MD, PhD, FMedSci, FSB, FRCP, FRCPEd

bogus claims

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Discussions about the dietary supplements are often far too general to be truly useful, in my view. For a meaningful debate, we need to define what supplement we are talking about and make clear what condition it is used for. A recent paper meets these criteria well and is therefore worth a mention.

The review was aimed at addressing the controversy regarding the optimal intake, and the role of calcium supplements in the treatment and prevention of osteoporosis. The authors demonstrate that most studies on the subject show little evidence of a relationship between calcium intake and bone density, or the rate of bone loss. Re-analysis of data from the placebo group from the Auckland Calcium Study demonstrates no relationship between dietary calcium intake and rate of bone loss over 5 years in healthy older women with intakes varying from <400 to >1500 mg per day .

The authors argue that supplements are therefore not needed within this range of intakes to compensate for a demonstrable dietary deficiency, but might be acting as weak anti-resorptive agents via effects on parathyroid hormone and calcitonin. Consistent with this, supplements do acutely reduce bone resorption and produce small short-term effects on bone density, without evidence of a cumulative density benefit. As a result, anti-fracture efficacy remains unproven, with no evidence to support hip fracture prevention (other than in a cohort with severe vitamin D deficiency) and total fracture numbers are reduced by 0-10%, depending on which meta-analysis is considered. Five recent large studies have failed to demonstrate fracture prevention in their primary analyses.

These facts, the authors argue, must be balanced against the possible harm. The risks of regularly taking calcium supplements include an increase in gastrointestinal side effects (including a doubling of hospital admissions for these problems), a 17% increase in renal calculi and a 20-40% increase in risk of myocardial infarction. Each of these adverse events alone neutralizes any possible benefit in fracture prevention.

The authors draw the following detailed conclusions: “Concern regarding the safety of calcium supplements has led to recommendations that dietary calcium should be the primary source, and supplements reserved only for those who are unable to achieve an adequate dietary intake. The current recommendations for intakes of 1000–1200 mg day−1 are not firmly based on evidence. The longitudinal bone densitometry studies reviewed here, together with the new data included in this review relating to total body calcium, suggest that intakes in women consuming only half these quantities are satisfactory and thus, they do not require additional supplementation. The continuing preoccupation with calcium nutrition has its origin in a period when calcium balance was the only technique available to assess dietary or other therapeutic effects on bone health. We now have persuasive evidence from direct measurements of changes in bone density that calcium balance does not reflect bone balance. Bone balance is determined by the relative activities of bone formation and bone resorption, both of which are cellular processes. The mineralization of newly formed bone utilizes calcium as a substrate, but there is no suggestion that provision of excess substrate has any positive effect on either bone formation or subsequent mineralization.

Based on the evidence reviewed here, it seems sensible to maintain calcium intakes in the region of 500–1000 mg day−1 in older individuals at risk of osteoporosis, but there seems to be little need for calcium supplements except in individuals with major malabsorption problems or substantial abnormalities of calcium metabolism. Because of their formulation, costs and probable safety issues, calcium supplements should be regarded as pharmaceutical agents rather than as part of a standard diet. As such, they do not meet the standard cost–benefit criteria for pharmaceutical use and are not cost-effective. If an individual’s fracture risk is sufficient to require pharmaceutical intervention, then safer and more effective measures are available which have been subjected to rigorous clinical trials and careful cost–benefit analyses. Calcium supplements have very little role to play in the prevention or treatment of osteoporosis.”

Clear and useful words indeed! I wish there were more articles like this in the never-ending discussion about the complex subject of dietary supplements.

‘Doctor’ Don Harte is former medical student who prematurely left medical school and currently works as a chiropractor in California. He, has served on the Boards of the World Chiropractic Association and the Council on Chiropractic Practice. He has published extensively; on his website, he offers a list of his articles:

His website also reveals that Harte views chiropractic as a ‘cure all’ and believes that the “Vertebral Subluxation Complex (VSC) is THE most serious threat to your health and well-being.”

Harte is not impressed with conventional medicine: “Virtually everyone has lost loved ones to medical mistakes and indifference. I, myself, count my father, my favorite uncle and two cousins amongst this unnecessary medical death toll. Though people concoct all kinds of charges against Chiropractic, nobody knows of any deaths from Chiropractic, because there just aren’t any. You might want to read the article that I wrote on this subject in the San Francisco Chronicle, “Where is the Danger in Chiropractic.”

