Edzard Ernst

MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

Recently, I received an email with this ‘special offer’ for purchasing a book and was impressed – but not in a positive sense:

Dr Farokh’s commendable work at upto 22% off – Healing Cancer. For Limited time period only.

Healing Cancer: A Homoeopathic Approach

As a homeopath one should not deter oneself in dealing with any type of cases, be it cancer. But for executing that an ultimate guidance is needed. Cancer is so much prevalent and challenging medical problem of today that a trustworthy source of accurate information becomes pertinent and this work of Dr. Farokh Master  immediately propels at the top of quality books for cancer. Based on Master’s  40  years of experience this book was written for students to understand the basis of oncology and for practitioners for brushing-up of their knowledge in this growing discipline. Author says that to get a grasp on cancer cases we should believe in the potential of the homeopathic treatment, that healing from cancer refers to internal process of becoming whole and feeling harmonious with yourself and your environment.To even start with handling the cases of cancer one should be aware of understanding of cancer, its cause, pathophysiology, different types, conventional treatment and their side effects, integrative medicines, social problems in the treatment, such topics are well casted by Volume 1 of the book.

Peak points of Volume 1-  •    A full chapter is dealing with Iscador, a relatively old method, very effective but unfortunately underemployed.•    Published papers about Homeopathy in the treatment of cancer are presented before the last chapter which is on some of most used allopathic drugs in cancer with a focus on their side-effects. After the coverage of basic information on oncology in Volume 1 comes the Volume 2 which explores topics like understanding cancer from homoeopathic point of view, constitutional remedies, therapeutics of individual cancers, nutrition, general management.

Peak points of Volume 2-•    A whole chapter on Cadmium salts and cancer.•    51 “lesser known remedies” are briefly quoted and their usefulness in different situations and types of cancer exposed.•    A long chapter deals with the “Indian drugs”, it is important that these remedies are used mostly in tincture or low potencies, as herbal or Ayurvedic remedies or food supplements relieving the patients. •    The choice and differentiation between the remedies is then helped by the “Repertory of Cancer”, very well compiled and a highly useful section. “Clinical tips from my practice” given as a sub-chapter. •    It ends with recommendations on how to deal with radiation illness and the side-effects of conventional treatment, as well as the treatment of pain and help with palliative care.

For fighting and curing cancer and improving the quality and quantity of life of people, knowledge of Homeopathy, both philosophically and scientifically is needed which this work of art portrays delightfully.

About Book Author: 

Dr. Farokh J. Master’s birth into homeopathy was in the year 1976, when he joined Bombay homeopathic medical college, after giving up his studies at the orthodox school of medicine. Dr Master was instrumental in starting homeopathic out-patient dept in many allopathic hospitals viz. Bombay Hospital, KEM Hospital & Ruby Hall, Pune. Besides his work as a senior Homeopath of the HHC, Dr. Farokh Master is teaching homeopathy (advanced level) at the Mumbai Homeopathic Medical College, part of Mumbai university. He is also teaching at other homeopathic colleges in India and abroad. He has given seminars in various countries like Austria, Australia, India, Japan etc. Dr Master has written more than 50 books like -The Homeopathic Dream Dictionary, Cross References of the Mind, Perceiving Rubrics of the Mind, The State of Mind affecting the Foetus, Tumors and Homeopathy, The Bedside Organon of Medicine, The proving of Mocassin Snake, Bungarus, etc. Dr. Master is the originator of many recent new approaches and insights in homoeopathy.

Some people claim that homeopaths are not dangerous and argue that their placebos cannot harm patients. I have long disagreed with this position. As homeopathy is not an effective therapy (it has no effects beyond placebo), its use simply means allowing diseases to remain untreated.

  • If we are dealing with a common cold, this might be little more than a costly nuisance.
  • If we are dealing with a chronic condition such as arthritis, it means causing unnecessary suffering.
  • If we are dealing with life-threatening diseases like cancer, it means shortening the life of patients.

This is the politest way I can put it. There are of course other, less polite terms for ‘shortening a life’! Most of us shy away from using them in the context of homeopathy. In the case of the author of this book, we might make an exception. In my view, he is someone who is deluded to the point where he is ready to kill his patients with homeopathy.

PS

Iscador is not even a homeopathic remedy.

