Edzard Ernst

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

Exercise is recommended for managing pain, yet the consistency, magnitude, and certainty of effects across different pain conditions and exercises remain unclear. This umbrella review aimed to synthesize the best available evidence on the analgesic effects of exercise by examining systematic reviews and meta-analyses of randomized controlled trials (RCTs).
Eleven databases were systematically searched from inception to August 2024. Eligible studies included systematic reviews with meta-analyses of RCTs comparing exercise to control conditions, with pain as a primary or secondary outcome. Reviews without meta-analyses, those not involving RCTs, or those primarily focused on experimentally induced or laboratory pain were excluded. Two reviewers independently extracted data and assessed methodological quality using AMSTAR-2. Standardized mean differences in pain were synthesized using random-effects meta-meta-analysis. Certainty of evidence was evaluated using GRADE, with subgroup and sensitivity analyses.
A total of 157 systematic reviews comprising 2,736 RCTs and 221,279 participants were included. Exercise significantly reduced pain compared with controls (pooled standardized mean differences = −0.59; 95% CI, −0.65 to −0.53; P < 0.001). Effects were observed across both chronic and acute pain conditions, encompassing musculoskeletal, neurological, inflammatory, and cancer populations. Aerobic, resistance, yoga, Pilates, and tai chi were effective. Greater effects were observed in lower-intensity, shorter-duration (<12 weeks) programs. Sensitivity analyses supported the robustness of findings, and the overall GRADE certainty was moderate.
The authors concluded that this umbrella review provides robust evidence supporting the effectiveness of exercise for managing a wide range of pain conditions. Our findings suggest that relatively brief, low-intensity programs, often perceived as more achievable by people living with chronic pain, are associated with greater pain reductions on average. However, these patterns reflect trends across diverse studies and should not be interpreted as prescriptive. Rather, they underscore the importance of starting with accessible, lower-dose programs that can be adjusted based on individual needs, preferences, and progression. Given the consistent benefits observed across exercise types and populations, clinicians are encouraged to integrate exercise as a core component of multimodal pain care. These findings reinforce the role of exercise as a safe, adaptable, and patient-centred option, particularly valuable in addressing the limitations of pharmacological pain management. Future research should focus on how to best individualise, deliver, and sustain effective exercise interventions in real-world clinical settings..
This is an excellent paper that provides a wealth of data relevant to both clinicials and patients. The authors report that significant, large reductions in pain were observed for various modes of exercise, including aerobic, aquatic, dance, HIIT, mind body (various), mixed-mode, Pilates, resistance, tai chi, telehealth, exergames and VR, and yoga. The largest reduction in pain was observed for dance, Pilates, and tai chi. It occurs to me that these three forms of exercise are normally all performed in groups and thus have a strong sociaal element to them. Could it be that this is an additional factor in their analgesic benefit?
While these exercises seem particularly effective, the most remarkable finding is, in my view, that practically ALL types of excercise work for practically ALL types of pain. This means, I think, that it might be best to let the patient decide which type of excercise he or she prefers; this might be one way to increase compliance. Because compliance might in many cases a significant problem. If you have severe pain, you are not usually motivated to do excercise!

I spent the last 2 months in France where it happened to be hot. Too hot for my taste! I could not do much during the day and, at night, I was unable to sleep well. As the heatwave carried on, it began to impact on my mood and health. I may be particularly sensitive to heat, but I am by no means the only one who suffered. Record-breaking temperatures and unprecedented ocean warming have triggered a global health emergency. Driven by climate change, modern heatwaves are predicted to strike with greater frequency, intensity, and duration, pushing human physiology to (and sometimes past) its limits.

Extreme heat operates as a silent killer by severely exacerbating pre-existing cardiovascular and respiratory conditions. It can also cause acute medical issues like severe dehydration, kidney damage, heatstroke, and even death. Extreme heat disproportionately impacts highly vulnerable groups, including older adults, children, outdoor laborers, and individuals who are unhealthy to start with. Urban populations face magnified dangers due to the urban heat island effect, which traps dense pockets of heat in city environments.

