Ad hominem attacks, I have previously pointed out, are victories of reason over unreason. And they are used frequently by supporters of alternative medicine!
If you doubt it, see for yourself.
I recently posted a comment on new Nice guidelines. It generated lots of comments, and mostly they were rational discussions of the issues involved. This changed abruptly when, on 16 May, Mel’s comment started a new, concerted wave of discussion at a time when the usual debate had already subsided. In the course of this new and heated debate, I was repeatedly accused of being rude.
As I have stated repeatedly on this blog, I try to keep rudeness out of the comments as much as I can. Therefore, the claim surprised me and today I reviewed the entire comment section selecting all potential ad hominem attacks. Here are the results:
ACTUAL OR POTENTIAL AD HOMINEM ATTACKS AGAINST ME
Peter Deadman on Tuesday 17 May 2016 at 12:55 Edward Ernst, I always thought you were a bully and a fraud. You’re very macho when it comes to slapping down people who may have experiential reasons for supporting acupuncture and other therapies but don’t have the skill to challenge you on the clinical evidence. Now as soon as somebody does, you back off, cry ‘enough’, say you can’t possibly comment till some undetermined future date and generally act like a wuss. I say put up or shut up. I’d prefer the former because it would be good to see you eat crow but I lean towards the latter because of the substantial harm you are causing and the beautiful silence that would ensue if you did indeed go quiet.
tonto on Tuesday 17 May 2016 at 13:19 You appear as weak in your arguments, as some pendulum swinging, new age dowser, who vainly holds sticks to their guns, not because they can back their position up with scientific evidence, but because it is what they “believe”.
Jill Onyett on Tuesday 17 May 2016 at 14:29 …an unfortunate creature too keen on the sound of his own voice.
Tracey Phillips on Tuesday 17 May 2016 at 13:16 …to date you have been fairly opinionated …
Peter Deadman on Tuesday 17 May 2016 at 16:34 I made an ad hominem response because your blog is all about you as a person. You are constantly rude to others and bypass or ignore responses that you don’t like. It’s you who makes it hominem.
Peter Deadman on Tuesday 17 May 2016 at 16:52 You are hyper-emotional, extremely biased, hostile and contemptuous of anyone you think ‘beneath you’. You gloat over people’s real or imagined inconsistencies and generally come across as a nasty piece of work.
Peter Deadman on Tuesday 17 May 2016 at 19:30 How can such a childish provocateur remain in his post. It demeans the University and it’s time they let him go.
Kylee Junghans on Wednesday 18 May 2016 at 08:42 …you, kind Sir, with your rhetoric and tantrums, are exhibiting a prime example of confirmation bias.
Peter Deadman on Wednesday 18 May 2016 at 08:48 [Ernst] professes a scholarly detachment, a commitment to evidence and an open mind, but in fact is deeply biased… He clearly loves his childish provocative stance and is as far from a disinterested observer as it’s possible to be. I wouldn’t waste my time or breath on him if he didn’t have an influence that far exceeds his worth.
Carol Cooke on Wednesday 18 May 2016 at 09:27 I have followed this discussion with interest. Some of the rudest and most discourteous posts I can see are from Mr Ernst himself. But I get that, I imagine you seek to maintain a bold and authoritative tone simply by dismissing others. Being a bit controversial in your discourse has obviously served you well in that you have built a media profile on it.
ACTUAL OR POTENTIAL AD HOMINEM ATTACKS BY MYSELF
Edzard on Wednesday 18 May 2016 at 09:18 “it is also difficult to get a man to read something, when he is foaming from his mouth”.
I know, this is not really ‘ad hominem’ but I could not find anything more dramatic. Surely, some will disagree this me here, and I do invite them to cite my rudeness from this threat, if they spot it. You are more than welcome!