In particular, Harte is no friend of immunisation. Here are some of the things he has been quoted as saying recently about the subject:

  • He charged the media with “an evil bigotry” in relation to vaccination.
  • He said that “The mass media refuses to acknowledge the existence of vaccine-injured children. This is quite a trick, since we are talking millions of children.”
  • He explained that “their whole con game relies on fear, trying to convince you that you and your children have nothing inside to protect them from all those evil germs. That you need their HOLY WATER, the vaccines, or you will die.” Once again, Harte charged the California Governor and the legislature “as Destroyers of the family, as Enemies of liberty, as CHEMICAL CHILD MOLESTERS.”
  • He claimed that “His (Mr J Coleman’s) son, Otto, who was paralyzed by a vaccine reaction, was there, in his wheelchair; as were other vaccine-damaged children. Some participants held up photos of their children who had died from vaccines.” And he said, “There were no photos of these children, nor any mention of them in news accounts. Establishment media refuses to put a human face on the suffering caused by vaccinations. I don’t know whether to call them ‘chicken’ or ‘evil.’”
  • Harte also stated that “The claim that non-vaccinated children are a threat to Rhett has ZERO scientific basis. First of all, less-vaccinated and non-vaccinated kids tend to be healthier. And more specifically, children recently vaccinated with live virus vaccines will shed viruses, and thus, be contagious, for up to 28 days.”
  • “Here we have a case,” explained Harte, “of one boy held up as a potential victim of unvaccinated or less-vaccinated children, who has had, in reality, no harm done by those children. The millions of children who have endured great harm, up to and including paralysis and death, are ignored. This is not science, nor is it reputable news reporting nor reputable public policy. It is naked propaganda, paid for by Big Pharma.”

It seems that Harte is an altogether dangerous person.

Of course, chiropractors will (yet again) claim that Harte does in no way stand for chiropractic as a whole and that chiropractors are just as appalled by such dangerous anti-vaccination propaganda as we are. They will say he is just ‘a rotten apple’ within a mostly laudable profession.

But is that true? What have the professional bodies of chiropractic done against him and his hazardous views? Have they excluded or reprimanded him, or requested that he seeks treatment for what seems to be rampant paranoia?

The answer, I am afraid, is NO! What they did do instead was to name him, in 2006, as “Chiropractor of the Year” – an honour bestowed on him by the World Chiropractic Alliance.

NATURAL NEWS announced the death of Nicholas Gonzalez with the following words:

It is with great sadness that we report the death of health freedom advocate and individualized nutrition specialist Dr. Nick Gonzalez, who on the eve of July 21 died from an alleged heart attack. Dr. Gonzalez’ contributions to anticancer nutrition protocols and an array of other nutritional therapies have been invaluable, and we would like to honor this pioneering natural healer by recognizing his benevolent legacy…

In contrast to the conventional cancer treatment model, Dr. Gonzalez’s approach was always about helping individuals heal through individualized care. Along with fellow colleague Dr. Linda Isaacs, Dr. Gonzalez helped build a repository of dietary protocols to help patients overcome their specific conditions through advanced nutritional therapies. His methodology centered around detoxification, supplementation with healing foods and nutrients, and specialized enzyme therapy…

Dr. Gonzalez was always a strong adherent to sound science, and he was never in it for the money. His humble, cogent approach to helping people heal naturally without drugs or surgery is a legacy worth remembering and passing on, and we’re thankful to have gotten to know this honorable man during his time on this earth…

This sounds as though Gonzalez was some kind of medical genius and scientific pioneer. Most cancer experts would disagree very sharply with this. Here is what Louise Lubetkin wrote on this blog about him, and I very much encourage you to read her whole post.

Those who recognize and appreciate a fine example of pseudoscientific baloney when they see one know that there is no richer seam, no more inexhaustible source, than the bustling, huckster-infested street carnival that is alternative medicine. There one can find intellectual swindlers in abundance, all offering outrageously implausible claims with the utmost earnestness and sincerity. But the supreme prize, the Fabergé egg found buried among the bric-a-brac, surely belongs to that most convincing of illusionists, the physician reborn as an ardent advocate of alternative medicine…

So what are we to make of Gonzalez? Is he a cynical fraud or does he genuinely believe that coffee enemas, skin brushing and massive doses of supplements are capable of holding back the tsunami of cancer?

