MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

progress

MORE than £150,000 was spent by NHS Grampian on homeopathic treatments last year. Referrals to homeopathic practitioners cost £37,000 and referrals to the Glasgow Homoeopathic Hospital cost £7,315 in 2014-15. In view of the fact that highly diluted homeopathic remedies are pure placebos, any amount of tax payers’ money spent on homeopathy is hard to justify. Yet an NHS Grampian spokeswoman defended its use of by the health board with the following words:

“We have a responsibility to consider all treatments available to NHS patients to ensure they offer safe, effective and person-centred care. We also have a responsibility to use NHS resources carefully and balance our priorities across the population as well as individuals. We also recognise that patient reported outcome and experience measures are valued even when objective evidence of effectiveness is limited. Homeopathy can be considered in this arena and we remain connected with the wider debate on its role within the NHS while regularly reviewing our local support for such services within NHS Grampian.”

Mr Spence, a professional homeopath, was also invited to defend the expenditure on homeopathy: “When a friend started talking to me about homeopathy I thought he had lost his marbles. But it seemed homeopathy could fill a gap left by orthodox medicine. Homeopathy is about treating the whole person, not just the symptoms of disease, and it could save the NHS an absolute fortune. If someone is in a dangerous situation or they need surgery then they need to go to hospital. It’s often those with chronic, long-term problems where conventional treatment has not worked that can be helped by homeopathy.”

What do these arguments amount to, I ask myself.

The answer is NOTHING.

The key sentence in the spokeswomen’s comment is : “patient reported outcome and experience measures are valued even when objective evidence of effectiveness is limited.” This seems to admit that the evidence fails to support homeopathy. Therefore, so the argument, we have to abandon evidence and consider experience, opinion etc. This seemingly innocent little trick is nothing else than the introduction of double standards into health care decision making which could be used to justify the use of just about any bogus therapy in the NHS at the tax payers’ expense. It is obvious that such a move would be a decisive step in the wrong direction and to the detriment of progress in health care.

The comments by the homeopath are perhaps even more pitiful. They replace arguments with fallacies and evidence with speculation or falsehoods.

There is, of course, a bright side to this:

IF HOMEOPATHY IS DEFENDED IN SUCH A LAUGHABLE MANNER, ITS DAYS MUST BE COUNTED.

The nice thing about New Year is that one sometimes tries to get some order into the chaos of one’s files and thus finds things that were long forgotten. Such a thing, for instance, is the 1996 book ‘DURCH AEHNLICHES HEILEN‘ edited by the Austrian homeopath, Perter Koenig. It contains lots of uncritical, pro-homeopathy articles by homeopaths, but also an article I wrote upon invitation.

When I composed it, I had just started my research in Exeter after leaving my post in Vienna. The subject I had been asked to address was ‘THE PLACE OF HOMEOPATHY WITHIN MEDICAL SCHOOLS’. My short article arrives at the following conclusions (as it is in German, I did a quick translation):

What place does homeopathy have in medical schools? An extremely low one! Even homeopathic optimists cannot reasonably doubt this answer. And how can its position be improved? Only through systematic research! This research should best be conducted in cooperation between experienced homeopaths and university-based methodologists. It must fill the existing gaps in our current knowledge, particularly in respect to the proof of homeopathy’s clinical effectiveness, and the research methods must comply with the currently accepted quality standards. History demonstrates fairly clearly that conventional medicine has changed according to new knowledge. In homeopathy, such a demonstration is so far missing.

Would I change this conclusion now that 20 years worth of research is available?

Yes!

The cooperative evaluation of homeopathy that I had in mind has happened.

And what are its conclusion?

The Australian National Health and Medical Research Council (NH&MRC) has made the most thorough and independent assessment of homeopathy in its history. On 11/3/2015, the NH&MRC has released its final report on homeopathy. In essence, it concluded that there is no scientific basis for homeopathy and no quality evidence of its efficacy: 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.