The aim of this evaluator-blinded randomized clinical trial was to determine if manual therapy added to a therapeutic exercise program produced greater improvements than a sham manual therapy added to the same exercise program in patients with non-specific shoulder pain.

Forty-five subjects were randomly allocated into one of three groups:

  • manual therapy (glenohumeral mobilization technique and rib-cage technique);
  • thoracic sham manual therapy (glenohumeral mobilization technique and rib-cage sham technique);
  • sham manual therapy (sham glenohumeral mobilization technique and rib-cage sham technique).

All groups also received a therapeutic exercise program. Pain intensity, disability, and pain-free active shoulder range of motion were measured post-treatment and at 4-week and 12-week follow-ups. Mixed-model analyses of variance and post hoc pairwise comparisons with Bonferroni corrections were constructed for the analysis of the outcome measures.

All groups reported improved pain intensity, disability, and pain-free active shoulder range of motion. However, there were no between-group differences in these outcome measures.

The authors concluded that the addition of the manual therapy techniques applied in the present study to a therapeutic exercise protocol did not seem to add benefits to the management of subjects with non-specific shoulder pain.

What does that mean?

I think it means that the improvements observed in this study were due to 1) exercise and 2) a range of non-specific effects, and that they were not due to the manual techniques tested.

I cannot say that I find this enormously surprising. But I would also find it unsurprising if fans of these methods would claim that the results show that the physios applied the techniques not correctly.

In any case, I feel this is an interesting study, not least because of its use of sham therapy. But I somehow doubt that the patients were unable to distinguish sham from verum. If so, the study was not patient-blind which obviously is difficult to achieve with manual treatments.

The orgone accumulator (ORAC) is an invention of the psychiatrist Wilhelm Reich which he developed along with his ‘orgone hypothesis’ while residing in the US from 1939 on. It is a device that is used to collect the hypothetical ‘orgone energy’ from the environment and to concentrate it.

One provider of the ORAC claims he had received the exact building instructions in interviews with Wilhelm Reich. The conversation with the deceased Reich was allegedly realized with the assistance of a medium and in close cooperation with angels. Since his death, Reich allegedly has been able to vastly improve the ORAC. The correct arrangement of eight rose quartzes in every corner is said to be essential. The book “Der Engel-Energie-Akkumulator nach Wilhelm Reich” (The Angel-Energy-Accumulator by Wilhelm Reich) does not only quote the late Reich, but also Archangel Raphael and Jesus Christ have their say.

Wilhelm Reich developed the ORAC believing that the box trapped orgone energy that he could harness in groundbreaking approaches towards psychiatry, medicine, the social sciences, biology, and weather research. His discovery of orgone began with his research of a physical bio-energy basis for Sigmund Freud’s theories of neurosis in humans. Wilhelm Reich believed that traumatic experiences blocked the natural flow of life energy in the body, leading to physical and mental disease. Reich concluded that the Freudian libidinal energy was the primordial energy of life itself, connected to more than just sexuality. Orgone was everywhere and Reich measured this energy in motion over the surface of the earth and even determined that its motion affected weather formation.

In 1940, Wilhelm Reich constructed the first ORAC: a six-sided box constructed of alternating layers of organic materials (to attract the energy) and metallic materials (to radiate the energy toward the center of the box). Patients would sit inside the ORAC and absorb the energy through their skin and lungs. The accumulator allegedly had beneficial effects on blood and body tissue by improving life-energy flow and releasing energy blocks.

But Reich’s work with cancer patients and the ORAC received negative press and the Federal Drug Administration (FDA) sent an agent to investigate Reich’s research center. In 1954, the FDA issued an injunction against Reich, claiming that he had violated the Food, Drug, and Cosmetic Act by delivering misbranded and adulterated devices in interstate commerce and by making false and misleading claims. The FDA called the ORAC a sham and orgone energy non-existent. A judge ordered all accumulators rented or owned by Reich and those working with him destroyed and all labeling referring to orgone energy to be destroyed. Two years later, Reich was imprisoned for contempt of the injunction. On November 3, 1957, Wilhelm Reich died in his jail cell of heart failure. In his last will and testament, he ordered that his works be sealed for fifty years, in hopes that the world would someday be a place better to accept his work.

