they even employ real GPs who explain the SCIENCE OF CUPPING’ as follows:

“[Cupping]… involves, as the name suggests, a series of glass or plastic cups being placed on the recipient’s skin. The cups are heated and come into effect upon cooling; the air trapped between the cup and skin contracts, creating a suction-like effect that pulls the skin upwards, drawing blood to the surface to increase blood flow and give the resulting marks their deep crimson-purple colour. At times, vacuum pumps can be used along with the cups to aid the process of suction.”

Drawing blood to the surface to increase blood flow? Really?

In my quest to find some factual information I stumble across the website of HOLISTIC LIVING TIPS. Yes, I know, ‘holistic living’ does not sound like factual information. Yet I read on and find that…

“…along with Irritable Bowel Syndrome, which is closely linked to a stressed digestive tract, cupping has been used for stomach pains, diarrhea, gastritis and other common digestive issues. Flowing the energy to help release tension in and around the digestive tract, while aiding the abdomen with added nutrients and oxygen can help stimulate a healthier digestive tract… The most common skin issues cupping has been used for is acne, skinflammation and even herpes. Your capillaries are expanded by cupping and the addition flow of blood helps tone your skin and clear unwanted toxins from the skin to help get rid of acne. Also, wet cupping, where a small cut is made before the cup is applied can reduce acne better because with the incision the therapy can extract more of the toxins from your body. Cupping has also been used for cellulite and varicose veins. An increased flow of blood throughout the skin will help tone and tighten the skin. Also, cupping stimulates and improves the flow of blood, helping reduce varicose veins…  Mainly, cupping increases the flow of blood and lymphatic fluid throughout the body. Both of these help your body protect itself from illnesses and toxins. Additionally, cupping can help extract and remove phlegm and congestion from your body. The purpose of cupping is to enhance circulation, help relieve pain, remove heat and pull out the toxins that linger in your body’s tissues. It is not something that everyone is aware of, but just like other Chinese Medicine practices, like acupuncture, it can be an effective and most importantly a natural way, to help treat several conditions and help improve your body’s overall health and function.”

Even considering that we are in the realm of alternative medicine, the claims and explanations currently made for cupping seem impressive. With such a solid base in holistic anatomy and New Age physiology, the future of cupping ought to be delightful.

I can see all sorts of profitable options for those who want to jump on the vacuum-driven bandwagon:

  • courses for aspiring cupping therapists [a safe career, as demand is bound to soar]
  • DIY books for amateur cuppers
  • car seats that give you a love bite while you are driving home from work [very practical for the less than faithful alt med fan]
  • vacuum suckers for the dental patient [cupping kills pain and reduces anxiety, they say]
  • similar devices for Indian restaurants who offer it for customers to control the well-known digestive problems after a good Vindaloo chicken [Charles’ Dutchy Originals might already be planning the launch]
  • cupping walk-in centres for every-day emergencies
  • cupping clinics for those who fear the effects of ageing [cupping ‘tightens the skin’, you know]
  • a face mask with integrated vacuum cups for teenagers suffering from acne
  • shoes that produce a sucking action on the sole of the feet as you walk [thus ingeniously combining cupping with reflexology]
  • a 24-hours cupping helpline for the less experienced DIY-cuppers…

There really are no limits (neither to profit nor to fantasy) – the future of cupping is bright!

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!!!

 

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

Have I lost my senses?

Bear with me and find out for yourself.

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

My main fears are twofold;

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

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

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

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

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

FACTORS THAT COULD INCREASE THE USE OF ALTERNATIVE MEDICINE

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

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

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

FACTORS THAT COULD DECREASE THE USE OF ALTERNATIVE MEDICINE

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

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

CONCLUSION

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

It has been reported in most newspapers that Prince Charles has proposed a solution to the problem of antibiotic over-use in animals and humans. He told an international gathering of scientists and government officials in London that he treats his own cows and sheep with homeopathy. Many people reacted with dismay. I, however, plead for more understanding of this thoroughly good-willed man.

In fact, I intend to go one step further.