In view of this, I would today revise my conclusions as follows:

What place does homeopathy have in medical schools? Its place is in the history books of medicine! Even homeopathic optimists cannot reasonably doubt this answer. Systematic research in cooperation between experienced homeopaths and university-based methodologists complying with the currently accepted quality standards has filled the gaps in our knowledge, particularly in respect to the proof of homeopathy’s clinical effectiveness. Now it is up to homeopaths to demonstrate that they are sufficiently responsible to adapt to this new knowledge in the best interest of their patients. If they don’t, they cannot be considered to be members of the community of ethical health care professionals. 

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.

All across the world we see initiatives to regulate alternative medicine. The most recent news in this sphere comes from Switzerland. The ‘Swissinfo’ website reported that the training of alternative medicine practitioners is to be regulated by creating a ‘COMPLEMENTARY MEDICINE DIPLOMA’.

The decision was welcomed by the Organisation of Swiss Alternative Medicine Professionals (OdA KT), which will conduct the exams for the diploma in question. The five therapies selected by the government for the complementary medicine diploma are yoga, ayurveda, shiatsu, craniosacral therapy and eutony. The first exams are expected to be held in 2016.

“Recognition by the state provides an important political basis for these therapies,” Christoph Q Meier, secretary general of OdA KT told swissinfo.ch. “The diploma will also improve the quality of therapy offered in Switzerland, as until now anybody could call themselves a therapist.” Meier estimates that there are between 12-15,000 practitioners of complementary therapies in Switzerland. Applicants for the national diploma will first have to pass a series of pre-exams. However, those with recognised qualifications and at least five years of experience could be exempt from the pre-exams. The exam is open to foreign nationals but will only be offered in German, French and Italian. In April this year, ayurveda was also included for a separate national diploma in naturopathy medicine along with Chinese and European traditional medicine, as well as homeopathy. Switzerland has around 3,000 naturopaths.

Whenever issues like this come up, I ask myself: IS REGULATION OF ALTERNATIVE MEDICINE A GOOD OR A BAD THING?

On the one hand, one might be pleased to hear that therapists receive some training and that not everyone who feels like it can do this job. On the other hand, it has to be said that regulation of nonsense will inevitably result in nonsense. What is more, regulation will also be misused by the practitioners to claim that their treatment is now well-established and supported by the government. This phenomenon can already be seen in the comments above and it misleads the public who understandably believe that, once a form of health care is regulated officially, it must be evidence-based.

So, what is the solution? I wish I knew the answer.

Any suggestion is welcomed.

Who – apart from quacks – would not want to get rid of all quackery, once and for all? It would be a huge improvement to medicine, save thousands of lives, and reduce our expenditure for health care considerably.

But how? How can we possibly get rid of something that is as ancient as medicine itself?

Simple!

All we need to do is to employ the existing ethical imperatives. I am thinking in particular about INFORMED CONSENT.

Informed consent is a process for obtaining permission from a patient before treating him/her. It requires the patient’s clear and full understanding of the relevant facts, implications, and consequences of the treatment. It is a ‘condition sine qua non’; no health care professional must commence a treatment without it.

And how would informed consent get rid of all quackery?

This is perhaps best explained by giving an example. Imagine a patient is about to receive a quack treatment – let’s take crystal healing (we could have chosen any other implausible non-evidence based therapy, e. g. homeopathy, chiropractic, Bach Flower Remedies, faith-healing, etc.) – for his/her condition – let’s say diabetes (we could have chosen any other condition, e. g. cancer, asthma, insomnia, etc.). Informed consent would require that, before starting the intervention, the therapist informs the patient about the relevant facts, implications and consequences of having crystal healing for diabetes. This would include the following:

  • the therapy is not plausible, it is not in line with the laws of nature as we understand them today,
  • there is no evidence that the treatment will cure your condition or ease your symptoms beyond a placebo-effect,
  • the treatment may harm you in several ways: 1) it might cause direct harm (unlikely with crystal healing but not with chiropractic, for instance), 2) it will harm your finances because the therapist wants to be paid, 3) most importantly, if you believe that it could help you and therefore forego effective therapy for your diabetes, it could easily kill you within a few days.