The consequences are already devastating. The recent heatwaves in Europe caused over 1,300 excess deaths within just a few weeks. Extreme heat contributes to a global toll of hundreds of thousands of heat-related fatalities each year. It also ripples through societal infrastructure. Extreme heat heavily strains our healthcare systems, disrupts local economies, worsens food and water insecurity worldwide, endangers local transport and other infrastructure. Here in France, for instance, we had prolonged cuts first of electricity and then on the Internet/telephone; many people and shops had to throw away the content of their fridges and freezers. Even more alarming: one of France’s largest rivers, the Loire, went completely dry.Image result for loire dried up

An analysis of nearly 2,500 UK media articles covering the June heatwave found that most reports failed to connect the event to climate change, despite strong scientific evidence that global heating intensifies extreme weather. Approximately three-quarters of the articles made no reference to climate change or global warming, highlighting a significant gap between scientific consensus and public communication. Such omissions are problematic because they leave audiences without crucial context. Attribution science now allows researchers to quantify how much more likely or intense specific heatwaves have become due to greenhouse gas emissions, primarily from fossil fuel use. Without this information, heatwaves may be perceived as isolated or purely natural events rather than manifestations of a broader, human-driven trend. Failing to link extreme weather to climate change undermines public understanding and may weaken support for mitigation and adaptation policies.

The most worrying thing is that we are rapidly approaching irreversible thresholds. To mitigate this mounting catastrophe, immediate international cooperation is required. We must deploy both short-term adaptation strategies, such as robust local heat action plans and early warning weather networks, as well as aggressive, long-term global emissions reductions. And we also should vote out politicians who still:

  • pretend that climate change is a hoax,
  • blame their neighouring country, despite being huge polluters themselves,
  • shout “drill baby, drill”,
  • pretend that summers have always been hot,
  • claim (against all medical knowledge) that humans will somehow manage to adapt to extreme heat.

Without urgent measures, the human and economic toll will escalate uncontrollably.

Drugging soldiers seems to be an odd idea. Yet, it is not without precedent, e.g.:

  • Nazi Germany (WWII): The Wehrmacht and Luftwaffe were systematically supplied with Pervitin (methamphetamine), with tens of millions of tablets issued to keep soldiers and pilots awake, alert and aggressive during the war.
  • Britain/US (WWII air operations): Allied air forces issued amphetamine and caffeine tablets to bomber crews and other soldiers to counter fatigue on long missions, representing a state‑sanctioned stimulant program for performance enhancement.
  • US (Vietnam War): soldiers were routinely given Dexedrine (dextroamphetamine) and other psychoactive drugs to sustain long patrols and suppress combat stress; hundreds of millions of tablets were thus distributed with official approval.
  • Soviet Union (Cold War): State‑run sports programmes, closely tied to military and security structures, systematically administered anabolic steroids and testosterone derivatives to elite athletes to boost strength and recovery, normalising pharmacological enhancement in a militarised setting.

Now, the US Defence Secretary Pete Hegseth’s recent “High-T” initiative mandates annual testosterone screening for US troops aged 30 and older, coupled with optional hormone replacement therapy (TRT). This is a striking case of policy outrunning clinical evidence. While announced as a readiness initiative to keep the joint force on the “leading edge of lethality,” the proposal glosses over critical medical, ethical, and operational realities.

First, the medical rationale for mass screening is weak, to put it mildly. Established clinical guidelines recommend testing only men presenting with specific symptoms and risk factors, not broad, asymptomatic populations. Screening hundreds of thousands of personnel annually risks over-diagnosis and over-treatment, particularly in a young force where borderline-low values are common, highly fluctuating, and often transient. In a word: the “High-T initiative” is nonsense.

