I have recently given interviews to German, Austrian, French and Canadian journalists. They all had different perspectives, but they all had one question in common:

YOU ARE RETIRED AND COULD BE ENJOYING LIFE, WHY DO YOU CARRY ON WORKING?

And every time I was asked this question, I was surprised. To me, it seems perfectly natural to carry on. But having been asked several times, I did ponder: why do I do it? Here are some answers found through this exercise of introspection.

First let me list three reasons that my detractors regularly imply which, however, are all false:

1. I do not do it for the money. In fact, I earn nothing from writing this blog and even have to pay for the pleasure.
2. I do not do it because of a bad personal experience; such an event does simply not exist.
3. I do not do it because I want to be famous.

So, why then?

The best reason I can give is that I feel a responsibility to do what I do. I am perhaps the only person on the planet who has studied so-called alternative medicine (SCAM) extensively and who, at the same time, has been critical about it. Practically all other full-time SCAM researchers are demonstrably less than critical about their subject (in case you know someone who isn’t, please tell me). And other SCAM critics are often (rightly or wrongly) dismissed by SCAM enthusiasts because they have never done original research on the subject. This does not easily work in my case.

The responsibility I feel relates to the abominable amount of false or unreliable information that is being published every day about SCAM. In my view, it harms and even endangers the life of many consumers and patients (see, for instance, this recent case). Confronted with this endless flow of seriously misleading information, I feel unable not to do anything about it. I thus see my work since retirement as an attempt to counter-balance this danger and to make a small contribution to progress.

If I am honest, I also have to admit that I am enjoying what I do. Thus the question ‘why don’t you enjoy life…?’ entirely misses the point. I have enough time to pursue my hobbies and, when I work on SCAM, I usually have plenty of fun.

In conclusion, I am retired and I enjoy life!

In 1995, the Church of Scientology attempted to suppress the Fishman Affidavit which contained Church-copyrighted versions of Operating Thetan levels I-VII. This promptly resulted in hundreds of copies being circulated around the world.

In 2003, Barbra Streisand’s lawyers sent a cease and desist letter to the California Coastal Records Project about the inclusion of a photo of her Malibu beach house on their website. When the website operators rejected the demand, Streisand sued. Subsequently, the Los Angeles Superior Court dismissed the case and the worlds attention focussed on her villa (see below).

Today, there are numerous further cases where someone has tried to censor another party and the attempt spectacularly backfired thus resulting in the opposite effect. Ever since the events surrounding the Streisand affair, the phenomenon has been called the ‘Streisand Effect‘. But recently, German sceptics have proposed to re-name it in

THE ‘HEVERT EFFECT’.

The reason is that a firm producing homeopathic remedies in Germany, Hevert, sent a desist letter to German critics of homeopathy demanding they stop stating that homeopathy is not effective beyond placebo (I did mention the story in a previous post).

I do get the impression that Hevert are not very lucky with their PR. On their website, they claim that homeopathy activates the body’s own self-healing powers. I fear this is much more wishful thinking than fact; at least I know of no sound evidence that would prove this statement to be correct. They also claim that homeopathy is a naturopathic treatment method that was developed at the beginning of the 19th century by German physician and pharmacist Samuel Hahnemann (1755-1843). This does not seem correct either; homeopathy does not fall under the umbrella of naturopathic medicine, not least because it includes plenty of remedies as unnatural as the Berlin Wall. The Hevert website furthermore states that Hahnemann discovered that, with many substances, the healing powers are only released by potentization. He also discovered that toxic substances became valuable medicines when potentized. I fear that this is wrong too; in fact, Hahnemann discovered nothing of the sort – he merely postulated stuff that evidently turned out to be untrue.

Anyway, one of the recipients of the above mentioned desist letters, Natalie Grams, decided not to comply and rather risk the penalty of Euro 5 100. This news then resulted in a storm of angry protests. Germans do not like to be told what to say, and freedom of speech is valued highly these days. Numerous newspapers, magazines, radio broadcasts, blogs and tweets thus sided firmly with Dr Grams.