At the end of the day it hardly matters: either way, he’s a dangerous man.

Personally, I believe much more in the text of Louise Lubetkin. How about you?

Chiropractors are back pain specialists, they say. They do not pretend to treat non-spinal conditions, they claim.

If such notions were true, why are so many of them still misleading the public? Why do many chiropractors pretend to be primary care physicians who can take care of most illnesses regardless of any connection with the spine? Why do they continue to happily promote bogus treatments? Why do chiropractors, for instance, claim they can treat gastrointestinal diseases?

This recent narrative review of the literature, for example, was aimed at summarising studies describing the management of disorders of the gastrointestinal (GI) tract using ‘chiropractic therapy’ broadly defined here as spinal manipulation therapy, mobilizations, soft tissue therapy, modalities and stretches.

Twenty-one articles were found through searching the published literature to meet the authors’ inclusion criteria. The retrieved articles included case reports to clinical trials to review articles. The majority of articles chronicling patient experiences under chiropractic care reported that they experienced mild to moderate improvements in GI symptoms. No adverse effects were reported.

From this, the authors concluded that chiropractic care can be considered as an adjunctive therapy for patients with various GI conditions providing there are no co-morbidities.

I think, we would need to look for a long time to find an article with conclusions that are more ridiculous, false and unethical than these.

The old adage applies: rubbish in, rubbish out. If we include unreliable reports such as anecdotes, our finding will be unreliable as well. If we do not make this mistake and conduct a proper systematic review, we will arrive at very different conclusions. My own systematic review, for instance, of controlled clinical trials drew the following conclusion: There is no supportive evidence that chiropractic is an effective treatment for gastrointestinal disorders.

That probably says it all. I only want to add a short question: SHOULD THIS LATEST CHIROPRACTIC ATTEMPT TO MISLEAD THE PUBLIC BE CONSIDERED ‘SCIENTIFIC MISCONDUCT’ OR ‘FRAUD’?

The last time I had contact with Dr Fisher was when he fired me from the editorial board of his journal ‘Homeopathy’. He did that by sending me the following letter:

Dear Professor Ernst,

This is to inform you that you have been removed from the Editorial Board of Homeopathy.  The reason for this is the statement you published on your blog on Holocaust Memorial Day 2013 in which you smeared homeopathy and other forms of complementary medicine with a ‘guilt by association’ argument, associating them with the Nazis.

I should declare a personal interest….[Fisher goes on to tell a story which is personal and which I therefore omit]…  I mention this only because it highlights the absurdity of guilt by association arguments.

Sincerely

Peter Fisher Editor-in-Chief, Homeopathy

I did not expect to have any more dealings with him after this rather unpleasant encounter. But, as it turns out, I recently did have a further encounter.

When the BMJ invited me to write a debate article about the question whether homeopathy should continue to be available on the NHS, I accepted (with some reservations, I hasten to add). At the time, I did not know who would do the ‘other side’ of this debate. It turned out to be Peter Fisher, and our two articles have just been published.

As one would expect from a good journal, the articles were both peer reviewed. One of the peer-reviewers of my piece was most scathing of it essentially claiming that it was entirely worthless. Feeling that this was a bit harsh and very impolite, I was keen to see who this reviewer had been; it was none other than Andrew Vickers. This is remarkable because Vickers had not only published several homeopathic papers with Fisher, but also had been in the employment of the ‘Royal London Homeopathic Hospital’ under Fisher. To the best of my knowledge, his conflicts of interested had not been disclosed. I did point that out to the BMJ, but they seemed to think nothing of it.

Anyway, I was pleased to eventually (the whole procedure took many months) see the articles published, but at the same time somewhat irritated by Fisher’s piece. It contained plenty of misleading information that the peer-reviewers obviously had failed to correct. Here is a small sample from Fishers piece:

… recent overviews have had more favourable conclusions, including a health technology assessment commissioned by the Swiss federal government that concluded that homeopathy is “probably” effective for upper respiratory tract infections and allergies.

Readers interested in the clinical evidence can access the CORE-HOM database of clinical research in homeopathy free of charge (www.carstens-stiftung.de/core-hom). It includes 1117 clinical trials of homeopathy, of which about 300 are randomised controlled trials.