It is impossible to dispute that these facts are true and relevant, I think. And if they are relevant, the practitioner must convey them in such a way that they are fully appreciated by the patient. If the patient comprehends the implications fully, he/she is unlikely to agree to the treatment. If most patients refuse to be treated, the market for crystal healing quickly collapses, and crystal healers move into other, more productive jobs. This might even help the general economy!

But quacks are not in the habit of obtaining fully informed consent, I hear you say. I agree, and this is why they must be taught to do so in their quack colleges. If informed consent was taught to all budding quacks, they would soon realise that quackery is not a viable business and go to a proper school where they lean something useful (this too might help the economy). If that happens, the quack colleges would soon run out of money and close.

Meanwhile, one could remind the existing quacks that they break the law, if they neglect informed consent. In the interest of the patient, one could closely monitor the consent giving process, and even think of increasingly heavy finds for those who break the law.

As we see, almost all the means for rendering health care quack-free already exist. All we need to do is implement them. That shouldn’t be difficult, should it?

AND NOW I STOP DAY-DREAMING AND DO SOMETHING USEFUL.

For ‘my’ journal FACT, I review all the new articles that have emerged on the subject of alternative medicine on a monthly basis. Here are a few impressions and concerns that this activity have generated:

  • The number of papers on alternative medicine has increased beyond belief: between the year 2000 and 2010, there was a slow, linear increase from 335 to 610 Medline-listed articles; thereafter, the numbers exploded to 1189 (2011), 1674 (2012) and 2236 (2013).
  • This fast growing and highly lucrative ‘market’ has been cornered mainly by one journal: ‘EVIDENCE BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE’ (EBCAM), a journal that I mentioned several times before (see here, for instance). In 2010, EBCAM published 76 papers, while these figures increased to 546, 880 and 1327 during the following three years.
  • Undeniably, this is big business, as authors have to pay tidy sums each time they get published in EBCAM.
  • The peer-review system of EBCAM is farcical: potential authors who send their submissions to EBCAM are invited to suggest their preferred reviewers who subsequently are almost invariably appointed to do the job. It goes without saying that such a system is prone to all sorts of serious failures; in fact, this is not peer-review at all, in my opinion, it is an unethical sham.
  • As a result, most (I estimate around 80%) of the articles that currently get published on alternative medicine are useless rubbish. They tend to be either pre-clinical investigations which never get followed up and are thus meaningless, or surveys of no relevance whatsoever, or pilot studies that never are succeeded by more definitive trials, or non-systematic reviews that are wide open to bias and can only mislead the reader.
  • Nowadays, very few articles on alternative medicine are good enough to get published in mainstream journals of high standing.

The consequences of these fairly recent developments are serious:

  • Conventional scientists and clinicians must get the impression that there is little research activity in alternative medicine (while, in fact, there is lots) and that the little research that does emerge is of poor quality.
  • Consequently alternative medicine will be deemed by those who are not directly involved in it as trivial, and the alternative medicine journals will be ignored or even become their laughing stock.
  • At the same time, the field of alternative medicine and its proponents (the only ones who might actually be reading the plethora of rubbish published in alternative medicine journals) will get more and more convinced that their field is supported by an ever- abundance of peer-reviewed, robust science.
  • Gradually, they will become less and less aware of the standards and requirements that need to be met for evidence to be called reliable (provided they ever had such knowledge in the first place).
  • They might thus get increasingly frustrated by the lack of acceptance of their ‘advances’ by proper scientists – an attitude which, from their perspective, must seem unfair, biased and hostile.
  • In the end, conventional and alternative medicine, rather than learning from each other, will move further and further apart.
  • Substantial amounts of money will continue to be wasted for research into alternative medicine that, whenever assessed critically, turns out to be too poor to advance healthcare in any meaningful way.
  • The ones who medicine should be all about, namely the patients who need our help and rely on the progress of research, are not well served by these developments.

In essence this suggests, I think, that alternative medicine is ill-advised and short-sighted to settle for standards that are so clearly below those generally deemed acceptable in medicine. Similarly, conventional medicine does a serious disfavour to progress and to us all, if it ignores or tolerates this process.

