Edzard Ernst

MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Politeness means showing consideration for others and observing accepted social rules. Those who know me personally would probably confirm that I am a fairly polite person. And I had always hoped that politeness might also become a feature of how all of us deal with each other on this blog. Sadly this has not proven to be so.

Don’t get me wrong, I am not trying to say that I am blameless. Firstly I see all the comments before they get posted, and secondly I too have been rather the opposite of polite at times. How come?

My excuse is that I too often let myself get carried away. From my perspective, the typical exchange ending in impoliteness develops as follows:

  1. My post is formulated such that it provokes some strong reaction. I know, I do this all the time, and I cannot promise that I will not do it in the future. This is because I believe – and experience tells me that I am correct – that one has to provoke in order to get some reaction.
  2. The person I provoked posts a comment that challenges me or someone else to respond. The nature of the comment is often such that it comes close to a personal attack. For instance, someone might state that I was fired from my Exeter post, that I am paid by the pharmaceutical industry, that I don’t know my subject, etc.
  3. Often, I do not respond at all to this sort of thing. But sometimes I conclude that facts need to be corrected, and regrettably, I correct them with more provocation.
  4. This then gets up the nose of the commenter and he or she feels hurt and points out that the discourse has become less than polite – which, of course, is correct.

This is not to excuse anyone or anything; it is just to show how things happen.

The way I see it, there is a bit of a conundrum here: if I write a post without any provocation [which I have done often], there will be no feedback or comments at all [which also happens occasionally]. If I use the method of deliberately provoking people, things can easily escalate. The secret is obviously to get the dose right.

So, when I get it wrong, do blame me!

Politeness is undoubtedly desirable and we should all aim to be polite on this blog and elsewhere. At the same time, we should remember that politeness is not a virtue; it is simply following rules without requiring any moral judgment. Politeness is an artifice. The essence of politeness is form; the essence of virtue is character. A polite bastard is still a bastard! And an impolite man of virtue is still a man of virtue.

Impoliteness may be hurtful but the truth is sometimes hurtful too. And there is a danger in going too far in both directions; exaggerated politeness is close to insincerity. If it were a choice between politeness and truth, I would always opt for the latter.

But luckily this is rarely the case; one can usually have both!

Why am I rambling on about such an issue? Because I want to appeal to all who write and comment here – not least myself – that politeness is a very good thing and enables a better exchange than we sometimes had on this blog. So, lets not escalate things again, let’s understand little provocations for what they are meant to be: a stimulus to have an open, challenging but nevertheless polite debate.

Nobody can doubt that, during the last 200 years, conventional medicine has made monumental progress. Homeopathy, however, has remained more or less like Hahnemann invented it. But now it seems as though homeopathy can celebrate an unprecedented step ahead. As so often in medicine, it originates from a commercial enterprise.

Genexa is a US firm that produces natural health products. On their website, they state that “At Genexa, we believe medicine should be free from unhealthy fillers and toxins”. They recently published a press-release introducing a line of homeopathic medicines certified organic by the U.S. Department of Agriculture and Non-GMO Project verified. They are keen to point out that these products “do not contain any genetically modified ingredients.” In fact, several of their remedies do not contain any active ingredients to speak of: they are homeopathic!

“We are extremely proud of our organic and non-GMO certifications – the seals are prominently featured on all our products and website for easy label reading and patient education,” stated David Johnson, CEO of Genexa, in their press-release. “Our quality standards are among the highest in the over-the-counter medicine industry.”

Genexa’s 11 homeopathic formulations are being advertised for the treatment of common health issues such as flu, cold, allergies, stress, pain, leg cramps, sleeplessness and jet lag. An entire line of products is, according to the press-release, specially formulated for children and includes treatments for cold, allergy and calming.

Genexa’s CMO proudly announced that “It’s important to us that our retail customers feel confident in the products and know they can trust they are purchasing medicines free from unhealthy fillers and toxins and simply focus on healing.” Presumably that trust must include the trust into the efficacy of the homeopathic remedies! Yes, I am pleased to report that, apparently it does; elsewhere they confirm this by stating that “Genexa holds itself to the highest standards in both quality and ethics.” The highest standards of ethics surely include that the remedies in question are demonstrably efficacious.

