risk
The SPECTATOR recently published an article about the World Health Organisation’s (WHO) tendency to push so-called alternative medicine (SCAM). Here are a few excerpts from it: 
World Health Organisation (WHO) is meant to implore us to ignore hearsay and folklore, and to follow the scientific evidence. So why is it now suddenly promoting the likes of herbal medicine, homeopathy and acupuncture? In a series of tweets this week, the WHO has launched a campaign to extol the virtues of what it calls ‘traditional medicine’. ‘Traditional medicine has been at the frontiers of medicine and science, laying the foundation of conventional medical texts’, it asserts. It goes on to claim that ‘around 40 per cent of approved pharmaceutical products in use today derive from natural substances’ … it then poses the question: ‘which of these have you used: “acupuncture, Ayurveda, herbal medicine, homeopathy, naturopathy, osteopathy, traditional Chinese medicine, unani medicine?”’
… That some folk medicines might sometimes appear to work – in spite of apparently having no active ingredients – is itself explained by scientific inquiry: there is a proven ‘placebo effect’ that causes people to report an improvement in their symptoms as a result of taking something that they think will make them better.
The WHO should be having nothing to do with promoting any medicine which has not been proven without rigorous trials. So why is it suddenly pushing all kinds of dubious cures? It is hard not to see the latest campaign as part of the fashionable campaign to ‘decolonise’ medicine – which means refusing to see western science as superior to belief systems that have derived from elsewhere in the world. The WHO published a podcast on this subject in May, in which a Canadian medical historian, for example, denounced the concept of ‘tropical’ medicine as a construct by colonial powers to try to promote the false idea that the Third World presented a danger to Europe. …
… the WHO has achieved a massive amount by unashamedly exporting rigorous scientific inquiry to parts of the world which it had yet to reach. It wasn’t folk medicine that eradicated smallpox; it was western medicine, and the WHO should not be apologising for that. Promoting quackery seems an odd – and potentially disastrous – direction for the organisation to take.
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Personally, I concur fully – except for the notion that the WHO started its SCAM-promotion only recently. The truth is that it has done so since many years, and since many years we have on this blog discussed this bizarre trend. In my view, it is a relfection not of the science but of the politics that inflence the WHO to a very large extend in the realm of SCAM.
Vaccine hesitancy has become a threat to public health, especially as it is a phenomenon that has also been observed among healthcare professionals. In this study, an international team of researchers analyzed the relationship between endorsement of so-called alternative medicine (SCAM) and vaccination attitudes and behaviors among healthcare professionals, using a cross-sectional sample of physicians with vaccination responsibilities from four European countries: Germany, Finland, Portugal, and France (total N = 2,787).
The results suggest that, in all the participating countries, SCAM endorsement is associated with lower frequency of vaccine recommendation, lower self-vaccination rates, and being more open to patients delaying vaccination, with these relationships being mediated by distrust in vaccines. A latent profile analysis revealed that a profile characterized by higher-than-average SCAM endorsement and lower-than-average confidence and recommendation of vaccines occurs, to some degree, among 19% of the total sample, although these percentages varied from one country to another: 23.72% in Germany, 17.83% in France, 9.77% in Finland, and 5.86% in Portugal.
The authors concluded that these results constitute a call to consider health care professionals’ attitudes toward SCAM as a factor that could hinder the implementation of immunization campaigns.
In my view, this is a very important paper. It shows what we on this blog have discussed often before: there is an association between SCAM and vaccination hesitancy. The big question is: what is the nature of this association. There are several possibilities:
- It could be coincidental. I think this is most unlikely; too many entirely different investigations have shown a link.
- It could mean that people start endorsing SCAM because they are critical about vaccination.
- It could be that people are critical about vaccination because they are proponents of SCAM.
- Finally, it could be that some people have a mind-set that renders them simultaneously hesitant about vaccination and fans of SCAM.
This study, like most of the other investigationson this subject, was not desighned to find out which possibility is most likely. I suspect that the latter two explanations apply both to some extend. The authors of this study argue that that, “from a theoretical point of view, this situation may be explicable by reasons that are both implicit (i.e., CAM would fit better with certain worldviews and ideological standpoints that conflict with the epistemology and values that underlies scientific knowledge) and explicit (i.e., some CAM techniques are doctrinally opposed to the use of vaccines). Although we have outlined these potential explanations for the observed relationships, more research is needed to better understand the underlying mechanisms”.
