NEW!
NEW!
Updated Edition!
France, like most countries, has long had its fair share of pseudoscience (see also my previous post). What is new, I feel, is the fact that opposition to the promotion of this dangerous nonsense is becoming more visible and hopefully more effective.
The recent revelations about pseudoscientific content in the biology and geology (sciences de la vie et de la Terre) teacher‑training program at the “Institut National Supérieur du Professorat et de L’Education” in Dijon illustrate how deeply irrational ideas and outright quackery can infiltrate institutions that should embody and promote scientific rigour. For several years, future secondary‑school biology teachers enrolled in the master’s degree programme “Métiers de l’Enseignement, de L’Education et de la Formation, Sciences de la Vie et de la Terre” were reportedly offered modules on so-called alternative medicine (SCAM), such as “self‑healing,” homeopathy, and “mind over cancer,” where the power of mindset was presented as more important than chemotherapy. Such teaching does not simply represent a minor pedagogical eccentricity; it directly undermines the principles of evidence‑based medicine and science education.
Instead of learning how to critically appraise data, distinguish levels of evidence, and communicate scientific uncertainty, these trainees were exposed to narratives that elevate anecdote, belief and spurious “energy” concepts over controlled clinical trials and established oncological knowledge. More troubling still, students describe a climate in which questioning these contents could be seen as a lack of openness, thus inverting the very logic of critical thinking: scepticism toward dubious claims was implicitly discouraged, while credulity was smuggled in as a virtue.
The institutional response – acknowledging that “certain contents” might be problematic and promising internal reviews – remains inadequate as long as it treats pseudoscience as a marginal excess, rather than as a systemic failure of quality control and epistemic standards. In a context where schools already face conspiracy thinking and health misinformation, the responsibility of teacher‑training institutes is not merely to avoid obvious charlatanism, but to actively inoculate future teachers against it.
If those tasked with teaching biology and geology to the next generation are introduced to homeopathic and “mind‑healing” discourses without critical thinking, the boundary between science and pseudoscience becomes dangerously blurred. Defending that boundary is not an academic luxury; it is a matter of public health, intellectual integrity, and respect for the patients and families who depend on honest, evidence‑based information.
As calling out pseudoscience in France gets more effective, we will doubtlessly hear more about this issue. And as this development gathers momentum, the French will become more rational … yes, I know, I am an incurable optimist!
I must admit that, in recent months, I neglected my ALTERNATIVE MEDICINE HALL OF FAME. As my regular readers will know, this is an assembly of extraordinary researchers – extraordinary in the sense that they all have been busy studying so-called alternative medicine (SCAM) without ever managing to publish a single negative result.
At present, the ALTERNATIVE MEDICINE HALL OF FAME includes the following 27 men and women:
- Miek Jong (homeopathy, Norway)
- Josef M Schmid (homeopathy, Germany)
- Meinhard Simon (homeopathy, Germany)
- Richard C. Niemtzow (acupuncture, US)
- Helmut Kiene (anthroposophical medicine, Germany)
- Helge Franke (osteopathy, Germany)
- Tery Oleson (acupressure , US)
- Jorge Vas (acupuncture, Spain)
- Wane Jonas (homeopathy, US)
- Harald Walach (various SCAMs, Germany)
- Andreas Michalsen ( various SCAMs, Germany)
- Jennifer Jacobs (homeopath, US)
- Jenise Pellow (homeopath, South Africa)
- Adrian White (acupuncturist, UK)
- Michael Frass (homeopath, Austria)
- Jens Behnke (research officer, Germany)
- John Weeks (editor of JCAM, US)
- Deepak Chopra (entrepreneur, US)
- Cheryl Hawk (chiropractor, US)
- David Peters (osteopathy, homeopathy, UK)
- Nicola Robinson (TCM, UK)
- Peter Fisher (homeopathy, UK)
- Simon Mills (herbal medicine, UK)
- Gustav Dobos (various SCAMs, Germany)
- Claudia Witt (homeopathy, Germany/Switzerland)
- George Lewith (acupuncture, UK)
- John Licciardone (osteopathy, US)
Today, an article by Stephanie Benz published in L’Express caught my attention. It mentions a man who might well qualify as a candidate for my illustre assembly. As it is in French, let me summarise it for you.
The article focusses on the bixarre actions of Professor Julien Nizard. He is the vice-dean of Nantes University’s medical school, who stands accused of abusing his academic standing to promote SCAM, while suppressing scientific critique. Serving as an institutional shield for pseudo-sciences, Nizard uses his leadership at the university and within the Collège Universitaire de Médecine Intégrative et Thérapies Complémentaires (CUMIC) to introduce SCAM into official medical training.
The article explicitly notes Nizard’s defense, instruction, or validation of several SCAM practices, including:
- Acupuncture
- Hypnosis / Hypnotherapy
- Osteopathy
- Socio-aesthetic care (often used as part of supportive cancer care)
- Auriculotherapy (ear acupuncture)
- Various other “soft medicines” and non-medicinal interventions (INMs) lacking robust, peer-reviewed clinical proof.
