conflict of interest
“Popularity takes the place of plausibility, tradition replaces validity, and individual experience is positioned above objective efficacy.”
This sentence (my translaation of the German original) comes from a book by Udo Endruscheit that I have been reading. It is entitled “Vom Zweifel zur Haltung: Eine Reise durch die Geschichte der Erkenntnis” (From Doubt to Conviction: A Journey Through the History of Knowledge) and outlines the epistemological development of truth from the early thinkers of antiquity to the postmodern voices of today. It traces how the concept of truth has changed, how it has been criticized, relativized, and deconstructed, and how these changes have shaped us and our thinking.
The statement was no necessarily meant to me applied to medicine, but it does aply capture a recurring epistemological pattern within large segments of so-called alternative medicine (SCAM). It describes a shift away from the truth towards criteria that are socially and psychologically compelling but scientifically nonsensical.
The substitution of popularity for plausibility is evident in the way many SCAMs have gained traction. Treatments such as homeopathy, naturopathic detox regimens, or paranormal energy-based healing have achieved global followings despite the fact that there can hardly be a mechanism of action that does not fly in the face of science. Their popularity is often driven by anecdotal endorsements, celebrity advocacy, and market forces rather than by convergence of experimental and theoretical support. Opinion counts more than truth, and the absence of plausibility in a SCAM is frequent and frequently ignored.
The elevation of tradition over validity is a defining feature of most SCAMs. Historical longevity is often presented as implicit evidence of effectiveness. “It would not have survived, if it were ineffective!” Yet, from a scientific perspective, tradition is a most unreliable indicator: ineffective or even harmful practices can persist for centuries in the absence of effectiveness and even safety. Bloodletting in pre-modern Western medicine offers a cautionary example. The critical issue is not whether a therapy is old, but whether it has been subjected to rigorous evaluation and shown to produce reproducible benefits that exceed placebo and other non-specific effects.
The dominance of individual experience over objective effectiveness is perhaps the most pervasive and psychologically persuasive cause of SCAM’s popularity. Patients’ testimonials, often sincere and seemingly compelling, are being touted as sufficient evidence of effectiveness. Yet individual experience is highly susceptible to regression to the mean, natural disease fluctuation, placebo effects, confirmation and other biases and confounders. Without proper comparisons, it is impossible to distinguish specific therapeutic effects from non-specific ones. Evidence-based medicine does not dismiss patient experience; rather, it contextualizes it with external evidence to avoid misleading us all.
The above statement by Udo Endruscheit was meant as a general characterisation of the way we currently handle and mishandle truth. As such it applies to much more than just SCAM. Yet, it also provides an apt critique of dominant tendencies within SCAM. Popularity, tradition, and personal experience are, of course, not inherently without value, but when they displace plausibility, validity, and objective effectiveness, they create a situation that is wide open to error, exploitation and often also harm.
In a nutshell: the truth matters; watering it down – as we all currently tend to do – carries serious risks in medicine as much as in life.
PS
I almost forgot!
Yes, I do recommend reading Udo’s most fascinating book.
The Journal of Evidence Based Homeopathy (JEBH)?
Yes, it does exist!
It was launched in 2023 by Willmar Schwabe India, as a twice yearly publication that presents itself as a peer-reviewed outlet for research, clinical trials, case studies, reviews, and theoretical pieces about homeopathy. Its own site describes it as a “groundbreaking” journal meant to promote the “evidence-based practice and understanding of homeopathy,” and lists the editor-in-chief as Dr. Ramachandran Valavan who seems to be on the payroll of Schwabe India. As far as I can see, the editorial board consist exclusively of Indian homeopathy supporters.
The publisher is Dr. Willmar Schwabe India Pvt. Ltd., with a Noida/Ghaziabad address in Uttar Pradesh, India. The firm is a branch of the well-known German manufacturer of homeopathic products. JEBH is a specialty homeopathy journal rather than a mainstream medical journal. Its language is strongly promotional, emphasizing “rigorous investigation,” “scientific exploration,” and “solid evidence,” but those claims are made by the journal itself rather than independently demonstrated in the material available here.
