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Guest post by Udo Endruscheit
Switzerland is probably the European country with the strangest complementary and alternative medicine (CAM) regulations in the health insurance system. A total of five different CAM methods have been included in the benefits catalogue of basic insurance for several years. However, this is subject to a strange proviso. How did this come about?
As almost everywhere in Europe, there was a desire in Switzerland in the 1990s to include CAM in the public healthcare system, with homeopathy naturally once again taking pole position. Initially, the urge to include five CAM modalities in basic care was granted, but only provisionally. A major project called the “Complementary Medicine Evaluation Programme” (PEK) was launched in 1999 to evaluate the procedures. Even back then, the criteria of efficacy, appropriateness and cost-effectiveness were prerequisites for reimbursement in health insurance. PEK was intended to create clarity here.
One part of PEK has been the well-known Shang/Egger (2005) study on homeopathy “Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy”, which was to become a bone of contention without precedent. However, this did not change the negative result for homeopathy.
In any case, clear conclusions were drawn in Switzerland not only from this study, but also from the results of the other evaluations: the provisional inclusion of the methods in statutory basic insurance was terminated.
This in turn enraged the supporters of CAM methods, who thought they had already reached their goal with the provisional decision in their favour. Apparently, they had not even considered the possibility that scientific evaluations could actually lead to a sudden end to their wishes, which they believed had already been fulfilled.
In fact, in 2009, the friends of ineffective methods succeeded in bringing about one of the referendums for which Switzerland is known under the catchphrase “direct democracy”. And they prevailed – around two thirds of the votes cast were in favour of CAM and its inclusion in the Swiss Federal Constitution. However, it should be borne in mind that the two-thirds figure is put into perspective if the approval, including the low voter turnout, is converted to the proportion of the total electorate. This leaves just 17 per cent who voted for the CAM. And a closer look at the issue of the constitution also reveals that no unconditional protection space has been created for CAM. This is more or less a kind of good behaviour clause for CAM methods, but not rules that could render laws null and void.
The Swiss government was faced with the question of how to avoid simply ignoring the result of the referendum, while at the same time complying with the still valid requirements for reimbursement in basic insurance. So the representatives of the five CAM directions were actually asked to come to the Federal Office of Public Health with their proof of efficacy and economic efficiency. This was done in 2011.
Of course, this was a little bizarre at this stage – and of course nothing came of it. Or actually it did: once again, no proof could be provided. Meanwhile, a lot of time had passed again and a new Federal Council was forced to take up the matter.
The latter, Alain Berset, came up with the plan that the necessary proof of efficacy could actually be postponed until after the methods had been included in the catalogue of basic insurance benefits. In other words, he gave the methods a governmental leap of faith (which, in view of the long-year history of the case, meant closing several eyes) and postulated that this should be the matter until someone applied for an evaluation of one of the methods.
This is what happened in the year of our Lord 2017. Apparently everyone was able to make their peace with it, which is hardly surprising after ten years of moving around and around. Only the umbrella organisation of health insurers, Santesuisse, grumbled about it and predicted that the announced cost neutrality of such a measure could hardly be expected. Which Santesuisse did indeed prove in a dossier two years later.
The exhausted Swiss have so far left it at that. Homeopathy remained untouched. This was also unfortunate for the reason that the fairy tale of the clever and innovative Switzerland, which knew how important the wishes and preferences of its patients were, was propagated in Germany. The rather strange result of more than ten years of struggle was even passed around by German homeopaths under the name “Swiss model”. Even the leading Swiss press was embarrassed by this and published a clarifying article. And unfortunately, the Swiss began to get used to the existence of hocus-pocus in their basic insurance and to take it for granted.
Until now. Even in Switzerland, the fact that homeopathy is coming under increasing criticism everywhere has probably not gone unnoticed. And the Swiss are actually a rather critical and resistant people. And so it happened that a single brave inhabitant of the country recently decided to exercise his right to demand a new evaluation of homeopathy. The Federal Office of Public Health must have been surprised – or perhaps they were desperately waiting for it? Perhaps. In any case, the application was accepted without hesitation. Meanwhile, a notification has been issued that the hearing procedure for the evaluation has been initiated. The representatives of homeopathy (the service providers), the representatives of the Swiss medical profession and the representatives of the health insurance companies – the aforementioned Santesuisse – will be heard. The final decision will then be made by the Swiss government’s Department of Home Affairs.