To shield his SCAM programs from internal dissent, Nizard has allegedly turned to unusual administrative and legal pressures against critical faculty members and advocates of evidence-based medicine, like the Collectif No Fakemed. His tactics are said to include:
- Legal Threats and Institutional Action: Nizard has reportedly threatened to drag critical colleagues before the National Order of Physicians (CNOM) or pursue defamation lawsuits to silence them.
- Professional Hostility: Internal whistleblowers and professors attempting to uphold strict evidence-based standards report facing a hostile work environment, administrative stonewalling, and explicit professional pressure meant to damage their academic standing if they publicly oppose his pseudo-scientific initiatives.
- Political Manipulation: He uses behind-the-scenes lobbying at the ministerial level to bypass traditional university peer-review processes, relying on political influence to institutionalize practices that fail to meet baseline clinical research standards.
The article motivated me to look up Julien Nizard in order to find out what papers he has published in the realm of SCAM. The result is impressive. I found 7 abstracts of his SCAM-related papers listed on Medline.
Recent guidelines for managing fibromyalgia highlight the importance of a graded-care approach, tailoring treatment to predominant symptoms, and appropriately integrating nonpharmacological treatments and complementary medicine (CM). Many fibromyalgia patients turn to nonpharmacological treatment and CM for various reasons, including concerns about medication side effects and persistent symptoms despite pharmacological treatment. In addition, these approaches are sometimes mistakenly, but often, perceived as natural and, therefore, widely accepted as well-tolerated with minimal risks. However, as with many patients using CM, fibromyalgia patients frequently engage in these practices without informing their physicians, often because of fear of a negative reaction. This can occur in contexts that lack adequate safeguards, such as treatment by noncertified practitioners, undocumented practices, excessive costs, or unsafe environments. In this narrative review, we first provide updated definitions of these practices, discuss their potential benefits and associated risks, and explore the challenges in their evaluation. We then summarize key findings from the literature before proposing a structured approach for discussing these practices with fibromyalgia patients. This includes assessing their prior experiences, expectations, and motivations for long-term adherence. We also offer guidance on selecting qualified practitioners and ensuring a sufficiently safe treatment environment. Finally, we highlight essential “red flags” that pain specialists and health care providers should discuss with patients, emphasizing the need for caution or even discontinuation of certain practices when these warning signs are present.
The majority of nurses have a favourable opinion of complementary therapies. This makes it easier to identify the therapies used by patients. Being trained in and practising a complementary therapy strengthens the nursing skills and helps to give it new meaning. Nurses must play an active part in the ongoing structuring of integrative medicine in France.
Neuropsychiatric disorders are one of the frequent complications of neurocognitive disease, and have an impact on the quality of life of patients and caregivers. Non-phamacologic interventions are recommended as first-line treatment. The Snoezelen method is a multisensory stimulation method based on the assumption that acting on sensoriality can improve neuropsychiatric symptoms and thus quality of life, but its level of evidence is controversial. To explore this, we performed a systematic literature review of randomized controlled articles focusing on the use of the Snoezelen method in patients with cognitive disorders. Eighteen studies were included. The clinical outcomes studied were multiple (behavior, mood, cognition, functional capacities and biomedical parameters). When the Snoezelen method was compared to the “standard activities” group, it appears to be effective on short-term behavior. This was more negligible when the method was compared to others non-pharmacological interventions. Although the Snoezelen method could be effective on mood, cognition, and functional abilities, its level of evidence remains low. Furthers mixed studies (quantitative and qualitative) would be an interesting approach to delve into this topic in the most holistic way by integrating the patients, the caregivers and the cost of the method.
Background: Low Back Pain (LBP) is the leading cause of disability worldwide, 90% of which is nonspecific. Manual therapy is one of the recommended treatment modalities. However, reported outcomes may be variable. This review aims to identify their scope in the context of the development of a Core Outcome Set (COS), which is defined as « an agreed standardised set of outcomes that should be measured and reported, as a minimum, in all clinical trials in specific areas of health or health care ».
Methods: A scoping review with risk of bias assessment of randomised controlled trials (RCTs) of manual therapy for nonspecific LBP was conducted using MEDLINE, CENTRAL, PEDro, WebOfScience and ClinicalTrials.gov, from 2010 up to August 2024. Manual therapy was considered the use, alone or in combination, of manipulations (high velocity, low amplitude), mobilisations (low-grade velocity, small-to-large amplitude) or soft tissue relaxation (especially massage, trigger points, muscle contractions).
Results: Out of 3929 articles, 147 RCTs and 74 protocols were included. Two main outcomes emerged: pain intensity (assessed by numerical rating scale or visual analogue scale) and disability (mostly assessed by Rolland-Morris Disability Questionnaire or Oswestry Disability Index). Range of motion is the most frequent clinical outcome assessed. Psychological factors such as fear-avoidance beliefs, kinesiophobia and catastrophising, and healthcare consumption, particularly medication, are also frequent. Most of the outcomes were patient-reported outcomes.
Conclusion: Consistent with a previous COS on nonspecific low back pain, manual therapy appears to address the same outcomes. Clinical trials in manual therapy should focus on using the existing COS by measuring pain intensity using a numerical rating scale, disability using the ODI 2.1a or the 24-item RMDQ, health-related quality of life using the SF-12 or the 10-item PROMIS. Additionally, due to the gap between clinical research and pain experience, trials should consider conducting subgroup analyses to identify effects on outcomes related to gender or age, paying particular attention to health inequalities by carrying out analyses based on socioeconomic status, as these factors are well known to significantly impact pain experience and access to care.