The FBI does have a whole section on its website dedicated to Wilhelm Reich. This is what they had to say:

This German immigrant described himself as the Associate Professor of Medical Psychology, Director of the Orgone Institute, President and research physician of the Wilhelm Reich Foundation, and discoverer of biological or life energy. A 1940 security investigation was begun to determine the extent of Reich’s communist commitments. In 1947, a security investigation concluded that neither the Orgone Project nor any of its staff were engaged in subversive activities or were in violation of any statue within the jurisdiction of the FBI. In 1954 the U.S. Attorney General filed a complaint seeking permanent injunction to prevent interstate shipment of devices and literature distributed by Dr. Reich’s group. That same year, Dr. Reich was arrested for a Contempt of Court for violation of the Attorney General’s injunction.

The Wilhelm Reich Orgon Institut Deutschland currently state that they have been able to teach some Americans the proper way to build an ORAC:

Our teacher has been Dr. Walter Hoppe, the best student of Wilhelm Reich. He had lived over 40 years in Israel, and had done there very successful work with the orgone accumulator. Since 1974 he has been teaching psychiatric orgone therapy and the construction of the orgone accumulator in Germany.

So the triumphal procession of this model was starting up there. Dr. Hoppe gave the construction of the accumulator in the hands of Joachim Trettin. He said: orgone therapy is for few people while the orgone accumulator is for everybody. Meanwhile the Americans orientate themselves by this model today. So this accumulator is the best you can get.

We produce this accumulator with 5, 7, 10, 15 and 20 double layers. Every accumulator has a autonomous shooter which you can take out and use separately.

We also offer the accumulator with a breast and pelvis shield. We have a special packaging and ship our accumulator to every part of the world.

The orgone accumulator with 20- double layers, inside dimensions 120 x 70 x 55 cm, is available for the price of  7,250 EUR

Prof. Harald Walach and his work have been regular topics on this blog (e.g. here, here, and here). Walach has served as the editor of Forschende Komplementärmedizin / Research in Complementary Medicine for 20 years and is now retiring from this post. On this occasion, he just published an EDITORIAL looking both back and ahead on research into so-called alternative medicine (SCAM). Here are the last paragraphs of his piece:

What lies in store? We do not know. “Hidden is the future before me, I am wondering what my destiny will bring,” sings Lensky in Tschaikowsky’s opera Eugen Onegin, and this is a good description of our current situation, not only in medicine, but also politically. If I have one wish for the future of CAM, for the future of our journal, then it is to keep the fire ablaze and uphold the hope of change that has been at the source of its founding and is still empowering many in the field. The field of medicine, but also the world, needs examples of visions and visionaries. The landscape will change. While the beginning of the field and the journal was a decidedly German-speaking, central European enterprise, we have now seen the extension of the field.

China has entered the scene with enormous manpower, a venerable tradition, and a huge amount of experience, research, and funding. Other countries, Iran for instance, are discovering the sources of traditional medical approaches. It might well be the case that those who forget that the world does not end at the rim of the Mediterranean and of the Atlantic will be left behind. It has always been a decisive element of CAM research that it bridged countries, nations, polities, and worldviews. The ISCMR, Consortium, and European Congress for Integrative Medicine (ECIM) conferences probably had as attendees more researchers from outside Europe and the US than from their host countries. Africa is only slowly beginning to enter the scene. The future will be less Euro- and Western-centric than the beginning of CAM, I am quite sure. The Western model of healthcare and economic growth through single pharmacological inventions is not sustainable worldwide and in the long run, apart from the fact that it is conceptually ill-founded. Thus, our hope very likely lies in broadening our view: thinking about other systems of medicine, other approaches, whole-systems thinking. This is actually very similar to our beginning. Every end is a beginning, every beginning is an end, Oscar Wilde used to say.

Apart from the abundant use of platitudes, there are several statements that might deserve a comment:

  • The beginning of the field and the journal was a decidedly German-speaking, central European enterprise. Yes, the journal started as a predominantly German publication, yet the field was never mostly German/ central European. SCAM always included many modalities that originated from China, the US, and other non-European countries. Neither was the research into these areas ever dominated by German-speaking investigators.
  • China has entered the scene with enormous manpower, a venerable tradition, and a huge amount of experience, research, and funding. This is true – but is it a good development? On this blog, I have often written about the fact that research from China is notoriously unreliable or even fabricated. As the quantity of such work is about to totally overwhelm SCAM research, this is a most concerning development, in my view.
  • It has always been a decisive element of CAM research that it bridged countries, nations, polities, and worldviews. I would say that this is not something that characterizes SCAM research. It is a hallmark of any research. And considering my last point, it might soon no longer apply to SCAM. As we are being flooded with unreliable Chinese SCAM research, Chinese dominance might soon stifle criticism of SCAM.
  • The Western model of healthcare and economic growth? As far as I can see, the model of economic growth is fast being adopted by non-Western counties.