You may think this is a bit trivial, but I disagree. The main reason I did this little exercise is to demonstrate a point which I think is important and carries a relevant lesson for future comments and discussions:
- WHEN I OR ANYONE ELSE DEFENDING RATIONALITY GET AGGRESSED, WE NATURALLY TEND TO RESPOND SLIGHTLY MORE FORCEFULLY.
- SUBSEQUENTLY, THE OTHER SIDE OFTEN REACTS BY ATTACKING US PERSONALLY.
- THIS OFTEN LEADS TO AN ESCALATION OF TONE.
- EVENTUALLY THE OTHER SIDE CLAIMS WITH INDIGNATION THAT WE ARE THE ONES DOING THE PERSONAL ATTACKS.
- IT IS A TACTIC THAT IS EFFECTIVE BUT DISHONEST, IN MY VIEW.
- THE LESSON IS SIMPLE: DO NOT LET YOURSELF GET PROVOKED INTO ISSUING AD HOMINEM ATTACKS, BE POLITE AND PATIENT.
I know this sounds simpler than it is, and I am far from being immune to the problem, but we owe it to reason to give it a try.
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.
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.
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.
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.
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.
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?
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.
In a previous post, I asked this important question: how can research into alternative medicine ever save a single life?
The answer I suggested was as follows:
Since about 20 years, I am regularly pointing out that the most important research questions in my field relate to the risks of alternative medicine. I have continually published articles about these issues in the medical literature and, more recently, I have also made a conscious effort to step out of the ivory towers of academia and started writing for a much wider lay-audience (hence also this blog). Important landmarks on this journey include:
Alternative medicine is cleverly, heavily and incessantly promoted as being natural and hence harmless. Several of my previous posts and the ensuing discussions on this blog strongly suggest that some chiropractors deny that their neck manipulations can cause a stroke. Similarly, some homeopaths are convinced that they can do no harm; some acupuncturists insist that their needles are entirely safe; some herbalists think that their medicines are risk-free, etc. All of them tend to agree that the risks are non-existent or so small that they are dwarfed by those of conventional medicine, thus ignoring that the potential risks of any treatment must be seen in relation to their proven benefit.
For 20 years, I have tried my best to dispel these dangerous myths and fallacies. In doing so, I had to fight many tough battles (sometimes even with the people who should have protected me, e.g. my peers at Exeter university), and I have the scars to prove it. If, however, I did save just one life by conducting my research into the risks of alternative medicine and by writing about it, the effort was well worth it.
END OF QUOTE FROM MY PREVIOUS POST
Just now, I received an email from someone who clearly and vehemently disagrees with any of the above. As this blog is a forum where all sorts of opinions can and should be voiced, I thought I share this communication with you. Here it is:
Having been out of chiropractic practice for a while, I was thrilled to hear that you have been forced into early retirement on today’s Radio 4 programme. You have caused so many good people anguish and pain and your tunnel-visioned arrogance is staggering and detrimental to humanity. You REALLY think modern science has all the answers? Wow.
The question I ask myself is who is correct, the (ex-)chiropractor or I?
- Have I caused anguish and pain to many?
- Do I suffer from tunnel-vision?
- Am I arrogant?
- Is my work detrimental to humanity?
- Do I believe that modern science has all the answers?
Here is what I think about these specific questions:
- I have probably caused anguish (but no pain, as far as I am aware). This sadly is unavoidable if one seeks the truth in an area as alternative medicine.
- I am not the best person to judge this.
- Possibly; again I cannot judge.
- I truly don’t see this at all.
- No, not for one second.
In case you wonder what programme the author of the above email had been listening to, you can find it here.
Is there a bottom line? I am not sure. Perhaps this: whenever strong believes clash with scientific facts, some people are going to be unhappy. If we want to make progress, this seems to be almost unavoidable; all we can try to do is to minimize the anguish by being humble and by showing human decency.
In 2010, we published an investigation of 200 chiropractor websites and 9 chiropractic associations’ World Wide Web claims in Australia, Canada, New Zealand, the United Kingdom, and the United States. The outcome measure was claims (either direct or indirect) regarding the eight reviewed conditions, made in the context of chiropractic treatment.