This week, even a prominent and rather excellent German TV satirical programme aired a long film mercilessly mocking Hevert and homeopathy (no, nothing to do with me!). It is is, in my view, the best critique of homeopathy ever broadcast on German TV. Even if you do not understand the language , it is worth watching, if only for the musical finale:

One theme that occurs repeatedly in the film is the concept of ‘the three pillars of homeopathy’:

1. dilute;
2. shake;
3. waffle BS (the German original is even less polite [‘Scheisse labern’]).

The ‘three pillars’ have become an instant hit on twitter, with bloggers and elsewhere. They look destined to become the future hallmark of homeopathy. Hevert will now be asking themselves whether the thing with the desist letters was such a brilliant idea.

I suspect it wasn’t – perhaps only trumped by the idea to sell homeopathic remedies?

A few days ago, I received this email:

Dear Dr. Edzard Ernst,

I am xxyy*, Editorial assistant from xxxzzz* Publishing Group Ltd. contacting you with the reference from our editorial department. Basing on your outstanding contribution to the scientific community, we would like to write a book for you.

Researchers like you are adding so much value to the scientific community, yet you are not getting enough exposure. No matter how many papers you publish in famous journals, you will be still unknown to common people. To solve this problem, we came up with this unique solution.

With our book writing service, we will write your research contributions in common man’s language. We will also include all your published papers into this book in a way that a common man can understand it. And then, we will publish your book with our publishing group. Before, publication, we will send the draft to you for scientific accuracy, once you approve our draft, we then proceed for publication. You will get all the rights of your book, and all the sales generated from your book will be credited to you.

Your book will then be listed on famous websites like Amazon, eBay, Goodreads, and many other popular book websites. As a result, you will get good credit and people will recognize your hard work and your scientific contributions.

Last but not least, after the publication of your book, it will be published in Google News, Yahoo, and other major news channels. What more can you ask for?

All we need is your book writing contract, and you will get all the rights for your book.

Will be waiting to hear from you.

Best Regards,

xxyy

__________________________________________________

Amazed and curious, I replied:

Thanks xxyy,

that sounds interesting; please let me know what costs are involved.

Regards

E Ernst

____________________________________________________

The answer came a few days later. Here is the passage that addressed my question:

Usually, Researchers want their articles converted into common man’s language and make them into a book. But if you have a special requirement, then please let us know, so that our writers can write according to your needs. And once the drafting has finished, we will send it for your review for scientific accuracy. This includes book cover & page design, ISBN (International Standard Book Number) for your book, proofreading service and publication fee. And Our service fee for this is $1895. And it will take around 1 month to complete your project. Last but not least, once your book is published, we will write a news article about you and your book and will publish it in major newspapers to get proper publicity.

_______________________________________________________

I have to admit, I am still amazed! The price seems not high (though, judging from the quality of their English, the price/value balance might still be doubtful). Whenever I write a book, it takes me the best part of a year. Once I calculate a realistic $-figure for this effort, it would surely be more than one dimension higher.

So, am I going to have my next book ghost-written by this or any other service?

No, thanks!

(*Yes, I deleted the names)

The question whether chiropractic spinal manipulations are an effective treatment of infantile colic has been raging ever since the BCA sued Simon Singh over it (and lost). On this blog, I have discussed the evidence several times (see here, here, here and here). Now a new paper has emerged with the title ‘MEDICAL MANAGEMENT OF INFANTILE COLIC AND OTHER CONDITIONS WITH SPINAL MANIPULATION: A NARRATIVE REVIEW OF THE EUROPEAN MEDICAL LITERATURE’. As it was published on a journal not listed in Medline (J Contemporary Chiropr 2019;2:60-75), I will quote more extensively from it than I do normally. Here is the abstract in its original form:

Objective: Strong evidence is found for European medical management of ‘infantile colic’ by spinal manipulation. This paper identifies and describes this body of evidence. We apply the social research method of document analysis to the European medical literature and report the medical practices regarding the management of infantile colic by manual means including manipulation.
Data Sources: Primary data sources were Medline, accessed via PubMed, and the Index to Chiropractic Literature (ICL). Secondary material was sourced from the private collections of the authors. Acceptability criterion included a report of the medical management of infantile colic.
Data Synthesis: A range of languages were accepted and either translated or interpreted by clinicians known to the authors. Each retrieved paper was then hand-searched to identify additional citations which were also collected. A total of 69 papers met the acceptance criteria. The statements accepted for appraisal were those of methods descriptive of the clinical assessment and management of patients classified by the practitioner as a child with infantile colic.
Results: The medical management of infantile colic by spinal manipulation is well reported in the European medical literature. Triangulation also identified reports of medical management of a range of pediatric nonneuromusculoskeletal conditions. European medical papers report a number of positive outcomes for infantile colic with care broadly considered to be manipulative care. These outcomes parallel those known to be widely reported in the chiropractic literature.
Conclusion: We report strong evidence from the European medical literature related to the management by manipulation of infants with infantile colic and other conditions.