I am not at all sure how to reverse this trend. In the long-term, it would require a change of attitude that obviously is far from easy to bring about. In the short-term, it might help, I think, to de-list journals from Medline that are in such obvious conflict with publication ethics.

Necessity, they say, is the mother of invention. The meaning of this proverb is fairly clear:

  • In the Oxford Dictionary the proverb has been defined as– when the need for something becomes imperative, you are forced to find ways of getting or achieving it.
  • According to the Cambridge Dictionary, this is “an expression that means that if you really need to do something, you will think of a way of doing it.”
  • Finally, the Longman dictionary has defined the proverb as– “if someone really needs to do something, they will find a way of doing it.”

In the world of chiropractic the proverb acquires a special meaning: chiropractic relies almost entirely on inventions. A few examples have to suffice:

  • first, instead of pathophysiology, they invented subluxations,
  • this required the invention of adjustments which were needed for their imagined subluxation,
  • then they invented the ‘inate’,
  • then they invented the idea that all sorts of conditions are caused by subluxations and therefore require adjustments,
  • finally, they invented the notion that regular adjustments are needed for a healthy person to stay healthy.

I was reminded of the unique inventive capacity of chiropractic when I came across the website of the Foundation for Chiropractic Progress (F4CP). The F4CP is, according to their own statements, a not-for-profit organization dedicated to raising awareness about the value of chiropractic care (which is, of course, another invention).

Experts at the F4CP point out that a growing number of professional athletic teams utilize chiropractic care to maximize overall health and maintain peak performance. “Repetitive motion injuries, including shoulder tendinitis, elbow, lower back pain and muscle spasms, are common conditions and injuries among professional baseball players that can be successfully prevented, managed and treated with chiropractic care,” says Hirad N. Bagy, DC. “Chiropractic adjustments, in conjunction with soft tissue mobilization, provide athletes with proper structure, function and balance to reduce the risk of injury, accelerate recovery time and improve overall performance,” he continues – and he must know, because he has received specialized training and certifications specific to sports medicine, which include the Graston Technique®, Active Release Technique®, Myofascial Release Technique, Impact Concussion Testing and Functional Dry Needling. Dr. Bagy continues: “A number of athletes that I treat regularly understand the importance of chiropractic maintenance care, and also seek treatment when an injury arises. Through the restoration of proper bio-mechanics, doctors of chiropractic are now positioned as key health care providers throughout all of the sports teams that I work with.”

BRAVO! We are impressed! So much so, that we almost forgot to ask: “Is there any evidence for all of these therapeutic claims?”

Just as well! Because had we asked and perhaps even did a bit of research, we would have found that almost none of these far-reaching claims are evidence-based.

But who would be so petty? Instead of criticising the incessant flow of bogus claims made by chiropractors worldwide, we should really admire their remarkable skill of invention:

  • When the need for profit becomes imperative, CHIROPRACTORS are forced to find ways of getting or achieving it.
  • If CHIROPRACTORS really need to do something, they will think of a way of doing it.
  • If a CHIROPRACTOR really needs money, he will advocate ‘maintenance care’.

AND THAT’S WHAT IS CALLED ‘CHIROPRACTIC PROGRESS’!

Would you believe it? This is the 500th post on this blog!

When I started this blog less than three years ago, I would have never thought that I would have fun doing this; and I would not have expected to get hooked on it. In fact, it needed even a bit of arm twisting to try it, and I have to thank Alan for doing it and everything else. Without him, this blog would surely not exist.

With my very first post, I promised that my blog is not going to provide just another critique of alternative medicine; it is going to be different, I hope. The reasons for this are fairly obvious: I have researched alternative medicine for two decades. My team and I have conducted about 40 clinical trials and published more than 100 systematic reviews of alternative medicine. We were by far the most productive research unit in this area. For 14 years, we hosted an annual international conference for researchers in this field. I know many of the leading investigators personally, and I understand their way of thinking. I have rehearsed every possible argument for or against alternative medicine dozens of times.