We found evidence that 190 (95%) chiropractor websites made unsubstantiated claims regarding at least one of the conditions. When colic and infant colic data were collapsed into one heading, there was evidence that 76 (38%) chiropractor websites made unsubstantiated claims about all the conditions not supported by sound evidence. Fifty-six (28%) websites and 4 of the 9 (44%) associations made claims about lower back pain, whereas 179 (90%) websites and all 9 associations made unsubstantiated claims about headache/migraine. Unsubstantiated claims were made about asthma, ear infection/earache/otitis media, neck pain.
At the time, we concluded that the majority of chiropractors and their associations in the English-speaking world seem to make therapeutic claims that are not supported by sound evidence, whilst only 28% of chiropractor websites promote lower back pain, which is supported by some evidence. We suggest the ubiquity of the unsubstantiated claims constitutes an ethical and public health issue.
Have things changed since?
I fear not! I regularly come across websites of chiropractors where they happily make bogus claims. On this website, for instance, chiropractor Karen Smith claims that muscles in the upper neck affect the ear canals. “We don’t actually treat the ear infection, or the symptoms. What we do is, we assist the body’s natural healing ability,” says Smith. “So if there’s something going on with the joints and the muscles soft tissue, the nerves coming out that supply those muscles, those muscles can’t relax, so then they’re almost tight and in spasm, so that can’t allow the drainage to happen properly.”
When fluid builds up in the ears, it’s a breeding ground for bacteria and infection. Smith says specific, gentle adjustments, can help the body drain those fluids through the nose. “What we do is we get some motion in the upper neck, with my hands, or I might use an instrument as well,” says Smith. “There’s a few other techniques that we can do. We can do some sinus drainage. We can drain some of the fluid in the ear.”
A simple ear pull technique can also help. “So what we do is, we just take the ear of the child and we do a little pull and that can actually drain the fluid as well,” says Smith. Smith says a child’s overall health and immune system impacts how quickly they see results from the treatment. In some cases, relief can be instant. “What we notice right after an adjustment is a lot of times you’ll actually see the fluid drain through the nose,” says Smith… Smith says she also treats adults who have had chronic ear issues as a child or who are experiencing pain in the ear.
When I or others expose such nonsense, the apologists say that these are just a few ‘rotten apples’, and that the chiropractic profession is fast progressing. Yet, I very much doubt this claim. For any fast progression, one would want to see the profession taking decisive and effective action against the ‘rotten apples’. This is clearly not happening, at least not to an extend that would stop such dangerous quackery.
What practical lesson can be learnt from such insights?
The only responsible advice I can think of is this: IF YOU OR YOUR CHILD IS ILL, AVOID CONSULTING A CHIROPRACTOR.
I just came across this article which I find remarkable in several ways. Here is the abstract:
The purpose of this report is to describe 2 patients with coronary artery disease presenting with musculoskeletal symptoms to a chiropractic clinic.
A 48-year-old male new patient had thoracic spine pain aggravated by physical exertion. A 61-year-old man under routine care for low back pain experienced a secondary complaint of acute chest pain during a reevaluation.
INTERVENTION AND OUTCOME:
In both cases, the patients were strongly encouraged to consult their medical physician and were subsequently diagnosed with coronary artery disease. Following their diagnoses, each patient underwent surgical angioplasty procedures with stenting.
Patients may present for chiropractic care with what appears to be musculoskeletal chest pain when the pain may be generating from coronary artery disease necessitating medical and possibly emergency care.
