economic evaluation
In my view, it gets increasingly hard to ignore parallels between US anti-regulatory health movements and historical eugenics programs like the one enacted by the Nazis during the Third Reich. Evaluating the rhetoric of Robert F. Kennedy Jr. regarding disease, public health infrastructure, and chronic illness, an underlying philosophy emerges of prioritizing a return to idealized “natural health”, while dismantling the medical systems designed to protect the vulnerable. This, I would argue, echoes the tenets of “eugenics” as practiced by the Nazi regime.
To understand this comparison, we must examine the foundational ideology of Nazi eugenics. It was a concept wrapped in the language of public health and hygiene, biological purification, and economic efficiency. The Nazis aimed to eliminate what they deemed to be lebensunwertes Leben (life unworthy of life). German physicians at the time feared that medical science was keeping the weak alive at the expense of the strong, thereby subverting the natural laws of selection. The Nazis viewed chronic illness and disability to be a drain on the collective national body (Volksgesundheit). Their conclusion was that the elimination of the genetically inferior was a biological necessity.
A modern variant of this ideology manifests in rhetoric that views chronic illness not as a collective societal responsibility requiring robust medical intervention, but as a biological failure stemming from a corrupted modern infrastructure. Kennedy’s actions focus on dismantling federal health agencies and drastically alter the regulatory framework governing medicine. In public addresses, he has consistently attacks established medical consensus, stating that public health policies are “ruining our children’s health” and leading to an “epidemic of chronic disease.”
Further alignment with eugenicist thinking lies in the proposed solutions to this perceived crisis. Rather than strengthening protective medical care, the rhetoric frequently leans towards a form of biological determinism that views modern medical interventions, such as vaccines and standard pharmaceuticals, as inherently corrupting influences that prevent the human body from achieving its “natural” state. This brand of anti-science rhetoric effectively abandons the vulnerable, stating that the aggressive opposition to standard medical treatments threatens to reverse decades of progress in child survival and disproportionately harms those with compromised immune systems.
When politicians advocate dismantling public health protections in order to let ‘natural immunity’ or ‘cleansing’ of dependencies determine who survives and who does not survive, they risk endorsing a “survival-of-the-fittest” ideology that overlaps with social Darwinist and eugenic ways of thinking. By declaring chronic illness as something to be purged via the withdrawal of institutional medical support, the rhetoric subtly shifts from a message of health advocacy to one of biological exclusion.
Please don’t get me wrong! I do not for a moment seek to diminish the crimes and atrocities of Nazi eugenics; they remain a singular and unprecedented horror. My purpose, rather, is to highlight that any ideology which calls for the erosion of medical safeguards for the sick rests on a perilous philosophical kinship with the Nazi project of privileging the “healthy” over the “infirm.” By recognising these parallels, we may hope to remain vigilant and help forestall the repetition of such history.
Homeopaths tend to voice a standard set of arguments when confronted with irrefutable evidence against homeopathy. In the discussion sections of this blog, we heard them all:
- “The negative trials are flawed designed.” They claim these trials were done by ungifted therapists or used the wrong remedies, wrong potencies, wrong dosing schedules, etc. Therefore, they do not reflect true homeopathic practice.
- “Homeopathy is individualised, RCTs can’t capture it.” They argue that randomised clinical trials are inherently unsuitable because homeopathic treatment must be tailored to each patient, rendering RCTs “unfair” or even “unscientific.”
- “Only a fraction of the evidence has been considered.” They assert that critics cherry-pick negative evidence and ignore positive small trials, case series, or observational data that they regard as equally valid.
- “There is much positive evidence.” They point to older or methodologically weak positive studies and claim these outweigh or at least balance the otherwise negative body of evidence.
- “Meta-analyses and systematic reviews are biased and/or politically motivated.” They allege that negative evaluations are driven by ideological hostility to homeopathy, Big Pharma influence, or institutional bias.
- “Statistical significance is not the same as clinical reality.” They argue that statistics miss “real-world” benefits observed in practice and that evidence-based medicine is too narrow.
- “Evidence-based medicine overvalues RCTs and undervalues experience.” They insist that long clinical experience, case reports, patient testimonies, etc. should count as strong evidence and that their accumulated practice is itself proof of efficacy.