How many attempts at an evaluation has this actually been – the third? The fourth? We can’t keep up … We have seen the consequences of scientific questions being decided by majorities. It is to be hoped that Switzerland will not add another chapter to the drama that has been going on since 2005. Mr Berset’s successor, who has been in office since the beginning of the year, should only be given a brief reminder: in Switzerland, too, homeopathy has no effect beyond contextual effects. And that is not enough to prove efficacy, appropriateness and cost-effectiveness.
But cheers to the courageous descendant of William Tell, who is about to single-handedly bring down homeopathy in the Swiss healthcare system!
The Austrian ‘Initiative für Wissenschaftliche Medizin‘ (Initiative for Scientific Medicine) did a great job by summarizing the non-scientific training events dedicated to pseudomedicine organized, supported or promoted by the ‘Österreichische Akademie der Ärzte‘ (Austrian Academy of Physicians), a partner of the Austrian Medical Association. They sorted them by date in descending order, listing the DFP points (points required for postgraduate education) awarded and the link to each specific event. The content of the programme of such events, if available, is also often “interesting”. The pseudomedicine methods are provided with links to psiram.com, where these methods are described in more detail.
So, restricting ourselves to the period of 20 years (2003-2023) and merely looking at a selection of all possible so-called alternative medicine (SCAM), we find in this treasure trove of quackery the following:
- Anthroposophic medicine – 218 events
- Homeopathy – 1 708 events
- Orthomolecular medicine – 645 events
- Neural therapy – 864 events
- TCM diagnostics – 1214 events
In total, thousands SCAM events were organized, supported or promoted by the Academy, and I am not aware of any national physicians’ organization that has done anywhere near as much for quackery.
On their website, the Austrian Academy of Physicians state that they were founded by the Austrian Medical Association as a non-profit organisation with the aim of promoting and further developing medical education in Austria… The aim is to lead the way in medical education issues in order to achieve continuous improvement in the medical profession. For the Academy, continuing medical education is an essential component of medical quality improvement…
This may sound alright but, in my view, it raises several questions, e,g,:
- Does the Academy believe that continuous improvement in the medical profession can be achieved by promoting, organizing or conducting such a huge amount of courses in quackery?
- Do they not know that this is the exact opposite of medical quality improvement?
- Are they aware of their ethical responsibility?
- Do they know that the promotion of quackery puts patients at risk?
- Have they heard of evidence-based education?
It is easy to criticize but less obvious to improve. In case the people responsible for postgraduate education at the Academy want to discuss these issues with me, I would therefore be delighted to do so, for instance, via a series of evidence-based lectures on SCAM.
Proponents of so-called alternative medicine (SCAM) are often – as we had many opportunities to observe here on this blog – not impressed with the safety and efficacy of COVID vaccinations. This is despite the fact that several studies have demonstrated the huge number of lives saved by them, both at national and multi-country level in the earlier stages of the pandemic. I wonder whether the doubters will be convinced by new evidence.
This analysis estimates how many lives were directly saved by vaccinating adults against COVID in the Region, from December 2020 through March 2023.
The researchers estimated the number of lives directly saved by age-group, vaccine dose and circulating Variant of Concern (VOC) period, both regionally and nationally, using weekly data on COVID-19 mortality and COVID-19 vaccine uptake reported by 34 European areas and territories (CAT), and vaccine effectiveness (VE) data from the literature. They calculated the percentage reduction in the number of expected and reported deaths.
The authors found that vaccines reduced deaths by 57% overall (CAT range: 15% to 75%), representing ∼1.4 million lives saved in those aged ≥25 years (range: 0.7 million to 2.6 million): 96% of lives saved were aged ≥60 years and 52% were aged ≥80 years; first boosters saved 51%, and 67% were saved during the Omicron period.
The authors concluded that over nearly 2.5 years, most lives saved by COVID-19 vaccination were in older adults by first booster dose and during the Omicron period, reinforcing the importance of up-to-date vaccination among these most at-risk individuals. Further modelling work should evaluate indirect effects of vaccination and public health and social measures.
The authors feel that their results reinforce the importance of up-to-date COVID-19 vaccination, particularly among older age-groups. Communication campaigns supporting COVID-19 vaccination should stress the value of COVID-19 vaccination in saving lives to ensure vulnerable groups are up-to-date with vaccination ahead of periods of potential increased transmission.