I FIND THIS REMARKABLE FOR AT LEAST 3 REASONS:
- I don’t remember coming across the term ‘medical physician’ before. It is clear what the author meant by it. But it is also quite clear that such phraseology is nonsensical. My Oxford Dictionary defines ‘physician’ as: “A person qualified to practise medicine, especially one who specializes in diagnosis and medical treatment as distinct from surgery.” Therefore, a ‘medical physician’ would be ‘a medical person qualified to practise medicine.’ This begs the question why this term is used in a chiro-journal. The answer is probably quite simple: they want to arrive at a point where we all accept that there are two types of physicians: medical and chiropractic. But, using again my dictionary, this would be not just a little confusing. A chiropractic physician would be ‘a chiropractor qualified to practice medicine.’ And for that you need to go not to chiro-college but to medical school.
- The two case reports are remarkable in themselves, I find. They show that “patients may present for chiropractic care with what appears to be musculoskeletal chest pain when the pain may be generating from coronary artery disease necessitating medical and possibly emergency care.” The remarkable thing about this is that such basic knowledge ever merited a mention and publication in a journal. It should be clear to anyone who is in healthcare! I even know shop assistants who have called an ambulance because a customer suffered from what might have been misdiagnosed as a muscular problem in the left arm but was in truth due to coronary hear disease. The fact that chiros and editors of their journals feel that it worthy of publication seems a bit worrying and begs the question: how many other elementary things about the human body (known even to shop assistants) are unknown to the average chiro?
- Lastly, I must praise the chiro-profession for the progress they now seem to start making. About 120 years ago, DD Palmer, the founding father of chiropractic, famously treated a man with coronary heart disease by adjusting his spine. The author of the above article did not do that! Yes, progress was painfully slow, but the above article seems to indicate that at least some chiros have come around to agreeing with real physicians that the Palmer-gospel is based on little more than wishful thinking.
On their website, the American Chiropractic Association (ACA) recently updated its members on their lobbying activities aimed at having US chiropractors recognised as primary care physicians. The president of the ACA posted the following letter to ACA members:
For much of this past year, ACA’s staff and key volunteers have been laying the groundwork to achieve just that — quietly spending time building key support on Capitol Hill for this important legislative change. As you know, our progress advanced to the point where we were able on Oct. 27 to publically launch our grassroots campaign centered on the widespread circulation of our National Medicare Equality Petition.
Since the launch of our campaign, through very public and transparent means, ACA has received the support of various organizations and individuals within the profession. These supporters fully understand the importance of eliminating any and all provider discrimination by CMS. Further they fully understand and agree with the soundness of the strategic and tactical decisions we have made and continue to make an effort to achieve the desired reformation in Medicare.
Towards building a unified consensus within the profession for our objectives and plans to accomplish them, we have engaged in prolonged discussions, mostly via the Chiropractic Summit Steering Committee and Roundtable process that includes ACA, COCSA, ACC, ICA, NBCE, FCLB and CCE. Throughout this process we have provided for them written legal opinions and analyses relative to the precise legislative language needed to achieve the full-physician status we seek. We have outlined our strategy numerous times; have shared our materials and updates with any group wishing to review them; and have repeatedly urged state chiropractic associations, chiropractic colleges, corporate partners and individual DCs to join with us and enthusiastically support this reformation campaign.
While there was high consensus on the objective of Medicare reform during the Summit Roundtable process, there was much discussion surrounding the proposed legislative language. Specifically, whether or not “detection and correction of subluxation of the spine through manual manipulation” would need to be eliminated and replaced with language simply designating DCs as physician level providers on the same level as MDs and DOs who report/bill services to Medicare based on their individual state laws.
ACA is of the opinion that nothing less than removal of the “subluxation” language in the definition of physician section will accomplish our objectives. Historically, the facts are that this language has proven to be the major barrier within HHS and CMS when we advocated for regulatory remedies expanding our reimbursement and coverage for the full range of services provided by a DC. ACA (and our profession) has expended massive resources over the past decade or longer to no avail through regulatory channels (HHS, CMS). Based on these experiences, the only reasonable recourse to eliminate 40+ years of Medicare discrimination is through a thoughtful profession-wide legislative effort.