Second, oral testosterone undecanoate (TU) shares general testosterone risks, e.g. erythrocytosis, prostate effects (worsening BPH symptoms, small PSA rises, contraindication in prostate cancer), suppression of spermatogenesis and infertility, acne, fluid retention, mood changes, and possible lipid alterations. Compared with transdermal or injectable formulations, oral TU offers convenience but requires strict baseline and ongoing monitoring of blood pressure, haematocrit, PSA, and testosterone levels, and is best reserved for men without uncontrolled hypertension, high cardiovascular risk, or near-term fertility plans, and only after considering safer first-line options. In particular, TRT-induced suppression of spermatogenesis presents a serious threat to fertility for service members of reproductive age, introducing severe clinical trade-offs without clear medical indications. In a word: the “High-T initiative” is likely to do more harm than good.

Third, the policy dangerously blurs the line between therapeutic medicine and performance enhancement. Mass-screening healthy soldiers and offering TRT to asymptomatic individuals normalizes the pharmacological optimization of the force. This sets a dangerous precedent: once hormonal levels are treated as adjustable parameters for “readiness,” the boundary between standard healthcare and state-sponsored enhancement dissolves. In a word: the “High-T initiative” is unethical.

Fourth, the operational logistics remain unresolved. Mandating annual blood draws will strain military medical systems, must generate an influx of equivocal results, and will create a massive administrative trail of counselling, monitoring, and liability. In a word: the “High-T initiative” is unpractical.

Fifth, the policy’s ambiguity regarding female service members exposes a glaring double standard: the Pentagon has not clarified whether women will be screened for sex-hormone deficiencies, or if this “restorative” care is reserved strictly for men. In a word: the “High-T initiative” is sexist.

Sixth, the political optics are highly suspect. The initiative directly mirrors broader administration efforts to liberalize testosterone prescribing, raising concerns that ideology, rather than rigorous military medicine, is driving policy. In a word: the “High-T initiative” is ideological.

Unsurprisingly, many experts have criticised the initiative sharply, e.g.:

  • Stuart Phillips, a medical professor at McMaster University, told The Washington Post: “A blanket policy like we’re going to screen everybody over the age of 30 is kind of a ridiculous notion.”
  • Adriane Fugh-Berman, a Georgetown University professor of pharmacology and physiology, warned: Hegseth’s claims are “non‑evidence‑based and could cause harm.”

Overall, Hegseth’s policy is out-running clinical evidence, and his stupidity is out-doing common sense. There is no doubt in my mind that his testosterone obsession is extremely ill-advised and – if not urgently stopped – will do an abundance of harm.

Hypothyroidism is a prevalent hormonal disorder symptoms often persist despite levothyroxine therapy. Adjunctive individualized homeopathic medicines (IHMs) may improve clinical outcomes, biochemical markers, and quality of life, robust evidence of efficacy remains limited.

The objective of this study was to evaluate the efficacy of add-on IHMs alongside standard levothyroxine therapy in the treatment of hypothyroidism in children and adults.

A 3-month, double-blind, randomized, placebo-controlled trial was conducted in a homeopathic hospital involving 64 trial subjects with hypothyroidism undergoing levothyroxine therapy. The participants received either IHMs plus levothyroxine (verum; n = 32) or placebo plus levothyroxine (control; n = 32) for 3 consecutive months. Patients, study investigators, outcome evaluators, and data entry staff were all kept blinded about the allocation concealment according to a double-blinded approach. The codes were not disclosed to the principal investigator, and unblinding occurred only in cases of clear medication-related risk, substantial benefit, or futility. The primary outcome was the Zulewski’s Clinical Scoring (ZCS); secondary outcomes included thyroid-stimulating hormone (TSH), T3, T4, and ThyroPRO-39 scores.