Those SCAM proponents who are not convinced of the merits of COVID and other vaccinations will undoubtedly claim that this new analysis was biased and thus unreliable. Therefore, it seems worth stating that this work was supported by a US Centers for Disease Control cooperative agreement, who had no role in data analysis or interpretation. The authors affiliated with the World Health Organization (WHO) are alone responsible for the views expressed in this publication and they do not necessarily represent the decisions or policies of the WHO.
I had the rare pleasure to give an interview for the ‘Frankfurter Allgemeine’. As it was, of course, in German, I took the liberty to translate it for my non-German speaking readers:
You have researched so-called alternative medicine over several decades, including homeopathy. What is your conclusion?
We are talking about far more than 400 methods – to draw one conclusion about all of them
is completely impossible. Except perhaps for this one: if something sounds too good to be true, it probably is.
Does this apply to homeopathy?
Highly diluted homeopathic remedies are popular because they have no side-effects. But there is also no effect. They are touted as a panacea. This is certainly not the case, on the contrary, they are
ineffective. And any therapy that is ineffective and promoted as a panacea is also dangerous.
How do you explain the fact that so many people swear by homeopathy?
There are several reasons for this. In Germany, homeopathy has an unbroken tradition, it was, for instance, promoted by the Nazis and later in the Federal Republic of Germany. It has a reputation for being gentle and effective. It might be gentle, but it is certainly not effective. It is also supported by lobby groups such as the manufacturers. And most people who use it don’t even understand what it actually is.
In any case, the placebo effect helps. What’s so bad about that??
Nothing at all, on the contrary: it is to be advocated. When we talk about placebo effects, we subsume many things under this umbrella that do not actually belong to it, such as the extensive, empathetic conversation that homeopaths often have with their patients. Besides, a common cold goes away whether you treat it or not. If you then use homeopathy, you can easily get the impression that it worked. Every good, empathetic doctor tries to maximize the placebo effect. To put it bluntly: you don’t need a placebo to generate a placebo effect. Patients also benefit from it when I give an effective remedy with empathy. In addition they benefit from the specific effect of my therapy, which should make up the lion’s share of the therapeutic response. If I withhold the most important thing I mistreat my patient.
But there are diseases for which there are no good remedies.
I often hear that argument. But there is practically always something we can do that at least
improves symptoms. Otherwise you should also say that instead of lying and recommending homeopathy – and thinking that, although there is nothing in it and it doesn’t work, but the patient, being an idiot, should take it nevertheless. It is unethical to use placebos as much as it is to use homeopathy.
Neurophysiologically, the placebo effect is becoming better and better understood.
The Italian neuroscientist Fabrizio Benedetti in particular has done very good work. But he also warns that this does not justify the use of homeopathy, for example.
Are there any studies on whether the placebo effect of homeopathy with its esoteric superstructure is greater than that giving just a piece of sugar?
There are analyses of what makes a particularly effective placebo. From this, we can learn that effective therapies in evidence-based medicine must be applied with empathy and sufficient time in order to maximize the ever-present placebo effect. So-called alternative medicine often does this quite well, and we can learn something from it. But the reason is that it often has nothing else. Homeopaths are a serious danger because they see homeopathy as a panacea. If someone has homeopathically treated their cold “successfully” for years and then gets cancer, they might think of turning to homeopathy for their cancer. It sounds crazy, but many homeopaths do offer cancer treatments on the internet, for instance. That sends shivers down my spine.
How should doctors and pharmacists react to the demand for homeopathic remedies?
Pharmacists are not primarily salespeople, they are a medical profession – they have to adhere to ethical guidelines. In this respect, evidence-based information of their clients/patients is very important.
Thomas Benkert, President of the German Federal Chamber of Pharmacists, has stated that he would not be able to stop giving advice if he always had to explain the lack of proof of efficacy.
He should perhaps read up on what his ethical duty to patients is.
What if doctors or pharmacists themselves believe in the effect?
Belief should not play a role, but evidence should.
Are you pleased with Lauterbach’s plan to no longer reimburse homeopathy?
I think it’s a shame that he justifies it by saying it’s ineffective. That is true. But the justification should be that it’s esoteric nonsense and therefore ineffective – and dangerous.
In the end, the Bundestag will decide.