JEBH claims it is peer-reviewed. However, its articles often read like advocacy: they present homeopathy as being refined by “modern scientific exploration” and “real-world data,” and frequently treat positive case reports or reviews as confirmation of homeopathy’s validity. That style is, of course, not unusual in homeopathy publications, but from an evidence-based medicine perspective it is a ridiculous substitute for reproducible controlled data.
To give you a taster, here is the first section of a recent editorial published in the JEMH:
The Journal of Evidence-Based Homeopathy (JEBH) continues to strengthen its mission of uniting classical homeopathy with modern scientific exploration. This issue exemplifies how research, provings, and clinical observations converge to validate and refine homeopathic practice. The original articles section presents a diverse set of contributions from clinical case management to digital tools aiding repertorization. The featured case on Natrum muriaticum exemplifies the precision of individualized prescribing in addressing emotional and mental health concerns , while an insightful review on repertory software underscores the evolving integration of technology in clinical decision-making …
I wonder: does anyone know of another so-called “evidence-based” medical journal that is fully controlled, financed and run by a BIG PHARMA firm?
I don’t!
The JEBH confirms what we all suspected:
HOMEOPATHY IS UNIQUE.
The Nazi relic of the German Heilpraktiker – alternative health practitioner, who practise so-called alternative medicine (SCAM)) – is a topic that I wrote about repeatedly, e.g.:
- Prison sentence for a German HEILPRAKTIKER who issued false vaccination certificates
- Another death caused by a ‘Heilpraktiker’, non-medically trained alternative practitioner?
- A German Heilpraktiker was sent to jail for fraud
The path to becoming a Heilpraktiker is as unique as it is scandelously unregulated. By law, the profession requires no mandatory curriculum, no accredited school attendance, and no state-regulated university degree. Technically, anyone over the age of 25 holding a basic middle-school education (Hauptschulabschluss) can sit for the exam (the Heilpraktikerüberprüfung), even without any education or training at all. While some candidates choose to prepare by voluntarily attending a private and expensive school (a Heilpraktikerschule) for one to three years, the lack of standardized educational oversight leaves massive gaps in crucial medical and professional subjects.
Chief among these neglected subjects is, in my view, medical ethics. For those who do attend a school, average ethics instruction ranges from minimal to non-existent. Because private institutes design their own proprietary curricula, ethics is rarely taught as a standalone subject. Instead, it is briefly touched within broader modules concerning Berufs- und Gesetzeskunde (Professional and Legal Studies).
This systemic omission is directly tied to the narrow scope of the state licensing exam. Conducted by local health departments (Gesundheitsamt), the examination is explicitly designed around Gefahrenabwehr, i.e. the prevention of immediate danger to public health. The state’s priority is ensuring that applicants know what they are legally forbidden to do, such as managing highly infectious diseases, prescribing prescription-only medications, or practicing dentistry.
Consequently, broader ethical education is completely sidelined. Vital topics like the biomedical principles of patient autonomy, managing clinical conflicts of interest, and the complexities of informed consent are virtually absent. While some voluntary professional associations have established a code of conduct (Berufsordnung für Heilpraktiker), learning and understanding these ethical guidelines is entirely voluntary and self-guided.
Beyond ethics, maany other critical subjects are severely neglected in the Heilpraktiker schools, e.g.:
- Evidence-Based Medicine (EBM) and Scientific Literacy: students are rarely taught how to critically appraise clinical research, differentiate between correlation and causation, or recognize the cognitive biases inherent in anecdotal “success stories.”
- Pharmacology and Interaction Risks: While forbidden from prescribing prescription drugs, practitioners heavily utilize herbs and other dietary supplements. The study of how these substances interact with each other and a patient’s conventional pharmaceutical regimens is usually overlooked.
- Emergency Medicine and Differential Diagnosis: Because training lacks mandatory, standardized clinical rotations, practical competency in identifying red flags, such as atypical cardiac symptoms or early-stage oncological presentations, is dangerously variable.