So, what is the future of SCAM and SCAM research? Like Walach, I don’t know. But contrary to Walach, I hope for something entirely different. I hope that the stupidly short-sighted notion of two types of research and two types of healthcare can eventually be abandoned. In the end, there can only be one type of science – the one that understands itself as critically testing hypotheses by trying to prove them wrong – and only one type of medicine – the one that does more good than harm.

It has been reported that the Regional Court of Dortmund has prohibited the manufacturer of the homeopathic cold remedy Meditonsin from advertising with false health claims. The court did not see sufficient evidence for the advertising claims.

The Consumer Advice Centre (VZ) of North Rhine-Westphalia issued a warning to the Meditonsin manufacturer (MEDICE Arzneimittel Pütter GmbH & Co.) for misleading advertising statements and sued them. The complaint was:

  • that the advertising gave the false impression that an improvement in health could be expected with certainty after taking the product,
  • that no side effects were to be expected,
  • that the product was superior to “chemical-synthetic medicines”.

The Dortmund Regional Court was not convinced by a study referred to by the manufacturer. On its website, the manufacturer of Meditonsin presents the results of a “current, large-scale user study with more than 1,000 patients” under the heading “Proven efficacy & tolerability”. According to a pie chart, 90% of the patients were satisfied or very satisfied with the effect of Meditonsin.

However, according to the VZ, the study was only a “pharmacy-based observational study” with little scientific validity. Despite the lack of evidence, the manufacturer claimed that “the good efficacy and tolerability of Meditonsin® Drops could once again be impressively confirmed”. The Dortmund Regional Court, however, followed the VZ’s statement of grounds for action. “It is not allowed to advertise with statements that give the false impression that a successful treatment can be expected with certainty, as the advertisement for Meditonsin drops suggests,” emphasized Gesa Schölgens, head of “Faktencheck Gesundheitswerbung”, a joint project of the consumer centres of North Rhine-Westphalia and Rhineland-Palatinate. According to the Therapeutic Products Advertising Act, this is prohibited.

The Dortmund Regional Court also found that consumers were misled by the advertising because it gave a false impression that no harmful side effects were to be expected when taking Meditonsin. The package leaflet of the drug listed several side effects. According to this, there could even be an initial worsening of the symptoms after taking the medicine.

According to the VZ, the alleged advantage of the “natural medicinal product” over “many chemical-synthetic medicinal products that only suppress the symptoms”, as presented by the manufacturer, is also inadmissible. This is because it is not permissible to advertise to consumers with claims that the effect is equivalent or superior to that of another medicinal product. This, too, was confirmed by the court.

_________________________

In case you like to know more about the remedy, this is from its English language site:

Meditonsin consists of Aconitum, Atropinum Sulfuricum, Mercurius Cyanatus. Active ingredient is the part of the drug or medicine which is biologically active. This portion of the drug is responsible for the main action of the drug which is intended to cure or reduce the symptom or disease.

Quackery is rife in India. On this blog, I have occasionally reported on this situation, e.g.:

Now the Chief Justice of India (CJI) NV Ramana has pointed out that legislation needs to be brought in to save people “from falling prey to fraudulent practices in the name of treatment”. Speaking at the inaugural National Academy of Medical Sciences on ‘Law and Medicine’, the CJI said: “Quackery is the biggest disease affecting India” and that hospitals are “being run like companies, where profit-making is more important than service to society”. The CJI added, “another side of lack of accessible healthcare is giving space to quacks. Quackery begins where awareness ends. Where there is room for myths, there is room for quackery”. He continued, “Owing to the financial and time constraints, a huge majority of the Indian population approaches these untrained and uncertified doctors. Lack of awareness and knowledge, misplaced belief, and sheer inaccessibility have massive ramifications on the health of the country, particularly the rural and underprivileged Indian … The need of the hour is to bring in legislation to save people from falling prey to fraudulent practices in the name of treatment … Private hospitals are being opened at an exponential rate. This is not necessarily a bad thing, but there is a glaring need for balance. We are seeing hospitals being run like companies, where profit-making is more important than service to society.”