I think Lauterbach has a good chance because things have started to move. Medical associations in Germany have spoken out against the additional designation of homeopathy, for example, and overall the wind has changed considerably.
What is it like in the UK, where you live?
The UK healthcare system, NHS, said goodbye to reimbursement of homeopathy about five years ago, even before France. The pharmacists’ association has distanced itself very clearly from homeopathy. However, most pharmacists still sell the remedies and many continue to support them.
You have also had disputes with the current head of state, King Charles. How did that come about?
A few years ago, he commissioned a paper claiming that so-called alternative medicine could save the British health service a lot of money. I protested against this – Charles accused me of leaking it to The Times before it was published. My university launched an investigation, which eventually found me innocent, but it led to the demise of my department. That caused me to retire two years early.
So Charles managed to close down the only research unit in the world that conducted critical and systematic research into so-called alternative medicine. Most researchers in this field only want to confirm their own prejudices and not disprove hypotheses. This is a serious misunderstanding of how science works. If someone reports only positive results for their favorite therapy in all conditions, something is wrong.
Some people say that homeopathy should not be researched because nothing positive can come out of it anyway.
There are certainly some SCAMs that are so nonsensical that they should not be researched, as is currently the case with homeopathy. I put it this way because I have researched homeopathy myself and, from my point of view, the situation was not so crystal clear 30 years ago.
Would you say that you have approached the matter with a sufficiently open mind?
No one can be completely unbiased. That’s why it’s important to do science properly, then you minimize bias as much as possible. When I took up my position at Exeter in 1993, I was perhaps somewhat biased towards homeopathy in a positive sense, because I had learned and used it myself, as well as other alternative medicine methods. The fact that the results then turned out to be negative in the vast majority of cases initially depressed me. But I have to live with that.
Every researcher prefers positive results, also because they are easier to publish. It was clear to me that, if I had succeeded in proving homeopathy right, I wouldn’t get one Nobel Prize, but two. Who wouldn’t want that?
(The interview was conducted by Hinnerk Feldwisch-Drentrup.)
When I decided to write my recent post about bizarre things going on with the GWUP (the German Skeptics), I knew, of course, that it would cause a few ripples. As a member of the GWUP scientific committee, I had been on the receiving end for the best part of a year of virtually hundreds emails and other exchanges directly releted to the matter. Initially, I had decided to stay out of all this. Therefore, I had read most of this material but had not responded to it even once.
Eventually, I had come to the conclusion that I ought to resign from the GWUP. There were two main reasons for that conclusion:
- Even though I had had plenty of time and information to form my own opinion, I had little to contribute to the affair.
- At the best of time, I am not a person who fits well into or likes to belong to clubs, associations, etc., and I was getting increasingly frustrated with the whole ting.
Before formulating my resignation letter, I discussed the GWUP with a trusted friend. This changed my attitude: I now felt that, before resigning, I should give it a try and make my position public in the hope that this might help the GWUP to get their act together.
Consequently, I posted my article precisely a week ago, well-aware of the fact that this would be controversial and might lead to attacks on my integrity. Having previously survived much bigger battles than that, I was not worried – at least, here I will be dealing with rational people, I thought.
As predicted, the reactions to my blog post (which was later translated and also published in German) were multipe, often fierce, and occasionally insulting. As not predicted, my assumption about dealing with rational people was erroneous.
I received (and posted) ~ 120 comments on the blog (only discarding less than a handful that were too far below the belt) and even more on social media. Many of you asked questions, and I tried to answer them the best I could. I even added a clarification to my original post. Soon I had to realize that emotions were flying high and reached into spheres that I understand little about and had even less intention to go into.
With hindsight, would I do it again?
Probably not!
Why not? Mainly because my attempt to help the GWUP was naive. I got the feeling that the rift amongst the German skeptics is too deep, too emotional, and too irrational. More than once I got the impression that it might be beyond repair.
More worringly perhaps, I also feel that some people who think of themselves ‘skeptics’ lack some of the qualities that I consider to be hallmarks of skepticism – to name just three: openness, rationality, and (self)critical thinking.
If someone voices his/her opinion (as has happened repeatedly, e.g. on social media) that I have been mistaken in what I stated about the GWUP, openness and rationality require, in my view, that this opinion is substantiated by stating exactly where I was mistaken. Just claiming “you were misinformed”, for instance, is hardly enough! After all, my post was written not least with the intention of identifying errors and misunderstandings. I never assumed that I am infallible, and therefore I invited my critics to use my blog for pointing out any errors, mistakes, misunderstandings, sources of misinformation, etc. Quite frankly, I was reminded of Randi’s bon mot: “The first thing a cult does is tell you everyone else is lying.”