But how can we be sure? Are any of these homeopathic remedies supported by reasonably strong evidence? Oddly enough, despite all these affirmations, I did get my doubts when I tried to dig a bit deeper.

Take the homeopathic remedy called SLEEPOLOGY, for instance. The website informs us that “This homeopathic formulation consists of nine leading remedies designed to treat sleeplessness, inability to fall asleep, frequent waking, restless sleep and sleeplessness from stress, exhaustion, nervousness, excitability, restlessness, worries, irritability, and pain.” So, it’s a complex homeopathic remedy with 9 different ingredients. But is there any evidence of efficacy for this mixture? I am not aware of any clinical trials that have tested its efficacy. But I must be wrong, because on the website we are being told that “Clinical trials have demonstrated efficacy for treating sleeplessness for piper methysticum, and valeriana officinalis.” That may be so, but the trials were done with herbal extracts, not with homeopathic potencies! Could the statement therefore be more than a little misleading?

On the internet, I found all sorts of fascinating bits about the new homeopathic lines (my compliments to the PR firm that organised the launch!); for instance the revelation that: “The company’s proprietary medicines were created by and are regularly reviewed and enhanced by its chief medical officer, Dr. Todd Rowe*, a nationally respected physician with an expertise in homeopathic medicine formulation. Working with the Genexa team, Dr. Rowe and his team of chemists and pharmacists spent hundreds of hours meticulously formulating and testing the products. The result is a line of effective, potent medicines that are certified organic by the USDA and non-GMO verified by the Non-GMO Project. “Our formulations are based on tried and true principles for miasmatic and energetic balance, so that the remedies potentiate each other and promote the most positive patient outcomes,” said Dr. Rowe. “These powerful medicines work with your body to help it heal itself.”” However, I was unable to find out which potencies are being used for the Genexa homeopathic products. This information might not be that relevant: according to the homeopathic ‘like cures like’ principle, the effects of a substance are reversed through potentiation. This is why coffee, for instance, is potentised by homeopath to generate a sleeping remedy. Does it not follow then that, potentising two or more herbal ingredients that have hypnotic effects (as in SLEEPOLOGY), must generate a remedy for preventing sleep? A similarly puzzling lack of ‘homeopathic logic’ seems to apply to several other products in Genexa’s line of homeopathic remedies.

I have to admit, I am confused.

Could it be that the ‘breakthrough’ turns out to be a breakdown of ‘homeopathic logic’?

Let’s hope someone from Genexa reads these lines and can enlighten us.

[*he is the President of the American Medical College of Homeopathy]

It would be easy to continue this series on ‘tricks of the trade’ for quite a while. But this might get boring, and I have therefore decided to call it a day. So here is the last instalment (feel free to post further tricks that you may know of [in the comments section below]):

CRITICS DON’T UNDERSTAND

It is almost inevitable that, sooner or later, someone will object to some aspect of alternative medicine. In all likelihood, his or her arguments are rational and based on evidence. If that happens, the practitioner has several options to save his bacon (and income). One of the easiest and most popular is to claim that “of course, you cannot agree with me because you do not understand!”

The practitioner now needs to explain that, in order to achieve the level of expertise he has acquired, one has to do much more than to rationalise or know about science. In fact, one has to understand the subject on a much deeper level. One has to immerse oneself into it, open one’s mind completely and become a different human being altogether. This cannot be achieved by scientific study alone; it requires years of meditative work. And not everyone has the ability to go down this difficult path. It takes a lot of energy, insight and vision to become a true healer. A true Deepak Chopra is not born but trained through hard work, dedication and concentration.

Critics who disagree are really to be pitied. They fail to exist on quite the same level as those who ‘are in the know’. Therefore one must not get annoyed with those who disagree, they cannot understand because they have not seen the light.

My advice is to start thinking critically and read up about the NO TRUE SCOTSMAN FALLACY; this will quickly enable you to look beyond the charisma of these gurus and expose their charlatanry to the full.

RESEARCH IS BEING SUPRESSED

Some critics stubbornly insist on evidence for the therapeutic claims made by quacks. That attitude can be awkward for the alternative practitioner – because usually there is no good evidence.