Background: Deep brain stimulation (DBS) is an effective technique to treat patients with advanced Parkinson’s disease. The surgical procedure of DBS implantation is generally performed under local anesthesia due to the need for intraoperative clinical testing. However, this procedure is long (5-7 h on average) and, therefore, the objective that the patient remains co-operative and tolerates the intervention well is a real challenge.
Objective: To evaluate the additional benefit of electroacupuncture (EA) performed intraoperatively to improve the comfort of parkinsonian patients during surgical DBS implantation.
Methods: This single-center randomized study compared two groups of patients. In the first group, DBS implantation was performed under local anesthesia alone, while the second group received EA in addition. The patients were evaluated preoperatively, during the different stages of the surgery, and 2 days after surgery, using the 9-item Edmonton Symptom Assessment System (ESAS), including a total sum score and physical and emotional subscores.
Results: The data of nine patients were analyzed in each group. Although pain and tiredness increased in both groups after placement of the stereotactic frame, the ESAS item “lack of appetite”, as well as the ESAS total score and physical subscore increased after completion of the first burr hole until the end of the surgical procedure in the control group only. ESAS total score and physical subscore were significantly higher at the end of the intervention in the control group compared to the EA group. After the surgical intervention (D2), anxiety and ESAS emotional subscore were improved in both groups, but the feeling of wellbeing improved in the EA group only. Finally, one patient developed delirium during the intervention and none in the EA group.
Discussion: This study shows that intraoperative electroacupuncture significantly improves the tolerance of DBS surgery in parkinsonian patients. This easy-to-perform procedure could be fruitfully added in clinical practice.
Background: It is currently considered that around 30% of chronic pain patients are totally refractory to medical treatment. Among patients who remain responsive to medical treatment, it is estimated that between 20% and 50% are likely to discontinue treatment due to severe side effects. Given these therapeutic difficulties, a significant number of patients turn to complementary therapies.
Objective: The LineQuartz® is a medical device that combines 3 complementary therapies, namely, music therapy, light therapy, and chromotherapy. We propose to evaluate its effectiveness in chronic pain patients.
Methods: Between October 2021 and October 2022, 44 patients aged between 23 and 85 years (mean: 55.4 years) were included in a prospective study. All patients had background pain intensity greater than 4/10 on the Numerical Pain Scale (NS). Treatment consisted of 4 half-hour sessions, divided into one session per week for 3 weeks (21 days). Patients were assessed by the Brief Pain Inventory (BPI) and the Hospital Anxiety and Depression scale (HAD) the day before starting treatment (Day 0) and the day after the end of treatment (Day 22).
Results: Apart from the BPI item, “relationship with others,” all items improved significantly (p < 0.050). Background pain intensity (NS) and frequency of painful attacks improved very significantly (p < 0.001). The HAD anxiety subscore was also significantly improved (p < 0.001). Discussion. This open pilot study supports the idea that LineQuartz® has a place among complementary therapies dedicated to the treatment of chronic pain. However, these results need to be confirmed by a controlled study.
Context: In addition to curative care, supportive care is beneficial in managing the anxiety symptoms common in patients in sterile hematology unit. We hypothesize that personal massage can help the patient, particularly in this isolated setting where physical contact is extremely limited. The main objective of this study was to show that anxiety could be reduced after a touch-massage® performed by a nurse trained in this therapy.
Methods: A single-center, randomized, unblinded controlled study in the sterile hematology unit of a French university hospital, validated by an ethics committee. The patients, aged between 18 and 65 years old, and suffering from a serious and progressive hematological pathology, were hospitalized in sterile hematology unit for a minimum of three weeks, patients were randomized into either a group receiving 15-minute touch-massage® sessions or a control group receiving an equivalent amount of quiet time once a week for three weeks. In the treated group, anxiety was assessed before and after each touch-massage® session, using the State-Trait Anxiety Inventory questionnaire with subscale state (STAI-State). In the control group, anxiety was assessed before and after a 15-minute quiet period. For each patient, the difference in the STAI-State score before and after each session (or period) was calculated, the primary endpoint was based on the average of these three differences. Each patient completed the Rosenberg Self-Esteem Questionnaire before the first session and after the last session.
Results: Sixty-two patients were randomized. Touch-massage® significantly decreased patient anxiety: a mean decrease in STAI-State scale score of 10.6 [7.65-13.54] was obtained for the massage group (p ≤ 0.001) compared with the control group. The improvement in self-esteem score was not significant.
Conclusion: This study provides convincing evidence for integrating touch-massage® in the treatment of patients in sterile hematology unit.
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Are you as impressed as I am?
Not only has this vice-dean of a medical school shown how to properly defend SCAM by innovative means including legal threats, he has also found the time to publish 7 Medline-listed papers on various forms of SCAM! I am even more impressed that someone with so little valid SCAM research can become such an ardent “defender of the indefensible”. But what impresses me most is this: in all his publications, I cannot find a single negative result, nor a word of SCAM-related criticism.
This, by Jove, is a remarkable achievement!
I hope you all agree that it deserves inclusion into my ALTERNATIVE MEDICINE HALL OF FAME.
