The sale and promotion of a therapeutic drug in most countries require rigorous assessment and licencing by that country’s therapeutic regulatory body. However, a new surgical technique can escape such checks and overview unless the technique is subject to local medical ethics review in the context of a research trial. New medical devices in Australia such as carbon dioxide or Er-YAG lasers can be listed on its therapeutic register without critical review of their efficacy and safety. Thermal injury to the postmenopausal vaginal wall in the hope of rejuvenating it has become a lucrative fad for some surgeons outside formal well-conducted clinical trials.
There are many published studies of this technique but the large majority are small, uncontrolled and observational. The few randomised controlled trials using sham controls show a placebo effect and debatable clinical efficacy with limited follow-up of adverse effects. A review of these therapies in July 2020 published by The National Institute for Health and Care Excellence summarised apparent claims for some efficacy in terms of vaginal dryness, dyspareunia, sexual function, and incontinence but noted confounding in the study’s designs such as concurrent breast cancer treatments, local oestrogen therapy and lubricants (!). Most studies had very limited follow up for adverse events but elsewhere the literature has reported burns, infection, increased dyspareunia and scarring. There is no physiological mechanism by which burning atrophic vaginal epithelium will magically rejuvenate it.
A recent well-conducted randomised sham-controlled trial with a 12-month follow-up of Fractional Carbon Dioxide Laser for the treatment of vaginal symptoms associated with menopause has been published in JAMA by Li et al has shown no efficacy for this treatment(2).
At 12 months, there was no difference in overall symptom severity based on a 0-100 scale (zero equals no symptoms), with a reduction in symptom severity of 17.2 in the treatment group compared with 26.6 in the sham group.
The treatment had no impact on quality of life. “Sexual activity rates and quality of sex were not significantly different between the groups at baseline or 12 months”. The study compared 46 paired vaginal wall biopsies, taken at baseline and six months into treatment, and no significant histological improvement with laser was evident.
“The annual cost of laser treatment to the individual for management of vaginal menopausal symptoms was reported to be AUD$2,733, and because there is no demonstrable difference versus sham treatment, it cannot be considered to be cost-effective.”
Although one could still call for more quality sham-controlled randomised trials in different circumstances there is no justification for touting this therapy commercially. Complications following this therapy outside of ethical trials could become the next medico-legal mine-field.
Vaginal atrophy in the years after menopause is almost universal and is primarily due to oestrogen deficiency. The efficient solution is local vaginal oestrogen or systemic hormone replacement therapy. However, the misreporting of the Women’s Health Initiative and Million Women’s Study has created exaggerated fear of oestrogen therapies and thus a market for alternative and often unproven therapies (3). The way forward is education and tailoring of hormonal therapies to minimise risk and maximise efficacy and quality of life and not to resort to quackery.
2. Li FG, Maheux-Lacroix S, Deans R et al. Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Symptom Severity in Women With Postmenopausal Vaginal Symptoms A Randomized Clinical Trial. JAMA. 2021;326:1381-1389.
3. MacLennan AH. Evidence-based review of therapies at the menopause. Int J Evid Based Healthc 2009; 7: 112-123.
The bad news for German homeopathy just keeps on coming. As I reported, recent events must be depressing for homeopaths, e.g.:
- A recent investigation disclosed that the German homeopathy cult is at the heart of Germany’s anti-vax movement.
- In July 2021, a German court ruled against a homeopathic HCG remedy.
- In 2020, a German study failed to show that homeopathy is cost-effective.
- In 2019, the attempt by a German homeopathy manufacturer to silence critics backfired spectacularly.
- About 10 years ago, 5 German firms clubbed together supporting a journalist at the tune of Euro 30 000/year to defame me (at the time I was one of the few who regularly informed the public about the evidence on homeopathy). The plot was discovered and published whereupon the journalist committed suicide.
After heated debates in the run-up, the Bavarian Medical Association decided yesterday to ditch the postgraduate education program in homeopathy for its doctors. This means that, of the 17 regional medical associations in Germany, 12 have now discontinued their further education efforts in homeopathy. The ones that have not yet done so are:
In the past months, homeopaths had collected 11,597 signatures in favor of maintaining the additional qualification of homeopathy. The ~ 400 doctors in Bavaria, who have acquired ‘homeopathy’ as an additional title, will be permitted to continue to use it.