In the article proper, the authors conclusions are more detailed and very much longer:

It is difficult to reconcile the positive evidence for manipulative management of infantile colic recorded in
the European medical literature and the known safety of chiropractic management with the need for the 2019 Safer Care Victoria inquiry into Chiropractic manipulation of infants. We consider there is no reasonable evidential basis for this inquiry.
The evidence is that “Infantile colic is an easily identified childhood entity that has no clear treatment guidelines. The management of infantile colic varies among physicians, and families are often frustrated by the medical community’s inability to prescribe a cure for colic.” (163)
Infantile colic remains a medical enigma with no evidence of safety for medical management, in fact the determination of terminology for reporting such adverse events is relatively new. (164) On the other hand the remarkable safety of chiropractic management is known and the finding that European medical literature strongly indicates manipulative management of infantile colic as a safe and effective practice, places conventional chiropractic as a safe evidence-based choice to meet parental demand.
Alcantara et al (165) show support for this position by stating “chiropractic care is a viable alternative to the care of infantile colic and congruent with evidence-based practice, particularly when one considers that medical care options are no better than placebo or have associated adverse events.”
In the absence of consistently effective management options, accepting the evidence of the European medical literature shows the benefit of manipulative care for infantile colicky patients and the wider collateral beneficial effect on parents. (166,167)
We consider it important to report the uncertainty of medical management of infantile colic and to recognize manual therapy as a legitimate management option as actively utilized by mostly European medical doctors. Multiple case reports document the efficacy of manual therapy of infants. There is a distinct absence of original evidence contradicting the efficacy of spinal manipulative management of infantile colic and an absence of evidential contraindications for its implementation.
This paper reports considerable material in the European medical literature on the manipulative management of infants, particularly infantile colic. Although supportive in safety (150,158) and efficacy (145), the chiropractic literature on these topics was not the primary focus at this time. However in relation to safety, Funabashi and colleagues noted providers of spinal manipulation have similar or better dimension scores compared to the 2016 medical data base of the Agency for Healthcare Research and Quality. (158)

On balance we can state with confidence that the published, indexed evidence places conventional chiropractic management of infantile colic as safe and effective in the manner clearly documented as clinical methods in the European Medical literature.

I find it hard to decide where to begin. The problem is that there is almost nothing right with this review.

Let’s start with the title, ‘MEDICAL MANAGEMENT OF INFANTILE COLIC AND OTHER CONDITIONS WITH SPINAL MANIPULATION: A NARRATIVE REVIEW OF THE EUROPEAN MEDICAL LITERATURE’. What do they mean with ‘other conditions’? As the review does, in fact, include plenty of non-European papers, this title is simply nonsensical.

Next is the objective: it states that there is good evidence for spinal manipulation as a treatment of infantile colic. The authors thus managed to disclose their bias in the very first sentence of their paper.

The rest of the abstract is similarly incompetent. Crucially, we do not learn what inclusion/exclusion criteria the authors applied and how they evaluated the methodological quality of the included studies. Remarkably, this information is also not provided anywhere else in the paper. Thus, this article lacks all the essential elements of a scientific review and turns out to be little more than a highly biased opinion piece. In fact, it is worse; the introduction, for instance, begins with what I can only call a rant: Within Australia there is a government-manufactured controversy regarding the management of infants by chiropractors…

The results section is equally remarkable. Here are a few direct quotes to give you a flavour:

Forty-five papers were accepted as valid clinical reports of the management of infantile colic by medical manipulation (Table 1). There are over 60 papers relating to infantile colic on ICL; we do not report these. The Chiropractic Resource Organisation (CRO) website essentially carries the same papers as ICL. Many of these listings are case reports and outcome-based studies. (33, 34) Reference lists were also obtained from indexed papers as well a range of medical and chiropractic textbooks. (35 – 37)