I like skeptics; they have taught me a lot, and I am thankful for it.
At the same time, they occasionally irritate me when they comment on so-called alternative medicine (SCAM).
Why? Because, when they comment on SCAM, they are not rarely wrong or at least not quite correct.
I am referring to the typical scenario where a skeptic discusses a form of SCAM and explains that there is no evidence on it. Such statements are almost invariably false. There is evidence on almost all forms of SCAM; it may not be positive but it exists. To make statements to the contrary is demonstrably wrong.
Let’s assume that a skeptic discusses CUPPING (I am referring to an actual video that I recently watched). He explains its history, how it’s done, that there is no plausible mode of action, and that there is NO evidence on it.
This is not correct!
In fact, there is a substantial body of evidence in terms of clinical trials and even systematic reviews (if you search this blog, you will find quite a bit; if you go on Medline, you’ll find even more). And there is some evidence about cupping’s possible mode of action.
Don’t get me wrong:
- I am not a fan of cupping,
- in fact, cupping is merely an example – I could have chosen almost any other SCAM,
- I am certainly not defending therapists who practice cupping,
- the evidence is far from convincing.
All that I am trying to say is this:
When you comment on a SCAM (or anything else), it is worth checking the evidence. More often than not, you will then find that there is quite a lot of evidence. You might conclude that:
- the evidence is poor quality,
- the evidence is negative,
- the evidence is suspect,
- etc., etc.
So, please comment accordingly. Just saying THERE IS NO EVIDENCE is not just wrong, it is irritating, because it gives the SCAM promoters the occasion to rightly point out that skeptics are just badly informed. And that surely is worth preventing!
This systematic review with meta-analysis of randomized clinical trials (RCTs) estimated the benefits and harms of cervical spinal manipulative therapy (SMT) for treating neck pain. The authors searched the MEDLINE, Cochrane CENTRAL, EMBASE, CINAHL, PEDro, Chiropractic Literature Index bibliographic databases, and grey literature sources, up to June 6, 2022.
RCTs evaluating SMT compared to guideline-recommended and non-recommended interventions, sham SMT, and no intervention for adults with neck pain were eligible. Pre-specified outcomes included pain, range of motion, disability, health-related quality of life.
A total of 28 RCTs could be included. There was very low to low certainty evidence that SMT was more effective than recommended interventions for improving pain at short-term (standardized mean difference [SMD] 0.66; confidence interval [CI] 0.35 to 0.97) and long-term (SMD 0.73; CI 0.31 to 1.16), and for reducing disability at short-term (SMD 0.95; CI 0.48 to 1.42) and long-term (SMD 0.65; CI 0.23 to 1.06). Only transient side effects were found (e.g., muscle soreness).
The authors concluded that there was very low certainty evidence supporting cervical SMT as an intervention to reduce pain and improve disability in people with neck pain.
Harms cannot be adequately investigated on the basis of RCT data. Firstly, because much larger sample sizes would be required for this purpose. Secondly, RCTs of spinal manipulation very often omit reporting adverse effects (as discussed repeatedly on this bolg). If we extend our searches beyond RCTs, we find many cases of serious harm caused by neck manipulations (also as discussed repeatedly on this bolg). Therefore, the conclusion of this review should be corrected:
Low certainty evidence exists supporting cervical SMT as an intervention to reduce pain and improve disability in people with neck pain. The evidence of harm is, however, substantial. It follows that the risk/benefit ratio is not positive. Cervical SMT should therefore be discouraged.
This article entitled: Keeping Medical Science Trustworthy: The Threat by Predatory Journals caught my attention.
Many scientific journals have started to ask article processes costs from authors. This development has created a new category of journals of which the business model is totally or predominantly based on financial contributions by its authors. Such journals have become known as predatory journals. The financial contributions that they ask are not necessarily lower than those asked by high-quality journals although they offer less:
- there is commonly no real review,
- texts are not edited,
- there are commonly no printed editions.
The lack of serious reviews might make predatory journals attractive particularly to authors of low-quality (or even fraudulent) manuscripts.