- “Patient demand and satisfaction are evidence.” They use high patient satisfaction, repeat consultations, and word-of-mouth popularity as a proxy for effectiveness.
- “Millions use it worldwide.” They argue that longstanding, global usage implies that it must work; otherwise it would have disappeared.
- “Conventional medicine is not perfect either.” They respond to criticism by highlighting harms, errors, and historical reversals in conventional medicine, implying that science-based critics lack moral authority.
- “If it were only placebo, it wouldn’t work on XY.” They claim efficacy in infants, animals, or unconscious patients as evidence that placebo cannot fully explain the effects.
- “Mechanisms aren’t fully known, but that doesn’t matter.” They liken homeopathy to earlier medical advances whose mechanisms were unknown at the time (e.g. aspirin), arguing that lack of a plausible mechanism is not a valid reason to reject positive clinical observations.
- “Physics and chemistry are incomplete; future science will explain it.” They invoke concepts like quantum physics, nanostructures, or complex systems to argue that current science is still too limited to explain homeopathy.
- “Regulatory / institutional conspiracies.” They suggest that powerful pharmaceutical or medical lobbies seek to suppress homeopathy to protect their financial interests.
- “Homeopathy is cheap and safe; risk–benefit favours it.” They argue that even if evidence is thin, the very low risk and low cost justify its use.
- “The therapeutic encounter itself is part of the effect.” They turn criticisms about placebo and context effects into a strength: the long consultation, empathy, and attention are claimed to be legitimate and central components of homeopathy.
- “Freedom of choice / patient autonomy.” They shift from scientific to ethical/political ground, insisting that patients should be free to choose homeopathy regardless of scientific consensus.
- “Skeptics misunderstand what homeopathy really is.” They claim that people conflate homeopathy with herbalism, confuse potencies, or misunderstand Hahnemann’s principles, so their critiques do not address true homeopathy.
- “Critics don’t see the individual ‘miracle’ cases.” They counter population-level data with vivid anecdotes of dramatic improvements which they regard as decisive.
- “Negative evidence is ‘absence of evidence’, not ‘evidence of absence’.” They argue that failed trials or negative reviews merely show that efficacy hasn’t been proved yet, not that homeopathy does not work.
- “Science evolves; today’s ‘overwhelming evidence’ may be overturned.” They claim that scientific consensus has been wrong before and that homeopathy will eventually be vindicated when paradigms shift.
In discussions with homeopaths, these points are repeated endlessly. One could easily get the impression of a broken record. All of the above arguments have in common that – even as some of then contain a kernel of truth – they are erroneous. In theory it could be easy to point this out to the stereotypical homeopathy promoter; in practice, however, it often is impossible, since the broken record continues turning senselessly.
A recent survey of the “Österreichische Gesellschaft für Marketing” (OMG), a Viennese opinion research and market research institute shows a notable shift in public attitudes towards homeopathy. In 2010, nearly one in five Austrians reported greater confidence in homeopathy than in evidence-based medicine. By 2026, that proportion had fallen to just one in ten (10%), indicating a substantial erosion of support over the past decade and a half. Interestingly, the percentage differed acconding to politics; for voters of the right-wing freedom party and the greens the percentages were notably higher (15 and 19% respectively).
Several factors likely contribute to this trend. One important driver is the increasingly critical stance adopted by mainstream media. Over recent years, reporting on homeopathy has become more evidence-focused, often highlighting the lack of plausible mechanisms and robust clinical efficacy beyond placebo. This shift in media tone may have played a significant role in reshaping public perceptions, particularly among more scientifically literate audiences.
Equally important is the growing distance between homeopathy and the scientific community. As medical research continues to emphasize rigorous methodology and reproducibility, homeopathy has struggled to meet these standards. The accumulation of negative or inconclusive findings in high-quality trials has further weakened its credibility within academic medicine.
Yet, the responsibility for declining trust does not rest solely with external critics. Instances of scientific misconduct within homeopathy research – such as studies later found to involve highly probable data manipulation and subsequently retracted – have likely contributed to skepticism. In particular, the now infamous study by the Vienna-based Michael Frass might have contributed to the decline. Such events undermine not only individual studies but also the broader integrity of the field.
Overall, the Austrian data suggest a gradual but meaningful realignment toward evidence-based medicine, driven by both external scrutiny and internal weaknesses within homeopathy itself. This surely must be good news. But, as a rational person, I still ask myself, how is it possible that 1 in 10 Austrians have greater confidence in homeopathy than in evidence-based medicine?