In a nutshell, I am not someone who judges alternative medicine from the outside; I come from within the field. Arguably, I am the only researcher in this area who is willing [or capable?] to state publicly what is wrong with alternative medicine. This is perhaps one of the advantages of being an emeritus professor!

I am not sure whether I lived up to this promise – but I did try. And one thing is for sure, it was an eventful exercise. The blog now has ~ 20 000 readers every week; we had something like 15 000 comments; and some posts were re-tweeted several hundred times.

This seems to indicate that there is a need for a forum of this nature. Alternative medicine continues to be popular but critical thinking is not something that this field is blessed with. On the contrary, the misinformation on this subject is simply monstrous and seems to be growing every day. Factual and reliable information is very hard to come by, and therefore I feel that I am doing an important educational job here.

It’s a job which I certainly could not do alone. I therefore like to take this occasion to thank everyone who made my blog what it is today. Alan has already been mentioned but the many commentators deserve a big THANKS too – regardless of whether I agree or disagree with you, your comments make it all worth my while.

On 26/5/2015, I received the email reproduced below. I thought it was interesting, looked up its author (“Shawn is a philosopher and writer educated at York University in Toronto, and the author of two books. He’s also worked with Aboriginal youth in the Northwest Territories of Canada”) and decided to respond by writing a blog-post rather than by answering Alli directly.

Hello Dr. Ernst, this is Shawn Alli from Canada, a blogger and philosopher. I recently finished a critical article on James Randi’s legacy. It gets into everything from ideological science, manipulation, ESP, faith healing, acupuncture and homeopathy.

Let me know what you think about it:

http://www.shawnalli.com/james-randi-disingenuous-legacy.html

It’s quite long so save it for a rainy day.

So far, the reply from skeptical organizations range from: “I couldn’t read further than the first few paragraphs because I disagree with the claims…” to one word replies: “Petty.”

It’s always nice to know how open-minded skeptical organizations are.

Hopefully you can add a bit more.

Sincerely,

Shawn

Yes, indeed, I can but try to add a bit more!

However, Alli’s actual article is far too long to analyse it here in full. I therefore selected just the bit that I feel most competent commenting on and which is closest to my heart. Below, I re-produce this section of Alli’s article in full. I add my comments at the end (in bold) by inserting numbered responses which refer to the numbers (in round brackets [the square ones refer to Alli’s references]) inserted throughout Alli’s text. Here we go:

Homeopathy & Acupuncture:

A significant part of Randi’s legacy is his war against homeopathy. This is where Randi shines even above mainstream scientists such as Dawkins or Tyson.

Most of his talks ridicule homeopathy as nonsense that doesn’t deserve the distinction of being called a treatment. This is due to the fact that the current scientific method is unable to account for the results of homeopathy (1). In reality, the current scientific method can’t account for the placebo effect as well (2).

But then again, that presents an internal problem as well. The homeopathic community is divided by those who believe it’s a placebo effect and those that believe it’s more than that, advocating the theory of water memory, which mainstream scientists ridicule and vilify (3).

I don’t know what camp is correct (4), but I do know that the homeopathic community shouldn’t follow the lead of mainstream scientists and downplay the placebo effect as, it’s just a placebo (5).

Remember, the placebo effect is downplayed because the current scientific method is unable to account for the phenomenon (3, 5). It’s a wondrous and real effect, regardless of the ridicule and vilification (6) that’s attached to it.

While homeopathy isn’t suitable as a treatment for severe or acute medical conditions, it’s an acceptable treatment for minor, moderate or chronic ones (7). Personally, I’ve never tried homeopathic treatments. But I would never tell individuals not to consider it. To each their own, as long as it’s within universal ethics (8).

A homeopathic community in Greece attempts to conduct an experiment demonstrating a biological effect using homeopathic medicine and win Randi’s million dollar challenge. George Vithoulkas and his team spend years creating the protocol of the study, only to be told by Randi to redo it from scratch. [29] (9) I recommend readers take a look at:

The facts about an ingenious homeopathic experiment that was not completed due to the “tricks” of Mr. James Randi.