During the Roundtable discussions, compromise language was reached placing the current “subluxation language” into the preamble of a proposed law stating that DCs must continue to have the ability to detect and correct subluxations of the spine for Medicare beneficiaries. Six of seven Summit Roundtable organizations voted in favor of this language that was offered by the Association of Chiropractic Colleges.
ACA`s intent on removing the “subluxation” reference in the Social Security Administrative statute is in no way an attempt to quash our ability to perform those services that so many of the Medicare population need and deserve. Rather, the ultimate goal of this historic effort is to gain the privilege to manage our Medicare patients within state scopes of practice and allow reimbursement for all those services that the Medicare beneficiaries are currently forced to pay out of pocket. ACA supports fully our continued ability to correct subluxations through appropriate active care and, in fact, achieve coverage for manipulation of all areas, not simply limited to the spine.
Expanding Medicare scope reimbursement will allow our profession to practice contemporary chiropractic and to potentially increase utilization of our services to the ever-increasing aging population. Expansion and reformation will also place DCs in a position to participate in alternative payment models, quality healthcare initiatives, community health centers, hospitals and other integrated settings which are vital to professional growth.
In conclusion, should you as an HOD member be questioned on our intent you should be able to answer unequivocally that ACA supports the right to manage our patients as dictated by our training and competencies based on state scopes of practice. Further, we support those who wish to provide necessary active subluxation care for the Medicare population. Please support this initiative and let’s join together to encourage your state association, colleges and universities, corporate partners, patients and individual DCs to become true partners in order to make this a success for our patients and for our grand profession.
A list of talking points will be distributed in the coming days.
Sincerely, Tony Hamm, DC President, ACA
Do I read this correctly?
The term subluxation is a hindrance to business. Therefore chiros need to do something about it. Never mind that the principle of subluxation as used in the realm of chiropractic is nonsense!
This might throw an entirely different light on those chiros who want to get rid of the term ‘subluxation’.
And what about chiros as primary care physicians?
Recently Dave Newell posted on this blog: “chiropractors in the UK … are primary care clinicians”. I objected and he insisted to be correct because “Primary Care is defined as a clinician that is the first port of call for patients seeking help.” Frank Odds then countered: “This business of “primary care provider” is becoming enervating! Edzard has now spelt out the meaning of the term as defined by Wikipedia. You are quite right that a dentist is a primary care provider: people go to a dentist when they have symptoms affecting their mouth in general — more often their teeth and gums in particular. They know that’s what dentists deal with. A general practitioner is a primary care provider: people go to a GP when they have symptoms anywhere. They know that’s what GPs deal with. A chiropractor is indeed a primary care provider: of chiropractic. ”
I think that primary care physicians are doctors who are capable of handling everything or at least most of what primary care may present to them. Chiros do not fulfil this criterion, I think.
I would be interested what you feel on this important issue.
The Independent asked me yesterday to write a 500-word piece on homeopathy. I accepted with pleasure. About two hours after I had sent it, my article appeared on their website. As I had not even seen their edited version, I was surprised how much they changed without my permission.
No, I am not cross about this – I know by now how journalists function. Yet I think that some of their changes did change my meaning, and therefore I have decided to post here the original. Since I did not get paid nor sign a copyright transfer, I think I am perfectly entitled to do that.
HERE IT IS
Time to get real about homeopathy
EDZARD ERNST, EMERITUS PROFESSOR, UNIVERSITY OF EXETER
The National Health and Medical Research Council of Australia recently published what might be the most thorough evaluation of homeopathy in the 200-year long history of this therapy. They assessed a total of 57 systematic reviews summarizing 176 individual clinical trials focused on 68 different conditions. They concluded that, firstly, there is no evidence that homeopathy works better than placebo, and, secondly, that patients may harm themselves, if they nevertheless employ homeopathy instead of effective therapies. Already in 2002, on the basis of a similar but less comprehensive analysis, I concluded that “the best clinical evidence for homeopathy available to date does not warrant positive recommendations for its use in clinical practice” [http://www.ncbi.nlm.nih.gov/pubmed/12492603]. Yet homeopaths around the world seemed shocked by this news and are now on the war-path to rubbish or suppress it.