We have often heard that he is a considerate and caring man. We ought to give him the benefit of the doubt. I have tried therefore to empathise with his situation, put myself into his shoes and repeat the considerations that made him say what he said. My empathy went so far that I tried to re-live and formulate his thoughts in the first person singular (or should I have used the ‘Royal We’?). The result is the following little monologue where I categorised the considerations under 7 headings.

THE OCCASION

I wonder why they invited me to give a speech. True, I am a farmer at heart and I know all about husbandry, but I have no real expertise in the field of antibiotics.

Perhaps it is an occasion to tell them a bit about homeopathy. Yes, that subject would surely fascinate the audience!

THE INTELLECTUAL ENVIRONMENT

They tell me that the conference will be packed with very bright people. That sort of thing always makes me a bit self-conscious. Perhaps I should decline the invitation after all? Sometimes, I have the impression that people make fun at me.

No, I must not think like that – after all, I have had a very expensive education too, and I know my stuff.

THE ISSUE

Homeopathy is such a wonderful subject. I must try to win them over and make them appreciate its beauty. These experts should realize that homeopathy is the future.

I have heard rumours that some blinkered scientists doubt that homeopathy works. But my advisors tell me that it is best to ignore this sort of thing. And my advisors know their stuff even better than I.

POTENTIAL IMPACT

This conference is going to have a very high impact. The press will be there. It will be reported across the world. And government’s chief medical officer, Dame Sally Davies (why can we not have more holistic doctors in position like these; I must remember to discuss this with Michael Dixon asap); she once called homeopathy ‘rubbish’ – enough to throw her in the Tower!

Mustn’t think like that! On the contrary, I will make sure they all get the message. I will bowl them over! The press will surely be on my side. This will be a victory for homeopathy.

THE RISKS

Mother might be upset; she does not like me to stick my neck out like that…goes on about constitutional role and such trivia…she thinks we should not put our nose into things that are none of our business. And the Royal PR team will not like it either. They do what they can to distract from the image of ‘THE MEDDLING PRINCE’ might think that my speech is a hindrance to their efforts. I better don’t tell anyone in advance about this, they might try to stop me.

But now I feel quite unstoppable.

THE SPEECH

This is what I will tell them about homeopathy: “It was one of the reasons I converted my farming operation to an organic – or agro-ecological – system over 30 years ago and why we have been successfully using homeopathic – yes, homeopathic – treatments for my cattle and sheep as part of a programme to reduce the use of antibiotics.” I think this will convince everyone. Who needs science when there is powerful rhetoric like this?

LAST DOUBTS

What if it does not go well? They will not dare to contradict me, I am the future King, for heaven’s sake! Even if they disagree, they will not show it. They just don’t have the guts. And anyway, I will not take questions, I never do enter into any debate on homeopathy. It is simply too tedious to argue with people who do not understand the issues involved.

It is decided – I’ll do it. I’ll do it for homeopathy and for the good of mankind. If they then chose to misunderstand me, that’s their problem, and my people will issue a statement for the press saying “Homeopathy is used on a case-by-case basis at Home Farm, in combination with more conventional medicine, to minimise dependence on antibiotics.”

 

*In case you are a lawyer hired by HRH to check out this post: it is pure satire through and through, there is not a factual sentence here; if you want to sue me, please find another reason.

Non-validated diagnostic methods, like those in abundant use in alternative medicine, run an unacceptably high risk of producing false positive or false negative diagnoses. The former would be a diagnosis that the patient is, in fact, not suffering from; this enables the charlatan to get rich on treating something that is not even there. The latter would be missing an illness that might even kill the patient. Thus both scenarios are unquestionably harmful.

It is now 21 years ago that I published a review of alternative diagnostic techniques entitled ‘WHICH CRAFT IS WITCHCRAFT?’. Here is the abstract:

The prevalence of complementary medicine in most industrialised countries is impressive and increasing. Discussions of the topic often focus on therapeutic approaches and neglect diagnostic methods specific for complementary medicine. The paper summarises the data available on such “alternative” diagnostics. Scientific evaluations of these are scant, and most techniques have never been properly validated. The ones that have can be demonstrated to be not reproducible, sensitive, or specific. The ones that have not should be regarded as such until shown otherwise by rigorous testing. Therefore it seems that “alternative” diagnostic methods may seriously threaten the safety and health of patients submitted to them. Orthodox doctors should be aware of the problem and inform their patients accordingly.