Bienvenue Julien!
Tolerance is widely regarded as a moral virtue, a cornerstone of pluralistic societies and a safeguard against dogmatism. Yet, tolerance can sometimes be misplaced. Thomas Mann suggested that “tolerance becomes a crime when applied to evil”. In a similar vein, I propose that tolerance can become unethical when applied to homeopathy.
Homeopathy presents itself as a benign and natural alternative to or complement of conventional medicine. Its appeal lies partly in its historical pedigree and partly in its promise of gentle healing without side effects. However, beneath this veneer lies a system of belief that is fundamentally incompatible with science and ethics. Its core principles – the notions that like cures like and that substances become more potent through extreme dilution – contradict basic laws of physics, chemistry and pharmacology. After more than two centuries of use and more that 500 clinical studies, there is no credible evidence that homeopathic remedies perform better than placebos.
In many areas of life, tolerance for differing beliefs is both appropriate and necessary. However, medicine is different. It is not merely a matter of opinion; it is a field grounded in empirical evidence, where opinions can have direct and drastic consequences for health and survival. To tolerate ineffective and therefore potentially harmful treatments within this domain risks legitimizing misinformation and undermining public trust in evidence-based care.
The ethical problem intensifies when homeopathy is integrated into healthcare systems or endorsed by public institutions. Such endorsement conveys an implicit message of efficacy and legitimacy, misleading patients who may lack the expertise to critically evaluate medical claims. This is particularly concerning in cases where patients choose homeopathic remedies as an alternative therapy, i.e.in place of effective treatments, potentially resulting in preventable harm. Here, tolerance can easily degenerate into complicity.
Defenders of homeopathy often invoke patient choice and patient autonomy. While these are important principles, they do not justify the abdication of professional responsibility. True respect for patients involves providing accurate information and protecting them from ineffective or deceptive practices. Allowing patients to choose homeopathy without clear, despite all the evidence that speaks against it is not an expression of respect but a failure of duty.
Moreover, the commercial dimension of homeopathy raises additional ethical concerns. The marketing of homeopathic products often exploits the language of science and medicine while evading the standards that govern them. Consumers are led to believe they are purchasing effective treatments. In reality, they are buying fake medicines that contain no active ingredients. This practice tolerance has degenerated into exploitation.
A society that prides itself on scientific progress and rational inquiry cannot afford to suspend its critical faculties in the name of tolerance. While civility and openness are essential virtues, they must not be confused with randomness or indiscriminate acceptance. Tolerance has limits, particularly when it intersects with matters of public health and scientific integrity.
Thus, the tolerance extended to homeopathy is not merely misplaced; it is ethically problematic. By granting homeopathy a status it does not merit, we risk eroding the very standards that protect patients and uphold the credibility of medicine. In this context, I feel that intolerance is not a vice but a necessary stance, one that affirms the primacy of evidence, reason, and the ethical obligation to do no harm.
A recent paper entitled “Research Ethics and Integrity and the Different Forms of Misconduct: Applications and Challenges in Traditional, Complementary, and Integrative Medicine Research” caught my eye. As the subject is close to my heart and often covered on this blog, I studied it carefully. Here is the abstract:
Research ethics and integrity are foundational to the credibility, safety, and societal trust of scientific inquiry. As the use of traditional, complementary, and integrative medicine (TCIM) grows globally, concerns about research misconduct (including fabrication, falsification, and plagiarism) have become increasingly salient. With up to 80% of populations in certain countries utilizing TCIM, the field’s expansion underscores the need for rigorous, ethically grounded evidence to guide practice and policy. However, around 470 TCIM-related articles have been retracted to date, as indicated on the Retraction Watch database, which may be due to ethical or non-ethical concerns. This educational article critically examines the state of ethics and integrity in TCIM research, drawing on case studies of misconduct and highlighting the broader consequences for patient safety, scientific credibility, and healthcare integration. In addition, the educational article explores emerging ethical dilemmas posed by artificial intelligence (AI), including risks of automated fabrication, falsification, plagiarism, and opacity in research reporting. To strengthen ethical conduct, we propose strategies spanning four domains: 1) improving education and fostering interdisciplinary collaboration to enhance research literacy, 2) embedding open science practices to promote transparency and reproducibility, 3) leveraging meta-research to monitor and advance research quality, and 4) developing policies and safeguards for responsible AI use. Upholding high ethical standards in TCIM research is essential not only to ensure reliable evidence but also to protect patients, sustain public trust, and enable meaningful integration of TCIM within evidence-based healthcare systems.
The full conclusions of the authors are as follows: “With the increasing global use of TCIM therapies, it is crucial for TCIM researchers to uphold high ethical standards to ensure the feasibility, validity, efficacy and safety of TCIM interventions. TCIM research challenges such as heterogeneity, complexity, and lack of standardization practices, alongside issues with research training and funding, create both transformative opportunities and ethical dilemmas that require reflection. Addressing these challenges requires a firm commitment to enhancing research ethics and integrity in TCIM. This commitment must be translated into action through multifaceted strategies: improving research and ethics literacy, fostering open science practices, and ensuring the transparency, integrity, and reproducibility of TCIM research. Strengthening ethical and research practices will not only support its continued development as a discipline but also maximize its potential to contribute to global health.”