I am sure the CJI is correct; India does have a quackery problem. If nothing else, the fact that one website lists a total of 746 Alternative Medicine Colleges in India, leaves little doubt about it.

This systematic review, meta-analysis, and meta-regression investigated the effects of individualized interventions, based on exercise alone or combined with psychological treatment, on pain intensity and disability in patients with chronic non-specific low-back pain.

Databases were searched up to January 31, 2022, to retrieve respective randomized clinical trials of individualized and/or personalized and/or stratified exercise interventions with or without psychological treatment compared to any control.

The findings show:

  • Fifty-eight studies (n = 10084) were included. At short-term follow-up (12 weeks), low-certainty evidence for pain intensity (SMD -0.28 [95%CI -0.42 to -0.14]) and very low-certainty evidence for disability (-0.17 [-0.31 to -0.02]) indicates superior effects of individualized versus active exercises, and very low-certainty evidence for pain intensity (-0.40; [-0.58 to -0.22])), but not (low-certainty evidence) for disability (-0.18; [-0.22 to 0.01]) compared to passive controls.
  • At long-term follow-up (1 year), moderate-certainty evidence for pain intensity (-0.14 [-0.22 to -0.07]) and disability (-0.20 [-0.30 to -0.10]) indicates effects versus passive controls.

Sensitivity analyses indicate that the effects on pain, but not on disability (always short-term and versus active treatments) were robust. Pain reduction caused by individualized exercise treatments in combination with psychological interventions (in particular behavioral-cognitive therapies) (-0.28 [-0.42 to -0.14], low certainty) is of clinical importance.

The certainty of the evidence was downgraded mainly due to evidence of risk of bias, publication bias, and inconsistency that could not be explained. Individualized exercise can treat pain and disability in chronic non-specific low-back pain. The effects in the short term are of clinical importance (relative differences versus active 38% and versus passive interventions 77%), especially in regard to the little extra effort to individualize exercise. Sub-group analysis suggests a combination of individualized exercise (especially motor-control-based treatments) with behavioral therapy interventions to boost effects.

The authors concluded that the relative benefit of individualized exercise therapy on chronic low back pain compared to other active treatments is approximately 38% which is of clinical importance. Still, sustainability of effects (> 12 months) is doubtable. As individualization in exercise therapies is easy to implement, its use should be considered.

Johannes Fleckenstein, the 1st author from the Goethe-University Frankfurt, Institute of Sports Sciences, Department of Sports Medicine and Exercise Physiology, sees in the study “an urgent health policy appeal” to strengthen combined services in care and remuneration. “Compared to other countries, such as the USA, we are in a relatively good position in Germany. For example, we have a lower prescription of strong narcotics such as opiates. But the rate of unnecessary X-ray examinations, which incidentally can also contribute to the chronicity of pain, or inaccurate surgical indications is still very high.”

Personally, I find the findings of this paper rather unsurprising. As a clinician, many years ago, prescribing exercise therapy for low back pain was my daily bread. None of my team would have ever conceived the idea that exercise does not need to be individualized according to the needs and capabilities of each patient. Therefore, I suggest rephrasing the last sentence of the conclusion: As individualization in exercise therapies is easy to implement, its use should be standard procedure.

 

It has been reported that America’s Frontline Doctors (a right-wing organization that is associated with the ‘Tea Party’) is suing one of its founders in a battle for control over the controversial group, which gained national notoriety for spreading misinformation about COVID-19 treatments and vaccines during the pandemic.

The organization and its current board chairman have sued Simone Gold, MD, alleging that she misused the nonprofit organization’s funds to buy a $3.6 million Florida mansion, purchase a Mercedes-Benz and other luxury vehicles, and take trips on private planes.

The lawsuit, filed November 4 in federal court, comes just months after Gold was released from prison for her role in the January 6 US Capitol insurrection. Gold pleaded guilty to trespassing in the Capitol and was sentenced to 60 days in federal prison.

The group and the board chairman, Joseph Gilbert, claim that after her release from prison, Gold attempted to reassert control of the group, take over its website, and fraudulently represent herself as its director, according to the complaint. The complaint referred to Gold as a “rogue founder,” alleging that she spent almost $50,000 monthly on personal expenses using the organization’s credit cards.