The authors of this paper suggest that numerous journals, some of which may predatory, attract manuscripts by approaching authors of articles in high-quality journals. They conclude that publication of articles in such journals contaminates the medical literature and undermines the trustworthiness of science and medicine. Any involvement in such journals (as an author, reviewer or editor) should therefore be discouraged.
The ironic thing here is that the paper was published by a journal that itelf is, in my view, borderline, to say the least. But let me nonetheless contribute a recent, personal experience on this issue.
About 2 weeks ago, I received an invitation to join the editorial board of a general medicine journal that I had never heard of. I looked it up and found that it had a decent impact factor and a long list of international members of the board. But then I found that the journal charged around $ 1 500 for each submission. I was told that this is to cover the cost of the review process.
I then decided to write to the editor thanking her for the kind invitation. I also asked her how much the journal would pay its reviewers for reviewing submissions. I received a polite answer explaining that the amount was $ 00.00. My response was to politely decline the invitation to join the editorial board and to urge the journal editor to make it clear from the outset that the fees charged to authors did NOT go to the reviewers.For many years now, I have taken a very dim view on predatory journals. Sadly, in the realm of so-called alternative medicine (SCAM), there currently are dozens of such publications. I believe their danger in polluting the medical literature is hard to over-estimate. I think they ought to be stopped. One way of doing this is refusing to co-operate with them in any way.
The increasing demand for fertility treatments has led to the rise of private clinics offering so-called alternative medicine (SCAM) treatments. Even King Charles has recently joined in with this situalion. One of the most frequently offered SCAM infertility treatment is acupuncture. However, there is no good evidence to support the effectiveness of acupuncture in treating infertility.
This study evaluated the scope of information provided by SCAM fertility clinics in the UK. A content analysis was conducted on 200 websites of SCAM fertility clinics in the UK that offer acupuncture as a treatment for infertility. Of the 48 clinics that met the eligibility criteria, the majority of the websites did not provide sufficient information on:
- the efficacy,
- the risks,
- the success rates
of acupuncture for infertility.
The authors concluded that this situation has the potential to infringe on patient autonomy, provide false hope and reduce the chances of pregnancy ever being achieved as fertility declines during the time course of ineffective acupuncture treatment.
The authors are keen to point out that their investigation has certain limitations. The study only analysed the information provided on the clinics’ websites and did not assess the quality of the treatment provided by the clinics.
Therefore, the study’s fndings cannot be generalized to the quality of the acupuncture treatment provided by the clinics.
Nonetheless the paper touches on very important issues: far too many health clinics that offer SCAM for this or that indication operate way outside the ethically (and legally) acceptable norm. They advertise their services without making it clear that they are neither effective nor safe. Desperate consumers thus fall for their promises. In the case of infertility, this might result merely in frustration and loss of (often substantial amounts of) money. In the case of serious disease, such as cancer, this often results in premature death.
It is time, I think, that this entire sector is regualted in a way that it does not endanger the well-being, health, or life of consumers.
Spiritual healing has been defined as the direct interaction between one individual (the healer) and a patient, with the intention of improving the patient’s condition or curing the illness. Treatment can occur through personal, direct contact between healer and patient or at a (sometimes large) distance. Spiritual healers, who are usually not medically qualified, believe that the therapeutic effect results from the channelling of ‘energy’ from an undefined source via the healer to the patient. The main problem with this concept is that there is no evidence that this energy actually exists. Therefore, the assumptions on which spiritual healing is based lack plausibility.
The central claim of healers is that they promote or facilitate self-healing and wellbeing, both of which could be relevant to patients with any type of condition. An article by enthusiasts of spiritual healing explains: “All conditions can be treated by spiritual healing—but not all people. Some people are more receptive than others to this treatment, due to a number of factors such as karma and mental outlook. As such the results of healing can vary a great deal. If the patient has faith in the technique and the healer, this will of course aid the healing process, but is not necessary; this is not faith healing as practiced in some religions—it is based instead on spiritual energy. This being the case, it is possible for a skeptic to receive healing and benefit from it.”