Exactly 15 years after the publication of this paper, PRINCE CHARLES published his book ‘HARMONY‘ where is covers amongst many other topic also the subject of alternative diagnostics. This is what he tells us about them:

I have also learn from leading experts how we can understand a great deal about the causes of ill health through more traditional methods of diagnosis – for example, through examination of the iris, ears, tongue, feet and pulse, very much the basis of the Indian Ayurvedic system. This is not to say that modern diagnostic techniques do not have a role, but let us not forget what we can gain by using the knowledge and wisdom accumulated over thousands of years by pioneers who did not have access to today’s technology. In fact, an over-reliance can often mean that the subtle signs of imbalance revealed by the examination of the eyes, pulse and tongue are totally missed. Including the fruits of such knowledge, gleaned over 8 000 years of studying the relationship of the human body to the rest of Nature and to the Universe, can but only provide an extra, valuable resource to doctors as they seek to make a full diagnosis. Why persist in denying the immense value of such accumulated wisdom when it can tell us so much about the whole person – mind, body and spirit? Employing the best of the ancient and modern in a truly integrated way is another example of harmony and balance at work.

Charles is talking here about iridology, amongst other methods. Iridologists try to diagnose disease or susceptibility to disease by analysing the colour pattern of a patient’s iris. It happens to be a technique that has repeatedly been put to the test. In 1999, I published a systematic review of the evidence and concluded that the validity of iridology as a diagnostic tool is not supported by scientific evaluations. Patients and therapists should be discouraged from using this method.

Given that the evidence for alternative diagnostic techniques is either negative or absent, why does the heir to the throne advocate using them? Does he not know that he has considerable influence and endangers the health of those who believe him? Why does he call this nonsense valuable? The answer probably is that he does not know better.

There is nothing wrong with Charles’ ignorance, of course. He is not a medic (if he were, his quackery might get him struck off the register!) and does not need to know such things! But, if he is ignorant about certain technicalities, should he write about them? At the very least, when giving such concrete medical advice about diagnostic methods, should he not recruit the expertise of people who do know about such matters?

In Charles’ defence, I should mention that apparently he did ask several physicians for help with his book. Two of those who he acknowledged in HARMONY have been mentioned on this blog before: Mosaraf Ali and Michael Dixon.

I MIGHT BE MISTAKEN, BUT IT SEEMS TO ME THAT CHARLES IS NOT JUST IGNORANT ABOUT MEDICINE BUT ALSO ABOUT THE ART OF CHOOSING EXPERTS.

Samuel Hahnemann, the founder of homeopathy, gave a lecture on the subject of veterinary homeopathy in the mid-1810s. Ever since, homeopathy has been used for treating animals. Von Boennighausen, a Dutch lawyer and early convert to homeopathy, was one of the first influential proponents of veterinary homeopathy.

However, veterinary medical schools tended to take a very dim view of homoeopathy, and the number of veterinary homeopaths initially remained small. In the 1920ies, veterinary homoeopathy was revived in Germany. Members of the “Studiengemeinschaft für tierärztliche Homöopathie” (Study Group for Veterinary Homoeopathy), which was founded in 1936 and had Nazi support, started to investigate this approach.

Today, veterinary homeopathy is popular, not least because of the general boom in alternative medicine. Prince Charles has become one of its most prominent advocate. In his book HARMONY, he writes:

“…one of the big arguments used against homeopathy is that it does not really work medically. The criticism is that people simply believe they feel they are going to feel better and so they think they are better. They have responded to the so-called ‘placebo effect’. It is for this reason that critics of homeopathy argue that it is a trick of the mind and its remedies are nothing more than sugar pills. What none of those who take this view ever seem to acknowledge is that these remedies also work on animals, which are surely unlikely to be influenced by the placebo effect. I certainly remember that when I started to introduce homeopathic remedies on the Duchy Home Farm, farm staff who had no view either way reported that the health of an animal that had been treated had improved so I wonder what it is that prevents the medical profession from even considering the evidence that now exists of trials of homeopathic treatments carried out on animals? It is not the quackery they claim it to be. Or if it is, then I have some very clever cows in my shed!”