Cornered in this way, quacks often come up with a simple but effective conspiracy theory: the research has been done and it has produced fabulous results, but it has been supressed by… well, by whoever comes to mind. Usually BIG PHARMA or ‘the scientific establishment’ have to be dragged out into the frame again.

According to this theory, the pharmaceutical industry (or whoever comes in handy) was so shaken by the findings of the research that they decided to make it disappear. They had no choice, really; the alternative therapy in question was so very effective that it would have put BIG PHARMA straight out of business for ever. As we all know BIG PHARMA to be evil to the core, they had no ethical or moral qualms about committing such a crime to humanity. Profits must come before charity!

My advice is to explain to such charlatans that such conspiracy theories do, in fact, merely prove is that the quack’s treatment is not effective against their prosecution complex.

CRITICS ARE BOUGHT AND CORRUPT

If  critics of alternative medicine become threatening to the quackery trade, an easy and much-used method is to discredit them by spreading lies about them. If the above-mentioned ploy “they cannot understand” fails to silence the nasty critics, the next step must be to claim they are corrupt. Why else would they spend their time exposing quackery?

Many people – alternative practitioners included – can only think of financial motivations; the possibility that someone might do a job for altruistic reasons does not occur to them. Therefore, it sounds most plausible that the critics of alternative medicine are doing it for money – after all, the quacks also quack for money.

My advice to potential users of alternative medicine who are confused by such allegations: do your own research and find out for yourself who is bought by whom and who has a financial interest in quackery selling well.

EVEN NOBEL PRIZE WINNERS AGREE WITH US

It is true, there are some Nobel Prize winners who defend homeopathy or other bogus treatments. Whenever this happens, the apologists of alternative medicine have a field day. They then cite the Nobel laureate ad nauseam and imply that his or her views prove their quackery to be correct.

Little do they know that they are merely milking yet another classical fallacy and that such regrettable events merely demonstrate that even bright people can make mistakes.

My advice is to check what the Nobel laureate actually said – more often than not, it turns out that a much-publicised quote is, in fact, a misquote – and what his or her qualifications are for making such a statement; a Nobel Prize in literature, for instance, is not a sufficient qualification for commenting on healthcare issues.

AS I ALRADY SAID: IF YOU KNOW OF MORE ‘TRICKS OF THE QUACKARY TRADE’, PLEASE POST THEM BELOW.

This series of post is quite good fun – at least for me who is writing it.  But I also hope that it is useful to those readers who are tempted to consult alternative practitioners. My intention is to stimulate people’s ability to think critically and to provide some sort of guide for patients which might help them in deciding which practitioners to avoid.

In this spirit, I now offer you the next instalment of three ‘tricks of the trade’:

 

NATURAL IS GOOD

Everyone working in advertising will confirm: the ‘natural label’ is a great asset for boosting sales of all sorts of things. Practitioners of alternative medicine have long appreciated this fact and exploited it to the best of their abilities. They stress the ‘naturalness’ of their treatments ad nauseam, and more often than not they use the term misleadingly.

For instance, there is nothing natural to thrust a patients spine beyond the physiological range of motion [chiropractic]; there is nothing natural in endlessly diluting and shaking remedies which may or may not have their origin in a natural substance [homeopathy]; there is nothing natural in sticking needles into the skin of patients [acupuncture].

Moreover, the notion of a benign ‘mother nature’ is naïvely misleading. Ask those who have been at sea during a storm or who have been struck by lightning.

My advice is to see through transparent marketing slogans and to tell the anyone who goes on about the ‘naturalness’ of his therapy to buzz off.

ENERGY

When one goes to a meeting of alternative practitioners, the term ‘energy’ is mentioned more often than at a board meeting of EDF. The difference is that the alternative brigade does not mean really energy when they speak of energy; they mean ‘vital force’ or one of the many related terms from other traditions.

Practitioners do prefer to use ‘energy’ because this sounds modern and impressive to many consumers. Crucially, it avoids disclosing how deeply steeped the therapists are in vitalism and vitalistic ideas. Whereas rational thinkers have discarded such concepts more than a century ago, alternative medicine advocates find it hard to do the same – if they did, there would be little else to underpin their various ‘philosophies’.