Randi’s war against homeopathy is an ideological one (10). He’ll never change his mind despite positive results in and out of the lab (11). This is the epitome of dogmatic ideological thinking (12).

The same is true for acupuncture (13). In his NECSS 2012 talk Randi says:

Harvard Medical School is now offering an advanced course for physicians in acupuncture, which has been tested endlessly for centuries and it does not work in any way. And believe me, I know what I’m talking about. [30]

Acupuncture is somewhat of a grey area for mainstream scientists and the current scientific method. One ideological theory states that acupuncture operates on principles of non-physical energy in the human body and relieving pressure on specific meridians. The current scientific method is unable to account for non-physical human energy and meridians.

A mainstream scientific theory of acupuncture is one of neurophysiology, whereby acupuncture works by affecting the release of neurotransmitters. I don’t know which theory is correct; but I do know that those who do try acupuncture usually feel better (14).

In regards to the peer-reviewed literature, I believe (15) that there’s a publication bias against acupuncture being seen as a viable treatment for minor, moderate or chronic conditions. A few peer-reviewed articles support the use of acupuncture for various conditions:

Eight sessions of weekly group acupuncture compared with group oral care education provide significantly better relief of symptoms in patients suffering from chronic radiation-induced xerostomia. [31]

It is concluded that this study showed highly positive effects on pain and function through the collaborative treatment of acupuncture and motion style in aLBP [acute lower back pain] patients. [32]

Given the limited efficacy of antidepressant treatment…the present study provides evidence in supporting the viewpoint that acupuncture is an effective and safe alternative treatment for depressive disorders, and could be considered an alternative option especially for patients with MDD [major depressive disorder] and PSD [post-stroke depression], although evidence for its effects in augmenting antidepressant agents remains controversial. [33]

In conclusion: We find that acupuncture significantly relieves hot flashes and sleep disturbances in women treated for breast cancer. The effect was seen in the therapy period and at least 12 weeks after acupuncture treatment ceased. The effect was not correlated with increased levels of plasma estradiol. The current study showed no side effects of acupuncture. These results indicate that acupuncture can be used as an effective treatment of menopausal discomfort. [34]

In conclusion, the present study demonstrates, in rats, that EA [electroacupuncture] significantly attenuates bone cancer induced hyperalgesia, which, at least in part, is mediated by EA suppression of IL-1…expression. [35]

In animal model of focal cerebral ischemia, BBA [Baihui (GV20)-based Scalp acupuncture] could improve IV [infarct volume] and NFS [neurological function score]. Although some factors such as study quality and possible publication bias may undermine the validity of positive findings, BBA may have potential neuroprotective role in experimental stroke. [36]

In conclusion, this randomized sham-controlled study suggests that electroacupuncture at acupoints including Zusanli, Sanyinjiao, Hegu, and Zhigou is more effective than no acupuncture and sham acupuncture in stimulating early return of bowel function and reducing postoperative analgesic requirements after laparoscopic colorectal surgery. Electroacupuncture is also more effective than no acupuncture in reducing the duration of hospital stay. [37]

In conclusion, we found acupuncture to be superior to both no acupuncture control and sham acupuncture for the treatment of chronic pain…Our results from individual patient data meta-analyses of nearly 18000 randomized patients in high-quality RCTs [randomized controlled trials] provide the most robust evidence to date that acupuncture is a reasonable referral option for patients with chronic pain. [38]

While Randi and many other mainstream scientists will argue (16) that the above claims are the result of ideological science and cherry picking, in reality, they’re the result of good science going up against dogmatic (17) and profit-driven (17) ideological (17) science.

Yes, the alternative medicine industry is now a billion dollar industry. But the global pharmaceutical medical industry is worth hundreds of trillions of dollars. And without its patients (who need to be in a constant state of ill health), it can’t survive (18).

Individuals who have minor, moderate, or chronic medical conditions don’t want to be part of the hostile debate between alternative medicine vs. pharmaceutical medical science (19). They just want to get better and move on with their life. The constant war that mainstream scientists wage against alternative medicine is only hurting the people they’re supposed to be helping (20).