[I do love this quote; it so very clearly shows the frightfully muddled thinking of this man.]

In many countries, veterinary homeopaths have their own professional organisations. In other countries, however, veterinarians are banned from practicing homeopathy. In the UK, only veterinarians are allowed to use homeopathy on animals, but ironically anyone regardless of background can use it on human patients. In the US, homeopathic vets are organised in the Academy of Veterinary Homeopathy.

But what do homeopathic vets treat? One website informs us that the conditions frequently treated are: arthritis, lameness, cruciate rupture, chronic diarrhoea, atopy, allergy, autoimmune disorders (auto-immune), periodic ophthalmia (moon blindness, moonblindness, recurrent uveitis, recurrent ophthalmia, ERU), head shaking (headshaking, head-shaking), hip dysplasia, COPD, sweet itch, laminitis, corneal ulcer, elbow dysplasia, RAO, DJD, OCD, bone cysts, pasteurellosis (pasteurella), chlamydia, cryptosporidia, pneumonia, meningitis, mastitis, ringworm, epilepsy, pyoderma, eczema, dermatitis, eosinophilic myositis, eosinophilic granuloma, rodent ulcer, miliary eczema (miliary dermatitis), kidney problems, liver problems (hepatopathy), cystitis.

Now I can almost hear you shout: WHERE IS THE EVIDENCE???

May I refer you to a previous post on the matter?

It discussed a review aimed to assess risk of bias and to quantify the effect size of homeopathic interventions compared with placebo for each eligible peer-reviewed trial. Judgement in 7 assessment domains enabled a trial’s risk of bias to be designated as low, unclear or high. A trial was judged to comprise reliable evidence, if its risk of bias was low or was unclear in specified domains. A trial was considered to be free of vested interest, if it was not funded by a homeopathic pharmacy.

The 18 RCTs found by the researchers were disparate in nature, representing 4 species and 11 different medical conditions. Reliable evidence, free from vested interest, was identified in only two trials:

  1. homeopathic Coli had a prophylactic effect on porcine diarrhoea (odds ratio 3.89, 95 per cent confidence interval [CI], 1.19 to 12.68, P=0.02);
  2. individualised homeopathic treatment did not have a more beneficial effect on bovine mastitis than placebo intervention (standardised mean difference -0.31, 95 per cent CI, -0.97 to 0.34, P=0.35).

The authors conclusions are clear: Mixed findings from the only two placebo-controlled RCTs that had suitably reliable evidence precluded generalisable conclusions about the efficacy of any particular homeopathic medicine or the impact of individualised homeopathic intervention on any given medical condition in animals.

…homeopaths…will try to claim that [the review] was a biased piece of research conducted, most likely, by notorious anti-homeopaths who cannot be trusted. So who are the authors of this new publication?

They are RT Mathie from the British Homeopathic Association and J Clausen from one of Germany’s most pro-homeopathic institution, the ‘Karl und Veronica Carstens-Stiftung’.

At this stage, some of my readers are quite angry, I imagine. They might wonder how to protect defenceless animals from homeopathic quacks. But how?

Simple! Just sign the petition to ban veterinary homeopathy! I mean it – please do!!!

We could have expected it, couldn’t we? With so much homeopathy in the press lately, Dr Dixon (we have seen him on this blog before, for instance here, here and here) had to comment. His article in yesterday’s NURSING IN PRACTICE is far too perfect to abbreviate it; I just have to cite it in full (only the reference numbers are mine and refer to my comments below).

HERE WE GO

Should homeopathy be blacklisted in general practice?