Both groups showed significant improvement in symptoms and thyroid indices. Between-group difference in ZCS was nonsignificant (mean diff: 0.1, 95% confidence interval [CI] −0.3–0.6, P = 0.567), but significant in T3 (mean diff: −0.2, 95% CI −0.4 to −0.1, P = 0.002), T4 (mean diff: 1.6, 95% CI 1.2–2.0, P < 0.001), and TSH (mean diff: −3.0, 95% CI −5.8 to −0.3, P = 0.033), favoring homeopathy against placebo. Quality-of-life changes were minimal, though some ThyroPRO-39 domains improved significantly with IHMs (e.g., symptoms, P < 0.001; tiredness, P = 0.012; nervousness and tension, P = 0.001; and daily activity, P = 0.001).

The authors concluded that adjunctive IHMs did not improve symptoms or quality-of-life outcomes over placebo conclusively, but revealed favorable biochemical changes, meriting further long-term studies.

I must admit: I am puzzled by this paper:

  • According to the primary endpoint, the result is squarely negative.
  • Yet, the article itself is presented as though the findings were positive.
  • This is because the some secondary endpoints yielded positive results.
  • But how can this be?
  • I find the power justification unconvincing; perhaps the study was under-powered?
  • The authors report that “Neither group experienced any adverse effects.”
  • How can this be?
  • Even placebo therapy generates adverse effects!
  • And common problems of levothyroxine therapy are palpitations, tremor, nervousness, insomnia, sweating, heat intolerance, headache, diarrhoea, weight loss, and increased appetite.

As I said, I am puzzled. Perhaps the authors’ affiliations might explain?

  • Department of Materia Medica, D. N. De Homoeopathic Medical College and Hospital, Affiliated to the West Bengal University of Health Sciences, Kolkata – 700 046, West Bengal, India
  • Department of Repertory, D. N. De Homoeopathic Medical College and Hospital, Affiliated to the West Bengal University of Health Sciences, Kolkata – 700 046, West Bengal, India
  • Department of Homeopathy, East Bishnupur State Homoeopathic Dispensary, Chandi Daulatabad Block Primary Health Centre, Under Department of Health and Family Welfare, Govt. of West Bengal, India

My previous post provided tips for examining health claims. An area where health claims need to be examined cautiously is supplements, and one UK firm seems to deserve scrutiny more than most. British Supplements, was founded around 2015 by Chris Boyle. Rather than positioning himself as a traditional executive or scientist, Boyle markets himself as a rebellious outsider fighting against a corrupt health industry. He heavily promotes a narrative of “us versus them,” framing himself as a truth-teller. He regularly uses his platform to criticize mainstream competitors like Holland & Barrett, alleging they sell “private-label junk” filled with binders and excipients.

There is no publicly available record of any formal professional background, medical training, scientific schooling, or nutritional education for Chris Boyle. As far as I can see, he does not hold degrees or certifications in biochemistry, pharmacology, dietetics, medicine, or any related fields. In his public branding and communication, Boyle’s lack of formal scientific or medical training is not something he attempts to hide; rather, he weaponizes it as part of his “rebel outsider” persona to build trust with customers who are skeptical of the traditional medical and regulatory establishment.

Boyle’s firm is an online seller of mushroom and herbal products marketed under a “Clean Genuine” label. Operating with an antagonistic, anti-establishment brand voice, the company has constructed a conspiratorial marketing ecosystem designed to bypass UK advertising laws. It has fast grown into a highly profitable, multi-million-pound operation. Despite its “underdog” and “persecuted outsider” marketing narrative, it is now a major player in the direct-to-consumer wellness market, fueled by heavy advertising on social media and public transport. Recently, the company has even taken out a nationwide bus-advertising deal. To sell products like Turkey Tail and Lion’s Mane for serious illnesses without violating UK regulations, Boyle employs a “half-censorship” tactic. By partially starring out crucial terms, he tells customers that he is forced to censor the text due to a corrupt alliance between “Big Pharma” and the UK government.