To me, this indicates that much more work is needed to inform the public responsibly about homeopathy and other bogus alternative treatments.
A contentious debate has just erupted in Germany over the government’s plan to remove homeopathy and anthroposophic medicine from coverage under statutory health insurance (GKV). Former prominent politicians, including Green Party leader Winfried Kretschmann (former Minister President of Baden-Württemberg) and SPD leader Malu Dreyer (former Minister President of Rhineland-Palatinate), signed an “open letter” opposing the removal, arguing it would harm patients and violate ethical principles.
The open letter, launched by the German Central Association of Homeopathic Doctors (DZVhÄ) on June 17, 2026, claims that removing these therapies would be “an expensive wrong decision at the expense of patients.” It cites studies suggesting homeopathy is effective beyond the placebo effect and argues that the majority of German citizens value and benefit from these treatments. Signatories include former Federal Interior Minister Otto Schily (SPD), Greens co-founder Lukas Beckman, actress Sarah Wiener, Alo natura founder Götz Rehn, and “Tatort” actors Hans-Jochen Wagner and Felix Klare, along with former BMG state secretaries Marion Caspers-Merk and Edgar Franke.
The German Ministry of Health (BMG) defends the planned removal as part of the “GKV Contribution Rate Stabilization Act,” which aims to save €20–50 million annually. The ministry correctly states there is “insufficient scientific evidence for effectiveness” and that no evidence exists to justify cost coverage for these therapies. Under the new law, statutorily insured patients would need to pay for homeopathy and anthroposophic medicine themselves or obtain private insurance.
The Bundestag’s final reading of the law was delayed from June 26 to July 10, 2026, giving lawmakers more time to review the open letter before the parliamentary summer recess. This delay reflects the political sensitivity of the issue.
Opposition to the open letter comes from major healthcare organizations. The GKV-Spitzenverband (health insurance federation) supports removing services without scientific evidence, the Kassenärztliche Bundesvereinigung (doctors’ association) welcomes returning to “proven treatment methods.” and IQWIG, the health economics institute, confirms that homeopathy and anthroposophy lack evidence for GKV coverage.
This controversy is unusual because Kretschmann (Greens) and Dreyer (SPD) have in the past been aligned with evidence-based medicine and scientific attitude towards so-called alternative medicine (SCAM).
Allow me to congratulate the signatories for producing what possibly is the finest piece of health-related BS of 2026!
The effect of calcium, vitamin D, or combined supplementation on fractures and falls in adults were assessed in this systematic review and meta-analysis. Randomised clinical trials were eligible, if they compared calcium, vitamin D, or combined supplementation with placebo or no treatment in adults (≥18 years) not receiving drug treatment for osteoporosis. The primary outcome was the risk of any fracture. Secondary outcomes included the risk of hip fracture, non-vertebral fracture, vertebral fracture, and falling, as well as the total number of falls. Pairs of reviewers independently screened trials, extracted data, and assessed risk of bias using the second version of Cochrane’s risk of bias tool. Findings were synthesised using random effects meta-analyses and appraised using Grading of Recommendations Assessment, Development and Evaluation, with application of thresholds for absolute effects considered important.
The review included 69 trials involving 153 902 participants. Participants in most of the trials were community dwelling (87%) and not at high risk of fractures or falls (73%). For the primary outcome of any fracture, little to no effect was found from use of calcium supplements (11 trials, 9067 participants; risk ratio 0.91, 95% confidence interval 0.81 to 1.01; moderate certainty), vitamin D supplements (36 trials, 92 045 participants; 1.00, 0.95 to 1.06; high certainty), or combined supplementation (15 trials, 51 126 participants; 0.91, 0.84 to 0.99; high certainty). Calcium, vitamin D, or combined supplementation appeared to have little to no effect on other fracture and fall outcomes, based largely on moderate to high certainty of evidence. The findings remained robust after an extensive exploration of heterogeneity across multiple subgroup analyses. Evidence for high risk patients or those requiring residential care was limited for many outcomes for calcium monotherapy and for combined supplementation.
The authors concluded that, based on absolute risk reductions and thresholds considered clinically meaningful, this review found little to no benefits from use of calcium, vitamin D, or combined supplementation on the prevention of fractures and falls.