The Heilpraktiker system offers unparalleled freedom of practice. At the same time, there is a near total lack of rigorous educational standards. This huge and dangerous imbalance leaves practitioners ill-equipped and put the public at unacceptable risks. Here are some examples of what can thus happen:
- The Klaus Ross / 3-Bromopyruvat (3-BP) Tragedy (2016): In one of Germany’s most notorious SCAM scandals, a Heilpraktiker operating a “Biological Cancer Center” in Brüggen treated terminally ill cancer patients with 3-Bromopyruvat, an unapproved, highly experimental chemical compound. Using an inaccurate kitchen scale to mix the powder himself, he administered massive overdoses via intravenous infusions. At least three patients died within days of the treatment, leading to his conviction for negligent homicide.
- The “BG-Mun” Fake Cancer Cure Scandal (Schrobenhausen): A Heilpraktiker, working alongside a businessman, defrauded desperately ill cancer patients by selling a fake “miracle serum” called BG-Mun for up to €5,900 per package. The practitioner explicitly pressured patients to abandon their conventional oncological treatments (like chemotherapy), promising that the serum would reverse tumor growth. Chemical testing later revealed the expensive liquid was nothing but worthless dilutions of glucose and basic amino acids. Multiple patients, including a 52-year-old esophagus cancer patient who went public with the story, died after their cancers metastasized following their cessation of proper medical care.
- Severe Complications from Autologous Blood Therapy (Eigenbluttherapie): A widespread SCAM among Heilpraktiker involves drawing a patient’s blood, mixing it with ozone, oxygen, or homeopathic remedies, and reinjecting it back into the muscle or vein to “stimulate the immune system.” Due to insufficient training in strict clinical hygiene, numerous documented cases have occurred where patients suffered from sepsis, internal abscesses, and systemic bacterial infections requiring emergency ICU hospitalizations.
- Misdiagnosis of Life-Threatening Emergencies: Because the Heilpraktiker exam does not mandate clinical training, practitioners have no clinical experience and frequently miss time-critical medical diagnoses. Documented cases include patients presenting with atypical chest pain being treated with acupuncture for “energy blockages” rather than being immediately referred to a hospital for an evolving myocardial infarction. Similarly, early-stage, highly curable melanomas or other malignancies have been misidentified as benign skin lesions or metabolic imbalances, delaying life-saving surgeries until the diseases reached terminal stages.
- Ineffective SCAMs for Acute Psychiatric Crises: Some Heilpraktiker choose to specialize in psychotherapy (Heilpraktiker für Psychotherapie). Scandals have arisen where patients suffering from severe clinical depression or acute psychotic episodes were treated solely with Bach flower remedies, St. John’s wort, or talking therapy rooted in esoteric ideas. The rejection of conventional psychiatric intervention and pharmaceutical stabilization in these acute phases has directly led to preventable self-harm and suicides.
So, why does Germany put up with the Heilpraktiker?
Despite repeated and fierce criticism, the German Heilpraktiker is sustained by a combination of law, politics, and tradition. The primary legal shield is Article 12 of the German Basic Law, which guarantees freedom of occupation (Berufsfreiheit). Because the state’s entry exam pretends to screen for immediate public danger (Gefahrenabwehr), courts pretend the system is legally sufficient; completely banning the profession would trigger severe constitutional challenges.
Furthermore, as often discussed on this blog, SCAM enjoys immense public popularity in Germany. Millions of Germans value the Heilpraktiker for the long and empathetic consultations that the overburdened conventional insurance system rarely permits. This widespread voter support, coupled with a highly organised political lobby, makes outright abolition a political non-starter.
Thus Germany continues to have a two-tier health system. This paradox exposes a profound cultural contradiction in the German psyche, which is famously stereotyped as risk-averse, highly bureaucratized, and obsessed with systemic order. While Germany tends to regulate everything from highway speeds to the exact composition of its beer, its tolerance of the Heilpraktiker system represents a massive, hazardous blind spot.
By clinging to an outdated Nazi-law out of political convenience and romanticized cultural traditions, the state has allowed this two-tier medical landscape to persist – one built on rigorous science, and another shielded by a legal loophole. In trying to uphold the constitutional freedom of occupation, the German legislative framework inadvertently compromises a far more fundamental duty: the protection of the public from dangerous quacks. This leaves a nation known for “playing it safe” in the ironic position of legally sanctioning pseudo-scientific nonsense within its healthcare system.
A fuller analysis of the Heilpraktiker can be found in my book “Vorsicht Heilpraktiker” [in German].