The spokesperson of the Information Network Homeopathy, Dr. Christian Lübbers, welcomed the decision of the Medical Association. It was a “landslide victory for patient safety”, he said. The Bavarian regional chairman of the German Central Association of Homeopathic Doctors, Dr. Ulf Riker, regretted the outcome of the vote and added: “We will consider legal steps very seriously.” I would advise against such a step which would only render homeopaths more ridiculous than they already are.
Yes, it’s bad news for German homeopaths – very bad news indeed. Of course, homeopathy fans will claim that it is all a sinister conspiracy against them. Sadly, they are unable to realize that the only driving force behind the long-overdue decline of German homeopathy is the evidence: HOMEOPATHY DOES NOT WORK BEYOND PLACEBO and therefore it has no place in the evidence-based medicine of the 21st century.
One argument that we hear regularly in the comment sections of this blog and elsewhere goes something like this:
“Why worry about a bit of so-called alternative medicine (SCAM like homeopathy or chiropractic, or Reiki, or Bach flower remedies, or detox, etc.)? Why should it bother us? Why not let everyone use what they want? Why not be a bit more tolerant?”
Tolerance is defined as sympathy or indulgence for beliefs or practices differing from or conflicting with one’s own. It is, of course, a quality that normally should be welcomed, taught, and celebrated. So, why not be more tolerant with enthusiasts of pseudoscientific SCAM?
In my view, there are several reasons.
- Ineffective therapies harm patients. The public tends to believe that SCAM is inherently safe. This is, of course, not true – think of chiropractic, for instance. But some treatments seem entirely harmless. Homeopathy might be a good example; its remedies contain nothing and therefore homeopathy can do no harm. Sadly, this is not true either. If a patient uses homeopathy to treat a serious condition, she is likely to harm herself by not treating that condition effectively. In extreme cases, this course of action can be fatal.
- Ineffective therapies are a waste of resources. It seems obvious that the money spent on something that does not work is money wasted. This is true whether we buy a car that is beyond repair or a SCAM that does not work beyond placebo.
- Pseudoscience makes a mockery of evidence-based medicine. If we are tolerant towards useless SCAM and accept that some people make money on, and mislead the public about SCAM, we basically send out a message that evidence is of secondary importance. This would weaken the trust in evidence-based medicine which, in turn, is bound to render healthcare less effective and stand in the way of progress.
- Pseudoscience undermines rationality and one form of irrationality begets another. Perhaps the biggest danger of tolerating promoters of quackery is that this undermines rational thinking far beyond the realm of healthcare. “Those who can make you believe absurdities can make you commit atrocities,” wrote Voltaire. I fear that he might have been correct.
In my view, tolerance about pseudoscientific, implausible, ineffective, or harmful SCAMs is misplaced. On the contrary, I feel that it is our duty to limit the harm they do to the public, patients, and progress by exposing them for what they are.
A second look at old research suggested that the recommended dose for vitamin C is far too low. Here is the abstract of the recently published paper:
A double-blind controlled trial initiated in 1944 has led to the common narrative that a 10-mg daily vitamin C intake is adequate to prevent and treat impaired wound healing, and by inference, other collagen-related diseases such as heart disease or stroke. The WHO relies on this narrative to set the recommended nutrient intake for vitamin C. This narrative, however, is based on what is known as the eyeball method of data assessment. The 1944 trial published individual participant data on scar strength providing an opportunity to statistically probe the validity of the 10-mg narrative, something which has not yet been done. The findings show that a vitamin C intake that averages to 10 mg/d over a mean follow-up of 11.5 mo was associated with a 42% weakened scar strength when compared with 80 mg vitamin C intake/d (P < 0.001). The observed dose-response curve between scar strength and vitamin C intake suggests that the daily vitamin C intake needed to prevent collagen-related pathologies is in the range recommended by the National Academy of Medicine and the European Food Safety Authority (75 to 110 mg/d), not the WHO recommendation (45 mg/d). The findings also show that a vitamin C intake that averages to 65 mg/d over a mean follow-up of 6.5 mo failed to restore the normal wound-healing capacity of vitamin C-depleted tissues; such tissues had a 49% weaker scar strength when compared with nondepleted tissues (P < 0.05). Thus, average daily vitamin C intakes ∼50% higher than the WHO recommends may fail to treat existing collagen-related pathologies. It is concluded that the prior lack of statistical analyses of a landmark trial may have led to a misleading narrative on the vitamin C needs for the prevention and treatment of collagen-related pathologies.