In the podcast that accompanies the articles Fisher insists that, on this database, there are well over 300 RCT, and I had to admit that this was new to me. Keen to learn more, I registered with the database and had a look. What I found startled me. True, the database does claim that almost 500 RCTs are available, but just a very superficial scrutiny of these studies reveals that

  • some are not truly randomised,
  • some are not even clinical trials,
  • the list includes dual publications, re-analyses of already published studies as well as aborted trials,
  • many have never been peer-reviewed,
  • many are not double-blind,
  • many are not placebo controlled,
  • the majority are of poor methodological quality.

As to the other thing mentioned in the above excerpt from Fisher’s article, the famous ‘health technology assessment commissioned by the Swiss federal government’, I can refer my readers to a blog post by J W Nienhuys which probably says it all, if not, there is plenty more criticism of this report available on the Internet.

My conclusion from all this?

THE QUEEN’S HOMEOPATH USES ARGUMENTS THAT SEEM JUST AS BOGUS AS HOMEOPATHY ITSELF.

I will state my position up front: THERE IS NO CHILDHOOD CONDITION FOR WHICH CHIROPRACTIC SPINAL MANIPULATION GENERATES MORE GOOD THAN HARM. What is more, I have published evidence (published herehere, here, and here, for instance) to support this statement. If you disagree with it, this is the place and time to do so – and please don’t forget to cite the evidence that supports your statements.

Given that there is very little reliable evidence in this area, I find it surprising that so many chiropractors continue to treat kids. Not true! I hear some chiropractors shout, we do not often treat children. Who is correct? Clearly, we need data to answer this question.

The objective of a new paper was to investigate characteristics of clinical chiropractic practice, including the age of pediatric patients, the number of reports of negative side effects (NSEs), the opinions of doctors of chiropractic on treatment options by patient age groups, the conditions seen and the number of treatment sessions delivered by conditions and by patient age.

An Internet cross-sectional survey was conducted in 20 European countries with 4109 chiropractors invited to reply. The 19 national associations belonging to the European Chiropractic Union and the Danish Chiropractic Association were asked to participate. Respondents were asked to self-report characteristics of their practices.

Of the 956 (23.3%) participating chiropractors, 921 reported 19821 pediatric patients per month. Children represented 8.1% of chiropractors’ total patient load over the last year. A total of 557 (534 mild, 23 moderate, and 0 severe) negative (adverse) side effects were reported for an estimated incidence of 0.23%. On the given treatment statements, chiropractors reported varying agreement and disagreement rates based on patient age. The 8309 answers on conditions were grouped into skeletal (57.0%), neurologic (23.7%), gastrointestinal (12.4%), infection (3.5%), genitourinary (1.5%), immune (1.4%), and miscellaneous conditions (0.5%). The number of treatment sessions delivered varied according to the condition and the patient age.

The authors of this survey concluded that this study showed that European chiropractors are active in the care of pediatric patients. Reported conditions were mainly skeletal and neurologic complaints. In this survey, no severe NSEs were reported, and mild NSEs were infrequent.

In my view, a more appropriate conclusion might be that MANY EUROPEAN CHIROPRACTORS ARE ACTIVE IN QUACKERY.

Placebo effects are important and often misunderstood. This is perhaps nowhere more true than in the realm of alternative medicine. Here they are often used to justify bogus treatments with the argument ‘I DON’T CARE HOW IT WORKS AS LONG AS IT DOES HELP PATIENTS, EVEN IF THIS SHOULD BE VIA A PLACEBO EFFECT’.

A recent article published in the prestigious NEJM sheds some light on these issues – all the more so, as one of its authors has a background as an advocate of alternative medicine. Here are a few passages from this paper which I think are particularly relevant:

… placebo effects are improvements in patients’ symptoms that are attributable to their participation in the therapeutic encounter, with its rituals, symbols, and interactions. These effects are distinct from those of discrete therapies and are precipitated by the contextual or environmental cues that surround medical interventions, both those that are fake and lacking in inherent therapeutic power and those with demonstrated efficacy…

So what have we learned about placebo effects to date, and what does our current understanding say about medicine?