Gold resigned from the group’s board in February ― before she pled guilty ― so that she could pursue her goal of opening health and wellness centers nationwide, according to the complaint. At that time, the board voted Gilbert to be its chairman and agreed to have Gilbert negotiate an agreement for Gold to serve as a consultant. Gold sought a “signing bonus” of $1.5 million, along with $50,000 to be paid monthly as a consulting fee, according to the complaint.

Another report has more details on Gold’s alleged wrong-doing: The complaint claims that in November 2021, Gold used “AFLDS charitable funds to purchase a $3.6 million home in Naples, Florida for her personal rent-free use, and at least three vehicles and has otherwise used AFLDS funds to resource her personal lifestyle and expenses since she formed AFLDS.” Plaintiffs also allege that Gold “currently lives in this home with John Strand, rent free.” Strand is a former underwear model and boyfriend of Gold’s who was arrested with her in connection with the January 6, 2021 insurrection in the U.S. Capitol. She moved with Strand to Florida this year from Los Angeles, where she had been an emergency room physician. Strand allegedly was paid $10,000 per month as an AFLDS employee and allegedly spent $15,000 to $17,000 a month using those credit cards. He was terminated from AFLDS in summer 2022, according to the complaint. In addition to purchasing the house with AFLDS funds, the complaint said Gold purchased a Mercedes Benz Sprinter van, a Hyundai Genesis, and a GMC Denali. After taking possession of the Naples home, she used AFLDS funds to pay a personal security officer $12,000, a personal housekeeper $5,600 a month, and charged “nearly $50,000 per month” to AFLDS credit cards.

I tried to find some information on th health and wellness centers that Simone Gold wanted or did open. Alas I was unsuccessful in my endeavor. However, I found an interesting passage she once wrote:

The World Health Organization, the FDA, the NIH, and the CDC are proven liars who have lost all credibility and common-sense, while jeopardizing YOUR health and safety. What disgusts me most is how their failed prescriptions have exposed the most vulnerable: our elderly and our children. The New York Times, CNN, NPR, and hundreds of other news outlets have censored the truth in order to preserve their power. Twitter, Facebook, Google/YouTube, Apple, and dozens of other Tech companies are throttling down content, suppressing information, and de-platforming those with whom they disagree.

I find it hard to find words for a comment – except perhaps this: maybe it is not such a bad thing when anti-vaxxers fight each other; it means they have less time, energy, and money to confuse the public with their lies.

A review conducted in 2015 reported community pharmacists are willing to adopt a professional role in counselling consumers about the appropriate and safe use of so-called alternative medicine (SCAM) but faced multiple barriers in doing so. This current review aimed to update and extend these findings, by identifying studies published since 2015 that reported on pharmacists across any setting.

Eligible studies published between January 01, 2016, and December 31, 2021, were identified across 6 databases (PubMed, Scopus, Web of Science, EMBASE, ScienceDirect and MEDLINE). A grounded theory approach was used to thematically synthesize the data extracted.

A total of 64studies representing pharmacists across 30 countries were included for review. The study designs varied and included:

  • cross-sectional surveys (n = 36),
  • qualitative studies (n = 14),
  • pseudo-patient studies (n = 3).

Eight studies reported on practice and/or bioethical responsibilities and 19 studies documented factors that would enable pharmacists to fulfill these responsibilities, while 37 studies reported on both.

The authors concluded that these findings indicate research about pharmacists’ responsibilities associated with SCAM is evolving from gap analysis towards research that is proactive in advocating for change in multiple areas. These findings can be used to inform a consensus discussion among pharmacists and key stakeholders regarding a set of professional responsibilities that would serve in the development of: a clearly defined role and associated practice standards, and competency requirements that inform educational learning objectives for inclusion in undergraduate, post-graduate and continuing professional pharmacy education.

I am puzzled why so many researchers in this specific area seem to avoid clearer language plainly stating the essential, simple, and undeniable facts. I am equally puzzled why so few pharmacists speak out.

It is obvious that community pharmacists are firstly healthcare professionals and only secondly shopkeepers. As such, they have important professional and ethical duties. Foremost, they are obliged to inform their customers responsibly – and responsible means telling them about the evidence for or against the SCAM product they are about to purchase. This duty also entails that pharmacists must inform themselves about the best current evidence. In turn, this means they must stop tolerating the current plethora of under- or post-graduate SCAM courses that are not evidence-based.