The lead author of the recent re-analysis, Professor Philippe Hujoel from the Department of Epidemiology, School of Public Health, University of Washington, Seattle, said: “The vitamin C experiment is a shocking study. They depleted people’s vitamin C levels long-term and created life-threatening emergencies. It would never fly now. The findings of the re-analyses of the Sorby data suggest that the WHO’s recommendation is too low to prevent weak scar strength. Robust parametric analyses of the trial data reveal that an average daily vitamin C intake of 95mg is required to prevent weak scar strength for 97.5 percent of the population. Such a vitamin C intake is more than double the daily 45mg vitamin C intake recommended by the WHO but is consistent with the writing panels for the National Academy of Medicine and (other) countries.”
The original research of 1944 was headed by the British-German biologist and Nobel-prize winner Sir Hans Adolf Krebs. At the time, researchers conducted an experiment that controlled and monitored vitamin C consumption of just 20 volunteers. They were each given varying amounts of vitamin C, which helps the body to produce collagen – and given wounds to observe how quickly their scar tissue healed. The research aimed to ascertain how much vitamin C navy members living off rations is required in order to prevent them from developing scurvy, rather than how much is needed to boost health overall.
Prof Hujoel concluded that: “The failure to reevaluate the data of a landmark trial with novel statistical methods as they became available may have led to a misleading narrative on the vitamin C needs for the prevention and treatment of collagen-related pathologies.”
Research on glucosamine, one of the most popular dietary supplements, shows anti-inflammatory and anti-cancer benefits with minimal adverse effects. An international team of researchers aimed to explore the relationship between the use of glucosamine and the risk of lung cancer and lung cancer mortality based on data from the large-scale nationwide prospective UK Biobank cohort study.
Participants were enrolled between the years 2006 and 2010 and followed up to 2020. The Cox proportion hazards model was used to assess the relationship between glucosamine use and the risk of lung cancer and lung cancer mortality. Subgroup analyses and sensitivity analyses were performed to explore the potential effect modifications and the robustness of the main findings.
A total of 439,393 participants (mean age: 56 years; 53% females) with a mean follow-up of 11 years were included for analyses. There were 82,603 (18.80%) participants reporting regular use of glucosamine at baseline. During follow-up, there were 1,971 (0.45%) lung cancer events documented. Glucosamine use was significantly associated with a decreased risk of lung cancer (hazard ratio=0.84, 95% CI: 0.75-0.92, p<0.001) and lung cancer mortality (hazard ratio=0.88, 95% CI: 0.81-0.96, p=0.002) in fully adjusted models. A stronger association between glucosamine use and decreased lung cancer risk was observed in participants with a family history of lung cancer when compared to those without a family history.
The authors concluded that regular use of glucosamine was significantly related with decreased risk of lung cancer and lung cancer mortality, based on data from this nationwide prospective cohort study.
A previous analysis of the same data concluded that regular glucosamine supplementation was associated with lower mortality due to all causes, cancer, CVD, respiratory and digestive diseases. The new analysis shows a strong association with lung cancer.
This is certainly interesting, but does it prove a causal relationship?
The answer is no.
Correlation is not causation!
What would be helpful in testing whether we are dealing with a cause-effect relationship?
- We need data from other studies. Several other epidemiological investigations indicated that glucosamine use might play a role in the prevention of cancer.
- We require to know the strength of the association. The new analysis suggests that it is indeed strong.
- We need a mode of action. Might the anti-inflammatory action of glucosamine explain the effect?
- We should ask whether there is a dose-response relationship. As far as I know, this has not been addressed as yet.
- Ideally, we would require a randomized trial to test the hypothesis. But I fear that such a study might be too difficult to conduct and will thus not be forthcoming.
And what if glucosamine should one day be proven to reduce the cancer risk? Would it become the first ALTERNATIVE measure to prevent cancer?
It would automatically become a conventional method of cancer prevention. All the research into the subject has been entirely conventional and is unrelated to the alternative medicine movement. Or, to put it bluntly, alternative cancer prevention is a contradiction in terms. Either it works in which case it is conventional medicine, or it doesn’t in which case it is not even an alternative but at best so-called alternative medicine.
In their 2019 systematic review of spinal manipulative therapy (SMT) for chronic back pain, Rubinstein et al included 7 studies comparing the effect of SMT with sham SMT.
They defined SMT as any hands-on treatment of the spine, including both mobilization and manipulation. Mobilizations use low-grade velocity, small or large amplitude passive movement techniques within the patient’s range of motion and control. Manipulation uses a high-velocity impulse or thrust applied to a synovial joint over a short amplitude near or at the end of the passive or physiological range of motion. Even though there is overlap, it seems fair to say that mobilization is the domain of osteopaths, while manipulation is that of chiropractors.