I find it most commendable that this subject has finally been addressed by a group of researchers, most of who are known advocates of so-called alternative medicine (SCAM). I hope that this is proves to be a step in the right direction for the fileld of SCAM.
Yet, I fear that it is a small or even tiny step. The reason for my fear is that several important issues related to research ethics and integrity in SCAM are let untouched by the authors. In my view, the one of the most important amongst them is the SCAM researcher him/herself. As often discussed on this blog, SCAM research is unique amongst all areas of medical research for being populated by individuals who have a strong ideological bias in favour of SCAM.
These (pseudo)scientists tend to abuse science by trying to prove that their beliefs are correct. Rather than trying to falsify their hypotheses, they would bend over backwards to show that their favourite SCAM is effective. I tried to demontrate this clearly by establishing my ALTERNATIVE MEDICINE HALL OF FAME on this blog.
As to the many other omissions of important ethical concerns from the above paper, I recommend having a look at our book “More Harm than Good?: The Moral Maze of Complementary and Alternative Medicine“. It offers a much more complete review of the ethical issues involved in SCAM research (amusingly, it was not cited in the paper above).
I have never commented on football before on this blog (I am not even a big fan, yet I have been involved in doctoring for a team many years ago). Today, I make an exception because, in the very early hours of 6 July (UK time), England will be playing Mexico in the World Cup. This would, of course, not be worth writing about, were it not for a crucial detail: the match will be at the ‘Estadio Azteca’ in Mexico City, at about 2,240 meters above sea level, at a hight of roughly 2250 metres above seal level.
It is almost 40 years ago that I was interested in the human physiology at high altitudes. At the time, we concluded that this affects the fluidity of blood unfavourably, an effect that is likely to limit physical performance. But this is just one factor of several that can prove to be a significant handicap for a non-adapted athlete.
Playing at high altitude is medically significant mainly because the thinner air lowers the partial pressure of oxygen, so England’s players will absorb less oxygen with each breath. That means the muscles receive less oxygen when they need it most, e.g. during repeated sprints, accelerations, and recoveries.
The immediate consequence is a higher heart rate, heavier breathing, and faster, profounder and longer-lasting fatigue. In a football match, that can reduce high-intensity running, impair decision-making, and slow recovery between bursts of effort. The extraordinary fitness of professonal football players does not fully protect against low oxygen availability, because the body’s aerobic energy system is being forced to work under a constraint it is not used to. The body can adapt to high altitudes by making more red blood cells, but that process takes days to weeks, so a short turnaround leaves little time for meaningful acclimatisation.
Altitude also creates problems that are less obvious but might still turn out to be important. Sleep would be worse after arrival at high altitude, and poor sleep impairs recovery and performance the next day. In addition, there may also be a tactical issue that few have thought about. The ball travels a little faster and farther in thin air. This obviously can alter passing, shooting, and goalkeeping judgments.
The Mexican team is of course well adapted to the altitude. Their players are used to training and playing at Mexico City’s elevation, so the thinner air is far less of a shock for them. That matters because the home side can maintain intensity for longer, recover more quickly between sprints, and avoid unusual fatigue.
In short, high altitude is not just an inconvenience. It is a significant medical stressor that reduces oxygen delivery, worsens recovery, and makes sustained effort harder for the unadapted England team.
Fingers crossed, I hope they win nontheless.
Will I stay up to watch?
No, that would also be a significant medical stressor, one that I prefer to avoid.
In the US, scientific research is facing a new bureaucratic obstacle marked by a stringent escalation in research security enforcement by major federal funding bodies. Traditionally, the US has positioned itself as the vanguard of open, globalized scientific inquiry, a model predicated on the understanding that breakthrough discoveries thrive on cross-border intellectual synergy. However, recent regulatory shifts initiated by the National Institutes of Health (NIH) and the National Aeronautics and Space Administration (NASA) indicate a retreat from this paradigm. By retroactively and rigidly redefining international authorship as a national security risk, federal grant managers threaten to balkanise academic collaboration and stifle scientific progress.
At the core of the current crisis is the administrative weaponization of the “foreign component” clause. Historically, the NIH mandated prior approval only when federal funds were explicitly exported or when critical project segments were physically conducted abroad. Contemporary enforcement, however, relies heavily on automated digital auditing systems that flag any international institutional affiliation on published papers as evidence of an unauthorised foreign component. This algorithmic surveillance penalizes benign, routine academic practices. US-based principal investigators have been forced to expunge highly cited, peer-reviewed publications from their federal progress reports simply because a co-author was an international scholar, a foreign student working within an US lab, or a colleague who provided isolated research materials.
This bureaucratic overreach is amplified by a lack of institutional transparency. Rather than issuing clear, standardized guidelines through formal rule-making channels, agencies are executing these directives via private, ad-hoc communications between individual grant managers and researchers. This strategy of decentralised intimidation leaves academic institutions without uniform legal recourse, compelling university compliance offices to draft defensive internal policies. For instance, researchers are now advised to attach granular, defensive footnotes to their manuscripts explicitly certifying the physical, geographic location of every contributor during the research process to avoid automated funding freezes.