My advice is to avoid clinicians who are ‘vitalists’ because adhering to long obsolete concepts is a sure sign of dangerous backward thinking.

STIMULATING THE IMMUNE SYSTEM

‘Your immune system need stimulating!’ – how often have we heard that from practitioners of alternative medicine? By contrast, conventional clinicians are most reserved about such aims; they might try to stimulate the immune system in certain, rare circumstances. Quite often they need to achieve the opposite effect and use powerful drugs to suppress the immune system. But even when they aim at stimulating the immune system of a patient, they would not use any of the treatments alternative practitioners swear by.

How come? There are several reasons:

  1. The alternative ‘immune stimulants’ do not really stimulate the immune system.
  2. Stimulating the immune system is rarely a desirable therapeutic aim.
  3. Stimulating a normal immune system is hardly possible.
  4. For many of us, stimulating the immune system might even be a very risky business (if it were at all achievable).

My advice is to ask your practitioner precisely why he wants to stimulate your immune system. If he can give you a good reason, ask him to try stimulating his own immune system first and to show you the proof that his therapy can do such a thing.

In part one and part two of this series of posts, we have discussed altogether six ‘tricks of the trade’:

TREAT A NON-EXISTING CONDITION

MAINTENANCE TREATMENT

IT MUST GET WORSE BEFORE IT GETS BETTER

THINK HOLISTICALLY

IT’S DUE TO THE POISONS YOUR DOCTOR GAVE YOU

A CURE TAKES A LONG TIME

Now it is time to disclose three more.

DETOX

Alternative therapies are hugely diverse, but they nevertheless have a few characteristics in common. One is that many of their practitioners try to persuade their patients that they are being poisoned. This sounds odd, however, it is true.

Most alternative therapists tell their patients sooner or later that they need to ‘detox’ and, as it happens, their type of treatment is ideally suited to achieve this aim. Detox is short for detoxification which, in real medicine, is the term used for weaning addicts off their drugs. In alternative medicine, it is used as a marketing slogan.

Yes, detox, as used in alternative medicine, is nothing but a marketing slogan. I have several reasons for this statement:

  • The poisons in question are never accurately defined. Instead, we hear only vague terminologies such as metabolic waste products or environmental toxins. The reason for that lack of precision is simple: once the poison is named, we could be able to measure it and test the efficacy of the treatment in  question in eliminating it from the body. But this is the last thing these ‘detoxers’ want because we would soon establish how bogus their claims are.
  • None of the alternative therapies claimed to detox our body take any toxin from us; all they do take from us is our cash.
  • Our body has powerful organs and mechanisms to detoxify (skin, lungs, kidneys, liver). These take care of all the toxins we undoubtedly are exposed to. If any of these organs fail, we do not need homeopathic globoli or detoxifying diets, or electric foot baths or any other charlatanry; in this case, we are more likely to need an A&E department’s intensive care.

My advice is, as soon as you hear the word ‘detox’ from a quack, ask for your money back and go home.

THE TEST OF TIME

Another thing that many alternative therapies have in common is their age. They have almost all been around for hundreds, if not thousands of years. To the enthusiasts of alternative medicine, this means that these interventions have ‘stood the test of time’; they argue that acupuncture, for instance, would not be around any more, if it were not effective. They tell their patients, write in books and argue in debates that the age of their therapy is like a badge of approval from millions of people before us, a badge that surely weighs more that modern scientific studies (which tend to cast doubt on the effectiveness of the treatments in question).

This line of thinking has always puzzled me. We are talking of TECHNOLOGIES, health technologies, in fact. Would we argue that a hot air balloon is an older technology that an aeroplane and therefore better suited for transporting people from A to B? The fact that acupuncture was developed thousands of years ago might just mean that it was invented by relatively ignorant people who understood too little about the human body to create a truly effective intervention. And the fact that blood-letting was used for centuries (and thus killed millions), might teach us a lesson about the true value of ‘the test of time’ in medicine.

My advice is to offer leeches, blood-letting and mercury cures to those who try to persuade you that the test of time has meaningful therapeutic implications.