The researchers found:
- low-quality evidence suggesting that SMT does not result in a statistically better effect than sham SMT at one month,
- very low-quality evidence suggesting that SMT does not result in a statistically better effect than sham SMT at six and 12 months.
- low-quality evidence suggesting that, in terms of function, SMT results in a moderate to strong statistically significant and clinically better effect than sham SMT at one month. Exclusion of an extreme outlier accounted for a large percentage of the statistical heterogeneity for this outcome at this time interval (SMD −0.27, 95% confidence interval −0.52 to −0.02; participants=698; studies=7; I2=39%), resulting in a small, clinically better effect in favor of SMT.
- very low-quality evidence suggesting that, in terms of function, SMT does not result in a statistically significant better effect than sham SMT at six and 12 months.
This means that SMT has effects that are very similar to placebo (the uncertain effects on function could be interpreted as the result of residual de-blinding due to a lack of an optimal placebo or sham intervention). In turn, this means that the effects patients experience are largely or completely due to a placebo response and that SMT has no or only a negligibly small specific effect on back pain. Considering the facts that SMT is by no means risk-free and that less risky treatments exist, the inescapable conclusion is that SMT cannot be recommended as a treatment of chronic back pain.
This systematic review assessed the effect of spinal manipulative therapy (SMT), the hallmark therapy of chiropractors, on pain and function for chronic low back pain (LBP) using individual participant data (IPD) meta-analyses.
Of the 42 RCTs fulfilling the inclusion criteria, the authors obtained IPD from 21 (n=4223). Most trials (s=12, n=2249) compared SMT to recommended interventions. The analyses showed moderate-quality evidence that SMT vs recommended interventions resulted in similar outcomes on
- pain (MD -3.0, 95%CI: -6.9 to 0.9, 10 trials, 1922 participants)
- and functional status at one month (SMD: -0.2, 95% CI -0.4 to 0.0, 10 trials, 1939 participants).
Effects at other follow-up measurements were similar. Results for other comparisons (SMT vs non-recommended interventions; SMT as adjuvant therapy; mobilization vs manipulation) showed similar findings. SMT vs sham SMT analysis was not performed, because data from only one study were available. Sensitivity analyses confirmed these findings.
The authors concluded that sufficient evidence suggest that SMT provides similar outcomes to recommended interventions, for pain relief and improvement of functional status. SMT would appear to be a good option for the treatment of chronic LBP.
In 2019, this team of authors published a conventional meta-analysis of almost the same data. At this stage, they concluded as follows: SMT produces similar effects to recommended therapies for chronic low back pain, whereas SMT seems to be better than non-recommended interventions for improvement in function in the short term. Clinicians should inform their patients of the potential risks of adverse events associated with SMT.
Why was the warning about risks dropped in the new paper?
I have no idea.
But the risks are crucial here. If we are told that SMT is as good or as bad as recommended therapies, such as exercise, responsible clinicians need to decide which treatment they should recommend to their patients. If effectiveness is equal, other criteria come into play:
Can any reasonable person seriously assume that SMT would do better than exercise when accounting for costs and risks?
I very much doubt it!
Weleda, the firm founded by Rudolf Steiner and Ita Wegman originally for producing and selling their anthroposophic remedies, celebrates its 100th anniversary. It is a truly auspicious occasion for which I feel compelled to offer a birthday present.
I hope they like it!
On the Weleda UK website, we find an article entitled ‘ An introduction to Homeopathy‘ which contains the following statements:
- Homeopathy works by stimulating the body’s own natural healing capacity. The remedy triggers the body’s own healing forces and so a remedy is prescribed on a very individual basis.
- If you do experience complex, persistent or worrying symptoms then please seek the advice of a doctor who specialises in homeopathy.
- Today there are four homeopathic hospitals offering treatment under the National Health Service – in London, Glasgow, Liverpool and Bristol.
- It’s still the only alternative medicine incorporated into the NHS.
- Homeopathy can be used to treat the same wide range of illness as conventional medicine, and may even prove successful when all other forms of treatment have failed.
- Over-the-counter homeopathic medicines are made using natural plant, mineral and, occasionally, animal substances
- … active elements are in infinitesimally small quantities.
