MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

EBM

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Today is the official publication date of my new book ‘DON’T BELIEVE WHAT YOU THINK‘. It is essentially a crash course in critical thinking. To give you a flavour, here is an excerpt from its preface:

… So-called alternative medicine (SCAM) is a complex and controversial subject. Many people pretend to be experts in SCAM, but few know even the basic facts about it. Many consumers talk about SCAM, but few can be bothered to look behind the smokescreen of misleading claims. Many feel emotionally attached to SCAM, but few manage to think rationally about it. Many religiously believe in SCAM, but few show concern about the evidence. Many are desperate for help, but few seem to mind getting ripped off…

Enthusiasts of SCAM tend to hope for less side-effects, symptom relief, a cure of their condition, improvements in quality of life, and protection from illness. Such high expectations are usually based on misinformation, often even on outright lies. The disappointing truth is that not many SCAMs are truly effective in treating or preventing disease, and that none is totally harmless. In fact, the dangers of SCAM are multi-fold and potentially serious:

  • harm due to adverse effects such as toxicity of an herbal remedy, stroke after chiropractic manipulation, pneumothorax after acupuncture (see chapter 3.2);
  • harm caused by bogus diagnostic techniques (see chapter 4.4);
  • harm of using materials from endangered species (see chapter 3.15);
  • harm through incompetent advice by SCAM providers (see chapter 4.5);
  • harm due to using SCAM instead of an effective therapy for serious conditions (see chapter 4.5);
  • harm due to the high costs of SCAM (see chapter 3.8);
  • harm due to SCAM undermining evidence-based medicine (see chapter 5.4);
  • harm caused by inhibiting medical progress and research (see chapter 5.1).

In this book, I address these issues in detail and explain how consumers get manipulated into believing things that are evidently wrong. Using plenty of real-life examples, I outline how the constant flow of misinformation, coupled with motivated ignorance, motivated reasoning, and cognitive bias can produce a form of wishful thinking that is detached from reality. In the interest of my readers’ health, I aim to correct some of these false beliefs and fallacious thought processes.

My book consists of 35 concise essays each of which addresses one commonly held belief about SCAM. The essays can be read as stand-alone articles; occasionally, this necessitates a degree of repetition which, however, is minimal. The text avoids technical jargon and is therefore easy to follow. For those who want to dig deeper into the scientific evidence, links are provided to numerous papers that might prove to be helpful. A glossary is added at the end to explain some terms that might be unfamiliar.

This book is meant to stimulate critical thinking not just about SCAM, but also in a more general way. Science deniers employ similar techniques no matter whether they focus on health, climate change, evolution or other subjects. Exposing their techniques for what they are is thus important.

  • They ignore the scientific consensus.
  • They cherry-pick their evidence.
  • They rely on poor quality studies, opinion and anecdotes.
  • They invent conspiracy theories.
  • They defame their opponents.
  • They point out that science has been wrong before.
  • They say, ‘science does not know everything’.

Critical thinking is the best, perhaps even the only protection we have from being fooled and, crucially, from fooling ourselves. If my book enables you to question nonsense, call out untruths, correct falsehoods, ridicule stupidity, and disclose fake news, it surely was worth the effort.

 

Yesterday, it was announced that Prince Charles, a long-time advocate of so-called alternative medicine (SCAM), has been taken ill with the corona virus. Since then, I have been inundated with messages about this fact. Many thought that, because Charles and I have a bit of history (details here), I might now ‘have a cup of tea and a malicious smile on [my] face thinking about it’, as someone put it on Twitter. Others made sarcastic comments suggesting that he will be fine because of all the help of the homeopathic cult.

I cannot join these sentiments. On the contrary, I sincerely wish him well – not because he is royalty, but because I wish everyone well who has been infected with this virus.

And I honestly do not think that Charles will be popping homeopathic placebos to save his life. Whenever a member of his (usually pro-homeopathy) family had fallen seriously ill in the past, they very quickly sought the help of the very best evidence-based medicine could offer. Charles’ present illness will be no exception, I am sure. If his infection becomes serious, he will have the benefit of everything modern scientific healthcare has to offer.