The ramifications extend beyond administrative inconvenience, posing a existential threat to the integrity of global science. Faced with the existential threat of funding termination or legal prosecution, US scientists are disincentivised from pursuing crucial international partnerships. Others may choose to obfuscate federal sponsorship on collaborative papers to circumvent algorithmic detection, thus undermining the transparency of research funding.
Update:
In June 2026 the White House OMB released proposed revisions to the federal Uniform Guidance that would tighten oversight of federal awards, explicitly addressing foreign collaborations, reporting, and recipient responsibilities; commentators warn these changes could widen the administrative burden on grantees and institutional compliance offices. Coverage in major science outlets and policy analyses framed these actions as part of a broader administration push to overhaul transparency and control in federal research funding. Critics argue some proposals risk politicising grant making and chilling international collaboration.
News pieces and policy briefs describe more aggressive enforcement by grant managers (including retrospective audits and requests to remove or explain foreign co‑authorship), plus institutions drafting defensive procedures to avoid triggering automated audits. Scientists, scientific societies, and international collaborators have expressed concern that tighter rules and algorithmic detection of foreign affiliations will disincentivize open co‑authorship and complicate routine global partnerships.
The proposed Uniform Guidance revisions will follow a formal notice-and-comment process; watch for the final rule text and agency-specific implementing guidance because those will determine the precise legal obligations and whether the most burdensome interpretations survive.
A position paper of the Associazione Pazienti Malattie Oculari (APMO) evaluated IRIDOLOGY. Here is its abstract:
Iridology is an alternative diagnostic practice that claims to identify systemic diseases and organ dysfunction through visual inspection of iris features, including pigmentation patterns, crypts, furrows, and discolorations. Despite its continued presence within complementary and alternative medicine, iridology has not been incorporated into mainstream medical practice. This review critically examines iridology from an ophthalmologic perspective, addressing its historical origins and epistemological foundations, proposed mechanisms, biological plausibility, and clinical evidence. A systematic appraisal of the available literature, including the most recent government-commissioned evidence evaluation, demonstrates a consistent lack of diagnostic accuracy, reproducibility, and pathophysiological rationale. The ethical and clinical implications of iridology use are discussed, with particular attention to the risk of delayed diagnosis and patient misinformation. Based on the totality of evidence, iridology cannot be supported as a diagnostic or screening tool in ophthalmology or general medicine.
In the article itself, the authors drew the following, detailed conclusion: Iridology is a diagnostic practice whose foundational maps were constructed through uncontrolled post hoc observation, without anatomical, physiological, or embryological basis. Decades of controlled investigation – including the most recent government-commissioned systematic review applying GRADE methodology [16] – have failed to demonstrate diagnostic accuracy beyond chance, and no credible mechanism links iris features to systemic organ pathology.
A scientifically rigorous appraisal must acknowledge several nuances: the evidence base itself is limited in volume and methodological quality; a single study using automated photodensitometry produced one marginally significant finding; and one recent unblinded study reported high sensitivity at the cost of unacceptably low specificity. These exceptions do not alter the overall conclusion but illustrate that further high-quality prospective blinded trials would strengthen the evidentiary record.
Based on the available evidence, the Associazione Pazienti Malattie Oculari endorses the following key messages:
- Iridology should not be used or endorsed as a diagnostic or screening tool in ophthalmology or general medicine.
- The epistemological foundations of iridology (chart construction through uncontrolled post hoc correlation) are incompatible with scientific validation regardless of clinical trial results.
- Computer-aided iridology represents a technological advance that has not yet addressed the underlying validity problem and should not be regarded as validated.
- Patient inquiries should be addressed with empathy, scientific clarity, and a clear distinction between genuine ocular signs of systemic disease and unsupported claims.
- Ophthalmologists have a professional responsibility to safeguard the scientific integrity of ocular diagnostics and to protect patients from practices with potential for harm.
All of this confirms what I have been saying and writing for several decades. My recent book BIZARRE MEDICAL IDEAS has a chapter on iridology and his inventor. Here is its abstract:
Ignaz von Peczely (1826-1911) was born into a noble Hungarian family. He became a lay homeopath but later decided to study medicine in Vienna where he graduated aged 36. He then had a thriving medical practice in Vienna. Peczely’s discovery of iridology allegedly goes back to his childhood when he noted discolourings in the eye of an injured owl. Throughout his professional life, Peczely promoted iridology with some success. Other practitioners took over the mantle and made sure iridology is popular to the present day.
What needs stressing, I feel, is the fact that iridology is not just a mere folly, it is dangerous! False negative and false positive diagnoses – iridology is unable to deliver anything else – carry serious, sometimes life-threatening risks.
Ten years after Brexit, it seems reasonable to ask what effects Brexit has caused on health-related matters for the UK and beyond. Here is my attenpt to provide an answer; these are the 8 issues that come to my mind:
- Workforce Disruption and Recruitment Shift: The ending of free movement led to a sharp drop in EU-trained doctors, nurses, and social care staff. To plug these vacancy gaps, the UK was forced into recruiting heavily from non-EU nations. This created a fragile reliance on international recruitment from countries facing their own healthcare worker shortages. In turn, this further supported the xenophobic sentiments of some UK citizens.
- Medicine Supply Problems: Leaving the EU single market introduced significant customs and regulatory friction. This friction directly contributed to the frequency and severity of local pharmaceutical shortages in the UK.