His website employs customer reviews to make forbidden clinical claims. British Supplements encourages customers to leave detailed, condition-specific feedback, structuring its website collections such that searching for terms like “cancer” highlights these reviews. While the UK Advertising Standards Authority (ASA) demands that customer testimonials used in marketing are legally considered advertisements and must be clinically backed, the company falsely claims  that “Article 10 of the Human Rights Act 1998” protects this type of “free speech”, dismissing regulators as tools of a “United Kingdom of North Korea.”

The brand positions itself within a broader web of alternative-medicine conspiracies. On social media and review platforms like Trustpilot, Boyle aggressively attacks critics. Negative reviewers are routinely insulted, with Boyle publicly labeling them as “woke,” “Karens,” “femboys,” or suffering from “mental breakdowns.”

This aggressive stance is more than just an offensive marketing strategy; it represents a growing public health challenge. By promoting unproven remedies to severely ill patients and actively cultivating distrust in evidence-based medicine and regulatory bodies, British Supplements not only financially exploit vulnerable consumers, it also endager the health of those who might believe in their unsubstantiated claims.

The Medical Journalists’ Association (MJA) has outlined six practical tips to help scrutinise health claims responsibly and accurately. They are primarily meant for journalists but, I think, they are also usefull for the general public, particularly when dealing with health claims in the realm of so-called alternative medicine (SCAM):

Check the source
Assess whether the claim originates from credible, peer-reviewed research and a reputable institution. Be wary of press releases, anecdotal reports, or media outlets known for sensationalism. Specifically for claims about SCAM, we might also add caution regarding the many third class SCAM journals.

Look for conflicts of interest
Investigate who funded the research and whether any authors or organisations stand to profit from the findings. Industry sponsorship can introduce bias, even in otherwise well-conducted studies. For claims about SCAM, we should remember that financial interest might be secondary to ideological ones.

Examine the study design
Consider whether the research used appropriate methods – such as randomisation, control groups, and adequate sample sizes – to support its conclusions. Observational studies, or case reports, or trials with the often-discussed ‘A+B versus B’ design, for example, cannot prove causation.

Consider the magnitude and relevance of effects
Distinguish between statistical significance and clinical importance. A tiny effect may be statistically significant in a large trial but meaningless in practice. Also ask whether the study population is representative and the outcome can be generalised.

Look for independent replication
Single studies should be treated cautiously until confirmed by other researchers. Consistent findings across multiple studies increase confidence in a claim.

Beware of over-interpretations
Scrutinise whether the authors or media coverage extrapolate beyond what the data support. For instance, generalising from animal studies to humans, or implying benefits without evidence of improved health outcomes.

___________________

If I may, I will add an 7th to the six by the MJA. It is one that I have issued many times previously and that is, I think, essential in SCAM:

If it sounds too good to be true, it probably is!

Exaggerated or false health claims are endemic in SCAM. These 7 tips might be useful in disclosing them and in minimising the harm they can do.

Medical ethics rests on 4 core principles: autonomy, beneficence, non-maleficence, and justice, along with the crucial rule of veracity (truth-telling). In the realm of chiropractic, the most significant ethical issues/problems generally fall into the following ethical categories:

  1. Compromised Informed Consent & Veracity

Informed consent requires that a patient fully understands the nature, risks, benefits, and scientific backing of a treatment before proceeding.

1.1.The “Subluxation” Theory: A sizable segment of the chiropractic community still adheres to the erroneous belief that spinal “vertebral subluxations” cause a disruption in the body’s “innate intelligence,” leading to systemic disease. From an ethical standpoint, promoting an unproven, pseudo-scientific premise as medical fact violates veracity and compromises patient autonomy, as patients cannot give truly informed consent based on erroneous concepts.

1.2. Over-claiming Scope of Efficacy: While evidence might support spinal manipulation for acute lower back pain (if one were to interpret the dtat optimistically), most chiropractors claim they can treat many other illnesses, including non-musculoskeletal conditions such as asthma, allergies, infantile colic, ADHD, and high blood pressure. Marketing these services without robust clinical trial backing misleads vulnerable populations.