Because homeopathic remedies are usually diluted to the point where none of the original substance remains (often beyond Avogadro’s number), the ethical concerns with this treatment must focus on veracity (truth-telling), patient autonomy, beneficence, and justice. Here are some of the problems that ensue**:
Violations of Veracity and Informed Consent
Informed consent is an essential element of medical ethics and dictates that a patient must be given full, accurate, and evidence-based information regarding a treatment’s nature, mechanisms, risks, and efficacy to make an autonomous decision.
Homeopathy operates on two main principles: “like cures like” (Law of Similars) and the “law of minimum dose” (the more diluted a substance, the more potent it becomes). Scientifically, these principles contradict established kowledge of chemistry, physics, and pharmacology. Presenting these concepts nevertheless as scientifically valid violates veracity.
When a practitioner administers or sells a homeopathic remedy without explicitly stating that it contains no active ingredients and performs no better than a placebo in clinical trials, the patient’s autonomy is compromised. In other words, patients are making a healthcare choice based on deception or omission.
Maleficence
While homeopathics are physically inert and thus unlikely to cause direct harm, homeopathy poses a severe threat via indirect harm.
The most critical ethical issue occurs when patients use homeopathy for severe, progressive, or life-threatening conditions (such as cancer, severe infections, or chronic diseases like diabetes). Delaying or entirely replacing evidence-based medicine with placebo treatments (i.e. homeopathy) violates the duty of non-maleficence (do no harm). It can lead to preventable suffering, worsening of the condition, or even death in extreme cases.
Homeopathic “Vaccines” (Homeoprophylaxis) is an apt example. Some homeopaths offer all sorts of homeopathic vaccinations as alternatives to standard immunizations. Marketing these as effective protection against potentially deadly diseases like measles, polio, or pertussis erodes public herd immunity, leaves individuals entirely unprotected, and can endanger us all. This is a massive failure of both individual and public health ethics.
Beneficence
Beneficence requires healthcare providers to act in the best interest of the patient by offering treatments that provide a tangible, therapeutic benefit.
While the empathetic, unhurried nature of a homeopathic consultation can provide psychological comfort, homeopaths cannot ethically justify charging high fees for what is essentially a placebo wrapped in pseudo-medicine. Relying on a mechanism that depends on the patient remaining ignorant of the treatment’s true nature is fundamentally paternalistic and violates modern standards of beneficence.
Justice and the Exploitation of Vulnerability
The ethical principle of justice involves fairness, equity, and the responsible distribution of healthcare resources. It is regularly violated in the realm of homeopathy.
Homeopathic remedies are cheap to manufacture, yet they are marketed at unjustifiably inflated prices. Targeting vulnerable populations, such as the chronically ill, parents anxious about medication side effects in their children, or low-income individuals seeking cheap alternatives, is an ethical violation of justice.
When public the health insurance programs of certain countries, or mainstream pharmacies fund or promote homeopathic products alongside effective medicines, they misallocate resources and mislead the public. In other words, they give a false stamp of authority to quackery, draining resources that could support evidence-based public health initiatives.
So, how unethical is homeopathy? My short answer is: VERY!
** for a more detailed discussion, please have a look at our book.
The long-standing consensus surrounding moderate alcohol consumption has recently been disrupted by a landmark review. Initiated under a US congressional mandate to evaluate the evidence base for the US Dietary Guidelines for Americans, the study—convened by the National Academies of Sciences, Engineering, and Medicine (NASEM) alongside the Department of Health and Human Services (HHS)—concluded that even a single alcoholic beverage per day significantly elevates the risks of serious chronic illness and premature death. After unexplained bureaucratic delays, the release of this taxpayer-funded research delivers a sobering truth: there is no net health benefit derived from alcohol consumption at any level.
For decades, public perception was shaped by data suggesting that a daily glass of wine or beer could act as a cardiovascular shield. This new review systematically dismantles that notion by identifying significant methodological biases in the previous evidence. Chief among these is the “sick quitter” effect, wherein baseline categories of non-drinkers inadvertently included individuals who had abstained precisely because of pre-existing, severe health conditions. By correcting for these distortions, the review demonstrated that health risks accumulate linearly. Alcohol acts as a dose-dependent toxin with no safe lower threshold, and even minimal daily intake accelerates linear risk trajectories for:
- liver cirrhosis,
- severe hypertension,
- various malignancies, including esophageal, colorectal, and breast cancers.