The evidence from clinical trials of spiritual healing is contradictory. Many studies have serious flaws, and the most reliable trials fail to show effects beyond placebo. Research papers often fail to differentiate between different types of paranormal healing. One Cochrane, for instance, review “found inconclusive evidence that interventions with spiritual or religious components for adults in the terminal phase of a disease may or may not enhance well-being. Such interventions are under-evaluated. All five studies identified were undertaken in the same country, and in the multi-disciplinary palliative care interventions it is unclear if all participants received support from a chaplain or a spiritual counsellor. Moreover, it is unclear in all the studies whether the participants in the comparative groups received spiritual or religious support, or both, as part of routine care or from elsewhere. The paucity of quality research indicates a need for more rigorous studies.”
Many people believe that spiritual healing is harmless. Sadly, this is not the case. The BBC’s ‘Women’s Hour’ reported on 9 August this year about serious abuses of spiritual healers. Here you can find the published test of the broadcast:
Spiritual healing is extremely popular in many countries in the Middle East and North Africa. But the practice is unregulated and that means women are vulnerable to sexual exploitation. An investigation by BBC News Arabic has uncovered allegations of widespread sexual abuse by healers in Sudan and Morocco. Clare McDonnell is joined by the BBC’s Hanan Razek and Senior Women’s Rights Researcher at Human Rights Watch, Rothna Begum, to discuss.
And here you can listen to the actual broadcast. Briefly, what it reveales is deeply shocking:
- Spiritual healing is extremely popular in Sudan and Morocco.
- Healers charge hefty sums and healing is big business.
- Anyone regardless of background or training can call themselves a healer.
- There is no regulation whatsoever.
- Healers claim to cure illnesses, expell evil spirits, help with emotional problems, etc.
- For the programme, the BBC asked 80 women who had received healing.
- They accused 60 different healers of sexual transgression, including rape.
- Undercover recording revealed a healer placing his hand on a woman’s abdomen and then putting a finger “all the way down”.
- The police refuses to investigate if a women complains.
- The authorities refuse to take notice of the problem.
- A minister was quoted stating that there is no need for regulation.
- Another one said that the political athmosphere is not allowing to investigate the issue.
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The references for the evidence cited above can be found here.
This short news report appeared on X [formerly Twitter]:
The Ohio State Medical Board just approved the indefinite suspension Dr. Sherri Tenpenny’s medical license, an osteopathic physician and longtime figure in the anti-vaccine movement. The board got around 350 complaints into her behavior, but that’s not why she’s being suspended.
As this could easily be unreliable, I looked for confirmations … and found several, for instance, this one:
An Ohio physician who sparked widespread ridicule in 2021 after spreading bizarre COVID-19 vaccine conspiracies to the House Health Committee by claiming the jabs magnetize their hosts and “interface” with cell towers had her medical license indefinitely suspended Wednesday. Anti-vaccine spreader Sherri Tenpenny sparked a firestorm in June, 2021 after making the comments, which saw 350 complaints sent to the State Medical Board. According to Cleveland.com, the board’s decision was not based on the comments, rather on procedural grounds, citing Tenpenny’s refusal to cooperate with investigators during the inquiry. “Dr. Tenpenny, neither you nor any doctor licensed by this board is above the law, and you must comply with the investigation,” said Dr. Jonathan Feibel, an orthopedic surgeon and medical board member, according to the outlet. “You have not done so, and therefore, until you do, your license will be suspended.” A lawyer for Tenpenny, Tom Renz, described the investigation as a form of “harassment” on her “free speech rights.” Tenpenny did not speak after the announcement, however Renz declared, “This appears very much like a lynch mob.”
Who is Sherry Tenpenny? Here is what Wiki tells us about her:
Sherri J. Tenpenny is an American anti-vaccination activist and conspiracy theorist who promulgates the disproven hypothesis that vaccines cause autism.[1] An osteopathic physician, she is the author of four books opposing vaccination. A 2015 lecture tour of Australia was canceled due to a public outcry over her views on vaccination, which oppose established scientific consensus. A 2021 Center for Countering Digital Hate analysis concluded that Tenpenny is among the top twelve people spreading COVID-19 misinformation and pseudoscientific anti-vaccine misinformation on social media platforms. She has falsely asserted that the vaccines magnetize people and connect them with cellphone towers…
The story is puzzling, in my view. The biggest question for me is this:
Why only now?
She should have been suspended years ago!