  1. Violations of Non-Maleficence

The principle of non-maleficence requires practitioners to avoid inflicting unnecessary harm or exposing patients to disproportionate risks.

2.1. Cervical Manipulation and Stroke Risk: One of the most severe ethical concerns involves high-velocity, low-amplitude (HVLA) thrusts to the upper neck, the hallmark modality of chiropractors. This procedure has been linked to vertebral artery dissection (VAD), which can cause strokes and deaths. The ethical failure is most obvious when chiropractors perform these adjustments without warning the patient of this and other adverse outcomes.

2.2. Paediatric Chiropractic: Performing spinal adjustments on infants and toddlers (whose spines are primarily cartilage and still developing) poses distinct physical risks. Because infants cannot consent and the evidence of benefit for childhood ailments is practically non-existent, this behaviour violates non-maleficence.

  1. Secondary Harm: Delay of Standard Medical Care

Harm does not only come from physical injury; it also comes from omitting or delaying necessary medical treatment.

3.1. Anti-Vaccine and Anti-Medicine Sentiments: A large proportion of the chiropractic profession advise patients against conventional medicine, pharmaceuticals, and vaccination. When a chiropractor discourages a patient from seeking standard medical care, they are actively contributing to potentially life-threatening delays in care.

  1. Violations of Beneficence and Justice

Beneficence means acting in the patient’s best interest, while justice involves the fair and equitable distribution of healthcare resources.

4.1. The “Maintenance Care” Business Model: A common predatory practice of chiropractors involves convincing patients that they require lifelong, regular spinal adjustments to “stay aligned” and prevent disease, often locked into expensive upfront contracts. Recommending continuous, costly treatments that lack clinical evidence of long-term benefit shifts the focus from patient welfare (beneficence) to practitioner financial gain.

4.2.Over-Utilization of X-rays: Some chiropractic clinics mandate full-spine X-rays for every new patient, regardless of symptoms, and repeat them frequently to “prove” alignment changes. Exposing patients to unnecessary ionizing radiation for marketing or diagnostic justification is a direct violation of both non-maleficence and the ethical use of healthcare resources.

For a more detailed account of the ethical problems in so-called alternative medicine, please see our book on this very subject.

Religiosity has been linked to a wide range of health outcomes, with evidence for both benefits and harms.

Alleged positive effects

Many studies have found positive associations between religious involvement and physical and mental health, including lower mortality, better self-rated health and greater psychological well‑being. However, most of this literature is methodologically weak, with selection bias, poor control for confounders and selective reporting, so firm causal conclusions are difficult.

Religiosity and spirituality have frequently been associated with positive effects on mental health, such as higher levels of life satisfaction, meaning in life, hope, optimism and lower rates of depression, substance misuse and some forms of suicidal behaviour. Proposed mechanisms include social support from religious communities, promotion of coping resources, encouragement of health‑promoting behaviours and cognitive frameworks that help some people make sense of adversity.

In addition, observational studies have linked religious participation with positive effects on physical endpoints, such as reduced smoking, more moderate alcohol use and in some cases better cardiovascular outcomes and lower all‑cause mortality, though effect sizes are usually modest. Cross‑national analyses show that religious people sometimes report better self‑rated health, but these associations vary widely by country and are sensitive to socioeconomic and cultural context.onlinelibrary.

Alleged negative effects

Some aspects of religiosity might be harmful: religious struggles—such as feeling punished by God, spiritual discontent or conflict with religious communities—are consistently associated with higher levels of depression, anxiety and distress. Some studies also suggest that rigid or punitive religious beliefs can exacerbate guilt, internalized stigma (for example around sexuality) and delay help‑seeking for mental illness.

