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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:
- The microbe must be present in every case of the disease.
- The microbe must be isolated from the sick host and grown in a lab.
- The lab-grown microbe must cause the same disease when introduced to a healthy host.
- 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.
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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:
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
This recent survey caught my attention; here is the abstract:
Homeopathy is one of the most widespread alternative methods of treatment in Bulgaria in the last 25-30 years. The aim of the research is to study and analyze the knowledge and attitudes of Bulgarians over the age of 18 regarding the application of homeopathy as a curative method in general medical practice. A cross-sectional survey among a sample of the general Bulgarian population was conducted during a 4-week period in April-May 2022. The data were collected using the Google Forms platform via an online questionnaire. A total of 508 completed responses were collected (women-450, men-58). The overwhelming number are familiar with homeopathy and have used it before for their own health problems (97% of women and 86% of men). A large number of those who have used homeopathy report an improvement in their health (88% of women and 74% of men). The majority of respondents believe that homeopathy is useful for health care (93% of women and 79% of men). Further representative studies are needed to determine the role of homeopathy as a complementary method in general medical practice.
So, the researchers collected 508 responses on Google Forms. This method does not allow calculating a response rate, i.e. a percentage of those who saw the questionnaire and decided to reply. It might well have been 1% or lower. Who can reasonably be assumed to have resopnded? My guess is that those with an interest in homeopathy did and those without it did not respond. Thus, we should not be surprised to see that 97% of women (~90% of the respondents were women) had used homeopathy, 88% reported improvements, 93% belilieve it to be useful for Health care. I have previously compared such SCAM surveys to someone studying our views about hamburgers by placing themselves outside McDonalds and interviewing customers about the subject.
What these figures do not tell us is that presumably ~90% of Bulgarians could not care less about homeopathy! Despite this rather obvious suspicion, the authors ignore the fatal flaw in their survey and state that “the prevailing opinion that homeopathy is beneficial to health care in general is noteworthy. In other studies it is found that patients expected their family physician to refer them to CAM, including homeopathy, to have updated knowledge about CAM, and to offer CAM treatment in the clinic based on appropriate training. It can be assumed that homeopathy could be part of an integrative approach in health care, given the increased number of people wishing to use it, as well as the large number of doctors who have completed a training course in homeopathy in Bulgaria.”
Of course, this would be trivial, if it were not rather typical for a large chunk of “research” getting published in the realm of so-called alternative medicine (SCAM). I did put research in ” “, because it is, in fact, not research as we know it. Too many SCAM “researchers” have settled for conducting pseudo-research, i.e. investigations, like the one above, which can only produce findings that favour SCAM in one way or another. As this sort of thing is happening a thousand times over every month, it gradually erodes science and creates a general (erroneous) feeling (not least on the political level) that SCAM must be good for our health, after all.
And why do SCAM researchers prefer pseudo-research to proper science?
In my view, the answer is clear: they have realised or feel instinctively that proper hypothesis-testing research would not generate the results they so ardently need in order to promote their creed/ideology/business.
As explained in my previous post, plausibility matters. The post was predominantly about biological plausibility – but things can be a little more complex, and it would be foolish to deny the fact that there are two kinds of plausibility; biological and clinical.
Biological plausibility concerns compatibility with established physiology, biochemistry, and pathology. It asks whether a credible pathway exists by which an assumed cause could produce an effect. And it takes into account current knowledge from biology and other natural sciences. Within the Bradford Hill framework, biological plausibility helps distinguish mere statistical associations from actual causes. For more details see my previous post.
Clinical plausibility, by contrast, is based on much softer criteria, such as clinical observation and real-world outcomes. Here, the core question is whether a claimed effect fits observed patient patterns, e.g.:
- temporal relationships,
- dose-response gradients,
- reproducibility across cohorts,
- alignment with known clinical phenotypes.
Supported by case series, observational studies, clinical trials, or epidemiological studies, an intervention can be clinically plausible long before its underlying biology is understood. This has historically been the case for many drugs; an apt example is aspirin which has been used clinically long before a biologically plausible mechanism was discovered..
The two forms of plausibility should be complementary. Ideally, a robust causal claim satisfies both mechanistic logic and clinical observation. Biological plausibility without clinical evidence remains speculative. Clinical plausibility without a known mechanism invites skepticism and further inquiry.
The deficit of biological plausibility is a major indictment of many forms of so-called alternative medicine (SCAM). They often offer no tenable mechanism and fail under rigorous testing. Conversely, demanding full mechanistic clarity before accepting consistent clinical data is likely to hinder progress in healthcare.