This reaction is as surprising as it is ridiculous. The conclusion that highly diluted homeopathic remedies are pure placebos had already been derived from the utter implausibility of Hahnemann’s theories that like cures like and that diluting a remedy would render it not weaker but stronger. Oliver Wendell Holmes, for instance, famously wrote in 1842 that homeopathy is “a mingled mass of perverse ingenuity, of tinsel erudition, of imbecile credulity, and of artful misinterpretation, too often mingled in practice…with heartless and shameless imposition.”
Homeopaths, however, claimed for the last 200 years that science was not yet able to explain how homeopathy works, in other words, that homeopaths are ahead of their time. The fact, however, is that scientists have always been perfectly able to affirm that there cannot be an explanation for homeopathy that does not fly in the face of science.
“The proof is in the pudding”, homeopaths countered, “if patients benefit from homeopathy, it works regardless what the science tells us!” This argument too has long been shown to be based on little more than the delusion of homeopaths. Patients benefit from the therapeutic encounter, from the placebo-effect and from other phenomena that are unrelated to the sugar pills dished out by homeopaths. To convey such benefits to their patients, clinicians do not need placebos. Administering truly effective treatments with compassion will make them benefit from both the specific and the non-specific effects of the therapy in question. This means that just using placebos like homeopathics is unethical and amounts to cheating the patient.
Given the overwhelming evidence against homeopathy it seems now time to act. There is no reason any longer for consumers, patients, politicians, journalists etc. to believe in homeopathy. Pretending there is room for a legitimate debate is merely misleading the public. There is also no reason to have homeopathy on the NHS, to pay for homeopathic hospitals or to invest into further research. After researching the subject for more than two decades, I am convinced that the only legitimate place for homeopathy is in the history books.
Germany is, as we all know, the home of homeopathy. Here it has an unbroken popularity, plenty of high level support and embarrassingly little opposition. The argument that homeopathy has repeatedly been shown to merely rely on placebo effects seems to count for nothing in Germany.
Perhaps this is going to change now. On January 30, a group of experts from all walks of life have met in Freiburg to discuss ways of informing the public responsibly and countering the plethora of misinformation that Germans are regularly exposed to on the subject of homeopathy. They founded the ‘Information Network Homeopathy’ and decided on a range of actions.
No doubt, some will ask where does their financial support come from? And no doubt, some will claim that we are on the payroll of ‘Big Pharma’. The truth is that we have no funding; everyone gives his/her own time free of charge and pays for his/her own expenses etc. And why? Because we believe in progress and feel strongly that it is time to improve healthcare by relegating homeopathy to the history books.
One of the first fruits of the network’s endeavours is the ‘Freiburger Erklärung zur Homöopathie’, the ‘Freiburg Declaration on Homeopathy’. I have the permission to reproduce the document here in full (the translation is mine):
HOMEOPATHY IS NEITHER NATUROPATHY NOR MEDICINE
Despite the support of politicians and the silence of those who should know better, homeopathy has remained a method which is in clear opposition to the proven basics of science. The members and supporter of the ‘Information Network Homeopathy’ view homeopathy as a stubbornly surviving belief system, which cannot be accepted as part of naturopathy nor medicine. The information network is an association of physicians, pharmacists, veterinarians, biologists, scientists and other critics of homeopathy who are united in their aim to disclose this fact more openly and make the public more aware of it.
NO SPECIAL STATUS FOR HOMEOPATHY
During the more than 200 years of its existence, homeopathy has not managed to demonstrate its specific effectiveness. Homeopathy only survives because it has been granted special status in the German healthcare system which is, in the opinion of the experts of the network, unjustified. Drugs have to prove their effectiveness according to objective criteria, but homeopathics are exempt from this obligation. We oppose such double standards in medicine.