When he recovers – and I do hope he does – he will have plenty of time to think. Chances are that he never before had been afflicted with a killer disease. This should make him see things from an entirely new perspective. He must realise that so-called alternative medicine (SCAM) is an option only as long as one is healthy. Once the battle for saving a life is on, real medicine must save the day.

I am a born optimist, and therefore I hope that Charles on his sick-bed might even think a little further. He might realise that a health crisis, like the current corona pandemic, regularly brings out the charlatans who are trying to flog their wares or services to the unsuspecting public. On my blog, I have discussed some of these irresponsible rogues:

With a bit of luck, Charles might even reflect that his past endorsement of these quacks has been less than helpful; in the present crisis, it might even cost lives. Charles, I hope, will thus reconsider his attitude towards medicine, heaven knows, he might even become an outspoken advocate fro EBM!

So yes, I am an incurable optimist. Yet, I realise, of course, that Charles might not have any of these insights. That would be regrettable, but it does not deter me from wishing him a speedy recovery:

GET WELL SOON, CHARLES!

Dr Jens Behnke has attracted my attention several times before (most recently here and here). Today I have decided to admit him into my ‘ALTERNATIVE MEDICINE HALL OF FAME’.

He finds himself in the company of giants:

John Weeks (editor of JCAM)

Deepak Chopra (US entrepreneur)

Cheryl Hawk (US chiropractor)

David Peters (osteopathy, homeopathy, UK)

Nicola Robinson (TCM, UK)

Peter Fisher (homeopathy, UK)

Simon Mills (herbal medicine, UK)

Gustav Dobos (various, Germany)

Claudia Witt (homeopathy, Germany and Switzerland)

George Lewith (acupuncture, UK)

John Licciardone (osteopathy, US)

Why does Behnke deserve this honour?

Because, 4 years ago, he made his doctorate under the supervision of Prof Harald Walach, pseudoscientist of the year 2012 and proven teller of falsehoods?

No, there are better reasons.

On Twitter, Behnke describes himself as a research consultant for homeopathy at the Karl and Veronica Carstens-Foundation: Evidence based medicine, CAM, clinical and basic research, health. The Carstens Stiftung say he is ‘programme director integrative medicine’. On facebook, he is merely ‘ ‘Referent of  ‘Redaktion Natur und Medizin’. And on ‘Research Gate’ he lists 12 areas of skills and expertise:

Evidence Based Medicine
Medical & Health Profession Education
Meta-Analysis
Observational Studies
Science Communication
Social Media
Randomized Control Trials
Clinical Research
Philosophy Of Science
Complementary & Alternative Medicine
Integrative Medicine
Homeopathy

If this is not impressive, I don’t know what is! Particularly, if one knows that he is not a medical doctor at all!!!

So, let’s look at the list to decide whether he deserves the honour of becoming a member of my ‘HALL OF FAME’. Specifically, let’s check how many Medline-listed articles he has to his name in each of the above areas:

Evidence Based Medicine = 0
Medical & Health Profession Education = 0
Meta-Analysis = 0
Observational Studies = 0
Science Communication = 0
Social Media = 0
Randomized Control Trials = 0
Clinical Research = 0
Philosophy Of Science = 0
Complementary & Alternative Medicine = 0e
Integrative Medicine = 0
Homeopathy = 0

(No, you don’t need to praise me for my detailed, time-consuming research. It was not difficult and very quick: Jens Behnke, the ‘research consultant, has precisely zero Medline-listed publications).
So has Behnke ever conducted:

  • a meta-analysis? No
  • an observational study? I don’t think so
  • a randomised trial? No
  • any other clinical research? No

In the past, I tended to admit to my HALL OF FAME mainly those SCAM researchers who had published plenty of papers but had no study to their name that drew a negative conclusion. Behnke is not in that league. He is nevertheless worthy for his highly elaborate concept. Remember, he is a ‘research consultant in homeopathy’, and homeopathy obeys different rules than any other form of quackery. One of its axioms holds that LESS IS MORE. And considering this principle, Behnke surely must be THE expert! No publication, in homeopathic logic, evidently means that he is better than anyone else.

So, a warm welcome to our new member Jens Behnke: MAY YOUR UNPRODUCTIVITY AS A EXPERT IN 12 DIFFERENT FIELDS OF INQUIRY LAST FOR MANY MORE YEARS!