And what happened?
Were my critics able to demonstrate where I have made errors or false allegations?
No – at least, I am not aware of such demonstrations which, of course, would require written statements that can be checked not just by me but by everyone else who is in the know.
Based on this situation, I feel tempted to conclude that the multiple claims of me having made false allegations are, in fact, false allegations.
Of course, I could be wrong!
And because I could be wrong, I am issuing herewith yet another invitation: if you are in possession of facts that contradict my previous post, here is your chance to disclose them by posting a comment below.
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And where do we go from here?
I will postpone my decision to leave the GWUP for a few weeks and hope that, contrary to my pessimism, the GWUP might manage to get its act together. The more I try to understand the reasons for the rift, the more I feel that they are emotionally hyped trivialities. With a healthy dose of openness, rationality, and (self)critical thinking, the rift might still be repairable.
he German press reported yesterday that the country’s Health Minister Karl Lauterbach plans to remove homeopathic treatments from the benefits catalog of statutory health insurance companies. “Services that have no medically verifiable benefit should not be financed from contribution funds,” states a recommendation paper by the minister. “For this reason, we will remove the option for health insurance companies to include homeopathic and anthroposophic services in their statutes, thereby avoiding unnecessary expenditure by health insurance companies.” However, private supplementary insurance should still be possible.
Lauterbach had already announced last year that he would review the funding of homeopathic treatments. “Although homeopathy is not significant in terms of expenditure, it has no place in a science-based healthcare policy,” the SPD politician told “Der Spiegel” last October. The measure would save merely a maximum of ten million Euros. This is because firstly not all health insurance companies offer the option to reimburse homeopathy, and secondly, because not that many Germans use homeopathy.
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Before I was joined about a decade ago by a group of excellent and effective skeptics, I seemed to be a lone, lost voice in Germany cautioning against the misunderstanding that homeopathy and anthroposophical medicine were backed by evidence. Thus, you probably think that I am rejoicing at this spectacular success. At first glance, it does indeed seem to be great news for those who support evidence-based medicine. But sadly, I also have second thoughts.
We should, I think, be concerned that Lauterbach intends to leave homeopathic and anthroposophical remedies reimbursible via private supplementary insurance. Most Germans have such insurance which means that, despite Lauterbach’s grand announcement, very little will probably change. Homeopathy and anthroposophic medicine, both pure placebo therapies, will still be able to pretend to be real medicine.
Moreover, we should be concerned about Lauterbach’s reasoning. It is, of course, laudable to point out that homeopathic and anthroposophic remedies are not demonstrably effective. But clearly, this is only half of the truth. The full truth is that they are based on totally ridiculous assumptions, that, in other words, they fly in the face of science. Only if we manage to get this message across, will we inform the public responsibly, in my view.
A total ban then? No, personally, I don’t want to ban homeopathic or anthroposophical remedies. If someone loves esoteric nonsense or placebos, he/she should, in my view, be able to buy them. But he/she should use their own money for the purchase. We should remember that wasting notoriously scarce public funds from either statutory or private health insurances is not just uneconomical but foremost unethical.
Diabetic peripheral neuropathy (DPN) is a common complication of diabetes mellitus and can lead to serious complications. Therapeutic strategies for pain control are available but there are few approaches that influence neurological deficits such as numbness.
This study investigated the effectiveness of acupuncture on improving neurological deficits in patients suffering from type 2 DPN.
The acupuncture in DPN (ACUDPN) study was a two-armed, randomized, controlled, parallel group, open, multicenter clinical trial. Patients were randomized in a 1:1 ratio into two groups: The acupuncture group received 12 acupuncture treatments over 8 wk, and the control group was on a waiting list during the first 16 wk, before it received the same treatment as the other group. Both groups received routine care.
Outcome parameters were evaluated after 8, 16 and 24 wk. They included:
- neurological scores, such as an 11-point numeric rating scale (NRS) for hypesthesia,
- neuropathic pain symptom inventory (NPSI),
- neuropathy deficit score (NDS),
- neuropathy symptom score (NSS);
- nerve conduction studies (NCS) as assessed with a handheld point-of-care device.