An accompanying BMJ editorial points out that observational studies have associated low dietary calcium and low serum levels of vitamin D with low bone density and falls. Consequently, calcium, vitamin D, or combined supplementation has been widely promoted for preventive musculoskeletal health in older adults…
Th editorial concludes that other interventions, such as balance and resistance exercise, and several multicomponent interventions (eg, combining exercise, hazard assessment, or education with other interventions tailored to risk assessment) have been shown to offer meaningful prevention of falls and falls related injuries.
This new systematic review is a prime example for the slaying of a beautiful hypothesis with an ugly fact. But all is not negative – think of the money that can now be saved and put to better use!
Guest post by Udo Endruscheit
Two years ago, in a guest post on this blog, I described the long and winding history of homeopathy in Switzerland — a story marked by political expectations, institutional entanglements, and repeated attempts to reconcile a lack of evidence with a desire for legitimacy. I ended that article with the hope that the country would not embark on yet another “honour lap” around the same unresolved questions.
In 2024, however, Switzerland initiated a new evaluation of homeopathy — a renewed attempt to clarify its role within the national health insurance system. It was, in many ways, the beginning of yet another loop in the same story.
Now, in 2026, that loop has come to an unexpected end. The evaluation was halted.
Not postponed, not softened, not watered down — simply stopped.
And this stop is not merely a political gesture. It marks the structural endpoint of a system that has exhausted its internal possibilities.
A system designed to avoid the evidence question
To understand why Switzerland has arrived at this point, one must look beyond the political headlines and examine the institutional landscape that has shaped the country’s approach to homeopathy for more than a decade.
Three elements are central:
- The political mandate created by the 2009 referendum, which placed homeopathy and other CAM modalities into the basic health insurance package.
- The professional environment, in which thousands of Swiss physicians hold CAM qualifications and the national medical association (FMH) views integrative medicine positively.
- The academic anchor, the Institute for Complementary and Integrative Medicine (IKIM) at the University of Bern, which provides an appearance of scientific legitimacy without producing evidence capable of resolving the core question of efficacy.
This combination created a system in which homeopathy became institutionally normalised — not because of evidence, but because of political and professional expectations.
The HTA as a detour — and the beginning of the dead end
When the Federal Office of Public Health (BAG) was tasked with evaluating homeopathy after the referendum, it faced an impossible dilemma:
- The clinical evidence was weak to non‑existent.
- The political expectation was strong.
- A direct assessment of the evidence would have produced a negative result.
The solution was a detour: a Health Technology Assessment (HTA). But HTAs are not designed to determine efficacy. They assume efficacy has already been established through robust clinical research. Their purpose is to assess cost‑effectiveness, safety, and system impact.
The Swiss HTA did the opposite. In its conclusion, it stated:
“The effectiveness of homeopathy can be considered as proven when internal and external validity criteria are taken into account.”
This is a remarkable inversion of the HTA principle. The report asserted efficacy — without the evidence required to do so — while simultaneously admitting that the actual HTA questions (such as cost‑effectiveness) could not be answered reliably.
In retrospect, this HTA was not the beginning of a solution. It was the beginning of a dead end. A system that asserts efficacy without evidence cannot move forward. It can only circle around itself.
The IKIM: an academic structure without academic function
The IKIM at the University of Bern has played a central role in stabilising this circular logic. Its research output is broad in appearance but narrow in substance. It avoids the central question of efficacy and instead focuses on:
- sociological aspects,
- patient satisfaction,
- model validity,
- and experimental approaches that are not independently reproducible.
The IKIM does not produce evidence. It produces normality — the impression that homeopathy is a legitimate academic field simply because it is housed within a university.
This normality has been crucial for maintaining the political and professional acceptance of homeopathy in Switzerland. But it has also contributed to the structural dead end: an academic institution that cannot resolve the evidence question because it is not designed to ask it.
The 2026 decision: not a surprise, but a consequence
Against this background, the 2026 decision to halt the renewed evaluation of homeopathy is not really surprising. It is the logical endpoint of a system that has exhausted its internal possibilities.
- The evidence has not improved.
- The HTA detour has failed to provide a foundation.
- The institutional structures have stabilised expectations but not knowledge.
- The political mandate cannot be fulfilled without contradicting scientific standards.