Homeopathy has also not managed to demonstrate a plausible mode of action. Instead its proponents pretend that there are uncertainties which need to be clarified. We oppose such notions vehemently. Homeopathy is not an unconventional method that requires further scientific study. Its basis consists of long disproven theories such as the ‘law of similars’, ‘vital force’ or ‘potentisation by dilution’.
SELF-DECEPTION OF PATIENT AND THERAPIST
We do not dispute the therapeutic effects of a homeopathic treatment. But they are unrelated to the specific homeopathic remedy. The perceived effectiveness of homeopathics is due to suggestion and auto-suggestion of the patient and the therapist. The mechanisms of such (self-) deceit are multi-fold but well-known and researched. Symptomatic improvements caused by context-effects must not be causally associated with the homeopathic remedy. We assume that many physicians and alternative practitioners using homeopathy are unaware of the existence and multitude of such mechanisms and are acting in good faith. This, however, does not alter the fact that their conclusions are wrong and thus potentially harmful.
MEDICINE AND SCIENCE
We do not claim that the scientific method which we uphold can currently research and explain everything. However, it enables us to explain that homeopathy cannot explain itself. The scientific method shows the best way we have for differentiating effective from ineffective treatments. A popular belief in therapeutic claims nourished by politicians and journalists can never be a guide for medical activities.
AIM OF THIS DECLARATION
Our criticism is not aimed at needy patients or practising homeopathic clinicians; it is aimed at the school of homeopathy and the healthcare institutions which could have long recognised the nonsensical nature of homeopathy, but have chosen not to interfere. We ask the players within our science-based healthcare system to finally reject homeopathy and other pseudoscientific methods and to return to what should be self-evident: scientifically validated, fair and generally reproducible rules promoting top-quality medicine for he benefit of the patient.
Dr.-Ing. Norbert Aust, Initiator Informationsnetzwerk Homöopathie
Dr. med. Natalie Grams, Leiterin Informationsnetzwerk Homöopathie
Amardeo Sarma, GWUP Vorsitzender und Fellow von CSI (Committee for Skeptical Inquiry)
Edzard Ernst, Emeritus Professor, Universität Exeter, UK
Prof. Dr. Rudolf Happle, Verfasser der Marburger Erklärung zur Homöopathie
Prof. Dr. Wolfgang Hell, Vorsitzender des Wissenschaftsrates der GWUP
Prof. Norbert Schmacke, Institut für Public Health und Pflegeforschung, Universität Bremen
Dr. rer. nat. Christian Weymayr, freier Medizinjournalist
On his website, Christopher Kent describes himself as a chiropractor and an attorney. He is the owner of On Purpose, LLC, and the president of the ‘Foundation for Vertebral Subluxation’. This organisation states on their website the following:
The chiropractic profession is in the midst of deep and serious changes. These changes are taking place in the larger context of health care and an even larger socio-cultural worldview that is not necessarily congruent with the founding principles and tenets of the chiropractic profession. In other cases some of the original premises of the chiropractic profession are being co-opted by others as they come to see the value in the niche that chiropractic has carved out for itself. During this tumultuous time it is ever more important that the profession hold fast to its unique and distinguishing features for these are all we really have claim to. Beyond holding ground already gained there is a sense of urgency that the profession must seriously advance itself in the area of vertebral subluxation. The identification and care for this pathophysiological process is uniquely chiropractic and through research, education, policy and service we must ensure that we remain at the forefront of its elucidation. Through research, science, education, policy and service the mission of the Foundation is to advocate for and advance the founding principles and tenets of the chiropractic profession in the area of vertebral subluxation. A sick and suffering humanity needs us and we need you to join us on this mission.