Yes, the ideologies (21) are incompatible. Yes, there are no accepted scientific theories for such treatments. Yes, it defies what mainstream scientists currently “know” about the human body (22).

It would be impressive if a peace treaty can exist between both sides, where both don’t agree, but respect each other enough to put aside their pride and help patients to regain their health (23).

END OF ALLI’S TEXT

And here are my numbered comments:

(1) This is not how I understand Randi’s position. Randi makes a powerful point about the fact that the assumptions of homeopathy are not plausible, which is entirely correct – so much so that even some leading homeopaths admit that this is true.

(2) This is definitely not correct; the placebo effect has been studied in much detail, and we can certainly ‘account’ for it.

(3) In my 40 years of researching homeopathy and talking to homeopaths, I have not met any homeopaths who “believe it’s a placebo effect”.

(4) There is no ‘placebo camp’ amongst homeopaths; so this is not a basis for an argument; it’s a fallacy.

(5) They very definitely are mainstream scientists, like F Benedetti, who research the placebo effect and they certainly do not ‘downplay’ it. (What many people fail to understand is that, in placebo-controlled trials, one aims at controlling the placebo effect; to a research-naïve person, this may indeed LOOK LIKE downplaying it. But this impression is wrong and reflects merely a lack of understanding.)

(6) No serious scientist attaches ‘ridicule and vilification’ to it.

(7) Who says so? I know only homeopaths who hold this opinion; and it is not evidence-based.

(8) Ethics demand that patients require the best available treatment; homeopathy does not fall into this category.

(9) At one stage (more than 10 years ago), I was involved in the design of this test. My recollection of it is not in line with the report that is linked here.

(10) So far, we have seen no evidence for this statement.

(11) Which ones? No examples are provided.

(12) Yet another statement without evidence – potentially libellous.

(13) Conclusion before any evidence; sign for a closed mind?

(14) This outcome could be entirely unrelated to acupuncture, as anyone who has a minimum of health care knowledge should know.

(15) We are not concerned with beliefs, we concerned with facts here, aren’t we ?

(16) But did they argue this? Where is the evidence to support this statement?

(17) Non-evidence-based accusations.

(18) Classic fallacy.

(19) The debate is not between alt med and ‘pharmaceutical science’, it is between those who insist on treatments which demonstrably generate more good than harm, and those who want alt med regardless of any such considerations.

(20) Warning consumers of treatments which fail to fulfil the above criterion is, in my view, an ethical duty which can save much money and many lives.

(21) Yes, alt med is clearly ideology-driven; by contrast conventional medicine is not (if it were, Alli would have explained what ideology it is precisely). Conventional medicine changes all the time, sometimes even faster than we can cope with, and is mainly orientated on evidence which is not an ideology. Alt med hardly changes or progresses at all; for the most part, its ideology is that of a cult celebrating anti-science and obsolete traditions.

(22) Overt contradiction to what Alli just stated about acupuncture.

(23) To me, this seems rather nonsensical and a hindrance to progress.

In summary, I feel that Alli argues his corner very poorly. He makes statements without supporting evidence, issues lots of opinion without providing the facts (occasionally even hiding them), falls victim of logical fallacies, and demonstrates an embarrassing lack of knowledge and common sense. Most crucially, the text seems bar of any critical analysis; to me, it seems like a bonanza of unreason.

To save Alli the embarrassment of arguing that I am biased or don’t know what I am talking about, I’d like to declare the following: I am not paid by ‘Big Pharma’ or anyone else, I am not aware of having any other conflicts of interest, I have probably published more research on alt med (some of it with positive conclusions !!!) than anyone else on the planet, my research was funded mostly by organisations/donors who were in favour of alt med, and I have no reason whatsoever to defend Randi (I only met him personally once). My main motivation for responding to Alli’s invitation to comment on his bizarre article is that I have fun exposing ‘alt med nonsense’ and believe it is a task worth doing.

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