And congratulations also to the Carstens Stiftung who have so far spent 36 000 000 Euro on SCAM-research and pay Behnke’s salary as ‘research consultant’: I am sure you guys deserve him!

PS

In case Dr Behnke reads this: it is an internationally accepted standard of honesty and transparency that someone who has a doctor title and works in or comments on medical matters makes it clear that he/she is not medically trained or experienced, that in fact he/she is not a medical doctor. If not, one might think that this person is deliberately trying to mislead the public.

An article in the ‘Long Island Press’ caught my attention. Here are some excerpts:

A simple painless spinal adjustment by a chiropractor could be the latest breakthrough in the treatment of drug and alcohol addiction… Bridge Back to Life, an outpatient addiction treatment program, has teamed up with New York Chiropractic College (NYCC) … to offer the latest breakthrough therapy for substance use disorder. The first-of-a kind partnership, the brainchild of Bridge Back to Life’s medical director Dr. Russell Surasky, brings doctors from NYCC to evaluate and treat the center’s patients undergoing addiction therapy. Several diagnostic tests are performed at the base of the brainstem to determine if a misalignment exists. If present, the practitioners are taught to incorporate gentle painless, corrective spinal adjustments into the patient’s care plan. This treatment reduces stress on the spinal column and limbic system of the brain…

“Safe, painless adjustments to the upper cervical spinal bones can help normalize the brain’s limbic system by helping with the overall circulation of cerebrospinal fluid of the brain… I truly believe that this agreement with the college will serve as a national model for drug rehabilitation centers throughout the country,” says Surasky, who is triple board certified in neurology, addiction medicine, and preventive medicine. “Not only can spinal adjustments reduce the chronic pain issues that may have led patients into drug addiction in the first place, but now we also have evidence that spinal adjustments actually accelerate the healing of the brain from addiction.”

Surasky points to a study done in 2001 in the journal Nature: Molecular Psychiatry, which looked at the impact of spinal manipulations at an inpatient addiction treatment facility in Miami. The study found that chemically dependent patients who received specific spinal adjustments as part of their treatment reported fewer drug cravings and mental health symptoms. Moreover, 100 percent of the study patients who received chiropractic care completed the inpatient program, while about half of those not receiving treatments dropped out prior to completion. Yet no further studies were performed, and the information languished. Surasky began treating patients with the spinal adjustments at his private practice in Great Neck before bringing the treatment to Bridge Back to Life.

Mary W. came to Surasky’s Great Neck office for help with alcohol addiction nearly one year ago. She received monthly Vivitrol shots and had marked success in curbing her cravings and drastically reducing her drinking. But Mary still had one-day “slips” from time to time. She also complained of insomnia and migraine headaches. She recalled an accident in the past, where she hit her head. Dr. Surasky took X-rays of her upper neck and performed a Tytron scan. He said the digital images showed she had misalignments at the C1 vertebral level, likely putting pressure on the lower brainstem area. In addition to Vivitrol shots, Mary started receiving upper cervical adjustments and has remained sober since. Her migraines have dropped from five per month to one or none and she is sleeping better.

Where to start?

There is much to be concerned about in this short article. Let me mention just a few obvious points:

  1. A treatment that is not backed by solid evidence is hardly a ‘breakthrough’.
  2. The ‘misalignments’ they are looking for do not exist.
  3. Spinal manipulation is not as safe as presented here.
  4. The assumption that it reduces stress on the limbic system is far-fetched.
  5. To suggest this approach as a ‘national model’, is simply ridiculous.
  6. The notion that adjustments increase the circulation of the cerebrospinal fluid is not evidence-based.
  7. What are ‘chronic pain tissues’?
  8. The claim that spinal manipulation accelerates healing of the brain is not evidence-based.
  9. The study in Nature Molecular Psychiatry does not seem to exist (I could not find it, if anyone can, please let me know).
  10. X-ray diagnostics cannot diagnose ‘misalignments’.
  11. Tytron scans are used mostly by chiropractors are not a reliable diagnostic method.
  12. Anecdotes are not evidence.

