It is today exactly 8 years that I am writing this blog. To mark the occasion, I am trying to write my shortest post ever. It focusses on a question that has often occupied my mind and rarely leaves the comments sections of this blog: What makes a healthcare professional use a bogus SCAM therapy? Think, for instance, of any practitioner of homeopathy. What makes him or her tick? Why does (s)he practice homeopathy and not real medicine? After years of thinking about it, the answer turns out to be really quite simple. There are only three possibilities:
Practitioners who employ disproven treatments either
try to con you
or
they have been conned themselves
or
both.
________________________
Think of it, there is no other explanation!
If, however, you do know of another one, please let me know.
AND THANKS FOR MAKING THIS BLOG A SUCCESS.
28 Responses to Con or conned or both? – Another reason to celebrate!
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I think a muddy mix of anecdotal evidence that something works, combined with provider financial self-interest, and patient demand merits mention. This mix can be quite powerful. And not necessarily malintentioned. Even if, this mix is ultimately ineffective. Or at best, the natural progression of the disease is inappropriately attributed to the provider’s intervention. It’s complicated. As I’m sure you’ve observed.
THANKS
yes, I have observed all of these.
but, if you think that, in medicine, anecdotes are evidence, you have been conned.
financial self-interest means you are conning someone.
patient demand means patients are conned + you con yourself in assuming that demand means efficacy.
mistaking natural progression for efficacy means you have been conned.
Don’t forget the ego, which is a huge motivator too. No-one could ever mistake Dana & pals for humble.
My daughter in law works at a Chiropractic office and has a degree in Kinesiology. She rarely uses conventional medication and would rather suffer than ingest or apply traditional medication. She has had severe eczema for almost a year which I also had at one time. I was given one Kenalog shot which cleared up my eczema almost overnight and hasn’t returned in 39 years. I told her about this medical miracle and she doesn’t like the “potential” side effects. She would rather suffer than be free of pain.
My belief is that people who believe in the benefits of irrational and ineffective Homeopathy have a belief that nature holds all the answers and traditional medicine is unnatural. They rely on antidotal evidence instead of science.
a degree in Kinesiology???
It seems so.
https://www.naturalhealers.com/blog/applied-kinesiology/
oh dear!
The use of language at that page is interesting. They are inconsistent with capitals for Applied Kinesiology. I suspect that putting a lowercase k on kinesiology is to connote that Applied kinesiology is a real thing, as kinesiology is a real thing. I am especailly impressed by “Applied kinesiology is an approach that uses muscle testing in order to zero in on health problems throughout the body”.
Zero in on? Zero in on? What kind of medical language is that? Do you use a CT scan to “zero in on” tumors? I wonder if they say “zero in” because to say “diagnose” would be to commit them to something with a medical meaning, and the risk of litigation…..
Wikipedia says this:
But also gives this warning:
Many quacks seem to thrive on people thinking they mean the same.
@Kate
I had a conversation recently with a woman who also had a degree in kinesiology. She worked in a hospital department that conducted science-based medical testing. Given her surroundings and training, I was surprised at her beliefs in SCAMs. Maybe it’s not so uncommon among kinesiologists.
Nevertheless, in reading your comments, a couple of things come to mind.
1. If your daughter-in-law doesn’t like the potential side effects of traditional medicine, I wonder what she thinks about the potential—and real—side effects of a chiropractic treatment gone wrong?
2. If she likes “natural,” you should introduce her to pharmaceutical medicines. Far and away most come from from quite natural ingredients (plants).
Re. #2: https://en.wikipedia.org/wiki/Pharmacognosy
That it does, if by “answers” they mean pain and death. Which is the norm for most animal life on Earth.
Nature is awesome, but it is not our personal friend. It cares not one whit for our special human feels and most of its inhabitants will happily eat us, if they can.
At an Annual General Meeting and Conference of the National Eczema Society years ago (I was then on its Board of Directors), an audience member during a panel discussion with dermatology consultants and specialst nurses, asked a vague question about ‘natural’ treatments. One of the dermatologists – I think it was Dr David Atherton, but cannot recall with certainty – answered, with a hint of a sigh, “What’s natural? There’s nothing more natural than a rattlesnake bite”. That has always stuck with me!
It was my observation over the years, that ‘alternative’ practitioners have done NOTHING to advance the understanding, or treatment, of eczema. A belief seems to persist among many of them, in the old and false idea of something working its way out of the body, which you have to allow (indeed, ‘eczema’ is Greek for ‘boil out’. Treatments based on such an idea, or “mental model” have brought people near to death, from thermal shock due to generalised erythema, or from sepsis resulting from S aureus infection. In an article I wrote years ago for Exchange magazine, called Mental Models of Eczema, I suggested that it is much better not to talk of the skin “breaking out” and instead to speak of the skin “breaking down” or “breaking up”. Both of those descriptions coorrectly convey the connotation of a process that has to be halted and the damage repaired.
Dermatologists in the USA are quicker to give steroid injections (like Kenalog); in the UK, they are a little more conservative in treatment. At any event, a Kenalog shot can indeed suspend the inflammatory processes long enough to let the skin heal. If, after it is healed, it gets looked after properly (with a regular emollient regimen if its dry atopic skin, which doesn’t produce enough of its own lamellar lipids to glue the corneocytes together) then serious inflammation may never recur.