I have not prescribed them myself but I know of many GPs and patients who find homeopathic preparations helpful, especially in clinical areas where there is no satisfactory conventional treatment [1]. They are cheap and entirely safe [2], which cannot always be said of conventional treatment [3]. Is the concern about cost? That is implausible as GP prescriptions cost a mere £100,000 per annum, approximately £10 per UK General Practice but effectively less as some patients will be paying for them and they may reduce other prescriptions or medical costs [4]. Is it about evidence? [5] Possibly, and that is because the necessary pragmatic trials on comparative cost effectiveness have never been done [6]. Homeopathy thus joins the frequently quoted 25% of general practice activity that has an insufficient evidence base… So, why not do the research rather than single out homeopathy for blacklisting [7]? Apparently, because it irritates a powerful fraternity of “scientists” [8] with a narrow biomedical perspective on health and healing, who feel the need to impose their atheism [9] on others. They seem opposed to “patient-centred medicine” which factors in the mindset, culture, history, wishes and hopes of each patient, and a wider concept of science that might take account of them [10]. Led by the World Health Organization, many countries are examining the appropriate role of complementary and traditional medicine (CAM). Indian Prime Minister Modi has created the first minister for medicine in this area (called AYUSH with the “H” standing for homeopathy). Australia, whose government and medical deans (unlike the UK ) are not intimidated by this breed of scientific fundamentalism, has invested money in research, regulated its herbal [11] practitioners and created important trade links with China in this area [12]. Meanwhile the UK invests 0% of its research budget on CAM and appears to have a closed mind [13]. General practice is at its best a subtle and complex blend of science and art combined in a heady mixture, which recognises personal belief and perspective and respects differences [14]. Blacklisting homeopathy would be the thin edge of the wedge. It would be a mean-minded act of outside interference by many who do not treat patients themselves, denying patient choice and signifying a new age of intolerance and interference [15]. It is a threat to the autonomy of general practice that should concern every GP and patient whatever their views on homeopathy [16].

About the Author

Mike Dixon

Chairman of the NHS Alliance and a GP

Mike Dixon, chairman of the NHS Alliance and a GP at College Surgery in Cullompton, Devon and a Royal College of General Practitioners presidential candidate.

END OF QUOTE AND BEGINNING OF MY DELIBERATELY BRIEF COMMENTS

  1. Whenever this argument comes up, people fail to cite an example. Are they afraid that we would point out what can be done for such a patient other than prescribing placebos?
  2. Actually, they are extremely expensive considering that they are just lactose or water. And the claim that homeopathy is safe merely displays an embarrassing lack of knowledge; see the many posts on this blog that deal with this issue.
  3. Classical ‘tu quoque’ fallacy; display of the ignorance of the risk/benefit concept for judging the value of medical interventions.
  4. Display of ignorance regarding the actual evidence, see here, for instance.
  5. Yes, it’s the evidence but also it’s the biological implausibility and the fact that disregarding it undermines rationality in general.
  6. Pure ignorance again, see my point 4.
  7. Are ~ 300 clinical trials and about 100 systematic reviews not enough? How much more money needs to be wasted?
  8. It seems that Dixon has a problem with science and those who pursue it to improve future health care for the benefit of patients.
  9. Does Dixon admit that homeopathy is a religion?
  10. Patient-centred medicine which factors in the mindset, culture, history, wishes and hopes of each patient, and a wider concept of science that might take account of them – does Dixon not know that all good medicine fits this description, but homeopathy certainly does not?
  11. Every one with an IQ above 50 knows by now that herbal is not homeopathic; is Dixon the exception?
  12. What about the Australian report which concluded that “Homeopathy should not be used to treat health conditions that are chronic, serious, or could become serious. People who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness. People who are considering whether to use homeopathy should first get advice from a registered health practitioner. Those who use homeopathy should tell their health practitioner and should keep taking any prescribed treatments.”
  13. This is simply not true, and Dixon should know it.
  14. No reason to include disproven nonsense like homeopathy.
  15. Intolerance is on Dixon’s side, I think. Improving health care by abandoning disproven therapies in favour of evidence-based treatments is no interference, it’s progress.
  16. This can only be true, if we misunderstand autonomy as arbitrariness without rules, checks, ethics and controls. Good general practice has, like all medicine, be in the best interest of patients. An obsolete, expensive, unsafe, ineffective and implausible treatment is clearly not.

Yes, I got an award – and a very prestigious one at that!

Thanks to everyone who supported me in often difficult times and made this possible.