As I understand a bit about the subject – not as much as my friend Dana Ullman, of course, but evidently more than the Weleda team – I thought I might offer them, as a birthday present, a free correction of these 7 passages. Here we go:
- Homeopathy is claimed to work by stimulating the body’s own natural healing capacity. In fact, it does not work. Yet, believers argue that the remedy triggers the body’s own healing forces and so a remedy is prescribed on a very individual basis.
- If you do experience complex, persistent or worrying symptoms then please seek the advice of a doctor who specializes in something other than homeopathy.
- Today there are no homeopathic hospitals offering treatment under the National Health Service – the ones in London, Glasgow, Liverpool, and Bristol all closed or changed their names.
- It’s no longer incorporated into the NHS.
- Homeopathy cannot be used to treat the same wide range of illnesses as conventional medicine and is not successful when all other forms of treatment have failed.
- Over-the-counter homeopathic medicines are made using any imaginable substance and even non-material stuff like vacuum or X-rays.
- … active elements are absent.
HAPPY BIRTHDAY, WELEDA!
Ever wondered what homeopathy truly is?
Who better to ask than Boiron?
Homeopathy is a therapeutic method that uses natural substances to relieve symptoms. It derives from the Greek words homeo, meaning “similar,” and pathos, meaning “suffering” (such as the pathology of a disease). Homeopathy operates on a “like cures like” principle that has been used empirically for more than 200 years and continues to be confirmed in pharmacological research and clinical studies.
What this means is a person suffering from symptoms can be treated by microdoses of a substance capable of producing similar symptoms in a healthy person. It is said that homeopathic medicines stimulate the body’s physiological reactions that restore health. This is accomplished with a very low risk of side effects due to the use of microdoses.
Homeopathy in Action
An example of how homeopathic medicines work is the similarity of symptoms between allergies and chopping onions. When you cut into an onion, your eyes will water and your nose runs. If similar symptoms appear after contact with pollen or a pet, the homeopathic medicine most appropriate to treat these symptoms is made from a tiny amount of onion. Instead of masking symptoms, the medicine sends the body a signal to help it rebalance and heal.
The Benefits of Homeopathy and You
A natural choice. The active ingredients in homeopathic medicines are made from diluted extracts of plants, animals, minerals, or other raw substances found in nature.
For everyday use. Similar to other over-the-counter (OTC) medicines, homeopathic medicines can be used to relieve symptoms of a wide range of common health conditions such as allergies, coughs, colds, flu, stress, arthritis pain, muscle pain, and teething.
Safe and reliable. Homeopathy has been used for more than 200 years, building a remarkable safety record and generating a great body of knowledge. Homeopathic medicines do not mask symptoms, are not contraindicated with pre-existing conditions, and are not known to interact with other medications or supplements, making them one of the safest choices for self-treatment.
Rigorous standards. Homeopathic medicines are manufactured according to the highest standards, complying with U.S. Food and Drug Administration regulations and the Homeopathic Pharmacopoeia of the United States (HPUS).
More choices and preferences. Homeopathic medicines are available in a variety of dosage forms such as gels, ointments, creams, syrups, eye drops, tablets, and suppositories.
Are you pleased with this explanation?
One must not be too harsh with Boiron and forgive them their errors; a powerful conflict of interest might have clouded their views. Therefore, I shall now take the liberty to edit and update their text ever so slightly.
Homeopathy is an obsolete method that used all sorts of substances in the misguided hope to relieve symptoms. The word derives from the Greek words homeo, meaning “similar,” and pathos, meaning “suffering” (such as the pathology of a disease). Homeopathy was alleged to operate on a “like cures like” principle that had been used empirically for more than 200 years but was refuted by pharmacological research, clinical studies and more.
What it suggested was that a person suffering from symptoms might be treated by the absence of a substance capable of producing similar symptoms in a healthy person. It was said that homeopathic medicines stimulate the body’s physiological reactions that restore health. These assumptions proved to be erroneous.
Homeopathy in Action
An example of how homeopathic medicines were supposed to work is the similarity of symptoms between allergies and chopping onions. When you cut into an onion, your eyes will water and your nose runs. If similar symptoms appear after contact with pollen or a pet, the homeopathic medicine most appropriate to treat these symptoms was assumed to be made with the memory of an onion. These ideas were never proven and had no basis in science.
The Alleged Benefits of Homeopathy
A natural choice. The active ingredients in homeopathic medicines were often made from diluted extracts of plants, animals, minerals, or other raw substances found in nature. The appeal to nature is, however, misleading: firstly the typical remedy did not contain anything; secondly, some remedies were made from synthetic substances (e. g. Berlin wall) or no substances (e. g. X-ray).