TREATING THE ROOT CAUSE OF THE DISEASE

Alternative practitioners often claim that, in conventional medicine, doctors only treat the symptoms of their patients, whereas they treat the root causes of the illness. I have often wondered where this assumption and the fierce conviction with which it is so often expressed come from. I have to conclude that the explanations are quite simple.

  • This notion is the mantra that is being taught over and over again during the practitioners’ training. It even constitutes a central message of most ‘textbooks’ for the aspiring alternative practitioner.
  • More importantly in the context of this post, the notion is a clever sales-trick. It sounds profound and logical to many consumers who lean towards alternative medicine. Crucially, it kills two flies with one stroke: it denigrates conventional healthcare and, at the same time, elevates alternative medicine.

The idea that alternative practitioners treat the root causes is  based on the practitioners’ understanding of aetiology. If a traditional acupuncturist, for instance, is convinced that all disease is the expression of an imbalance of life-forces, and that needling acupuncture points will re-balance these forces thus restoring health, he must automatically assume that he is treating the root causes of any condition. If a chiropractor believes that all diseases  are due to ‘subluxations’ of the spine, it must seem logical to him that spinal ‘adjustment’ is synonymous with treating the root cause of whatever complaint his patient is suffering from.

These are concepts that are deeply engrained into the minds of alternative practitioners. And they have one embarrassing feature in common: they are false! Some practitioners surely must know that; yet I have so far not met one who therefore would have stopped using it. The reason must be that, as a trick of the trade to increase his cash flow, it is invaluable.

My advice is to use your abilities for critical thinking, explain to the practitioner who tells you that he is going to treat the root causes of your condition that he is a quack, and look for a proper physician.

 

In part one, we have dealt with three common tricks used by quacks to convince the public to consult them and to keep coming back for more. It has been pointed out to me that some of these tricks are used not just by alternative practitioners but also by real physicians. This is, of course, absolutely true. A quack can be defined as “a person who dishonestly claims to have special knowledge and skill in some field, typically medicine.” Therefore real doctors can be real quacks, of course. I happen to have an interest mainly in alternative medicine; that’s why I write about these type of quacks (if it helps keeping you blood pressure within the limits of normal, I can tell you that I occasionally also published about quackery in mainstream medicine, for instance here).

Anyway, now it is time to continue this series of posts by discussing three further common deceptions used by quacks.

A CURE TAKES A LONG TIME

Imagine a scenario where, even after, several therapy sessions, a patient’s condition has not improved. Let’s assume the problem is back pain, and that it has not improved a  bit despite the treatments and the money spent on it. Surely, many patients in such a situation are sooner or later going to give up. They will have had enough! And this is, of course, a serious threat to the practitioner’s cash flow.

Luckily, there is a popular ploy to minimize the risk: the practitioner merely has to explain that the patient’s condition has been going on for a very long time (if, in the above scenario, this were not the case, the practitioner would explain that the pain might be relatively recent but the underlying condition is chronic). This means that a cure will also have to take a very long time – after all, Rome was not built in one day!

This plea to carry on with the ineffective treatments despite any improvement of symptoms is usually not justifiable on medical grounds. It is, however, entirely justifiable on the basis of financial considerations of the practitioners. They rely on their patients’ regular payments and will therefore think of all sorts of means to achieve this aim.

Take my advice and see a clinician who can help you within a reasonable and predictable amount of time.

IT’S DUE TO THE POISONS YOUR DOCTOR GAVE YOU

In the pursuit of a healthy cash-flow, almost all means seem to be allowed – even the fabrication of the bogus notion that the reasons for the patient’s problem were the poisonous drugs prescribed by her doctor who, of course, is in cahoots with BIG PHARMA. Alternative medicine thrives on conspiracy theories, and the one of the evil ‘medical mafia’ is one of the all-time favourites. It enables scrupulous practitioners to instil a good dose of fear into the minds of their patients, a fear that minimises the risk of them returning to real medicine.

My advice is that alternative practitioners who habitually use this or any other conspiracy theory should be avoided at all costs.