Here are some details from the website of Nature:

Edzard Ernst, Emeritus Professor at Peninsula Medical School, and Susan Jebb, Professor of Diet and Population Health at the University of Oxford, have been awarded the international 2015 John Maddox Prize for courage in promoting science and evidence on a matter of public interest, despite facing difficulty and hostility in doing so.

Edzard Ernst is recognised for his long commitment to applying scientific methodologies in research into complementary and alternative medicines and to communicating this need. Prof Ernst continued in his work despite personal attacks and attempts to undermine his research unit and end his employment. As a result, he has addressed a significant gap in the research base in this field and has brought insights into discussions with the public, policy makers, commentators, practitioners and other researchers.

Susan Jebb is recognised for her promotion of public understanding of nutrition on a diverse range of issues of public concern, from food supplements to dieting. Prof Jebb tackled misconceptions about sugar in the media and among the public, and endured personal attacks and accusations that industry funding compromised her integrity and advisory capabilities. Despite this experience, she continued to engage with the media and the public on issues of dietary advice, talking about the need for sound science and high quality research, and advocating for high standards of research governance.

The John Maddox Prize is a joint initiative of the science journal Nature, the Kohn Foundation, and the charity Sense About Science, and it is awarded to one or two people a year. The late Sir John Maddox FRS, was editor of Nature for 22 years and a founding trustee of Sense About Science. A passionate and tireless communicator and defender of science, he engaged with difficult debates, inspiring others to do the same.

For full award details see http://www.senseaboutscience.org/pages/maddox-prize-2015.html.

END OF QUOTE

On the day, I was quite nervous – so much so that I forgot the little text which I had prepared for the occasion. Therefore I had to memorize it and got a bit muddled up in my excitement. For all who were not present, here is the very short (they asked me for 3 minutes only!) ‘thank-you-address’ I had wanted to give:

I am delighted to receive this prestigious award and to have the research of my team recognised in this way. But, as a true sceptic, I have to ask whether I really deserve this prize.

What is remarkable about what I have done?

For the last 20 years, I have tried to find out the truth about alternative treatments. The results were often not what enthusiasts of alt med had hoped for. But my job was to test and not to promote alternative medicine. So I published our findings and, if necessary, I defended them – nothing truly remarkable about that; it is exactly what scientists should be doing. To me, it seems almost as obvious as explaining that 2 + 2 = 4.

The remarkable thing is not standing up for well-documented facts; the remarkable thing surely is that there are others who claim that reductionist science is not applicable to such a problem, and that it has to be solved holistically: 2 and 2 must be integrated not added, and anyway, the whole is greater than its parts. Therefore 2 + 2 is not for 4, it is whatever you want to make of it.

The even more remarkable thing is that, about 10 years ago, my peers in Exeter all of a sudden seemed to defend such lunacy and joined the charlatans who promoted this nonsense in attacking me, my work and my integrity.

I thank you for the prize and I thank you for the cheque that comes with it. I have decided to donate the money to THE GOOD THINKING SOCIETY founded by my friend Simon Singh. This charity stands up for science by correcting some of the many false claims that are currently being made for bogus treatments. I think this is in the spirit of John Maddox and the prize in his honour. I hope the prize will inspire other scientists to stand up for science – because our science can only be as good as the integrity of our scientists.

For me, the most touching thing of the entire evening was a man who came up to me afterwards, shook my hand with enthusiasm and said: “If we all had courage like you, the world would be a better place”. Then he disappeared into the crowd and left me fighting back my tears.

The INDEPENDENT carried a nice article about the prize, Prof Jebb and myself the next day. It attracted a comment by someone calling himself ‘ZimJay’ which typifies the level of debate in the field of alternative medicine quite well, in my view:

Who knew there’s a science award for thumbsucking?  is there is a bigger white male whiner than Edzard Ernst acting out like a 4 year old while living in the UK? Name them.

The University of Exeter has, as far as I know, not put out a comment. Odd, as it is not every day that a professor from this institution wins an international prize of this standing. Or perhaps not odd at all? But it is early days, of course – I wait and see.

Today, the INDEPENDENT published a short editorial with this conclusion:

During two decades patrolling the boundary between magic and medicine, he has protected our dignity, our pockets and our health. For that, we salute him.