First, though placebos may provide relief, they rarely cure. Although research has revealed objective neurobiologic pathways and correlates of placebo responses, the evidence to date suggests that the therapeutic benefits associated with placebo effects do not alter the pathophysiology of diseases beyond their symptomatic manifestations; they primarily address subjective and self-appraised symptoms…

Second, placebo effects are not just about dummy pills: the effects of symbols and clinician interactions can dramatically enhance the effectiveness of pharmaceuticals…

Third, the psychosocial factors that promote therapeutic placebo effects also have the potential to cause adverse consequences, known as nocebo effects. Not infrequently, patients perceive side effects of medications that are actually caused by anticipation of negative effects or heightened attentiveness to normal background discomforts of daily life in the context of a new therapeutic regimen…

… research on placebo effects can help explain mechanistically how clinicians can be therapeutic agents in the ways they relate to their patients in connection with, and separate from, providing effective treatment interventions. Of course, placebo effects are modest as compared with the impressive results achieved by lifesaving surgery and powerful, well-targeted medications. Yet we believe such effects are at the core of what makes medicine a healing profession.

So what about the claim that it is fine to use homeopathy, for instance, because it might help via a placebo effect? There are several reasons why this is not a good idea some of which are hinted at in the above article:

  1. placebo effects are not usually powerful,
  2. they are not normally long-lasting,
  3. they are not reliable,
  4. they are merely symptomatic,
  5. they are not always risk-free,
  6. they usually require deceiving patients, and that is not ethical,
  7. pretending that a bogus treatment is alright can undermine rationality in general,
  8. happily using bogus treatments because they generate placebo effects is a disincentive to find effective treatments,
  9. we do not need a placebo to generate placebo effects because any empathetic therapeutic encounter will do that too.

My conclusion is deliberately flippant and provocative: PLACEBO EFFECTS ARE TOO IMPORTANT TO LEAVE THEM TO QUACKS AND CHARLATANS.

Many people seem to believe that homeopathy is harmless. It is a belief that can easily be shown to be wrong, and this blog has repeatedly done just that. Perhaps the best researched issue here is the stance of many homeopaths against vaccination.  But this is by no means all.

There are uncounted books, articles and websites which mislead consumers into believing that they can cure their illnesses with homeopathy. Take the website of ‘STAR HOMEOPATHY’ for instance. This organisation makes fantastic promises:

Star homeopathy, a chain of super specialty homeopathic clinic’s founded by a group of practically high qualified doctors with the vision to provide the best medical treatment in a scientific and most advanced way with the use of latest clinical knowledge and medical diagnostic equipment.

We boast of a combined experience of 200 years in the science of Homeopathy. We have 35 years of personal experience to provide you world-class solutions in health care. Experience the odour of advanced and New-Age Homeopathy–only at Star Homeopathy Clinics. It is no more a slow and long drawn treatment process.

You can rely on us to get world class homeopathic solutions for your problems like : Hair loss, Dandruff , Joint pains, Neck pain, Knee pain, Gastric and duodenal ulcer, Piles, Fissure, Fistula, Asthma, Skin and respiratory allergies , Sinusitis, Acne ,Hyperpigmentation , Psoriasis, Migraine , Headache, Anxiety, Depression , Sexual problems like Erectile dysfunction ,Premature ejaculation, Hormonal imbalance in female, Low sperm count in men…

We at star homeopathy, confidently say that we accurately diagnose the disease condition and treat all chronic diseases very efficiently without harming the patient’s body.

Such statements are bound to inspire confidence to many people who are chronically ill and frustrated with the fact that they need to take drugs for the rest of their lives to stay alive. Patients suffering from diabetes, for instance. They might hope that STAR HOMEOPATHY has a solution for them. And true enough, they do:

How Homoeopathy helps to cure Diabetes?

In homeopathy, diabetes is seen as a reflection of the body’s inability to function optimally. There is an imbalance that results in the body’s incapacity to effectively utilize the insulin that it produces, or to produce sufficient insulin for its needs. While symptoms often disappear after conventional treatment, the vital force does not. Homoeopathy can be used effectively in the treatment of diabetes. Here we mainly concentrate on functioning of the pancreas in efficient insulin production. The metabolic condition of a patient suffering from diabetes requires both therapeutic and nutritional measures to correct the illness. Homeopathy can regulate sugar metabolism while helping to resolve the metabolic disturbances that lead to diabetes. Furthermore, homeopathy helps stimulate the body’s self-healing powers in order to prevent complications such as open leg sores and other dysfunctions of the blood vessel, loss of vision, kidney failure. Homeopathic treatment does not target one illness, an organ, a body part or a symptom. Remedies are prescribed based on an assembly of presenting symptoms, their stresses in life.