THINK HOLISTICALLY

The notion that alternative medicine takes care of the whole person is a most attractive and powerful ploy. Never mind that nothing could be further from being holistic than, for instance, diagnosing conditions by looking at a patient’s iris (iridology), or focussing on her spine (chiropractic, osteopathy), or massaging the soles of her feet (reflexology). And never mind that any type of good conventional medicine is by definition holistic. What counts is the label, and ‘holistic’ is a most desirable one, indeed. Nothing sells quackery better than holism.

Most alternative practitioners call themselves holistic and they rub the holism into the minds of their patients whenever and however they can. This insistence on holism has the added advantage that they have seemingly plausible excuses for their therapeutic failures.

Imagine a patient consulting a practitioner with depression and, even after prolonged treatment, her condition is unchanged. Even in such a situation, the holistic practitioner does not need to despair: he will point out that he never treats diagnostic labels but always the whole person. Therefore, the patient’s depression might not have changed, but surely other issues have improved… and, if the patient introspects a little, she might find that her appetite has improved, that her indigestion is better, or that her tennis elbow is less painful (some things always change given enough time). The holism of quacks may be a false pretence, but its benefits for the practitioner are obvious.

My advice: take holism from quacks with a pinch of salt.

We were recently informed that Americans spend more than US$ 30 billion per year on alternative medicine. This is a tidy sum by anyone’s standards, and we may well ask:

Why do so many people opt for alternative medicine?

The enthusiasts claim, of course, that this is because alternative medicine is effective and safe. As there is precious little data to support this claim, it is probably not the true answer. There must be other reasons, and I could name several. For instance, it could be due to consumers being conned by charlatans.

During the 25 years or so that I have been researching alternative medicine, I got the impression that there are certain ‘tricks of the trade’ which alternative practitioners use in order to convince the often all too gullible public. In this series of posts, I will present some of them.

Here are the first three:

TREAT A NON-EXISTING CONDITION

There is nothing better for committing a health fraud than to treat a condition that the patient in question does not have. Many alternative practitioners have made a true cult of this handy option. Go to a chiropractor and you will in all likelihood receive a diagnosis of ‘subluxation’. See a TCM practitioner and you might be diagnosed suffering from ‘chi deficiency’ or ‘chi blockage’ etc.

Each branch of alternative practitioners seem to have created their very own diagnoses, and they have one thing in common: they are figments of their imaginations. To arrive at such diagnoses, the practitioner would often use diagnostic techniques which have either been found to lack validity, or which have never been validated at all. Many practitioners appreciate all of this, of course, but it would be foolish of them to admit it – after all, these diagnoses earn them the bulk of their living!

The beauty of a non-existing diagnosis is that the practitioner can treat it, and treat it and treat it…until the client has run out of money or patience. Then, one day, the practitioner can proudly announce to his patient “you are completely healthy now”. This happens to be true, of course, because the patient has been healthy all along.

My advice for preventing to get fleeced in this way: make sure that the diagnosis given by an alternative practitioner firstly exists at all in the realm of real medicine and secondly is correct; if necessary ask a real healthcare professional.

MAINTENANCE TREATMENT

As I just stated, practitioners like to treat and treat and treat conditions which simply do not exist. When – for whatever reason – this strategy fails, the next ‘trick of the trade’ is often to convince the patient of the necessity of ‘maintenance’ treatment. This term describes the regular treatment of an individual who is entirely healthy but who, according to the practitioner, needs regular treatments in order not to fall ill in future. The best example here is chiropractic.

Many chiropractors proclaim that maintenance treatment is necessary for keeping a person’s spine aligned – and only a well-serviced spine will keep all of our body’s systems working perfectly. It is like with a car: if you don’t service it regularly, it will sooner or later break down. You don’t want this to happen to your body, do you? To many ‘worried well’, this sounds so convincing that they actually fall for this scam. It goes without saying that the value of maintenance treatment is unproven.

My advice is to start running as soon as a practitioner mentions maintenance treatments.

IT MUST GET WORSE BEFORE IT GETS BETTER

Many patients fail to experience an improvement of their condition or even feel worse after receiving alternative treatments. Practitioners of alternative medicine love to tell these patients that this is normal because things have to get worse before they get better. They tend to call this a ‘healing crisis’. Like so many notions of alternative practitioners, the healing crisis is a phenomenon for which no or very little compelling evidence was ever produced.