In relation to so-called alternative medicine (SCAM), the issue was summarised more than 20 years ago as follows:
In summary, the way to prove the efficacy of most CAM therapies is with well-designed RCTs, and there is no reason to believe that clinical trial designs cannot be developed that allow even complex CAM therapies to be evaluated. The procedures involved can be sophisticated, complex and expensive, however, and this confronts investigators with the challenge of identifying which of the myriad of existing and future CAM therapies merit the effort and expense of definitive RCT evaluation. The challenge should be met as it is in conventional drug discovery, through plausibility-building research. Whenever possible, efforts should be made to establish a credible mechanism of action for a candidate CAM therapy, because this will increase its biological plausibility and reduce the risk of false-negative RCT results. When biological plausibility is lacking, clinical plausibility alone must be the basis for determining whether or not to proceed to the costlier phase of definitive RCTs. The creation of a plausibility-building CAM research strategy will require thought, instruction, funding, and collaboration among conventional clinical investigators and CAM advocates. The advantages are many: fairness, low cost and the creation of rules of engagement for CAM evaluation that foster balanced partnerships between CAM advocates and mainstream clinical scientists.
Ultimately, in my view, not a dogmatic stance but a balanced integration of both biological and clinical plausibility should underpin rational decisions about which medical hypotheses to pursue, adopt, or discard.
Evidence‑based medicine (EBM) was developed to make clinical decisions more reliable by grounding them more solidly in good research. Thus, randomised clinical trials, systematic reviews, and meta-analysis became crucial for healthcare. That development brought undeniable progress, but it also created a problem: if we focus exclusively on such evidence, we might neglect an important question:
IS THE TREATMENT IN QUESTION BIOLOGICALLY PLAUSIBLE?
Put simply, EBM asks “Does it work in this study?” without first asking “Could it reasonably work at all?”
The neglect of biological plausibility can lead to wasted resources, misleading conclusions and, in some cases, the promotion of nonsense. The issue is, of course, particularly relevant in so-called alternative medicine (SCAM) known for its frequent lack of plausibility. A simple example might explain this more clearly: in homeopathy, we see an abundance of poor-quality studies with a positive result. This could easily lead to the overall impression that homeopathy works, while in fact it cannot reasonably work at all.
So, how can we reasonably take account of this complication? It turns out there are several options:
Option 1 Gatekeeping
One way to account for plausibility within EBM is to use it to decide what we test in the first place. Before launching an expensive clinical trial, we can ask for a clear explanation of how the proposed intervention might reasonably work. If no such rationale can be articulated without contradicting science, it is reasonable to conclude that the intervention lacks sufficient plausibility to justify the time, money and ethical burden involved in testing it on patients. In practice, this kind of gatekeeping often happens informally, but making it explicit and mandatory could help keep overtly implausible interventions from consuming scarce resources.
Option 2 Prior probability
Plausibility can also be integrated into how we interpret trial results. Some trialists treat a statistically significant result as an infallible signal that the therapy was effective. When a trial result is “statistically significant”, it means the data we observed would be unlikely if the treatment had no effect. Prior probability is another way of expressing plausibility. If a hypothesis is highly plausible given existing scientific knowledge, a positive trial fits into a broader, coherent picture. If a hypothesis is highly implausible, a positive trial is more likely to be a false positive, an artefact of bias, chance, methodological flaws, or fraud. In other words, for low‑plausibility claims, we need stronger and more consistent evidence before accepting them as true. The less plausible a claim is, the more extraordinary the evidence must be.
Option 3 Guidelines
Guideline development offers another opportunity to embed plausibility into EBM. When expert panels prepare recommendations, they typically grade the strength of evidence according to study design, risk of bias, and consistency of results. They might also add a distinct step in which they rate the plausibility of the intervention. This rating could be justified explaining how well the intervention fits with established knowledge. Guideline writers could then let this plausibility rating influence the strength of their recommendations.
Health technology assessments have been moving in this direction for some time. It makes guideline documents more transparent: clinicians could see not only what the trials showed, but also how the intervention was judged to fit into or contradict broader scientific understanding.
Option 4 Causation
Finally, causation frameworks are being used to bring plausibility into EBM. When we decide whether an association is causal, we often rely on criteria such as consistency, temporality and strength of association. Biological plausibility is another of these criteria. Using it systematically means asking whether there is a logical pathway from intervention to outcome that passes through known mechanisms and observed effects. If such a pathway can be sketched in a way that accords with science, plausibility is high. If not, plausibility is low, and we should be more cautious about drawing causal conclusions from statistical associations alone.