Sixty-two participants were included. The NRS for numbness showed a difference of 2.3 (P < 0.001) in favor of the acupuncture group, the effect persisted until week 16 with a difference of 2.2 (P < 0.001) between groups and 1.8 points at week 24 compared to baseline. The NPSI was improved in the acupuncture group by 12.6 points (P < 0.001) at week 8, the NSS score at week 8 with a difference of 1.3 (P < 0.001); the NDS and the TNSc score improved for the acupuncture group in week 8, with a difference of 2.0 points (P < 0.001) compared to the control group. Effects were persistent in week 16 with a difference of 1.8 points (P < 0.05). The NCS showed no meaningful changes. In both groups only minor side effects were reported.
The authors concluded that acupuncture may be beneficial in type 2 diabetic DPN and seems to lead to a reduction in neurological deficits. No serious adverse events were recorded and the adherence to treatment was high. Confirmatory randomized sham-controlled clinical studies with adequate patient numbers are needed to confirm the results.
That “acupuncture may be beneficial” has been known before and presumably was the starting point of the present study. So, why conduct an open, under-powered trial with non-blind assessors and without defining a primary outcome measure?
Could the motivation be to add yet another false-positive study to the literature of acupuncture?
False-positive, you ask?
Yes, let me explain by having a look at the outcome measures:
- NRS = a subjective endpoint.
- NPSI = a subjective endpoint.
- NDS = a subjective endpoint.
- NSS = a subjective endpoint.
- NCS = the only objective endpoint.
And what is remarkable about that?
- Subjective endpoints are likely to respond to placebo effects.
- Objective endpoints are not likely to respond to placebo effects.
In other words, what the authors of this study have, in fact, confirmed with their study is this:
acupuncture is a theatrical placebo!
Many years ago, when I was first invited to give a talk to a gathering of skeptics, I started my lecture by stating: “I am very sceptical – so much so that I am even sceptical about the skeptics.” Now it seems that my words are about to acquire a new meaning.
Since several years, I am a member of the scientific committee of the German sceptic organisation GWUP and I have observed with increasing bewilderment what is happenting to this formerly solid organization.
For me, scepticism is based on at least three elements:
- free thought,
- open discourse,
- pursuit of the truth through criticical assessment.
The leadership of the GWUP, recent developments seem to suggest, have lost sight of these elements. It occurred after the election of the new board of the GWUP in May 2023 (https://skepticalinquirer.org/2023/10/shakeup-among-german-skeptics). Subsequently, the open exchange of ideas made way to an atmosphere where dissent is discouraged or stifled. Examples of this phenomenon, particularly by Hümmler the newly elected chair, are becoming increasingly evident.
The incident involving the German philosopher Andreas Edmüller might serve as an example. His presentation for a GWUP regional group on ‘The WOKE Phenomenon – A frontal assault on the values of the enlightenment?’ (https://www.youtube.com/watch?v=ljm0iqqFoqk) was met with vitriol before he even spoke. One individual even called Edmüller an “asshole” (‘Arschloch’ https://twitter.com/Diaphanoskopie/status/1715441184431067512). Hümmler, rather than apologising to Edmüller for the undue abuse, chose to lecture him on politically correct language and accuse him of spreading ‘alt-right’ talking points (https://twitter.com/hummler/status/1719114920250265733).
Another example is the case of Stefan Kirsch, a long-standing member of GWUP. “He has been dismissed by Hümmler from his role as ‘communication manager’. Why? Because, would you believe it, he shared Edmüller’s presentation on X (formerly Twitter) (https://twitter.com/gwup/status/1715284877375942964).
To make matters worse, Hümmler is also said to have interfered with the organizing committee’s decisions for the upcoming Skepkon conference in May 2024. He apparently insisted on removing presentations from some GWUP members who had been critical of his leadership. In addition, Hümmler repeatedly denied the GWUP’s scientific committtee to share material with the GWUP’s members.
Up to now, I have watched this embarrassing spectacle from the sidelines and deliberately stayed out of any disputes. But I do feel strongly that skeptics, of all people, must not endanger our good causes by behaving like children on an ego-trip. We are in danger of becoming the laughing stock of our opponents!