In highly secular societies, belonging to a religious minority may correlate with poorer health, possibly via discrimination, lower social integration or economic disadvantage. A critical economic analysis even reports a negative relationship between religious background and some health indicators once socioeconomic factors are carefully controlled, challenging simple “religion is good for you” narratives.

Methodological problems

Much of the evidence relies on observational studies, making it difficult to be sure about causality: healthier or more socially integrated people may be more likely to be religiously active. Measures of religiosity and spirituality are heterogeneous, ranging from attendance to private practices to diffuse “spiritual well‑being”, which complicates comparisons and may inflate positive findings. In other words, the effects of religiosity on health are less that certain or clear.

You wake up with a headache on a rainy day.

Did the rain cause your headache?

Or was it perhaps the late-night coffee?

You then take a homeopathic remedy, and an hour later the pain is gone.

Did the remedy cause this?

Or was it the shower you took, the placebo effect, or something else entirely?

Perhaps you don’t care? But, if we want to make progress, we ought to care and find the answers. Sorting out coincidence from actual cause is crucial for making progress. Causality is one of the most important concepts in research, because humans are naturally prone to seeing patterns where none exist. We are all easily fooled, and regularly even by ourselves. Mistaking a correlation (two things coicidentally happening in sequence) for a cause (one thing creating the other) can lead to wrong decisions, useless treatments, wasted resources, and often to significant harm. To prevent this, scientists have long relied on structured frameworks to prove when one event truly triggers another.

In the late 19th century, the German physician Robert Koch wanted a foolproof way to prove that a specific microbe caused a specific disease. He developed the “Koch’s Postulates”, a four-step checklist that transformed medicine:

  1. The microbe must be present in every case of the disease.
  2. The microbe must be isolated from the sick host and grown in a lab.
  3. The lab-grown microbe must cause the same disease when introduced to a healthy host.
  4. The microbe must be isolated again from the newly infected host.

While these rules worked beautifully for many infectious diseases, they have limits. Some viruses cannot be grown easily in a lab, and some people carry bacteria without ever getting sick. And, of course, there are many diseases that are not due to microbes.

As medicine evolved to tackle chronic, non-infectious conditions like heart disease or cancer, Koch’s checklist thus fell short. For instance, smoking causes lung cancer, but you cannot easily “isolate” smoking in a lab, nor does every smoker get cancer. To solve this riddle, the UK epidemiologist Austin Bradford Hill introduced a broader toolkit in 1965, today known as the “Bradford Hill Criteria”. Instead of a strict pass or fail test, it uses several simple viewpoints to weigh the evidence:

  • Strength: Is the connection large or powerful?
  • Consistency: Do different studies produce the same result?
  • Temporality: Did the cause occur before the effect?
  • Biological Gradient: Does more exposure lead to more severe outcomes?
  • Biological plausibility: Does the connection make sense with what we already know?

Without the guardrails of causality, medicine would still be based mostly on guesswork. Koch’s postulates gave us the clarity to cure deadly infections, and the Bradford Hill criteria allowed us to take on different public health threats like tobacco. By forcing us to ask how and why things happen, these criteria allow us to ensure that medical science is built on truth rather than mere coincidence.

In the realm of so-called alternative medicine (SCAM), causality has a particularly improtant role. This is because proponents often claim causality, while science rejects it:

Homeopathy:

Proponent claim: The fact that many patients get better after taking a homeopathic remedy proves that homeopathy works.

Reality: There are many other, more convincing explanations for this outcome.

 Applied Kinesiology

Proponent claim: Muscle response strength proves nutrient deficiencies, toxin exposure, or food allergies.

Reality: No consistent relationship between muscle testing results and actual health status. The practice fails basic reliability tests; different practitioners get different results from the same patient.

Reiki

Proponent claim: Practitioners channel “healing energy” from assumed sources that improves health and prompts recovery.

Reality: No such energy exists. Well-controlled studies show Reiki performs no better than placebo. The claimed energy has no basis in physics or biology.