- Loss of Regulatory Leverage: By exiting the European Medicines Agency (EMA), the UK became a standalone market. Pharmaceutical companies now regularly prioritize the much larger EU and US markets for rolling out cutting-edge new treatments, leaving the UK Medicines and Healthcare products Regulatory Agency (MHRA) to act as a “rule-taker” by fast-tracking approvals already granted elsewhere.
- Cross-Border Friction: Reciprocal healthcare arrangements became more complex under the new Global Health Insurance Card (GHIC) system. While basic travel is covered, specialized cross-border medical networks face ongoing administrative and legal hurdles. Many British ex-pats’ found themselves without health cover.
- Regulatory Divergence in Training and Innovation: The UK has increasingly diverged from EU rules, such as lowering the mandatory clinical training hours required for a nursing degree to get staff into hospitals faster. Additionally, medical technology and AI developers now face double-compliance costs (clearing separate UK and EU hurdles). This makes the UK a more expensive market to launch new health technologies.
- The Macro-economic Squeeze: The overall economic downturn resulting from Brexit reduced UK GDP, shrinking the available tax revenues. This has directly limited the government’s financial capacity to fund the NHS, to clear post-pandemic backlogs, and to invest in long-term social care reform.
- Exacerbating Health Inequalities: As inflation, food costs, and supply chain disruptions damaged the UK, vulnerable socioeconomic groups have been hit the hardest. These economic pressures, combined with a chronically strained social care sector, significantly widen UK health inequalities.
- Compounding Pressure on Patient Outcomes: While ultimate health metrics, such as mortality rates and overall life expectancy, are influenced by dozens of complex variables, an underfunded NHS, chronic staffing vulnerabilities, and restricted access to new drugs create a persistent, negative headwind against public health which, in the long run, can only negatively affect patient outcomes.
All of these effects are clearly negative.
Can anyone think of a positive effect?
I can’t!
The WHO’s supportive stance on so-called alternative medicine (SCAM) has been discussed on this blog many times before. Now a BMJ editorial criticized the WHO for uncritically promoting SCAM within mainstream health systems. It argues that WHO’s new strategy gives undue legitimacy to interventions whose evidence base is often weak, inconsistent, or absent. The author’s main concern is not cultural respect or patient choice, but the risk that policy language about “integration,” “tradition,” and “people-centred care” can blur the line between evidence-based medicine and therapies that have not demonstrated reliable benefit. The article points out that, while some traditional practices may be harmless or even useful, broad institutional support should depend on rigorous proof of safety and effectiveness. It also warns that promoting such therapies may waste scarce resources, confuse patients, and create false equivalence with established medical care. More broadly, the editorial presents this as a scientific and ethical issue: global health bodies should strengthen standards, not weaken them. The WHO should prioritize robust clinical evidence, transparent regulation, and careful harm-benefit assessment before endorsing any therapy for widespread use. In short, the article sees WHO’s current approach as a misguided attempt to accommodate alternative medicine rather than critically evaluate it.
The team of international authors of the editorial argue that an ideal strategy should mandate pharmacovigilance, including adverse event reporting, as a prerequisite. Large workforces should be redirected toward evidence-based primary care, such as screening, vaccination, chronic disease identification and maternal health. Research funding should prioritise independent clinical trials with negative results published as systematically as positive ones. The WHO Traditional Medicine Global Library must catalogue documented harms alongside knowledge claims. Commercial conflicts of interest must be transparent. And WHO’s messaging must remain unequivocally aligned with scientific consensus – a proven tool against misinformation that mixed messaging would fatally undermine.
The authors conclude that “billions use traditional medicine – many from uninformed choices. The ethical response is not to validate what remains unvalidated, but to expand access to what withstands scrutiny. Patients everywhere deserve nothing less.”
Readers might remember that I posted my own critique of the WHO’s new strategy on this blog already on 6/11/2025. Here is an excerpt of my post:
The WHO aim to “advance the contribution of evidence-based traditional, complementary and integrative medicine” seems laudable, yet it also raises concerns: once any form of medicine is “evidence-based”, it is not “traditional, complementary and integrative”. Then it is by definition EBM, evidence-based medicine! Thus, the entire premise of the WHO Global traditional medicine strategy 2025–2034 makes no sense.
The fact that “traditional medicine is the primary or preferred care for billions of people worldwide” does not necessarily mean that its “clinical potential is considerable”. More likely it means that billions have to rely on obsolete forms of medicine from the dark ages because they cannot afford effective treatments. This is far from an opportunity; it is a challenge for us to improve this inhuman situation.
The fact that “acupuncture is recommended for migraine”, while the evidence for this (and almost all similar) recommendations are not supported by sound evidence, amounts to a scandal. One would have hoped that, instead of promoting unproven ‘traditional medicine’, an urgent task of the WHO would be to warn people of bogus and often dangerous claims that are ubiquitous in this sector.
The fact that “1% of global health research funding is dedicated to traditional medicine” might look unfair at first glance. But global health research funding is in the range of US$ 200 billion per year. Thus 1% would amount to 2 billion, and I suggest that one could do plenty of good research with this money. Instead, the sector tends to waste its funds on lousy pseudo-research, as anyone interested can confirm by reading this blog. Why does the WHO not point this out and take measures to stop pseudo-science in the realm of ‘traditional medicine’? Do they really think that offensive ideological platitudes such as “restoring balance is a scientific, rights-based and sustainability imperative” cuts the mustard?