Beyond chronic pathology, low-level consumption also:
- impairs cognitive architecture,
- accelerating brain aging,
- elevates the immediate probability of physical injury.
The friction surrounding the report’s delayed release has exposed systemic vulnerabilities at the intersection of federal policy and corporate lobbying. Historically, US dietary guidelines defined moderate drinking as up to two drinks per day for men and one for women. The new scientific consensus exposes these thresholds as dangerously obsolete, highlighting a stark disconnect between federal health advice and contemporary medical data.
This friction might underscore the impact of the commercial determinants of health, exposing how multi-billion-dollar alcohol conglomerates employ aggressive public relations campaigns and sophisticated scientific interference to preserve market shares. By aggressively marketing alcohol as a benign staple of a healthy lifestyle, the industry had successfully obscured its intrinsic risks. The new evidence shifts the conversation from personal indulgence to an important public health issue.
Update (July 2026): a US government–commissioned analysis of alcohol-related risk was published. Here is its abstract:
The purpose of this study was to estimate the lifetime risk of alcohol-attributable mortality and morbidity in the United States based on a person’s average lifetime weekly alcohol consumption to assess the impact of per-occasion alcohol consumption on health.
Lifetime risks were estimated using a cause-specific modeling approach that combined exposure data from national health surveys, relative risks, population data from the U.S. Census Bureau, mortality data from the Centers for Disease Control and Prevention, and morbidity data from the Institute for Health Metrics and Evaluation. A narrative review assessed the health impact of per-occasion alcohol consumption on health.
At low levels of consumption, no protective net effect of alcohol consumption on health was observed. Elevated mortality and morbidity risks were associated with alcohol consumption starting at relatively low levels. Males consuming >6.5 (95% CI [<1, 13.5]) and females consuming >7.0 (95% CI [<1, 11.5]) drinks per week had life-time alcohol-attributable mortality risks >1:1,000. At >8.5 (95% CI [2.5, 13]) drinks per week for both males and females, these risks increased to >1:100. At 14 drinks per week for males (the upper limit of the former Dietary Guidelines for males), the risk of an alcohol-caused death was 1:25 (4%). Drinking patterns also impacted risk. Above 1 drink per occasion, higher consumption was associated with progressively increased risks of breast cancer, cardiovascular disease, and injury.
Alcohol consumption, including at what may be perceived as “moderate” levels, is associated with increased mortality and morbidity risks. These results support tightening alcohol use guidance in the United States, for both males and females, to no more than 1 drink per day.
Public health significance statement: The Alcohol Intake and Health Study shows that for Americans, even what is socially considered “moderate drinking” increases the risk of dying or developing health problems, helping people better understand the net health impact of alcohol. Furthermore, by identifying the levels of alcohol use that raise the risk of cancer, cardiovascular disease, and injury, these findings can guide individuals, families, and communities in making safer choices about drinking patterns. The results also support changing the U.S. Dietary Guidelines on alcohol to recommend that current adult drinkers consume 1 drink or less in a day.
Authors and independent observers have described the report as having been sidelined during the Trump administration, citing conflicts with industry interests and existing “moderate drinking is safe” messaging.
I spent the last 2 months in France where it happened to be hot. Too hot for my taste! I could not do much during the day and, at night, I was unable to sleep well. As the heatwave carried on, it began to impact on my mood and health. I may be particularly sensitive to heat, but I am by no means the only one who suffered. Record-breaking temperatures and unprecedented ocean warming have triggered a global health emergency. Driven by climate change, modern heatwaves are predicted to strike with greater frequency, intensity, and duration, pushing human physiology to (and sometimes past) its limits.
Extreme heat operates as a silent killer by severely exacerbating pre-existing cardiovascular and respiratory conditions. It can also cause acute medical issues like severe dehydration, kidney damage, heatstroke, and even death. Extreme heat disproportionately impacts highly vulnerable groups, including older adults, children, outdoor laborers, and individuals who are unhealthy to start with. Urban populations face magnified dangers due to the urban heat island effect, which traps dense pockets of heat in city environments.