Acupuncture

Proponent claim: Inserting needles at specific points along “meridians” releases blocked qi and cures various conditions.

Reality: Most ot the patient-blind acupuncture trials show no difference from placebo acupuncture (needles placed randomly or not penetrating skin). Cochrane Reviews find acupuncture does no better than placebo. The meridian system has no anatomical basis.

_________________

These 4 examples illustrate the fundamental problem: SCAM proponents routinely mistake correlation for causation, or propose causal mechanisms that have no basis in established physics, chemistry, or biology. Without satisfying the above-mentioned criteria, these claims remain unproven speculation rather than scientific fact.

To put it bluntly:

CAUSALITY MATTERS!

People use unproven so-called alternative medicine (SCAM) even when evidence quite clearly indicates that the SCAM in question does not work.

Why?

Here are some of the factors that can play a role:

  1. The Placebo Effect Makes People Feel Better

SCAM “helps” even though it doesn’t work. The placebo effect is a real neurobiological phenomenon that can reduce pain, improve mood, decrease stress, and affect lots of other, mostly subjective endpoints. In some situations, placebos can be as effective as real treatments. This creates genuine subjective improvement that convinces many people the SCAM in question is effective.

  1. False Hope and the Need for Control

When conventional medicine offers little, people “grab at straws” because hope drives them. For seriously ill patients, suggesting unproven interventions can provide hope and a sense of control over their illness. The ritual involved in administering SCAM creates profound impact because people feel they’re getting the attention they crave.

  1. Confirmation Bias

People selectively gather evidence conforming to their beliefs, while neglecting contradictory evidence. If someone feels better after acupuncture, for instance, they attribute it to the treatment rather than natural recovery, placebo, the attention from the therapist, or simply the restful time spent on the treatment bench. Experience or stories from others bring helped by a treatment are not evidence, of course, but they can be very compelling.

  1. The “Expensive = Good” Heuristic

It feels reassuring to spend some money on one’s health. “If it’s expensive, it must be good!” Traveling abroad for exotic SCAMs creates hope through fundraising. And expectation boosts the placebo response.

  1. Anti-Science Beliefs Predict SCAM Use

Anti-science beliefs and conspiracy theories increase the willingness to take risks and try SCAM. People who are suspicious, untrusting, eccentric, and see the world as dangerous tend to see meaningful patterns where none exist. If you believe that Big Pharma is trying to kill you, you are likely to employ SCAM.

  1. Dissatisfaction with Conventional Medicine

It’s “frustrating and demoralising when medical therapies do not offer the benefits people need or expect”. When doctors can’t provide answers or effective treatments, people are likely to seek SCAM. Sadly, I have to admit that some conventional healthcare professionals can behave such that one simply cannot be surprised, if patients look elsewhere.

  1. Humans Are Wired to See Patterns

Humans evolved to quickly detect patterns and understand how events might be causally related. We seek explanations rather than seeing randomness, but this makes us prone to seeing connections where none exist. This cognitive vulnerability is why we mistake correlation for causation. We are easily fooled, and most easily by ourselves.

8. Misinformation

Over the years, I have come to realise that all of these factors – and many more – can play a role, but that none of them is as important as misinformation. SCAM has been in the limelight sice decades, and the public is bombarded with misleading information about SCAM. It comes from journaalists, book authors, influencers, marketeers, bloggers, social media, and many other sources. And it continuously brainwashes the public into believing that even the most deplorably useless SCAM is effective, safe, and supressed by the establishment. I sympathise with everyone who is being sent up the garden path in this way and thus may get deprived of his/her savings or – much worse – health.

 

1 2 3 393

Subscribe via email

Enter your email address to receive notifications of new blog posts by email.

Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted but you must tick the box: “Save my name, email, and website in this browser for the next time I comment.”

The most recent comments from all posts can be seen here.

Archives

Categories