In short: this article reads like an advertisement for chiropractic as a treatment of addictions. As there is no evidence that chiropractic spinal manipulations are effective for this indication, it is hard to think of anything more irresponsible than that.

And here is the question that I often ask myself:

Are there any bogus, profitable, unethical claims that chiropractors would shy away from?

 

The website of this organisation is always good for a surprise. A recent announcement relates to a course of Thought Field Therapy (TFT):

As part of our ongoing programme to explore prospects for improved healthcare, the College is pleased to announce a course on TFT – a “Tapping” therapy – independently provided by Janet Thomson MSc.

In healthcare we may find ourselves exhausting the evidence-based options and still looking for ways to help our patients. So when trusted practitioners suggest simple and safe approaches that appear to have benefit we are interested.

TFT is a simple non-invasive, technique that anyone can learn, for themselves or to pass on to their patients, to help cope with negative thoughts and emotions. It was developed by Roger Callahan who discovered that tapping on certain meridian points could help counter negative emotions. Janet trained with Roger and has become an accomplished exponent of the technique.

Janet has contracted her usual two-day course into one: to get the most from this will require access to her Tapping For Life book and there will be pre-course videos demonstrating some of the key techniques.  The second consecutive day is available for advanced TFT training, to help in dealing with difficult cases, as well as how to integrate TFT with other modalities.

How much does it cost (excluding booking fee)?  Day One only – £195; Day Two only – £195 (only available if you have previously completed day one); Both Days – £375.

When is it?  Saturday & Sunday 7th-8th March – 09:30-17:30

What, you don’t know what TFT is? Let me fill you in.

According to Wiki, TFT is a fringe psychological treatment developed by an American psychologist, Roger Callahan.[2] Its proponents say that it can heal a variety of mental and physical ailments through specialized “tapping” with the fingers at meridian points on the upper body and hands. The theory behind TFT is a mixture of concepts “derived from a variety of sources. Foremost among these is the ancient Chinese philosophy of chi, which is thought to be the ‘life force’ that flows throughout the body”. Callahan also bases his theory upon applied kinesiology and physics.[3] There is no scientific evidence that TFT is effective, and the American Psychological Association has stated that it “lacks a scientific basis” and consists of pseudoscience.[2]

Other assessments are even less complimentary: Thought field therapy (TFT) is a New Age psychotherapy dressed up in the garb of traditional Chinese medicine. It was developed in 1981 by Dr. Roger Callahan, a cognitive psychologist. While treating a patient for water phobia:

He asked her to think about water, tap with two fingers on the point that connected with the stomach meridian and much to his surprise, her fear of water completely disappeared.*

Callahan attributes the cure to the tapping, which he thinks unblocked “energy” in her stomach meridian. I don’t know how Callahan got the idea that tapping on a particular point would have anything to do with relieving a phobia, but he claims he has developed taps for just about anything that ails you, including a set of taps that can cure malaria (NPR interview).

TFT allegedly “gives immediate relief for post traumatic stress disorder (PTSD ), addictions, phobias, fears, and anxieties by directly treating the blockage in the energy flow created by a disturbing thought pattern. It virtually eliminates any negative feeling previously associated with a thought.”*

The theory behind TFT is that negative emotions cause energy blockage and if the energy is unblocked then the fears will disappear. Tapping acupressure points is thought to be the means of unblocking the energy. Allegedly, it only takes five to six minutes to elicit a cure. Dr. Callahan claims an 85% success rate. He even does cures over the phone using “Voice Technology” on infants and animals; by analyzing the voice he claims he can determine what points on the body the patient should tap for treatment.

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Yes, TFT seems utterly implausible – but what about the clinical evidence?

There are quite a few positive controlled clinical trials of TFT. They all have one thing in common: they smell fishy to me! I know, that’s not a very scientific judgement. Let me rephrase it: I am not aware of a single trial that proves TFT to have effects beyond placebo (if you know one, please post the link).

And Janet Thomson, MSc (the therapist who runs the course), who is she? Her website is revealing; have a look if you are interested. If not, it might suffice to say that she modestly claims that she is an outstanding Life Coach, Therapist & Trainer.

So, considering that TFT is so very implausible and unproven, why does the ‘College of Medicine and Integrated Healthcare’ promote it in such strong terms?