I WOULD NOT HOLD MY BREATH FOR FURTHER VILE COMMENTS BY ALTERNATIVISTS – AND, IN THIS PARTICULAR INSTANCE, I OUGHT TO THANK THEM: WITHOUT THEIR INCESSANT DIRTY WORK, I WOULD PROBABLY NOT HAVE BEEN AWARDED THE JOHN MADDOX PRIZE 2015.

We used to call it ‘alternative medicine’ (on this blog, I still do so, because I believe it is a term as good or bad as any other and it is the one that is easily recognised); later some opted for ‘complementary medicine’; since about 15 years a new term is en vogue: INTEGRATED MEDICINE (IM).

Supporters of IM are adamant that IM is not synonymous with the other terms. But how is IM actually defined?

One of IM’s most prominent defenders is, of course Prince Charles. In his 2006 address to the WHO, he explained: “We need to harness the best of modern science and technology, but not at the expense of losing the best of what complementary approaches have to offer. That is integrated health – it really is that simple.”

Perhaps a bit too simple?

There are several more academic definitions, and it seems that, over the years, IM-fans have been busy moving the goal post quite a bit. The original principle of ‘THE BEST OF BOTH WORLDS’ has been modified considerably.

  • IM is a “comprehensive, primary care system that emphasizes wellness and healing of the whole person…” [Arch Intern Med. 2002;162:133-140]
  • IM “views patients as whole people with minds and spirits as well as bodies and includes these dimensions into diagnosis and treatment.” [BMJ. 2001; 322:119-120]

During my preparations for my lecture at the 16th European Sceptics Congress in London last week (which was on the subject of IM), I came across a brand-new (September 2015) definition. It can be found on the website of the COLLEGE OF MEDICINE  This Michael Dixon-led organisation can be seen as the successor of Charles’ ill-fated FOUNDATION FOR INTEGRATED HEALTH; it was originally to be called COLLEGE FOR INTEGRATED MEDICINE. We can therefore assume that they know best what IM truly is or aspires to be. The definition goes as follows:

IM is a holistic, evidence-based approach which makes intelligent use of all available therapeutic choices to achieve optimal health and resilience for our patients.

This may sound good to many who are not bothered or unable to think critically. It oozes political correctness and might therefore even impress some politicians. But, on closer scrutiny, it turns out to be little more than offensive nonsense. I feel compelled to publish a short analysis of it. I will do this by highlighting and criticising the important implications of this definition one by one.

1) IM is holistic

Holism has always been at the core of any type of good health care. To state that IM is holistic misleads people into believing that conventional medicine is not holistic. It also pretends that medicine might become more holistic through the addition of some alternative modalities. Yet I cannot imagine anything less holistic than diagnosing patients by merely looking at their iris (iridology) or assuming all disease stems from subluxations of the spine (chiropractic), for example. This argument is a straw-man, if there ever was one.

2) IM is evidence-based

This assumption is simply not true. If we look what is being used under the banner of IM, we find no end of treatments that are not supported by good evidence, as well as several for which the evidence is squarely negative.

3) IM is intelligent

If it were not such a serious matter, one could laugh out loud about this claim. Is the implication here that conventional medicine is not intelligent?

4) IM uses all available therapeutic choices

This is the crucial element of this definition which allows IM-proponents to employ anything they like. Do they seriously believe that patients should have ALL AVAILABLE treatments? I had thought that responsible health care is about applying the most effective therapies for the condition at hand.

5) IM aims at achieving optimal health

Another straw-man; it implies that conventional health care professionals do not want to restore their patients to optimal health.

In my lecture, which was not about this definition but about IM in general, I drew the following six conclusions:

  1. Proponents of IM mislead us with their very own, nonsensical terminology and definitions.
  2. They promote two main principles: use of quackery + holism.
  3. Holism is at the heart of all good medicine; IM is at best an unnecessary distraction.
  4. Using holism to promote quackery is dishonest and counter-productive.
  5. The integration of quackery will render healthcare not better but worse.
  6. IM flies in the face of common sense and medical ethics; it is a disservice to patients.
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