As we have discussed ad nauseam on this blog, none of this is actually happening (except in very few laudable cases)!

By and large, pharmacists continue to go along with the double standards of a) evidence for conventional drugs and b) fairy tales for SCAM. In the interest of progress, patient safety, and public health, it is time that pharmacists wake up and remind themselves that they are not commercially orientated shopkeepers but ethical healthcare professionals.

In recent weeks, I have been thinking a lot about ‘INTEGRATIVE MEDICINE‘. Skeptics mostly see it as a way of smuggling quackery into conventional healthcare. This is undoubtedly true and important. But it occurred to me that there also is a somewhat different perspective that has so far been neglected. Let me try to explain by recounting a story. It is fictive, of course, but the fiction is based on the observation of many cases during previous decades.

The story is about a doctor – let’s call him George – who, to be frank, is not the most gifted of his colleagues. Already at medical school, he was not as dedicated as his teachers would have hoped. In fact, medicine had not been his first choice at all. Yet he ended up as a general practitioner and eventually became a partner in a practice with 5 GPs.

Over the years, it became clear that George lacked something to be a good doctor. He knew his stuff, alright, got most of the diagnoses correct, and made not too many mistakes. But something was not quite right. One could say that, relative to his colleagues, he lacked kindness, dedication, compassion, and empathy. He often found it unnecessary to respect his patients. Sometimes, he even joked about them and about what he perceived as their stupidity.

If we view medicine as being both a science and an art, one might conclude that George was just about alright with the science but notably deficient in the art of healthcare. Most of his patients were aware that something was amiss; many even avoided him and tried to consult one of his colleagues instead. On more than one occasion, patients had told George that they were disappointed with his attitude. Some had even told him to the face that he lacked kindness. Such conversations made George think. He had to admit to himself that his colleagues were better at building good relationships with their patients. Eventually, George decided that something ought to change.

As it happened, George’s wife had a friend who was a Reiki healer. One day, he asked the healer – let’s call her Liz – whether she would like to try working alongside the GPs in his practice. Liz was delighted and accepted. George did not believe for a minute that Reiki was more than hocus-pocus, but he knew that Liz was kind and had loads of the compassion that he was so obviously lacking.

Hence force George and Liz formed a team: George looked after his patients the best he could and whenever he felt that more empathy and compassion were required, he would send the patient to Liz. This partnership changed everything. The patients were content, George was happy, and Liz was beaming.

As some patients frowned at the idea of Reiki, George soon recruited an aromatherapist as well. After that, a lay homeopath and a reflexologist were employed. George’s GP partners (who made little use of the alternative practitioners) were sure that none of these therapies had any specific effects (incidentally, a belief not shared by the practitioners in question who felt they were doing wonders). But for George, the therapists clearly did supplement his limited interpersonal skills. Patients were delighted and the GP practice began to thrive. As for George, he became an increasingly outspoken and prominent advocate of INTEGRATED MEDICINE. The fact that there was no evidence to support it did hardly matter to him; what counted was that it rendered his own incompetence less visible.

About a year later, George convinced his slightly bewildered partners to rename their practice ‘THE INTEGRATIVE HEALTH CENTRE’.

End of story

In case you did not get my point, let me make it more bluntly: INTEGRATIVE MEDICINE can be a way for some doctors to delegate the art of medicine to quacks. Good doctors don’t need to do this because they are able to show compassion and treat their patients as whole human beings. Less gifted doctors, however, find INTEGRATIVE MEDICINE a practical solution to their own incompetence.

So, is INTEGRATIVE MEDICINE a good compromise then?

No, certainly not!

The last thing we need in healthcare is for doctors to start delegating the art of medicine to others. It would be a serious mistake, nothing less than abandoning the core values of medicine to charlatans.

But what is the solution?

Obviously, it is to make sure all doctors are competent. We need to select medical students adequately, tell them much more about the importance of kindness, compassion, empathy, holism, etc., and teach them how to show and use these qualities. We need to train doctors to be competent in both the science and the art of medicine. This has to begin in medical school and must continue throughout their professional career. We need to make sure that doctors like George understand the message; if they prove to be unable to do so, we should direct them to professions where compassion is not essential.

The worst solution we can possibly envisage is to allow charlatans to cover up the incompetence of people like George and call it INTEGRATED MEDICINE.

 

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