EBM has revolutionized healthcare, but evaluating evidence in a vacuum can carry the risk of validating the absurd. To minimise this risk, we might consider integrating biological plausibility into EBM, a possibility that has long been discussed by many experts in the field. This approach is not a rejection of EBM, but a vital safeguard for it which ensures that the evidence aligns with and strengthened by fundamental science and existing knowledge. By demanding extraordinary evidence for extraordinary claims, medicine can better protect its resources, maintain intellectual integrity, and ensure that clinical practice rests on a foundation that is both statistically sound and scientifically reasonable.
Conversion therapy is a form of so-called alternative medicine (SCAM) that attempts to change an individual’s sexual orientation from homosexual or bisexual to heterosexual, or to change their gender identity from transgender or non-binary to cisgender. The practice is built on the false premise that being LGBTQ+ is a mental illness or a developmental flaw that can and should be “cured.” It can range from talk therapy and prayer groups to extreme and physically abusive techniques, such as aversion therapy. Major medical, psychiatric, and psychological organizations worldwide have overwhelmingly rejected conversion therapy. Research consistently shows that it is completely ineffective and causes severe psychological harm, including high rates of depression, anxiety, substance abuse, and suicide. Because of these dangers, dozens of countries have banned or heavily restricted the practice.
Amongst all the many dubious SCAM therapies, conversion therapy must be amongst the most vile, as discussed previously several times, e.g.:
- “Gay exorcism” and conversion therapy by the “Forward In Faith Church International Incorporated” in Scotland
- The ‘Association of Catholic Doctors’ and homeopathic conversion therapy
- Conversion therapy is ‘despicable and degrading’. IT SHOULD BE BANNED EVERYWHERE
Now the Church of England has decided to permit a General Synod event promoting “sexual identity transformation”, i.e. conversion therapy. Entitled “People Change: Sexual Identity Transformation”, the event features Matthew Grech, who claims to have left behind a homosexual lifestyle. Hosted by General Synod member Rebecca Hunt, the meeting highlights speakers who claim to have experienced “positive, beneficial change,” aligning with the Church’s traditional teaching on marriage. Although the Church cancelled an associated exhibition stand, the meeting itself is going ahead despite a 2017 Synod vote overwhelmingly rejecting conversion therapy.
This story unfolded shortly after the UK Government published its draft Conversion Practices Bill, aimed at banning abusive attempts to alter a person’s sexual orientation or gender identity. Humanists UK have long advocated for a comprehensive, loophole-free ban on these discredited and harmful practices, which seek to change, suppress, or “cure” LGBT individuals through coercive counselling, pseudo-psychological interventions, or intense prayer.
Crucially, data from the National LGBT Survey highlights that faith groups are the primary setting for conversion therapy. Furthermore, the LGBT+ charity Galop has documented numerous cases of faith-based conversion abuse.
Laura Newlyn, Policy and Campaigns Manager at Humanists UK, emphasized that conversion practices cause lasting harm, particularly to young and vulnerable individuals facing intense pressure from religious communities. She rejected the idea that these practices constitute harmless pastoral care or ordinary prayer, stressing that most of the public, including most Christians, support a ban. Humanists UK maintains that any effective legislation must fully cover religious settings and eliminate exemptions for “consent” or religious practices to ensure all LGBT individuals are protected from abuse.
I suppose nobody need eplanations what the Epstein files are, or what crimes they depict, or how often Trump is mentioned in them. What many might not know is that even the United Nations (UN) have commented on these documents
Independent human rights experts, operating under mandates from the UN Human Rights Council, have warned that the Epstein files reveal evidence of a possible global criminal enterprise involving systematic sexual abuse, trafficking, and exploitation of women and girls. Due to the scale, transnational reach, and systematic nature of these atrocities, the experts stated that the documented conduct may meet the legal threshold for crimes against humanity. Under international law, this threshold applies to acts like sexual slavery, torture, and trafficking when committed as part of a widespread or systematic attack against a civilian population.
The disclosure follows the “Epstein Files Transparency Act” of 2025, which led to the US Department of Justice releasing over three million pages, 2,000 videos, and 180,000 images in January 2026. The background involves wealthy financier Jeffrey Epstein, who died by suicide in 2019 while facing minor-recruitment and sexual exploitation charges, and his associate Ghislaine Maxwell, currently serving a 20-year prison sentence.
The experts emphasized that states are legally obligated to investigate these crimes, which were fueled by corruption, supremacy, and extreme misogyny. They called for independent and impartial investigations into all individuals, financial structures, and official entities implicated, asserting that resignations are not a substitute for criminal accountability.