I have to admit, I do not know the answer – perhaps they want at all costs to become known as the ‘College of Quack Medicine’?

I missed this article by Canadian vascular surgeons when it came out in 2018. It is well-argued, and I think you should read it in full, if you can get access (it’s behind a pay wall). It contains interesting details about the anti-vax attitude of doctors of integrative medicine (something we discussed before), as well as the most dubious things that go on in the ‘Cleveland Clinic’. Here is at least the abstract of the article:

Evidence-based medicine, first described in 1992, offers a clear, systematic, and scientific approach to the practice of medicine. Recently, the non-evidence-based practice of complementary and alternative medicine (CAM) has been increasing in the United States and around the world, particularly at medical institutions known for providing rigorous evidence-based care. The use of CAM may cause harm to patients through interactions with evidence-based medications or if patients choose to forego evidence-based care. CAM may also put financial strain on patients as most CAM expenditures are paid out-of-pocket. Despite these drawbacks, patients continue to use CAM due to media promotion of CAM therapies, dissatisfaction with conventional healthcare, and a desire for more holistic care. Given the increasing demand for CAM, many medical institutions now offer CAM services. Recently, there has been controversy surrounding the leaders of several CAM centres based at a highly respected academic medical institution, as they publicly expressed anti-vaccination views. These controversies demonstrate the non-evidence-based philosophies that run deep within CAM that are contrary to the evidence-based care that academic medical institutions should provide. Although there are financial incentives for institutions to provide CAM, it is important to recognize that this legitimizes CAM and may cause harm to patients. The poor regulation of CAM allows for the continued distribution of products and services that have not been rigorously tested for safety and efficacy. Governments in Australia and England have successfully improved regulation of CAM and can serve as a model to other countries.

Those who have been following this blog a little know how much I agree with these authors. In fact, in the peer-reviewed literature, I have been publishing similar arguments for almost 20 years, e.g:

The University College London Hospitals (UCLH) include the ‘Royal London Hospital for Integrated Medicine’ (RLHIM). The RLHIM offers a range of so-called alternative medicines (SCAMs), including acupuncture.

This is how they advertise traditional acupuncture to the unsuspecting public:

Acupuncture is a part of Traditional Chinese Medicine (TCM). This is a system of healing which has been practised in China and other Eastern countries for thousands of years.

Although often used as a means of pain relief, it can treat people with other illnesses. The focus is on improving the overall well-being of the patient, rather than the isolated treatment of specific symptoms.

You will be seen individually and assessed by an acupuncturist trained in TCM. They will use traditional Chinese techniques including pulse, tongue and abdominal diagnosis. They will also ask you about your medical history and lifestyle.

The TCM trained acupuncturist can stimulate the body’s own healing response and help to restore its natural balance.

The principal aim of acupuncture in treating the whole person is to create balance between your physical, emotional and spiritual needs. It can help to relax, improve mood and sleep, relieve tension and improve your sense of well-being, as well as improving symptoms.

We will assess your individual needs and discuss a treatment plan with you during your initial consultation.

The treatment may include the use of the following:

  • The use of fine acupuncture needles
  • Moxibustion (burning of the herb mugwort close to the surface of the skin)
  • Cupping therapy (to create local suction on the skin)
  • Acupressure (pressure applied to acu-points to stimulate energy flow)
  • Electro-acupuncture (a low voltage current is passed between 2 needles)

________________________________________________________________

How reliable is this information? I will try to answer this question by discussing the 6 statements that, in my view, are most questionable.

Although often used as a means of pain relief, it can treat people with other illnesses

Whether acupuncture is effective for pain relief is debatable. A recent analysis cast considerable doubt on the assumption. The notion that acupuncture ‘can treat people with other illnesses’ seems like a ‘carte blanche’ for treating virtually any condition regardless of evidence.

Improving the overall well-being of the patient

I am not aware of sound evidence that acupuncture is an effective treatment for improving overall well-being.

Traditional Chinese techniques including pulse, tongue and abdominal diagnosis

These diagnostic techniques have not been adequately validated and have no place in evidence-based healthcare.