The result is a dead end. Not because anyone wanted it, but because the system was built in such a way that no other outcome was possible.
A lesson beyond Switzerland
The Swiss case is often cited by proponents of homeopathy as a model of political and professional acceptance. But the 2026 decision reveals a different lesson:
A system that tries to reconcile political expectations with a lack of evidence will eventually reach a point where it can neither move forward nor turn back.
Switzerland has reached that point. The “endless story” of homeopathy in the Swiss health system has not been resolved — but it has reached its structural conclusion.
And unfortunately that conclusion is not a triumph of evidence. It is the recognition that evidence cannot be replaced by institutional normality. But one thing it certainly isn’t: an endorsement of homeopathy, even if its advocates will once again try to interpret it that way.
The Spanish Agency for Medicines and Medical Products (AEMPS) has just published a comprehensive technical report entitled “Homeopathy and Homeopathic Products: Evaluation of Evidence on Their Efficacy and Safety”, which categorically concludes that there is no scientific evidence supporting the efficacy of homeopathy as a therapeutic tool. After a systematic review of scientific literature and evaluations by state agencies internationally, the report states that the observed effects are comparable to placebo.
The report, which analyzed 64 systematic reviews published since 2009, highlights that most studies suggesting benefits from homeopathy have low methodological quality, often invalidated by small samples, short follow-up periods, or biases in randomization. Furthermore, it notes that as the quality and rigor of clinical trials increase, the supposed effect of homeopathy diminishes until it disappears entirely.
From a scientific standpoint, the principles of homeopathy clash with the laws of physics and current pharmacology. In typical dilutions like 12 CH—where one part of the original substance is mixed with 100 parts of solvent twelve times consecutively—it is mathematically impossible for a single molecule of the original ingredient to remain in the preparation, breaking any cause-and-effect relationship between the product and the therapeutic effect.
To illustrate this disproportion, the report points out that a dilution of just 6 CH (far less extreme than 12 CH) equates to dissolving a packet of sugar in the entire Mediterranean Sea. For this reason, the AEMPS classifies theories like “water memory”—the belief that the liquid retains the properties of a substance even without its molecules—as empirically baseless postulates that challenge scientific and rational thinking.
In compliance with European and national regulations, the AEMPS has completed a regularization process that has resulted in the market withdrawal of numerous products. As of the report’s publication date, no homeopathic product with authorized therapeutic indications exists in Spain. The 976 that remain registered did so via a simplified procedure, based on extreme dilutions ensuring the preparation’s innocuousness, which does not require proof of therapeutic effect and legally prohibits any therapeutic claims on labeling.
Spain aligns with a global trend of health institutions adopting critical stances:
- United Kingdom: The Science and Technology Committee recommended halting public funding and requiring labeling warnings about lack of efficacy.
- Australia: The National Health and Medical Research Council concluded that homeopathy should not be used for chronic or serious diseases.
- France: The Haute Autorité de Santé eliminated public reimbursement for these products in 2021 due to lack of demonstrated efficacy.
- Germany: Approval is expected in 2026 for the definitive removal of homeopathy coverage from statutory health insurance.
- United States: The Food and Drug Administration (FDA) considers these products “unapproved new drugs,” and the Federal Trade Commission requires warnings that there is no scientific evidence of their functioning.
Although there is a popular belief that these preparations are innocuous because they are “natural,” serious adverse reactions have been reported, including poisonings from poor dosing and infant deaths linked to teething products in other countries.
However, the AEMPS warns that the main associated risk is the abandonment or delay of proven effective medical treatments. Citizens opting for homeopathy to treat serious or chronic conditions may endanger their health by replacing evidence-based therapies with products lacking such evidence.
The AEMPS report reaffirms the Ministry’s commitment to public health protection and evidence-based medicine. In line with other international agencies, it emphasizes the need for transparent information so citizens can make safe health decisions. The conclusion of the report is firm:
Given the lack of evidence of efficacy, homeopathy cannot be considered a valid therapeutic alternative, and its use must not lead to delaying or abandoning treatments proven to be effective.
The story of how my new book came to get published is long and tedious – too long and tedious to be told here in full. Let me therefore try to give you just a very brief summary:
- The ‘Apotheken Umschau‘ is a journal with a circulation of 6m in Germany.