A 1973 graduate of Palmer College of Chiropractic, Kent is also a Diplomate and Fellow of the ICA College of Chiropractic Imaging. Dr. Kent, as he likes to call himself, is known within the chiropractic profession for his dedication to integrating the science, art, and philosophy of chiropractic for doctors and students of chiropractic. He was awarded Life University’s first Lifetime Achievement Award in 2007. Dr. Kent is former chair of the United Nations NGO Health Committee, the first chiropractor elected to that office.
It is easy to see that Kent one of the most rampant subluxationist one is likely to come across. He is alarmed by any fellow chiro who might be in the slightest critical about subluxation. On his blog, he writes about THE CANCER OF SUBLUXATION DENIALISM:
A position paper has been produced by a group of six European chiropractic programs which states, in part: “The teaching of vertebral subluxation complex as a vitalistic construct that claims that it is the cause of disease is unsupported by evidence. Its inclusion in a modern chiropractic curriculum in anything other than an historical context is therefore inappropriate and unnecessary.” This follows a similar statement issued by the General Chiropractic Council on the United Kingdom. Both statements are the latest manifestations of a growing movement of subluxation denialism. Logical fallacies and inherent contradictions are the currency used to propagate these positions… A disturbing trend is the willingness of some chiropractic academicians and researchers to abandon chiropractic terminology as well as chiropractic analytical strategies… One example is the suggestion that the terms vertebral subluxation, joint fixation, joint dysfunction are interchangeable. They are not the same thing. There are significant operational and epistemological differences. Implicit in the term vertebral subluxation are both biomechanical and neurological elements. Vertebral subluxation is a relational neurological process that impacts the human experience, not merely a fixated joint. A fixated or tender joint might represent one manifestation of vertebral subluxation, not a synonym for vertebral subluxation. The notion that they are the same leads to confusion and ambiguity—a denialist’s best friends. Research designs based upon the haphazard application of ill-defined interventions selected by utilizing examination procedures whose reliability has not been established cannot be considered “scientific.” What fruit has been borne by the allopathic research programs currently underway? The aberrant perception by students and some chiropractors that chiropractic is a subset of medicine, and that adjusting is a subset of manipulation? The perception that chiropractic care is temporary analgesia at best, and placebo therapy at worst? A pernicious consequence of failing to use chiropractic terms, such as subluxation and adjustment in article titles, abstracts, and key words is that when a scholar, journalist, researcher, or lay person searches databases for these words, the papers purporting to support subluxation will not show up as “hits.” One researcher has stated that she uses terms such as manipulation and joint fixation because subluxation and adjustment are not MESH terms. Therefore, some purportedly “high impact” journals will not allow them as key words. The fix is simple: include them in the title and abstract. Failure to do so will result in “no impact” when the papers cannot be found when searching using chiropractic terms. Rest assured denialists know this. Search PubMed using the terms “chiropractic” and “subluxation.” Up will pop denialist opinion pieces. Conspicuously absent will be papers purportedly supportive of subluxation, but use terms such as manipulation or joint fixation. The value of chiropractic research lies in its potential to improve our clinical strategies, and to provide us with a scientifically sound basis for making claims to the public and the scientific community. We cannot dismiss meaningful differences in culture and objectives as “just words.”
On this blog and elsewhere, people have been pointing out that
- subluxation is at the heart of chiropractic ‘philosophy’,
- subluxation, as understood in the realm of chiropractic, is a myth,
- yet it has kept chiropractors in clover from the day DD Palmer allegedly cured his janitor of his deafness,
- since several years, some rationalists within the chiropractic profession have started working towards abandoning this term and the concept behind it,
- in recent months, these efforts have yielded some limited success,
- one could therefore hope that progress is taking hold and the chiropractic profession might finally stop adhering to myths.
Reading what Kent and the many like-minded chiropractors have to say about these issues makes me less hopeful. Progress, it seems, is in the way of a healthy cash-flow, and therefore it must be vilified. A cult can tolerate neither criticism nor the progress that might come from it.
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.