I for one have grown increasingly sceptical about the GWUP and its future – so much so that I am now seriously considering my association with this organisation. If this embarrassingly counter-productive behavior does not demonstrably change after the annual convention in May this year, I (and probably many other German skeptics) will simply depart from the ruins of this organization.
PS
(added 8/1/2024)
I have been asked to be as transparent as possible and provide evidence for the statements I made above. Let me try:
- How do I know that Hümmler has interfered with the selection of the conference organising committee? Sorry, but I have been given this information in confidence; that is, I promised to not disclose the source. I tried my best to express this situation by wording my text accordingly: “Hümmler is also said to have interfered with the organizing committee’s decisions for the upcoming Skepkon conference in May 2024. He apparently insisted on removing presentations from some GWUP members who had been critical of his leadership.” Because of the interest in this matter, have now asked some people who may know about this to come forward to confirm my statement (e.g. on social media).
- As to my assertion that Hümmler “repeatedly denied the GWUP’s scientific committee to share material with the GWUP’s members”, I have first and knowledge of the situation. As a member of the committee, I was copied in to all the relevant exchanges. Moreover, his refusal is also documented in the minutes of the committee.
I hope this addresses the concerns that some readers have voiced.
On this blog, I have often been highly critical of integrative (or integrated) medicine (IM) – see, for instance:
- Integrative medicine: a satirical perspective
- A slightly different perspective on ‘INTEGRATIVE MEDICINE’
- Memorandum ‘INTEGRATIVE MEDICINE’
- Prince Charles’ opening speech at the ‘biggest ever’, ‘history-making’ integrative medicine conference
- The European Parliament’s Pathetic Attempt to Dabble in Integrative Medicine
- Integrative Medicine or Infiltrative Pseudoscience?
- Integrative Medicine: here is my slightly altered and much improved version
- More uncomfortable thoughts on ‘integrative medicine’
- The reality of ‘integrative medicine’ consists of little more than re-discoveries from conventional medicine, platitudes and outright nonsense
Recently, I began to realize that my previously critical stance has been largely due to the fact that 1) a plethora of definitions of IM exist causing endless confusion, 2) most, if not all, of the definitions of IM are vague and insufficient. At the same time, IM is making more and more inroads which makes it imprudent to ignore it.
I therefore decided it is time to change my view on IM and think more constructively. The first step on this new journey is to define IM in such a way that all interested parties can come on board. So, please allow me to present to you a definition of IM that is constructive and in the interest of progress:
IM is defined as the form of healthcare that employs the best available research to clinical care integrating evidence on all types of interventions with clinical expertise and patient values. By best available research, I mean clinically relevant (i.e., patient oriented) research that:
- establishes the efficacy and safety of all types of therapeutic, rehabilitative, or preventive healthcare strategies and
- seeks to understand the patient experience.
Healthcare practitioners who are dedicated to IM use their clinical skills and prior experience to identify each patient’s unique clinical situation, applying the evidence tailored to the individual’s risks versus benefits of potential interventions. Ultimately, the goal of IM is to support the patient by contextualising the evidence with their preferences, concerns, and expectations. This results in a process of shared decision making, in which the patient’s values, circumstances, and setting dictate the best care.
If applied appropriately, IM has the potential to be a great equaliser – striving for equitable care for patients in disparate parts of the world. Furthermore, IM can play a role in policy making; politicians are increasingly speaking to their use of research evidence to inform their decision making as a declaration of legitimacy. IM reflects the work of countless people who have improved the process of generating clinical evidence over several decades, and that it continues to evolve.
Developing the skills to practise IM requires access to evidence, opportunities to practise, and time. IM proponents strive to find novel ways to integrate evidence into personal holistic health in the best interest of our patients.
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I feel confident that this could create a basis for a fresh start in the dabate about the merits of IM. I for one am all for it!
In case some of my readers thought that the wording of my definition sounded somewhat familiar, I should perhaps tell you that it is my adaptation of the definition of evidence-based medicine (EBM) as published in ‘BMJ Best Practice‘.
What does that mean?
The points I am trying to make are the ones that I have tried to get across many times before:
- IM is a flawed, unethical, superflous and counter-productive concept.
- It is flawed because it is aimed at smuggling unproven or disproven treatments into routine care which can only render healthcare less safe and less effective.
- It is unethical because it cannot provide the best possible healthcare and thus is not in the best interest of patients.
- It is superflous because the aspects of IM that might seem valuable to proponents of so-called alternative medicine (SCAM) are already part of EBM.