The TCM trained acupuncturist can stimulate the body’s own healing response and help to restore its natural balance

I am not aware of sound evidence to show that acupuncture stimulates healing. The statement seems like another ‘carte blanche’ for treating anything the therapist feels like, regardless of evidence.

The principal aim of acupuncture in treating the whole person is to create balance between your physical, emotional and spiritual needs

The claim that acupuncture is a holistic treatment is based on little more than wishful thinking by acupuncturists.

It can help to relax, improve mood and sleep, relieve tension and improve your sense of well-being, as well as improving symptoms

I am not aware of sound evidence that acupuncture is effective in treating any of the named conditions. The end of the sentence (‘as well as improving symptoms’) is another ‘carte blanche’ for doing anything the acupuncturists feels like.

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The UCLH are firmly committed to EBM. The RLHIM claims to be ‘a centre for evidence-based practice’. This claim is not supported by the above advertisement of acupuncture which is clearly not based on good evidence. Moreover, it has the potential to mislead vulnerable patients and thus cause considerable harm. In my view, it is high time that the UCLH address this problem.

It has been reported that Brazil and India will collaborate in the promotion of quackery! Brazil’s president Jair Bolsonaro and India’s Prime Minister Narendra Modi, have just signed several agreements on collaboration. Agreement 8 is particularly intriguing:

8. Memo of agreement for cooperation in Traditional Medicine and Homeopathy

We seek to promote and develop bilateral cooperation in the field of traditional medicine and homeopathy. The areas of cooperation provided for in the instrument include exchange of experience in teaching regulations, practices, medicines and non-medicine therapies; knowledge promotion, exchange of training for therapists, health professionals, scientists, teaching professionals and students; and development of joint research, besides educational and training programs.

Homeopathy, already a recognized medical specialty in Brazil, is currently offered for free by the Brazilian national healthcare system. Other so-called alternative medicines (SCAMs) employed in the Brazilian healthcare system include:

  • acupuncture,
  • Reiki,
  • spiritual healing,
  • crystal healing,
  • aromatherapy.

Homeopathy and acupuncture are also recognized by the Brazilian Federal Council and both are taught in the most prestigious public Universities, in medical, veterinary, public health and nursing schools.

India has gone one step further by establishing its AYUSH ministry. It registers SCAM practitioners considered ‘indigenous’ by the Indian government under a separate board.  The SCAMs thus regulated are:

  • Ayurveda,
  • Yoga and Naturopathy,
  • Unani and Tibbi,
  • Siddha,
  • Homeopathy.

In India, practitioners are taught some of these subjects as MBBS ( Bachelor of Medicine and Surgery). The graduates are then considered to be ‘doctors’. In Brazil, homeopathy and acupuncture are practiced by medical doctors. Brazilian citizens are thus misled to believe that these SCAMs are evidence-based.

So, what this ‘bilateral co-operation’ is going to achieve? Narendra Nayak (President of the Federation of Indian Rationalist Associations and former Assistant Professor of Biochemistry in Mangalore) and Natalia Pasternak (President of the Instituto Questão de Ciência in São Paulo) are less than optimistic:

Exchange of ‘technology’ of so called ‘psychic surgery’ of  quacks like the late José Arigo, “the surgeon with the rusty knife”, with specialists of gaumutra (urine of India’s allegedly indigenous cows) whose concoction is supposed to be a panacea for 440 diseases? Is Brazil going to export to India the peculiar surgical techniques of the “medium” John of God, recently arrested, not for years of practicing unlicensed medicine and hurting people, but for sexual harassment and rape? Don’t get the wrong message, we are very glad John of God was convicted, and very glad for the brave women who came forward, but we cannot ignore the fact that he was never bothered by the authorities for placing people under his (usually not quite clean) knife.

Since India and Brazil are leaders in sugar production, are they going to support Homeopathy? Also the use of alcohol to produce their tinctures?

Again, we wonder why India and Brazil are going for an alleged system of medicine called homeopathy which is nowhere in the mainstream in the country of its origin -Germany. And why do they embrace it while the rest of the world is pushing back against homeopathy, after several scientific papers, reviews and meta-analyses showed beyond any reasonable doubt that it doesn’t work?