Commonly indicated Homoeopathic remedies:

Syzygium: A most useful remedy in diabetes mellitus. No other remedy causes in so marked degree the diminution and disappearance of sugar in the urine. Prickly heat in upper part of the body; small red pimples itch violently. Great thirst, weakness, emaciation. Very large amounts of urine.. Diabetic ulceration.. Syzygium Jambolanum has marked action on diabetes mellitus as it causes marked diminution of sugar in urine. Great thirst with weakness, emaciation inspite of proper nutritious diet. Profuse urination of high specific gravity. Small red pimples with much itching. Syzygium Jambolanum also helps in treating old ulcers of skin associated with diabetes mellitus.

Uranium nitricum: Uranium Nitricum is a chief diuretic remedy. There is copious urination with incontinence of urine. It is indicated in glycosuria with increased urination, emaciation and tympanites. Uranium Nitiricum also helps in enuresis, the patient is unable to retain urine without pain. Burning in urethra, with very acid urine. There is a tendency to great emaciation, debility and general dropsy. Causes glycosuria and increased urine. Is known to produce nephritis, diabetes, degeneration of the liver, high blood pressure and dropsy. Its therapeutic keynote is Great emaciation, debility and tendency to ascites and general dropsy. Backache and delayed menses. Dry mucous membranes and skin.

Lycopodium: Diabetes. Anger during disease. Lost of self confidence. The right side conditions works well and thus improve the liver and kidney functioning as conditions Neuropathy. There is constipation due to inactivity of the rectum. Impotence. Intense desire for sweets.

So, if you think that homeopathy is harmless, think again!

Following this advice, could mean the death of many diabetics.

No treatment for which hugely exaggerated claims abound can ever be safe.

Many chiropractors try to tell us that vaccinations are not necessary, if we receive regular spinal adjustments. This claim is based on the assumption that spinal manipulations stimulate the immune system. Take the text published on this website, for instance:

The nervous system and immune system are hardwired and work together to create optimal responses for the body to adapt and heal appropriately. Neural dysfunctions due to spinal misalignments are stressful to the body and cause abnormal changes that lead to a poorly coordinated immune response. Chiropractic adjustments have been shown to boost the coordinated responses of the nervous system and immune system…

Subluxation is the term for misalignments of the spine that cause compression and irritation of nerve pathways affecting organ systems of the body. Subluxations are an example of physical nerve stress that affects neuronal control. According to researchers, such stressful conditions lead to altered measures of immune function & increased susceptibility to a variety of diseases.

Inflammatory based disease is influenced by both the nervous, endocrine, and immune systems. Nerve stimulation directly affects the growth and function of inflammatory cells. Researchers found that dysfunction in this pathway results in the development of various inflammatory syndromes such as rheumatoid arthritis and behavioral syndromes such as depression. Additionally, this dysfunctional neuro-endo-immune response plays a significant role in immune-compromised conditions such as chronic infections and cancer.

Wellness based chiropractors analyze the spine for subluxations and give corrective adjustments to reduce the stress on the nervous system. A 1992 research group found that when a thoracic adjustment was applied to a subluxated area the white blood cell (neutrophil) count collected rose significantly.

Other websites go even further:

The best way to prevent meningitis, and other illness, is to develop a robust immune system. The most important element in developing a robust immune system is optimum communication between all systems of the body. Chiropractic does this. The goal of chiropractic is to remove interference in the nervous system, the system that controls and coordinates all other parts of the body. Interference is caused by subluxations or misalignments in the spine. When subluxations are corrected, the body’s nervous system functions optimally and boosts the immune functioning. In fact, individuals who receive chiropractic care have 200% greater immune competence than individuals who don’t. This is why it is vital to receive regular chiropractic adjustments…

If we look at the actual research that might support such strange claims, we find that that it is scarce, flimsy and unconvincing. To the best of my knowledge, nobody has yet shown that people who receive regular chiropractic care are protected from conditions mediated via the immune system. Unless such a phenomenon can be demonstrated beyond reasonable doubt, we should be highly sceptical of the claim that chiropractic care stimulates the immune system and thus generates better health. In my view, regular chiropractic adjustments stimulate only one thing: the cash flow of the therapist.