- It is counter-productive because it distracts from the laudable efforts of EBM.
“Le Figaro” has published two articles (one contra and one pro) authored by ‘NoFakeMed’ (an association of health professionals warning of the danger of fake medicine) signed by a long list of healthcare professionals (including myself) who argue that so-called alternative medicine (SCAM) should be excluded from public healthcare. It relates to the fact that, since last June, a committee set up by the French government has been bringing together opponents and supporters of SCAM. At the heart of the debate is the question of how SCAMs should be regulated, and the place they should occupy in the realm of healthcare. Should they be included or excluded?
Here is the piece arguing for EXCLUSION (my translation):
They’re called alternative medicine, complementary medicine, parallel medicine, alternative medicine, SCAM, and other fancy words. The authorities prefer to call them “non-conventional healthcare practices” (NCSP), or “non-conventional health practices” (NCHP). The choice of terminology is more than just a parochial quarrel: it’s a question of knowing what quality of medicine we want, and whether we agree to endorse illusory techniques whose main argument is their popularity. This raises the question of how to regulate these practices. Some people want to force them into the healthcare system, hospitals, health centres and nursing homes. And they are prepared to use all manner of oratory and caricature to legitimise questionable practices.
Unconventional healthcare practices are on the up, and the number of practitioners and practices has been rising steadily since the 2000s; there are now around 400 therapeutic NHPs. But their success is often due to a lack of understanding of the philosophy behind them, and their lack of effectiveness beyond context effects. This was seen in the debate surrounding homeopathy, which lost much of the confidence placed in it as soon as it stopped to be reimbursed in France and was confronted with the work of popularising it on its own merits among the general public. The ethical imperative of respect for patients means providing them with reliable information so that they can make a free and informed choice.
This raises the question of the place or otherwise to be given to NHPs within the healthcare system. Although there are many different names for them, they are all practices that claim to relate to care and well-being, without having been proven to be effective, and based on theories that are not supported by scientific evidence. Admittedly, the evidence is evolving, and a practice can demonstrate its usefulness in healthcare. This is true, for instance, of hypnosis, whose usefulness as a tool in certain situations is no longer debated since it has become possible to measure and explain both its benefits and its limitations.
However, there is no question of legitimising the entire range of NHPs on the pretext that they are supposedly harmless. Many of them do have adverse effects, sometimes serious, either directly or because they lead to a lack of care. These effects also exist with conventional treatments, but the risks must always be weighed against the proven benefits. The risks associated with NHPs are therefore unacceptable, given their ineffectiveness.
Furthermore, there are abuses associated with NHPs, even if (fortunately!) they are not frequent. Sectarian aberrations are not systematically linked to NHPs, but here again the risk is unacceptable. In its 2021 activity report, Miviludes indicates that 25% of referrals concern the field of health, and that 70% of these relate to SCAM. The number of health-related referrals has risen from 365 in 2010 to 842 in 2015, and exceed 1,000 in 2021.
Conventional medicine is of course not immune to such aberrations, and Miviludes estimates that 3,000 doctors are linked to a sectarian aberration. But the health professional associations have tackled the problem head-on, notably by setting up a partnership with Miviludes and multiple safeguards (verification of diplomas and authorisation to practise, obligation to undergo continuing training, codes of ethics and public health codes, professional justice, declaration of links of interest, etc.). The professional associations have raised awareness of sexual and gender-based violence, universities are providing training in critical reading of scientific articles, and community initiatives are flourishing to improve public information.
We agree that the choices of our patients must be respected, and everyone has recourse to the wellness practices of their choice. But, at the same time, patients have the right when they consult a healthcare professional, a hospital or a health centre, to know that they will be looked after by healthcare professionals offering conscientious, dedicated, evidence-based care.
In view of the current challenges facing our healthcare system, the response must not be to offer more pseudo-medicine on the pretext that people are already using it. The real answer is to rely on evidence, to provide resources for more research, to continue with research, to rely on social work, not to neglect mental health, to improve disease prevention, and to keep pressure groups at bay, whether they come from pharmaceutical companies or the promoters of esoteric, costly and sometimes dangerous practices.
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Tomorrow, I will translate and comment on the pro-piece that ‘Le Figaro’ today published alongside this article.
PS
The list of signatories can be found in the origninal paper.