Brazil and India have much in common, both are rising developing economies, with a diverse population, trying to be true to their democratic ideals. Unfortunately, another similarity comes to light: the fact that presently both our countries are governed by rulers that have shown total disregard by scientific knowledge and evidence in many of their public policy decisions.

As heads of organizations that promote science and rational thinking in Brazil and India, we regret the decision of our governments to promote quackery as a legitimate subject of an international agreement.

I feel that individuals and organisations promoting critical thinking in other parts of the world should lend their support to these two courageous people.

In 2011, the following leading researchers of so-called alternative medicine (SCAM) – no I was not invited – had a meeting in Italy, did a brainstorm and decided what we would need to know about SCAM by 2020 (today, in other words):

They proposed 6 core areas of research that should be investigated to achieve a robust knowledge base and to allow stakeholders to make informed decisions:

  1. Research into the prevalence of SCAM in Europe: Reviews show that we do not know enough about the circumstances in which SCAM is used by Europeans. To enable a common European strategic approach, a clear picture of current use is of the utmost importance.
  2. Research into differences regarding citizens’ attitudes and needs towards SCAM: Citizens are the driver for CAM utilization. Their needs and views on SCAM are a key priority, and their interests must be investigated and addressed in future SCAM research.
  3. Research into safety of SCAM: Safety is a key issue for European citizens. SCAM is considered safe, but reliable data is scarce although urgently needed in order to assess the risk and cost-benefit ratio of SCAM.
  4. Research into the comparative effectiveness of SCAM: Everybody needs to know in what situation SCAM is a reasonable choice. Therefore, we recommend a clear emphasis on concurrent evaluation of the overall effectiveness of SCAM as an additional or alternative treatment strategy in real-world settings.
  5. Research into effects of context and meaning: The impact of effects of context and meaning on the outcome of SCAM treatments must be investigated; it is likely that they are significant.
  6. Research into different models of SCAM health care integration: There are different models of SCAM being integrated into conventional medicine throughout Europe, each with their respective strengths and limitations. These models should be described and concurrently evaluated; innovative models of SCAM provision in health care systems should be one focus for SCAM research.

‘Look, half the work is done! All you need to do is fill in the top part so we can legally say the bottom part.’

The researchers then added:

We also propose a methodological framework for SCAM research. We consider that a framework of mixed methodological approaches is likely to yield the most useful information. In this model, all available research strategies including comparative effectiveness research utilising quantitative and qualitative methods should be considered to enable us to secure the greatest density of knowledge possible. Stakeholders, such as citizens, patients and providers, should be involved in every stage of developing the specific and relevant research questions, study design and the assurance of real-world relevance for the research.

Furthermore, structural and sufficient financial support for research into SCAM is needed to strengthen SCAM research capacity if we wish to understand why it remains so popular within the EU. In order to consider employing SCAM as part of the solution to the health care, health creation and self-care challenges we face by 2020, it is vital to obtain a robust picture of SCAM use and reliable information about its cost, safety and effectiveness in real-world settings. We need to consider the availability, accessibility and affordability of SCAM. We need to engage in research excellence and utilise comparative effectiveness approaches and mixed methods to obtain this data.

Our recommendations are both strategic and methodological. They are presented for the consideration of researchers and funders while being designed to answer the important and implicit questions posed by EU citizens currently using SCAM in apparently increasing numbers. We propose that the EU actively supports an EU-wide strategic approach that facilitates the development of SCAM research. This could be achieved in the first instance through funding a European SCAM coordinating research office dedicated to foster systematic communication between EU governments, public, charitable and industry funders as well as researchers, citizens and other stakeholders. The aim of this office would be to coordinate research strategy developments and research funding opportunities, as well as to document and disseminate international research activities in this field.

With the aim to develop sustainability as second step, a European Centre for SCAM should be established that takes over the monitoring and further development of a coordinated research strategy for SCAM, as well as it should have funds that can be awarded to foster high quality and robust independent research with a focus on citizens health needs and pan-European collaboration.

We wish to establish a solid funding for SCAM research to adequately inform health care and health creation decision-making throughout the EU. This centre would ensure that our vision of a common, strategic and scientifically rigorous approach to SCAM research becomes our legacy and Europe’s reality. We are confident that our recommendations will serve these essential goals for EU citizens.