The consequences are already devastating. The recent heatwaves in Europe caused over 1,300 excess deaths within just a few weeks. Extreme heat contributes to a global toll of hundreds of thousands of heat-related fatalities each year. It also ripples through societal infrastructure. Extreme heat heavily strains our healthcare systems, disrupts local economies, worsens food and water insecurity worldwide, endangers local transport and other infrastructure. Here in France, for instance, we had prolonged cuts first of electricity and then on the Internet/telephone; many people and shops had to throw away the content of their fridges and freezers. Even more alarming: one of France’s largest rivers, the Loire, went completely dry.
An analysis of nearly 2,500 UK media articles covering the June heatwave found that most reports failed to connect the event to climate change, despite strong scientific evidence that global heating intensifies extreme weather. Approximately three-quarters of the articles made no reference to climate change or global warming, highlighting a significant gap between scientific consensus and public communication. Such omissions are problematic because they leave audiences without crucial context. Attribution science now allows researchers to quantify how much more likely or intense specific heatwaves have become due to greenhouse gas emissions, primarily from fossil fuel use. Without this information, heatwaves may be perceived as isolated or purely natural events rather than manifestations of a broader, human-driven trend. Failing to link extreme weather to climate change undermines public understanding and may weaken support for mitigation and adaptation policies.
The most worrying thing is that we are rapidly approaching irreversible thresholds. To mitigate this mounting catastrophe, immediate international cooperation is required. We must deploy both short-term adaptation strategies, such as robust local heat action plans and early warning weather networks, as well as aggressive, long-term global emissions reductions. And we also should vote out politicians who still:
- pretend that climate change is a hoax,
- blame their neighouring country, despite being huge polluters themselves,
- shout “drill baby, drill”,
- pretend that summers have always been hot,
- claim (against all medical knowledge) that humans will somehow manage to adapt to extreme heat.
Without urgent measures, the human and economic toll will escalate uncontrollably.
Hypothyroidism is a prevalent hormonal disorder symptoms often persist despite levothyroxine therapy. Adjunctive individualized homeopathic medicines (IHMs) may improve clinical outcomes, biochemical markers, and quality of life, robust evidence of efficacy remains limited.
The objective of this study was to evaluate the efficacy of add-on IHMs alongside standard levothyroxine therapy in the treatment of hypothyroidism in children and adults.
A 3-month, double-blind, randomized, placebo-controlled trial was conducted in a homeopathic hospital involving 64 trial subjects with hypothyroidism undergoing levothyroxine therapy. The participants received either IHMs plus levothyroxine (verum; n = 32) or placebo plus levothyroxine (control; n = 32) for 3 consecutive months. Patients, study investigators, outcome evaluators, and data entry staff were all kept blinded about the allocation concealment according to a double-blinded approach. The codes were not disclosed to the principal investigator, and unblinding occurred only in cases of clear medication-related risk, substantial benefit, or futility. The primary outcome was the Zulewski’s Clinical Scoring (ZCS); secondary outcomes included thyroid-stimulating hormone (TSH), T3, T4, and ThyroPRO-39 scores.
Both groups showed significant improvement in symptoms and thyroid indices. Between-group difference in ZCS was nonsignificant (mean diff: 0.1, 95% confidence interval [CI] −0.3–0.6, P = 0.567), but significant in T3 (mean diff: −0.2, 95% CI −0.4 to −0.1, P = 0.002), T4 (mean diff: 1.6, 95% CI 1.2–2.0, P < 0.001), and TSH (mean diff: −3.0, 95% CI −5.8 to −0.3, P = 0.033), favoring homeopathy against placebo. Quality-of-life changes were minimal, though some ThyroPRO-39 domains improved significantly with IHMs (e.g., symptoms, P < 0.001; tiredness, P = 0.012; nervousness and tension, P = 0.001; and daily activity, P = 0.001).
The authors concluded that adjunctive IHMs did not improve symptoms or quality-of-life outcomes over placebo conclusively, but revealed favorable biochemical changes, meriting further long-term studies.
I must admit: I am puzzled by this paper:
- According to the primary endpoint, the result is squarely negative.
- Yet, the article itself is presented as though the findings were positive.