My conclusion: The claim that chiropractic adjustments have such profound effects on human health is highly irresponsible.

I have always wondered how pharmacists might justify using or recommending or selling homeopathic remedies. So far, I have not come across a pharmacist who would want to stick his/her neck out for homeopathy. Many pharmacists earn money by selling homeopathic preparations – but most seem to be embarrassed by this fact and don’t want to defend it.

Therefore, I was pleased when I found this interview with the pharmacist Christophe Merville. He got introduced to homeopathy as a 11 year old boy suffering from hay fewer; after using homeopathy, “the crises became less severe and less frequent”. Later, he studied to become a pharmacist in France and, in 1990, he joined Boiron, the world’s largest manufacturer of homeopathic remedies. The following is an extensive excerpt (I did not want to cite him ‘out of context’) from his interview about his views on homeopathy.

I remember attending the delivery of a woman and the contractions were very strong, and painful. She had some homeopathic medicine to take just at that time to make those contractions more regular and useful: less intense but longer and less brusque. I saw that happening within minutes, and I was thinking, “That’s very impressive.” That’s probably the time when I concluded that there is something to it. 

I witnessed the action of homeopathic medicines on pets also, on young children. I had enough personal anecdotes that I could say there is something more than just suggestion, or placebo, or just the simple act of being cared for. My attitude is to say, “There are enough signs to say that it’s really worth exploring more why it works, how it works, when does it work.” We are past the stage where we can say, “No, there is nothing.” It has been around for a long time and if was just mere placebo effect, it would have gone away, as so many different techniques did. 

If you look at the history of science, you find many instances where people first said, for example, “The theory of gravity explains everything.” And when some things are discovered that show it didn’t work in certain very narrow cases, there’s an understanding that we have to adjust. But every time you have to make that adjustment, there is a great body of people who say, “No, it cannot be.” 

The main argument against homeopathy is that a remedy is very, very diluted, so it cannot work. My reaction to that is to examine what happens when you dilute something. The act of dilution is not very simple. Those molecules are interacting together, they are interacting with the walls of the container, they are interacting with the solvent, and this interaction does not adhere to a precise mathematical law. The skeptics say, “You divide the number of molecules by 100 each time, so after awhile, there is less than one chance to find one single molecule.” They have their math right, but they have their physics wrong. 

Chemists try to use very pure substances. When you buy your reagent, you buy it at 99.999 percent pure. But you don’t have anything that’s 100 percent pure. It would take an infinite amount of energy to get rid of the last impurity. What I think we should explore is the fact that after a certain number of dilutions, the process is not very efficient at removing the last molecules. So there is always something that stays. That’s one thing. 

The second thing is in pharmacology for years, we were interested in the ability of large quantities of substances. But what about small ones? I always use the example of butterflies that can sense pheromones at great distances, salmon finding their way back to their native creek from far away, to sharks being able to detect blood in a huge amount of water. Biology uses very small quantities. In cells, you have communication between cells using a few molecules of a certain substance—and it works. 

I don’t pretend that I’ve put A and B and C together, and I’m able to provide you with a complete explanation. But I would say those are things to explore. Already the research that exists points to possible action of homeopathic dilution on activation or deactivation of genes. I won’t go into details, but I welcome the skepticism, I think it’s very constructive. But what I don’t really like is people whose mind is set on their misconception of what exactly a dilution is. Of course homeopathy doesn’t violate the laws of physics and chemistry, because that’s absurd. 

My first role is pharmacy development. I look at what are the tools that allow pharmacists to know what homeopathy is and for a certain number of them, how to use homeopathy. I consider how to train them, how to have them integrate homeopathy in their practice, because the goal isn’t about replacing other medicines with homeopathy. My first role is to say to pharmacists, “You have to know what it is because these are drugs. If you don’t believe in them, you don’t have to use them, but at least you need to be able to answer customers, your patients.”

And the second thing is that for those who are interested in knowing more, I translate books from France, I design trainings, activities, interactions, so they are placed in a situation of recommending and deciding if it is appropriate to recommend homeopathy, and what treatment is adapted to that particular person. 