The truth is that the 45 papers are not ‘valid clinical reports’ but a mixture of comments, case reports, opinion pieces, observational studies and a few clinical trials. The latter are identical with those discussed in proper systematic reviews of the subject. There is thus no reason for arriving at different conclusions than these reviews. But, of course, the authors do exactly that, and they do not explain why. They claim that European doctors use spinal manipulation routinely for colicky babies; this is not true (I am a European doctor and have never seen this happening). They claim that unearthing the European literature revealed more positive evidence; this is also not true: this literature was not hidden but it simply does not measure up to the standard required for evidence and was thus not included in previous reviews.

The authors could not identify any original research study report that rejected spinal manipulation of infants for colic on the grounds of being unsafe or with negative clinical outcomes.

As the authors did cite a few (by no means all) review papers that clearly showed the risks of spinal manipulation, one must ask what this statement was intended for. Was it to give the false impression that chiropractic spinal manipulations are safe?

The criticism of commentators seems to be that chiropractic care for infantile colic is no better than a placebo (147), the same finding for a common colic medication. (148) In other words, chiropractic care is equal to or just as effective as placebo and medication and therefore becomes the preferred clinical option on
the basis of safety and the absence of potential adverse effects. (63,149-151)

I fail to understand the logic behind this argument. The authors seem to admit that chiropractic care is a placebo therapy. To any reasonable person, this means that any benign and cost-free intervention (such as a gentle massage or cuddle by a parent) is preferable to an expensive and potentially harmful chiropractic treatment.

Chiropractic has been examined with rigour and found safe. Our interpretation of this evidence is that there is virtually no danger to infants from carefully applied manual methods by qualified providers and perhaps the best of both worlds is concomitant care among chiropractors and medical practitioners.

This conclusion is not supported by the evidence presented, and the authors do not explain how they arrived at it.

In addition to such irrational passages, we find plenty of nonsensical or factually incorrect statements in the authors’ pseudo-review. Here are a few examples that I found amusing:

Spinal manipulation as it is known today was brought to European medical doctors by chiropractors and osteopaths, (105) and since then it has become an entrenched medical practice in most European countries, particularly Germany. In Europe, the use of spinal manipulation within the medical profession for the management of infantile colic has been a well-recognised procedure for some decades. (38,43,63,106)

The chiropractic vertebral subluxation is recognised in the medical literature (107) contrary to unsupported claims that it cannot be identified. It is this type of mechanical spinal lesion that has been identified to address as a vertebrogenic factor under this model.

However, my favourite bit is this direct quote:

The evidence is that “Infantile colic is an easily identified childhood entity that has no clear treatment guidelines. The management of infantile colic varies among physicians, and families are often frustrated by the medical community’s inability to prescribe a cure for colic.”

The authors quote here from my own review, and remarkably it is the only quote from it. The authors otherwise ignore it completely and, crucially, they do also not list it as one of the 45 included papers. Why? To answer this question, we need to see what my review says. Here is its very short abstract:

Some chiropractors claim that spinal manipulation is an effective treatment for infant colic. This systematic review was aimed at evaluating the evidence for this claim. Four databases were searched and three randomised clinical trials met all the inclusion criteria. The totality of this evidence fails to demonstrate the effectiveness of this treatment. It is concluded that the above claim is not based on convincing data from rigorous clinical trials.

Call me biased, but I do believe that this is much closer to the truth than the lengthy pseudo-review above.

Let me finish this post by revealing who its authors are.

• Peter Rome, Chiropractor, retired
• John Waterhouse, Private practice of chiropractic
• Glenn Maginness, Private practice of chiropractic
• Phillip Ebrall, Tokyo College of Chiropractic

No funding was received for this study.

No author declared a conflict of interest (at least, this is what they claim).

No further contact details were provided.

My conclusion of all this:

We have to search long and far before we find a SCAM article that is more misleading and less competent than this one.