For everyday use. Similar to other over-the-counter (OTC) medicines, homeopathic medicines were promoted to relieve symptoms of a wide range of common health conditions such as allergies, coughs, colds, flu, stress, arthritis pain, muscle pain, and teething. These claims could never be verified and are therefore bogus.
Safe and reliable. Homeopathy had been used for more than 200 years. During all these years, no reliable safety record or body of knowledge had been forthcoming. Homeopathic medicines do not mask symptoms, are not contraindicated with pre-existing conditions, and are not known to interact with other medications or supplements. In fact, they have no effects whatsoever beyond placebo.
Rigorous standards. Homeopathic medicines were said to be manufactured according to the highest standards, complying with U.S. Food and Drug Administration regulations and the Homeopathic Pharmacopoeia of the United States (HPUS). This guaranteed that they were devoid of any active ingredient and made them pure placebos.
More choices and preferences. Homeopathic medicines were available in a variety of dosage forms such as gels, ointments, creams, syrups, eye drops, tablets, and suppositories. This means they offered a range of placebos to chose from.
In case, Boiron feels like adopting my updated, evidence-based version of their text, I am sure we can come to an agreement based on an adequate fee.
These days, I live in France (some of my time) and I am often baffled by the number of osteopaths and the high level of acceptance of osteopathy in this country. The public seems to believe everything osteopaths claim and even most doctors have long given up to object to the idiocies they proclaim.
The website of the Institute of Osteopathy in Renne is but one of many examples. The Institute informed us as follows (my translation):
In addition to back pain, the osteopath can act on functional disorders of the digestive, neurological, cardiovascular systems or conditions related to ear, nose and throat. Osteopaths can promote recovery in athletes, relieve migraines, musculoskeletal disorders such as tendonitis, or treat sleep disorders. Less known for its preventive aspect, osteopathy also helps maintain good health. It can be effective even when everything is going well because it will prevent the appearance of pain. Osteopathy is, in fact, a manual medicine that allows the rebalancing of the major systems of the body, whatever the age of the patient and his problems. The osteopath looks for the root cause of your complaint in order to develop a curative and preventive treatment.
Who are osteopathic consultations for?
Osteopathic consultations at the Institute of Osteopathy of Rennes-Bretagne are intended for the following types of patients and pathologies
BABY / CHILD
GERD (gastric reflux), plagiocephaly (cranial deformities), recurrent ENT disorders (sinusitis, ear infections…), digestive, sleep and behavioural disorders, motor delay, following a difficult birth…
Prevention, comfort treatment of osteoarthritis, musculoskeletal pain, functional abdominal pain, digestive disorders, headaches, dizziness, postural deficiency, facial pains…
Musculoskeletal pain (lumbago, back pain), digestive disorders, preparation for childbirth, post-partum check-up.
Prevention and treatment of MSDs (musculoskeletal disorders) linked to workstation ergonomics, stress, pain due to repetitive movements, poor posture at work, etc.
Scoliosis, prevention of certain pathologies linked to growth, fatigue, stress, follow-up of orthodontic treatment.
Musculoskeletal pain, tendonitis, osteopathic preparation for competition, osteopathic assessment according to the sport practised, repetitive injury.
In case you are not familiar with the evidence for osteopathy, let me tell you that as good as none of the many claims made in the above text is supported by anything that even resembles sound evidence.
So, how can we explain that, in France, osteopathy is allowed to thrive in a virtually evidence-free space?
In France, osteopathy started developing in the 1950s. In 2002, osteopathy received legislative recognition in France, and today, it is booming; between 2016 and 2018, 3589 osteopaths were trained in France. Osteopaths can be DO doctors, DO physiotherapists, DO nurses, DO midwives, DO chiropodists, or even DO dentists.
Thus, in 2018, and out of a total of 29,612 professionals practising osteopathy, there were 17,897 osteopaths DO and 11,715 DO health professionals. The number of professionals using the title of osteopath has roughly tripled in 8 years (11608 in 2010 for 29612 in 2018). There are currently around 30 osteopathic schools in France. About 3 out of 5 French people now consult osteopaths.
But this does not answer my question why, in France, osteopathy is allowed to thrive in a virtually evidence-free space! To be honest, I do not know its answer.
Perhaps someone else does?
If so, please enlighten me.