Conventional medicine has discovered a lot about the skin and eczema. Dermatology may still be something of a ‘Cinderella sector’ in medicine, but things have advanced, with the discovery of the filaggrin gene, the growing role of monoclonal antibody medicines, and increasingly sophisticated emollient formulations. CAM has done none of this, and offers nothing to eczema patients except a sympathetic ear.
The very first issue of Exchange magazine that I ever read, back in the early 1990s, contained a horiffic strory of a lady who was persuaded to try some kind of herbal cream by a snake-oil salesman. Her skin progressively deteriorated, and she kept phoning, only to be told this was expected and it was the eczema working its way out, and the process had to be continued, not to worry. Worry? She developed generalised erythema as the skin got more and more inflamed, and had an emergency admission to hospital near to death from thermal shock. Happily, with intensive treatment, she recovered, to tell the story.
Congratulations Edzard,
Thank you for the blog.
thank you for visiting occasionally.
I make sure to visit almost every day enjoying your sage advice and acerbic humor.
Dr. Ernst, please consider more topics concerning veterinary medicine. It is equally if not more infiltrated by SCAM.
Regards,
CG DVM
thanks
I know that vet med is SACM-infiltrated.
the trouble is that is that it is not exactly my area of expertise.
“the trouble is that is that it is not exactly my area of expertise.”
That is a good point and to that I would respond that while you claim not to be an expert in veterinary medicine, your bullshitometer , your ability to recognize and confront medical fraud perpetrated on patients and consumers is keen indeed. It doesn’t take an expert to recognize bad science when it comes across your desk, rather it takes a good critical thinker and that you are.
For example this article advocating for the use of traditional Chinese medicine as a treatment for epilepsy in animals should peg your bullshitometer without having to know too much of the pathophysiology of epilepsy in dogs.
https://www.ahvma.org/wp-content/uploads/TCVM-for-Seizures.pdf
I just glanced at the paper and think it is utter trash.
the only SR is ours and they don’t even cite it!
https://pubmed.ncbi.nlm.nih.gov/16734078/
if you are interested in skeptical veterinary blogs I can recommend the following:
https://www.doctorramey.com/
https://skeptvet.com/Blog/
https://www.nottingham.ac.uk/CEVM/Index.aspx – centre for evidence based veterinary medicine
Congratulations, Professor! For me, your blog is both a great source of education and, in the comments section, a great source of entertainment.
Keep up the good work!
thanks Ron
Today EE said:
“Practitioners who employ disproven treatments either
try to con you
or
they have been conned themselves
or
Both.”
This is not a special case, it is the general case for all human beings all the time i.e. the model we have of reality is just that, not reality – that’s why Feynman said “The easiest person to fool is yourself.”
Of course, charlatans do it deliberately, but even while they do that, what they think they do is still a model of reality, not reality, so they still fool themselves (while they imagine they fool others).
When a relative of mine was starting to develop brain-degeneration, he/she started telling the most obviously weird lies, that would not possibly fool anyone i.e. they were trying in the most pitiful way, to rationalise what they thought was happening to them – so that it made sense to them. This being an extreme example.
Another example, I suppose might be anorexia/bolimia type illness where a self-lie is very real to the patient as the “truth”.
When two people meet, they lie instantly, and then all the time, as part of normal social discourse – that is why the best conversations tend to be humorous (ambiguous) and why no one wants to discuss politics or religion (the “truth”).
The secret of happiness is to lie perfectly, “Does my bum look big in this?”
“No dear.”
House MD, said it best:
“Everybody lies.”
…
(sometime later)
Wilson, “I thought you said, everybody lies?”
House, “I was lying.”
When I first read, I think in The Independent newspaper, back in 1993, that there was a brand new Professorial Chair in Complementary Medicine at Exeter University, I thought “What a great idea!” It seemed to me that it was about time some real science was done, to discover if any ‘complementary’ or ‘alternative’ modalities were better than placebo.
As proper scientists, Professor Ernst and his team followed where the evidence led. Their conclusions were science-based, and it was Good Science. As might have been expected, not everyone was pleased.
I fully believe in the integrity of the then science at Exeter, and that of those carrying it out. I believe that if any alternative or complementary treatment had reliably proven better than plecebo, the Exeter team would have been fascinated and delighted, and would have done further work on it. They’d have got a Nobel prize and, at least in the case of homeopathy above 12C, the JREF million Dollars!
The department at Exeter did not end well, ffor the reasons Professor Ernst describes in “A Scientist in Wonderland” (which I still dare not read). We have reason to be grateful, however, that Professor Ernst, the Nightinggale Collaboration, Quackwatch, and other bodies, continue to protect patients by countering fake claims, using Good Science and thorough analysis.
Thank you!
NO, THANK YOU!
Congratulations on the blog anniversary Professor Ernst. I am only a recent addition to your blog readership but a long time reader of your research and popular literature. Your name is my gold standard for SCAM or herbal medicine-related matters for my students. Thank you. Here’s to another 8 years.
oh kind!
thanks