- As it has a history of being very much pro-SCAM (so-called alternative medicine), I was surprised to be invited some 5 years ago to write a critical article about the subject.
- I was even more surprised to be invited weeks later to write a book along similar lines.
- I submitted a full book proposal and suggested the title WER RECHT HAT HEILT which is a play on words; the German dogma for SCAM practitioners is WER HEILT HAT RECHT [He who heals is right] which I turned around into He who is right heals. In English, this does not work very well but in German it is – I hope – quite funny.
- The proposal was swiftly accepted and I got cracking.
- When I had almost finished writing the book, I was informed that my suggested title was disallowed by the publisher’s lawyers.
- The publisher then changed the title and, as I had written the text around the agreed title, I had to rewrite much of the text.
- I nevertheless managed to meet the contractual deadline and submitted my manuscript on time.
- After a few months the first proofs arrived, and, to my surprise, the publisher had altered several crucial sections of my text. These alterations made my text less critical about SCAM.
- We then exchanged many emails and had several video conferences. Altogether I must have exchanged some 200 emails with this publisher of which about a third remained unanswered (my estimate).
- Eventually, we agreed that the publisher had the right to correct my (often rusty) German but not the content or gist of the book.
- It followed a long period of finalizing the wording of the text, the subtitles and of proofreading.
- When this was finished, I was told that the book’s publication was imminent. That was around 3 years ago.
- Looking on Amazon one day, I was struck to see my book advertised under yet another title. It had not been agreed with me. In fact, I had not even been informed about it (and hated it).
- I asked the publisher what was going on and was not given a satisfactory answer.
- Now followed a long period of silence where nothing at all happened, despite me sending increasingly angry emails from time to time.
- Then, suddenly, it was all ‘go’ again and work on the book restarted afresh.
- One day, I was told that now even my original title, ‘WER RECHT HAT HEILT’ was acceptable.
- I thus revised large sections of the book a third time.
- Now, things seemed to advance smoothly, and my book started to be advertised on numerous websites with the title page depicting ‘WER RECHT HAT HEILT’.
- But now, another surprise awaited me: I was informed that my book would need to be ‘peer-reviewed’ by two ‘experts’. I have published plenty of books and never had encountered peer-review apart from that on the initial book proposal.
- Eventually, I received the reviewers comments which were both worryingly incompetent and intensely annoying.
- I nevertheless addressed them all, if only by explaining why the reviewer was, in my view, mistaken.
- When this process was over, I was informed that the last touches were now being made on the graphics and that publication was imminent.
- However, nothing happened and my many emails asking for an explanations did not result in satisfactory explanations.
- Finally, at the end of 2024, I was informed that my book would not be published. The alleged reason was that I had not adequately responded to the comments of the reviewers.
- In my view, the whole painfully long process was marked by a level of unprofessionalism on the side of the publisher that, in my extensive experience as an author, I had never encountered before.
- Luckily, the copyright was returned to me.
- Now I was free to contact another publisher, the ALIBRI VERLAG, and they accepted to publish my book.
- I then revised and updated my text yet again and, within just 4 months, my book finally saw the light of day.
In retrospect, I quite understand that publishers who are into promoting SCAM and heavily rely on advertising cannot afford to publish a book criticising SCAM. This would, of course, be bad for business! What I don’t get, however, is
why ask me and accept my book outline in the first place?
PS
As the book is in German, I will soon post a translation of a short section that explains what it is all about.
I recently asked ‘GOOGLE GEMINI’ about my problems with King Charles. The reply was concise, to the point and roughly correct:
Edzard Ernst’s “problem” with King Charles (then Prince Charles) stemmed from a fundamental disagreement over the promotion and integration of complementary and alternative medicine (CAM) within mainstream healthcare, particularly the National Health Service (NHS) in the UK.
Here’s a breakdown of the key issues:
- King Charles’s Advocacy for CAM: King Charles has been a long-time, vocal proponent of various alternative therapies, including homeopathy, and has actively lobbied for their greater inclusion in the NHS. He established and supported organizations like The Prince’s Foundation for Integrated Health to promote these views.
- Ernst’s Evidence-Based Approach: Edzard Ernst, as the world’s first professor of complementary medicine, took a strictly evidence-based approach. His research consistently aimed to evaluate the efficacy and safety of CAM treatments through rigorous scientific methods (like systematic reviews and meta-analyses). He concluded that the vast majority of alternative therapies lacked scientific evidence of effectiveness beyond a placebo, and some were even potentially harmful.