The experts praised the resilience of the survivors but criticized “grave errors” in the release process that exposed sensitive victim information, risking retaliation and stigma. They urged the adoption of victim-centered standard operating procedures for future disclosures and demanded that governments act decisively, declaring that no one is too wealthy or powerful to be above the law.
“Any suggestion that it is time to move on from the ‘Epstein files’ is unacceptable. It represents a failure of responsibility towards victims,” they said. “It is imperative that governments act decisively to hold perpetrators accountable,” the experts said. “No one is too wealthy or too powerful to be above the law.”
Trump and his team have repetedly responded to Epstein-file in general. Trump himself seems keen to disregard the experts, do precisely what they warned against, and move on. As far as I know, there is no statement of Trump or his team commenting directly on the UN experts’ “crimes against humanity” document itself.
The IGeL-Monitor is a German information portal that reviews self-pay medical services offered in doctors’ offices. It summarizes the likely benefit and harm of these services in plain language so patients can make more informed decisions. It is run by the “Medizinischer Dienst Bund” and uses evidence-based assessments rather than advertising or provider opinion.
The IGeL‑Monitor has recently focussed on osteopathy for non‑specific low back pain and judged the evidence as “unclear” stating that the current evidence does not reliably show a benefit, nor does it demonstrate meaningful harm. The reassessment pooled evidence from ten randomised clinical trials including about 1,160 participants. While some trials suggested small improvements in pain or function, the overall certainty of these findings was low due to methodological weaknesses in the primary studies. The reviewers therefore concluded that there is no convincing, high‑quality proof that osteopathic manual therapy provides a clinically relevant advantage over sham or usual care.
A further concern highlighted in the assessment is publication bias: positive trials may be preferentially published. This phenomenon that exaggerates apparent benefits.
No clear pattern of harm from osteopathic treatment was identified. Adverse events were inconsistently and inadequately recorded in the trials. This fact not only limits the confidence about safety, but is also a clear breach of medical ethics.
The IGeL‑Monitor reiterates its previous (2018) position: with current data one cannot reliably endorse osteopathy as an effective out‑of‑pocket intervention for non‑specific low back pain, nor can one identify significant risk. Hence the label “unclear.” For patients considering osteopathy as a self‑paid service, the IGeL‑Monitor recommends being informed about the uncertain benefit and the weak evidence base when weighing potential costs against likely outcomes.
The new assessment is in agreement with much that I have been saying on this blog. I nevertheless would like to add one important point: back pain is the one condition for which the evidence is relatively sound. There are many other conditions for which osteopathy is being relentlessly promoted as an effective therapy with even less or no reliable evidence at all.
The Church of Scientology has spent decades insisting that psychiatry is a terrorist conspiracy, antidepressants are a gateway to mass murder, and only its own “tech” can save humanity from the menace of Prozac and similar “poisons”. One might imagine this worldview would remain safely quarantined within L. Ron Hubbard’s realm of loons.
But then Robert F. Kennedy Jr. became Secretary of Health and Human Services!
By pure coincidence Kennedy’s “Make America Healthy Again” crusade, unveiled with the MAHA Action Plan to Curb Psychiatric Overprescribing, just happens to target the very same SSRIs that Scientology and its front group CCHR have been demonising for years. Antidepressants are singled out, deprescribing is framed as a patriotic duty, and psychotherapy and lifestyle tweaks are held up as the noble alternative to “overmedicalization.” The American Psychiatric Association calls SSRIs evidence‑based treatment; Kennedy, channelling his inner CCHR lawyer, suggests they’re harder to quit than heroin and may be helping to fuel mass violence.
Enter Wisner Baum, the mass‑tort firm whose senior partners have long, colourful histories with Scientology and its covert operations. This firm has spent years suing antidepressant manufacturers and other psychiatric technologies. And Kennedy has quietly pocketed over $850,000 in fees from them, while keeping a continuing financial interest as HHS Secretary. It is hard to imagine a neater arrangement: a Scientology‑linked law firm sues drug companies; a Scientology‑approved health secretary casts doubt on those same drugs from the cabinet; and fee income flows merrily along.
So, is Kennedy formally a Scientologist?
No, to the best of my knowledge, there is no evidence for that. But perhaps the label becomes somewhat unimportant, when the nation’s top health official is advancing policy that mirrors Scientology’s doctrine and staying financially intertwined with its legal defender. Whether or not he has taken the oath or not (and I am not saying he has), he seems to be doing the work of Xenu, the mysterious extraterrestrial ruler of a galactic confederacy.