As I know all of the members of the panel personally, I am not surprised by the content of this document. That does not mean, however, that I do not find it remarkable. In my view, it is remarkable because of the nature of the 6 items that we allegedly need to know by 2020, and because of the fact that, even though none of them seem particularly demanding, today we have clarity or sound information on none of them. I also thought that both the research topics and the research methods were on the woolly side and, to a large degree, avoided what would be standard in conventional medicine. The ‘vision’ of the 13 researchers thus turns out to be the view of 13 partially sighted people on an array of platitudes.

Being just a bit sarcastic, the document could be seen as a plea for letting SCAM researchers:

  • continue to play on their far from level playing field,
  • use their preferred and largely inadequate methodologies,
  • pretend they do cutting edge science,
  • continue to avoid the real issues,
  • enjoy a life free of demanding challenges,
  • have pots of EU money for doing largely useless work.

In a word, I am confident that their recommendations would not have served any essential goals for EU citizens.

‘HOMEOPATHY360’ are fiercely decided to defend homeopathy, no matter what. They state that we promise to stand by your side always to fight against the critical attacks on Homeopathy… Therefore, I was not really surprised when, a couple of days ago, I received an email by them urging me to support US homeopaths against the threat by the FDA. Here is part of this correspondence:

… If you want to know more about the FDA’s proposed new rules for homeopathic medicines, here’s a summary of the most important points:

  • The new rules, if adopted, will allow the FDA to withdraw even properly manufactured and labeled homeopathic medicines from the marketplace. This is puzzling because these have never posed any sort of safety concern according to an initial review of public FDA records by Americans for Homeopathy Choice.
  • It is clear that the FDA intends to use this authority and has even mentioned specific medicines such as Belladonna, Nux vomica and Lachesis muta in its public statements regarding enforcement.
  • The authority for this kind of assault on homeopathy will result from the declaration by the FDA that all homeopathic medicines are “new drugs.” We all know this is nonsense. Homeopathic medicines have been around for 200 years.
  • But this nonsense declaration means that under U.S. law all homeopathic remedies will become technically “illegal” and subject to withdrawal from the marketplace. If the FDA just thinks there is a problem with a homeopathic medicine, it can withdraw it forever without conducting any sort of investigation.
  • Since the agency has already said that it thinks that Belladonna, Nux vomica, Lachesis muta and several other remedies are dangerous, we can anticipate that it will try to remove them from the marketplace as soon as its new rules are adopted.
  • But, it won’t be possible for Americans to get remedies that are banned sent to them from abroad. The FDA will simply stop these remedies at the border.

I could tell you more, but what I’ve told you so far should convince you that we ought to help the American homeopathy community defeat these unreasonable and misinformed rules. The rules simply do not reflect the realities of homeopathic medicines, namely, that they are nontoxic, mild, effective and have few, if any, side-effects. And, homeopaths use them in ways that individualize treatment. That this is the best way to treat patients was discovered by Samuel Hahnemann 200 years ago.

The enemies of homeopathy are everywhere and they appear to be stepping up their attacks. That’s why the world homeopathy community must work together to stand up to them…

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I have reported about the FDA initiatives on homeopathy before. In 2015, they started it with a public hearing. Since then, the FDA also issued several warnings to manufacturers who were putting consumers at risk (see, for instance, here, here, and here).

What the FDA seem to be trying to do is nothing else but meeting their ethical, moral and legal responsibility vis a vis consumer safety. Homeopathy has had a free ride for far too long. It is high time that this sector joins the 21st century.

The above quote, with its bonanza of bogus claims and falsehoods, shows the urgency of this task. The defenders of homeopathy seem to live on a different planet where rationality, facts and evidence can easily be over-ruled by creed, dogma and wishful thinking. If homeopaths want their trade to join the realm of real medicine they need, at the very minimum, to show with sound evidence:

  1. that their remedies generate more good than harm,
  2. that they adhere to acceptable quality standards.

Failing this – and so far, homeopaths not only failed at this task but continue bombarding us with an incessant flow of bogus and dangerous claims – homeopathics cannot be considered to be medicines, and homeopaths cannot be called responsible healthcare professionals. It is high time to stop turning a blind eye to the double standards that have been applied for 200 years.

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