Online misinformation is disproportionality created and spread by people with extreme political attitudes, especially among the far-right. There is a debate in the literature about why people spread misinformation and what should be done about it. According to the purely cognitive account, people largely spread misinformation because they are lazy, not biased. According to a motivational account, people are also motivated to believe and spread misinformation for ideological and partisan reasons. To better understand the psychological and neurocognitive processes that underlie misinformation sharing among the far-right, an international team of researchers conducted a cross-cultural experiment with conservatives and far-right partisans in the Unites States and Spain (N = 1,609) and a neuroimaging study with far-right partisans in Spain (N = 36).
Far-right partisans in Spain and U.S. Republicans who highly identify with Trump were more likely to share misinformation than center-right voters and other Republicans, especially when the misinformation was related to sacred values (e.g., immigration). Sacred values predicted misinformation sharing above and beyond familiarity, attitude strength, and salience of the issue. Moreover, far-right partisans were unresponsive to fact-checking and accuracy nudges. At a neural level, this group showed increased activity in brain regions implicated in mentalizing and norm compliance in response to posts with sacred values.
The authors concluded that these results suggest that the two components of political devotion – identity fusion and sacred values – play a key role in misinformation sharing, highlighting the identity-affirming dimension of misinformation sharing. We discuss the need for motivational and identity-based interventions to help curb misinformation for high-risk partisan groups.
People who have followed the discussions on this blog closely could be forgiven in assuming that right-wing political devotion also plays an important role in spreading misinformation about healthcare (e.g. vaccination) and so-called alternative medicine (SCAM). It would be good, if someone could test this hypothesis more directly.
PS
Just as I had finished writing this post, I came across a quote given yesterday by Ben Habib on GBN:
“I’m very reluctant to put my destiny in the hands of scientists. You know, unbridled authority given to faux knowledge.”
QED
We discussed the 2015 Australian NHMRC report on homeopathy many times before, e.g.:
- Homeopathy: the 2015 NHMRC report and its criticism re-analysed
- HOMEOPATHY: the NHMRC report revisited
- Ombudsman investigates ‘flawed’ homeopathic study
- The final verdict on homeopathy: it’s a placebo
In a nutshell, the report was an hugely influential analysis of the effectiveness of homeopathy which came to squarely negative conclusions. Thus it was celebrated as a thorough and conclusive piece evidence demonstrating the madness of homeopathy. Unsurprisingly, homeopaths did not like it at all and produced various criticisms claiming that it was neither thorough nor conclusive.
Now the final evaluation of what has been going on was finally published (ISSUED BY THE COMMONWEALTH OMBUDSMAN, IAIN ANDERSON, ON 4 AUGUST 2023):
The Office of the Commonwealth Ombudsman (the Office) has finalised an investigation relating to the National Health and Medical Research Council’s (NHMRC) review of the evidence for the effectiveness of homeopathy, conducted between 2010 and 2015. We commenced this investigation in September 2017 in response to concerns raised with us about how the NHMRC review had proceeded.
The Office conducts its investigations in private, and the Ombudsman generally does not make a public statement in the absence of a formal report. In the circumstances of this matter, including that the then-Ombudsman released a public statement on 4 June 2021 which acknowledged the Office was investigating, we believe it is important to share publicly the information we can, now that the investigation is complete.
Our investigation was finalised in July 2023. We acknowledge the length of time the investigation has taken. This is in part due to the extensive efforts the Office made to source independent scientific expertise to advise us on some detailed and specific questions of scientific methodology that were raised with our Office, including some that were only brought to our attention as our investigation progressed. Despite our best efforts, it was not possible to engage an expert (or experts) to provide independent advice to our Office on this subject. In the absence of independent, expert scientific expertise we have not been able to conclusively determine those matters of scientific methodology. This did not prevent our Office from forming a view on other aspects of the matter.
Our investigation did not result in any adverse findings about the review or the NHMRC. When finalising investigations, we may offer comments and suggestions to an agency about areas for future improvement. In this instance, we offered comments and suggestions to the NHMRC about how it records and publicly explains decisions about its activities. The NHMRC also independently made several improvements to its processes during the course of our investigation.
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In essence, this means that the conclusions of the report stand:
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.
Thus the matter is closed – that is closed for rational thinkers. For irrationalists, the matter will no doubt continue to be a stone of contention. No, homeopath will be able to accept these conclusions simply because a member of a cult ceases to be a cultist once he/she accepts the criticism agaist the cult.