- This is because the some secondary endpoints yielded positive results.
- But how can this be?
- I find the power justification unconvincing; perhaps the study was under-powered?
- The authors report that “Neither group experienced any adverse effects.”
- How can this be?
- Even placebo therapy generates adverse effects!
- And common problems of levothyroxine therapy are palpitations, tremor, nervousness, insomnia, sweating, heat intolerance, headache, diarrhoea, weight loss, and increased appetite.
As I said, I am puzzled. Perhaps the authors’ affiliations might explain?
- Department of Materia Medica, D. N. De Homoeopathic Medical College and Hospital, Affiliated to the West Bengal University of Health Sciences, Kolkata – 700 046, West Bengal, India
- Department of Repertory, D. N. De Homoeopathic Medical College and Hospital, Affiliated to the West Bengal University of Health Sciences, Kolkata – 700 046, West Bengal, India
- Department of Homeopathy, East Bishnupur State Homoeopathic Dispensary, Chandi Daulatabad Block Primary Health Centre, Under Department of Health and Family Welfare, Govt. of West Bengal, India
The Medical Journalists’ Association (MJA) has outlined six practical tips to help scrutinise health claims responsibly and accurately. They are primarily meant for journalists but, I think, they are also usefull for the general public, particularly when dealing with health claims in the realm of so-called alternative medicine (SCAM):
Check the source
Assess whether the claim originates from credible, peer-reviewed research and a reputable institution. Be wary of press releases, anecdotal reports, or media outlets known for sensationalism. Specifically for claims about SCAM, we might also add caution regarding the many third class SCAM journals.
Look for conflicts of interest
Investigate who funded the research and whether any authors or organisations stand to profit from the findings. Industry sponsorship can introduce bias, even in otherwise well-conducted studies. For claims about SCAM, we should remember that financial interest might be secondary to ideological ones.
Examine the study design
Consider whether the research used appropriate methods – such as randomisation, control groups, and adequate sample sizes – to support its conclusions. Observational studies, or case reports, or trials with the often-discussed ‘A+B versus B’ design, for example, cannot prove causation.
Consider the magnitude and relevance of effects
Distinguish between statistical significance and clinical importance. A tiny effect may be statistically significant in a large trial but meaningless in practice. Also ask whether the study population is representative and the outcome can be generalised.
Look for independent replication
Single studies should be treated cautiously until confirmed by other researchers. Consistent findings across multiple studies increase confidence in a claim.
Beware of over-interpretations
Scrutinise whether the authors or media coverage extrapolate beyond what the data support. For instance, generalising from animal studies to humans, or implying benefits without evidence of improved health outcomes.
___________________
If I may, I will add an 7th to the six by the MJA. It is one that I have issued many times previously and that is, I think, essential in SCAM:
If it sounds too good to be true, it probably is!
Exaggerated or false health claims are endemic in SCAM. These 7 tips might be useful in disclosing them and in minimising the harm they can do.
Medical ethics rests on 4 core principles: autonomy, beneficence, non-maleficence, and justice, along with the crucial rule of veracity (truth-telling). In the realm of chiropractic, the most significant ethical issues/problems generally fall into the following ethical categories:
- Compromised Informed Consent & Veracity
Informed consent requires that a patient fully understands the nature, risks, benefits, and scientific backing of a treatment before proceeding.
1.1.The “Subluxation” Theory: A sizable segment of the chiropractic community still adheres to the erroneous belief that spinal “vertebral subluxations” cause a disruption in the body’s “innate intelligence,” leading to systemic disease. From an ethical standpoint, promoting an unproven, pseudo-scientific premise as medical fact violates veracity and compromises patient autonomy, as patients cannot give truly informed consent based on erroneous concepts.
1.2. Over-claiming Scope of Efficacy: While evidence might support spinal manipulation for acute lower back pain (if one were to interpret the dtat optimistically), most chiropractors claim they can treat many other illnesses, including non-musculoskeletal conditions such as asthma, allergies, infantile colic, ADHD, and high blood pressure. Marketing these services without robust clinical trial backing misleads vulnerable populations.
- Violations of Non-Maleficence
The principle of non-maleficence requires practitioners to avoid inflicting unnecessary harm or exposing patients to disproportionate risks.