- Clash over the Smallwood Report (2005): A major point of contention was a report commissioned by Prince Charles in 2005, written by economist Christopher Smallwood, which claimed CAM was cost-effective and should be available on the NHS. Ernst was initially involved in this report but withdrew his name and publicly denounced it as “complete misleading rubbish,” stating that the conclusions were written before the evidence was properly reviewed. He argued the report failed to address whether CAM treatments were actually effective.
- Lobbying and “Black Spider Letters”: Ernst criticized King Charles for “relentlessly meddling” in UK health politics and for using his influence to push for unproven treatments. This included Charles’s infamous “black spider letters” (so-called due to his distinctive handwriting) to government officials, lobbying for the inclusion of alternative therapies, such as homeopathy, in the NHS.
- “Duchy Originals” Products: Ernst also criticized products sold by Duchy Originals (a company founded by Prince Charles) that made unproven health claims, such as “Detox Tincture,” calling them “outright quackery” and “financially exploiting the vulnerable.”
- Impact on Ernst’s Career: The dispute had personal repercussions for Ernst. Prince Charles’s private secretary, Sir Michael Peat, filed a complaint with Exeter University, alleging that Ernst had breached confidentiality regarding the Smallwood report. Although Ernst was eventually “cleared of wrongdoing,” he stated that the ensuing 13-month university investigation was “very unpleasant” and led to the cessation of funding for his research unit, ultimately contributing to his early retirement. He felt that the university, despite clearing him, treated him as “persona non grata.”
In essence, the “problem” was a clash between the King’s personal conviction and advocacy for alternative medicine, and Ernst’s unwavering commitment to scientific rigor and evidence-based healthcare. Ernst believed that the King’s promotion of unproven therapies was irresponsible, potentially harmful to public health, and undermined scientific progress in medicine.
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In case you want to learn the full details about “the King’s personal conviction and advocacy for alternative medicine”, please read the book below.
Common Harms of CSM
- Musculoskeletal discomfort: Temporary soreness, stiffness, or pain in the muscles or joints after treatment.
- Headaches: Some individuals may experience headaches following spinal manipulation.
- Fatigue: Feeling tired or experiencing fatigue after treatment.
These harms occur after CSM in about 50% of all patients. They impact on their quality of life and usually last 1-3 days.
Serious Harms of CSM
- Vertebral artery dissection (VAD) and stroke: A tear in the vertebral artery can lead to stroke; the harm can be permanent.
- Death: A stroke can be fatal.
- Atlantoaxial dislocation
- Spinal cord injury: Damage to the spinal cord, potentially resulting in numbness, weakness, or paralysis.
- Herniated discs: Manipulation can exacerbate existing disc issues or cause a new disc herniation.
- Fractures: Osteoporotic patients or those with bone conditions are at risk of vertebral fractures.
- Cauda equina syndrome: Compression of nerves in the lower spine, potentially causing bowel or bladder dysfunction.
- Nerve damage: Injury to spinal nerves, leading to numbness, tingling, or weakness.
- Eye Injuries: these include central retinal artery occlusion, nystagmus, Wallenberg syndrome, ptosis, loss of vision, ophthalmoplegia, dipiopia and Horner’s syndrome.
The frequency of these harms is not known.
Other Risks
- Neglect: This happens whenever a chiropractor treats a condition that can more effectively be treated with another therapy.
- Misleading advice: This occurs whenever a chiropractor gives advice outside his area of competence, for instance, a recommendation against immunisations.
- False diagnoses: Chiropractors often diagnose a ‘vertebral subluxation’, a condition that exists only in their fantasy.
- Worsening of existing conditions: Manipulation may exacerbate underlying spinal problems or conditions like spinal instability.
- Waste of money: This occurs each time a patient pays for ineffective CSM.
The frequency of these risks is not well-documented but can be estimated to be very high.
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I have often pointed out that the value of a therapy is not solely determined by its potential for harm. It depends crucially on the risk/benefit profile. The benefits of CSM are few and mostly uncertain. Thus the question arises:
DO THE BENEFITS OF CSM OUTWEIGH ITS RISKS?
I let you, the reader, answer this question.
PS
References for the above statements can be found in my book.