Imagine a patient with moderately severe symptoms consulting a practitioner and receiving treatment. There are only three things that can happen to her:

  • she can get better,
  • she might experience no change at all,
  • or she might get worse.

In the first scenario, the practitioner would obviously claim that his therapy is responsible for the improvement. In the second scenario, he might say that, without his therapy, things would have deteriorated. In the third scenario, he would tell his patient that the healing crisis is the reason for her experience. In other words,  the myth of the healing crisis is little more than a ‘trick of the trade’ to make even these patients continue supporting the practitioner’s livelihood.

My advice: when you hear the term ‘healing crisis’, go and find a real doctor to help you with your condition.

 

 

 

 

“When orthodox medicine has nothing more to offer” is the title of an article by Dr Elizabeth Thompson, a UK medical homeopath. The article was written years ago, but it is still an excellent example for disclosing the dangerously false and deeply unethical reasoning used by many alternative practitioners. The notion that all sorts of disproven treatments like homeopathy are justified when orthodox medicine has nothing more to offer is so very prevalent that I decided to do this post analysing it.

In the following, you see the most relevant sections of Dr Thompson’s original article (in normal print) and my brief comments (in brackets and in bold):

…Some people come when conventional treatments can no longer offer them anything to save their lives. This is a frightening time for them and although the homeopathic approach may not offer a cure at this late stage of their illness (Is she implying that, in some cases, homeopathy can cure cancer?), it can often offer hope of a different kind. (Surely, one does not need homeopathy for giving patients hope). Sometimes it helps people to outlive the prognosis given to them by months or even years. (A prognosis is not a precise time of death; it is based on statistics and therefore depicts a likelihood, not a certainty. Thus patients outlive their prognosis all the time regardless of treatments.) Sometimes it helps them need less (less than what? there is no control group and therefore the statement seems nonsensical) in the way of conventional medicine including pain killers and offers them continuing support despite progressive disease (is she trying to say that in conventional medicine patients with progressive disease do not get continuing support?).

As a doctor working in both conventional and complementary cancer care I have learned the importance of integrating these two perspectives (the integration of unproven therapies into EBM can only render the latter less effective). Ideally the doctor practising homeopathy would work as an integral part of a much wider team which would include family members, nurses, general practitioners, oncologists, surgeons, palliative physicians and other complementary therapists (the concept of a multi-disciplinary team for cancer is one from conventional medicine where it has long been routine). It is disappointing sometimes to see that other healthcare professionals can be unsupportive of a person’s desire to use complementary therapies and for some people the knowledge that the team is not working together can cause doubt and insecurity (for the majority of patients, however, it might be reassuring to know that their oncology-team is evidence-based).

Some patients come at the beginning of their diagnosis wanting to support their bodies with gentler (homeopathic remedies are not gentler, they are ineffective) approaches and help themselves recover from some difficult and powerful treatments such as chemotherapy and radiotherapy (Why are they being told that alternative therapies are effective in achieving these aims when there is no good evidence to show that this is true? Isn’t that unethical?). As well as using homeopathic medicines (no good evidence of effectiveness!!!), the GHH also has experience in using Mistletoe which is given by injection and has been shown to stimulate the group of white cells whose numbers can be depleted during chemotherapy and radiotherapy (also no good evidence that it works clinically!!!).

Other patients come when they have finished most of their treatments but may still not be feeling well despite being given the all clear by their doctors (same again: no good evidence!!!)…

One wonderful aspect of the homeopathic approach is that it can be a very important opportunity to help someone re-evaluate their life and their health (We don’t need to prescribe placebos for that, this aim is better reached by employing a clinical psychologist).

Sometimes hurts in the past have never been healed and sitting with someone as they describe difficult experiences can be itself therapeutic. Combining this therapeutic listening time with substances from nature that gently stimulate the body’s own healing potential (where is the evidence for that claim?) can be an approach that through patient demand and research (what research?) we can demonstrate is really worth offering to many more people…

END OF QUOTE

 

This text shows in an exemplary fashion how desperate patients can be convinced to make dramatically wrong choices. If you read Dr Thompson’s text without my comments, it probably sounds fairly reasonable to many people. I can understand why patients and carers end up thinking that homeopathy or other disproven therapies are reasonable options WHEN ORTHODOX MEDICINE HAS NOTHING MORE TO OFFER.