Homeopathy is harmless; after all, the typical homeopathic remedy contains no active ingredient! Such claims can be seen abundantly. Sadly, however, they are not true. The remedies might be mostly (but, depending on potency and proper quality control, not totally) risk-free, yet homeopathy can and does kill patients. There is a depressingly long list of fatalities to prove this point. And here is another sad case that confirms it; this short article provides the essential facts:

The parents of a seven-year-old boy who died after they decided to treat his otitis only with homeopathy were convicted of manslaughter Thursday.

Francesco, from Cagli near Pesaro, died on May 27 2017 from bilateral bacterial otitis.

His parents were found guilty of complicity in aggravated culpable manslaughter.

They were given a suspended sentence of three months in jail.

The parents entrusted their son’s care to Pesaro homeopathic doctor Massimiliano Mecozzi, who is set to go on trial on September 24.

The homeopath advised treatment with homeopathic products instead of the antibiotics which would have saved him, the court found.

Francesco died after the otitis degenerated into encephalitis.

Another article offers a few more details about the case:

Francesco suffered from otitis media. The doctor Massimiliano Mecozzi (55) treated the child exclusively with homeopathic remedies. When the parents brought Francesco to the hospital a few days later, it was already too late: The boy died soon afterwards. According to “Corriere della Sera”, the parents decided to not give their child antibiotics since he was only three years old. Francesco’s illness had begun with a severe cold and fever, and his frequented the homeopathic doctor Mecozzi who discouraged the parents from bringing their child to a hospital. “He scared them by claiming that the doctors would give medicaments to Francesco that would make him deaf or would damage his liver. He promised them that Francesco will recover soon”, said grandfather Maurizio to “Il Mattino”.

But Francesco’s condition worsened over the course of the following days, and the infection spread to the head. When the parents brought their son to the emergency admission, a festering abscess had already formed. Francesco was brought to a hospital in Ancona for an emergency operation. An antibiotic shock therapy didn’t help at this point either, and the child died.

According the “Corriere”, the physician had a questionable career: After having been temporarily expelled from the physician’s association, he even worked as a doorman and as an allrounder in a supermarket. Then he came into contact with a religious community in Varese, whose founders have been accused of fraud. When the physician’s association in Pesaro inquired to his occupation as a homeopath, Mecozzi replied: “I have no interest in telling you about it.”

And a further article adds even more details: the 7 year-old boy was hospitalized in an intensive care unit at the Hospital Salesi of Ancona. The child, born in Cagli (Pesaro), had been treated with homeopathy instead of antibiotics and had arrived in hospital in a serious condition. The child subsequently went into a neurological coma; an EEG revealed the absence of electrical activity, and brain death was certified. The death occurred as the result of an ear infection treated with homeopathy.

Such cases are tragic but (hopefully!) rare. They are due to the neglect (failure to provide adequate medical care) by a homeopath. Obviously, such neglect does not always have to be fatal. I would guess that milder forms of medical neglect through homeopathy are, in fact, extremely common (nobody knows the exact figure). One could even argue that, by definition, homeopathic treatment amounts to medical neglect which falls into three overlapping categories:

• In the majority of cases, it has no or very little symptomatic consequences. For instance, if a homeopath prescribes a homeopathic remedy for a self-limiting condition, such as a common cold, and the patient soon improves due to the benign nature of the condition (often thinking that homeopathy was effective). There is, however, invisible harm such as the expense of the remedies and the false trust into a bogus therapy created by this experience (which might prove to be extremely harmful later on).
• In many instances, the neglect does cause unnecessary suffering of patients because the optimally effective treatment of their disease is not administered or delayed. Many doctor homeopaths would argue that this is not usually true because, for such patients, they also prescribe conventional treatments in parallel. But even if this were true, these clinicians would still cause harm through the waste of resources.
• In a sizable but unknown number of cases, homeopathy does cause very serious harm and, as the above case shows, even deaths.

The point I am trying to make is this: we usually only hear of the dramatic cases of neglect through homeopathy (or other forms of ineffective SCAM). What we tend to forget is that such cases are only the extreme end of a much wider spectrum, and that all clinicians who prescribe homeopathy are guilty of neglect. The symptomatic harm done ranges from almost zero to 100%, and the damage caused is merely a question of degree.

PS

Before some homeopathy-fan comments, “but the harm from conventional therapies is sooooooooo much more significant!!!”, let me stop you in your tracks by recommending you consider the concept of risk/benefit balance.