“Before coming to the conference, I researched what homeopathy is, and you will have a hard time telling me that it can work.” I talk with them to explore a little bit more what it is. We speak the language of pharmacology together, and what strikes me is that very soon, they are into it. They say, “Okay, we see the logic of it.” They realize that they have a tool where they can relieve without doing any harm, without interactions, so their interest is piqued. And they recognize that the mode of action of conventional medicines is not as clear as we thought.

Pharmacists are very pragmatic people—you cannot tell them fairy tales. When they see it, explore it, and use it, then when I meet them later, they tell me, “That stuff works.” And I ask, “Yeah, but do you know how it works?” They don’t, but they see the patient coming back happy. 

Of course, they are interested in the research and knowing how it works, but I just give them what we know in clinical research and we discuss it. They see that there is ongoing research and one day we’ll find more. But meanwhile, they are using the product. 

 You have two approaches. What I call “the user approach” is when people may not really completely understand how a medicine works, but they’re interested in taking it for stress or for allergies, whatever it might be, to see if it works for them. They’re interested in how this medicine will affect them, how should they take it. If it works for them, then great. 

Then you have what I call the “intellectual approach”—which is concerned about more cultural, philosophical, and social questions: what is the place of homeopathic medicine in today’s medicine, what are its principles, its history, its perspective. Is it a philosophy, is it a cult, what is it? My role is to try to give context for what homeopathy is. It’s a simple tool in the toolbox—we don’t exactly know all the details of how it works. And this is what we know, and this is what we don’t know, and this is what we speculate might be the way it works. People educate themselves. 

 Every day, I say, homeopathy doesn’t vaccinate, homeopathy doesn’t cure cancer, homeopathy doesn’t cure diabetes. It can relieve some of the symptoms or side effects of the treatments, but it has limits like every therapy. I fight against those outrageous claims and sometimes people that are really fanatical advocates for homeopathy do much worse for the cause. And I have to tell them: You cannot say that. It is untrue and it is dangerous. This is why I think pharmacists listen to me, because I’m not telling them to change their practice and their ethics. I’m telling them, this is another tool and this is how to use it properly. But there are fundamentals that are still there and will be there for a long time. You cannot replace vaccination by any other techniques—it’s unethical, it’s dangerous, it’s deadly. So we don’t do that. I’m completely against these kinds of claims.

 Let’s explore that: a patient suffering with AIDS, advanced infection with HIV, with immunity that decreases. Or a patient treated with antiretroviral therapy, they still have sometimes diarrhea, because their immune system is not able to fight everything. They still have side effects or anxiety. We want their treatment to be as comfortable as possible, because we want them to keep using the treatment. The same thing with cancer. The patient says, “I don’t want to have chemotherapy because it’s hurting me, it’s very difficult and uncomfortable.” We have with homeopathy ways to reduce nausea, for instance, then we increase the comfort of the patient, and the outcome is always better. That’s the framework. Someone who would say, “Oh, you have AIDS, throw away your antiretrovirals, I’m going to treat you with homeopathy”—that person would be a murderer

We develop tools to help people self-medicate. We say, “Okay, you’re stressed out, you need to sleep a little bit, you’re lacking sleep. Take this for a certain period of time—if it works for you, fine. If it doesn’t, doesn’t, stop it.” For people with what we call “self-limiting conditions”— a cold or a cough—we have good tools with warnings and precautions and things like that for them to self-medicate. And in the warnings, we tell them, “If you experience that kind of fever, if you have that symptom, see a doctor.” We don’t say see a homeopath, we say see a doctor. And among these doctors, there are doctors who have added in different techniques and some of them are using homeopathy when appropriate. For me, what is most important, is that a patient sees someone who is medically qualified.  

For people who want to further explore the possibilities that homeopathy offers, I recommend that they see a physician who is skilled in homeopathy but will not use homeopathy for everything. And is able to diagnose. A physician will tell you, “In this case, I can do something with homeopathy, or, in that case, I cannot use homeopathy.”

As I have once worked as a junior doctor in a homeopathic hospital (the full story is here), I knew of course all these arguments and fallacies. Nevertheless, I still ask myself: HOW CAN PHARMACISTS GET CONVINCED IN THIS WAY? ARE THEY REALLY CONVINCED? OR DO THEY JUST DO IT FOR THE MONEY?

I do not feel like prejudging these questions just now. But I do hope to hear from my readers, particularly from the pharmacists amongst them, what they think.

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