But the claim of homeopaths and others that mainstream medicine has, in certain cases, nothing more to offer is demonstrably wrong. Supportive and palliative care are established and important parts of conventional medicine. To deny this fact amounts to a lie! The implied scenario where a patient is told by her oncology team: “sorry but we cannot do anything else for you”, does quite simply not exist. The argument is nothing else but a straw-man – and a vicious one at that.

Moreover, the subsequent argument of homeopaths, “as ‘they’ have given you up, we now offer you our effective homeopathic remedies”, is not supported by good evidence. In other words, one lie is added to another. To call this unethical, would be the understatement of the year, I think.

Homeopathy must be effective! It is used extensively throughout the world, not least India! If it were ineffective, as all these nasty sceptics insist, Indians would not use it in such large numbers.

How often have we heard this argument?

Take, for instance, statements from the ‘peer-reviewed’ literature such as this one: “At present, in India, homeopathy is the third most popular method of medical treatment after allopathy and Ayurveda. There are over 200,000 registered homeopathic doctors currently, with approximately 12,000 more being added every year.” Or take statements from UK homeopaths like this one: “It seems clear that homeopathy is there to stay in India. So next time you see or read some condescending and patronising rubbish about homeopathy in the media, know that in India, a country with a population of 1.2 billion people (that’s more than 20x the population of the UK) homeopathy is an integral part of the healthcare system and deeply respected by the people of that country.”

Yes, homeopaths have always loved to mislead the public with fallacies!

The appeal to popularity is, of course, a classic fallacy – but, in the case of homeopathy’s popularity in India, it is not just that; here is an intriguing aspect to the use of homeopathy in that country that shines a different light on the whole story.

Epidemiologists from Canada conducted semi-structured interviews of 175 Mumbai slum-based practitioners holding degrees in Ayurveda, homeopathy and Unani. Most providers gave multiple interviews. The researchers also observed 10 providers in clinical interactions, documenting clinical examinations, symptoms, history taking, prescriptions and diagnostic tests.

No practitioners exclusively used his or her system of training. The practice of biomedicine was frequent, with practitioners often using biomedical disease categories and diagnostics. The use of homeopathy was rare; only 4% of consultations with homeopaths resulted in the prescription of homeopathic remedies.

The authors concluded that important sources of health care in Mumbai’s slums, AYUSH physicians frequently use biomedical therapies and most refer patients with TB to chest physicians or the public sector. They are integral to TB care and control.

These data seem to suggest that the use of homeopathic remedies in India is far, far less than often claimed by apologists. Indian homeopaths seem to have much more sense than to use homeopathy for serious conditions. This is good news for Indian public health, in my view.

The story also shows how the ‘appeal to popularity’ is being misused for the promotion of homeopathy: not only is it based on poor logic but often also on false information.

Some homeopaths advise parents not to vaccinate their kids and use homeopathic vaccinations or ‘homeo-prophylaxis’ instead. Despite the fact that it has long been clear that this approach is not effective and even dangerous, some homeopathic pharmacies have been selling the remedies used for that purpose. In the UK, Helios has been at the forefront of this dubious trade. But, a few days ago, they have changed their ways.

Here is a screenshot of the results of a search for the word ‘vaccine’, with the ‘remedies’ that were subsequently removed highlighted:

Helios vaccine remedies 1

Click the image to enlarge.

This is undoubtedly a step in the right direction. The question I ask myself is WHY DID HELIOS MAKE THIS CHANGE? Was it because they had to? Or was it because they saw the light and realised that the evidence did not support the remedies in question?

If it was the latter motivation, we will soon know – because, in that case, they will surely do the same with the entire rest of their remedies.

Why?

BECAUSE THERE IS NOT GOOD EVIDENCE THAT ANY HIGHLY DILUTED HOMEOPATHIC REMEDY IS MORE THAN A PLACEBO.

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