My recommendation to the WHO is as simple as it is important: if you want to create meaningful articles, documents or strategies on ‘traditional medicine’ (or indeed any other subject), don’t charge biased proponents with the task but recruit a few well-informed critical thinkers as well.
It is good that the BMJ editorial concurs with my assessment. The question is, will it have an effect? Considering the multiple times we had to criticise the WHO for its irresponsible stance on SCAM, it would be high time for adopting an evidence-based attitude.
The claim that Elon Musk might be “killing millions” sounds like hyperbolic rhetoric, but it is an entirely predictable mathematical projection of his policy choices. Peer-reviewed global health modeling showed that the systematic dismantling of USAID—spearheaded by Musk’s Department of Government Efficiency (DOGE)—will result in over 14 million preventable deaths by 2030, millions of whom are children. By freeze-framing and terminating programs that provide life-saving vaccines, malaria bed nets, and HIV therapeutics, these actions have directly triggered the resurgence of entirely controllable diseases.
Hard to believe?
See for yourself; here is the abstract of the paper published in the Lancet:
Background: Official development assistance (ODA) accounts for the majority of humanitarian and development assistance in the world’s most vulnerable countries and has played a pivotal role in advancing global health. We aimed to comprehensively evaluate the impact of ODA funding on mortality across the past two decades, and to project the potential consequences of current defunding trends.
Methods: We conducted an integrated retrospective evaluation and forecasting analysis using longitudinal panel data from 93 low-income and middle-income countries (LMICs). First, we estimated the association between ODA per-capita funding and mortality outcomes from 2002 to 2021 using a two-ways fixed-effects multivariable Poisson regression model with robust standard errors, adjusted for all relevant demographic, socioeconomic, and health-system covariates. We then assessed age-specific and cause-specific effects, performing extensive sensitivity and triangulation analyses to test the robustness and causal interpretation of results. Finally, we integrated the retrospective impact estimates into validated country-level microsimulation models to forecast mortality under three defunding scenarios up to 2030: a business-as-usual trajectory, a severe defunding scenario, and a mild defunding scenario.
Findings: Higher ODA funding levels were associated with a 23% reduction in age-standardised all-cause mortality (rate ratio [RR] 0·77; 95% CI 0·70-0·85) and a 39% reduction in under-5 mortality (0·61; 0·49-0·75). ODA funding was associated with large mortality declines in major communicable diseases: 70% for HIV/AIDS (RR 0·30; 95% CI 0·24-0·39), 56% for malaria (0·44; 0·35-0·56), 56% for nutritional deficiencies (0·44; 0·30-0·65), and 54% for neglected tropical diseases (0·46; 0·36-0·59). Significant reductions were also observed in mortality from tuberculosis, diarrhoeal diseases, lower respiratory infections, and maternal and perinatal causes. Forecasting analyses projected that ongoing reductions in ODA funding could, under a severe defunding scenario, result in 22·6 million (95% uncertainty interval [UI] 16·3-29·3) additional deaths across all ages by 2030, including 5·4 million (4·1-6·8) among children younger than 5 years. Under a mild defunding scenario-defined as a continuation of current downward trends-the projected excess deaths would be 9·4 million (95% UI 6·2-12·6) overall and 2·5 million (1·8-3·2) among children younger than 5 years.
Interpretation: ODA funding has played a decisive role in reducing preventable mortality across LMICs over the past two decades, and the abrupt withdrawal of this support threatens to cause millions of avoidable deaths, reversing decades of progress in global health.
Funding: RF Catalytic Capital and the Spanish Ministry of Science and Innovation.
Attempting to shield Musk from the moral indictment of these deaths by hiding behind bureaucratic complexity is a cop-out. Musk is not a passive advisor suggesting minor budgetary trims; he has aggressively engineered and celebrated the destruction of these aid mechanisms on his public platform, explicitly branding the defunding of life-saving infrastructure as “clipping waste.” When an individual wields unchecked power to eliminate interventions with legally and medically proven survival rates, the line between “efficiency” and institutional negligence disappears. He is fully aware of the survival benefits of these programs, making the choice to dismantle them a calculated acceptance of mass mortality.
While defenders argue that epidemiological models deal in macro-statistics rather than localized causality, this defense elides the nature of modern accountability. Musk cannot hand-select which specific child dies of malaria, but he did hand-select the budget line that funded their treatment. Pretending this is just a structural or collective government failure sanitizes the reality: a single billionaire used his leverage to treat global survival infrastructure like an unprofitable corporate acquisition, making him materially and morally responsible for the human body count that follows.
In March 2025, a federal judge ruled that DOGE’s effort to dismantle USAID likely violated the Constitution and ordered restoration of access to key systems, saying USAID had been effectively eliminated. That matters because it weakens any claim that the dismantling was merely speculative or rhetorical: courts have already treated the shutdown effort as legally serious.
For a deeper look into the systemic impact of these specific health program suspensions and the firsthand accounts of how these funding disruptions unfolded on the ground, you can watch this France 24 Interview with a USAID Whistleblower.