2.1. Cervical Manipulation and Stroke Risk: One of the most severe ethical concerns involves high-velocity, low-amplitude (HVLA) thrusts to the upper neck, the hallmark modality of chiropractors. This procedure has been linked to vertebral artery dissection (VAD), which can cause strokes and deaths. The ethical failure is most obvious when chiropractors perform these adjustments without warning the patient of this and other adverse outcomes.
2.2. Paediatric Chiropractic: Performing spinal adjustments on infants and toddlers (whose spines are primarily cartilage and still developing) poses distinct physical risks. Because infants cannot consent and the evidence of benefit for childhood ailments is practically non-existent, this behaviour violates non-maleficence.
- Secondary Harm: Delay of Standard Medical Care
Harm does not only come from physical injury; it also comes from omitting or delaying necessary medical treatment.
3.1. Anti-Vaccine and Anti-Medicine Sentiments: A large proportion of the chiropractic profession advise patients against conventional medicine, pharmaceuticals, and vaccination. When a chiropractor discourages a patient from seeking standard medical care, they are actively contributing to potentially life-threatening delays in care.
- Violations of Beneficence and Justice
Beneficence means acting in the patient’s best interest, while justice involves the fair and equitable distribution of healthcare resources.
4.1. The “Maintenance Care” Business Model: A common predatory practice of chiropractors involves convincing patients that they require lifelong, regular spinal adjustments to “stay aligned” and prevent disease, often locked into expensive upfront contracts. Recommending continuous, costly treatments that lack clinical evidence of long-term benefit shifts the focus from patient welfare (beneficence) to practitioner financial gain.
4.2.Over-Utilization of X-rays: Some chiropractic clinics mandate full-spine X-rays for every new patient, regardless of symptoms, and repeat them frequently to “prove” alignment changes. Exposing patients to unnecessary ionizing radiation for marketing or diagnostic justification is a direct violation of both non-maleficence and the ethical use of healthcare resources.
For a more detailed account of the ethical problems in so-called alternative medicine, please see our book on this very subject.
Religiosity has been linked to a wide range of health outcomes, with evidence for both benefits and harms.
Alleged positive effects
Many studies have found positive associations between religious involvement and physical and mental health, including lower mortality, better self-rated health and greater psychological well‑being. However, most of this literature is methodologically weak, with selection bias, poor control for confounders and selective reporting, so firm causal conclusions are difficult.
Religiosity and spirituality have frequently been associated with positive effects on mental health, such as higher levels of life satisfaction, meaning in life, hope, optimism and lower rates of depression, substance misuse and some forms of suicidal behaviour. Proposed mechanisms include social support from religious communities, promotion of coping resources, encouragement of health‑promoting behaviours and cognitive frameworks that help some people make sense of adversity.
In addition, observational studies have linked religious participation with positive effects on physical endpoints, such as reduced smoking, more moderate alcohol use and in some cases better cardiovascular outcomes and lower all‑cause mortality, though effect sizes are usually modest. Cross‑national analyses show that religious people sometimes report better self‑rated health, but these associations vary widely by country and are sensitive to socioeconomic and cultural context.onlinelibrary.
Alleged negative effects
Some aspects of religiosity might be harmful: religious struggles—such as feeling punished by God, spiritual discontent or conflict with religious communities—are consistently associated with higher levels of depression, anxiety and distress. Some studies also suggest that rigid or punitive religious beliefs can exacerbate guilt, internalized stigma (for example around sexuality) and delay help‑seeking for mental illness.
In highly secular societies, belonging to a religious minority may correlate with poorer health, possibly via discrimination, lower social integration or economic disadvantage. A critical economic analysis even reports a negative relationship between religious background and some health indicators once socioeconomic factors are carefully controlled, challenging simple “religion is good for you” narratives.
Methodological problems
Much of the evidence relies on observational studies, making it difficult to be sure about causality: healthier or more socially integrated people may be more likely to be religiously active. Measures of religiosity and spirituality are heterogeneous, ranging from attendance to private practices to diffuse “spiritual well‑being”, which complicates comparisons and may inflate positive findings. In other words, the effects of religiosity on health are less that certain or clear.
