The investigators wanted to find out what patient characteristics are associated with use of SCAM for cancer and what is the association of SCAM with treatment adherence and survival. They thus compared the overall survival between patients with cancer receiving conventional treatments with or without SCAM and the adherence to treatment and characteristics of patients in both groups.
Their retrospective observational study used data from the National Cancer Database on 1 901 815 patients from 1500 Commission on Cancer–accredited centers across the United States who were diagnosed with nonmetastatic breast, prostate, lung, or colorectal cancer between January 1, 2004, and December 31, 2013. Patients were matched on age, clinical group stage, Charlson-Deyo comorbidity score, insurance type, race/ethnicity, year of diagnosis, and cancer type. Overall survival, adherence to treatment, and patient characteristics were the study endpoints.
The cohort comprised 1 901 815 patients with cancer (258 patients in the SCAM group and 1 901 557 patients in the control group). In the main analyses following matching, 258 patients were in the SCAM group, and 1032 patients were in the control group. Patients who chose SCAM did not have a longer delay to initiation of conventional therapies, but had higher refusal rates of surgery, radiotherapy, and hormone therapy. Use of SCAM was associated with poorer 5-year overall survival compared with no SCAM (82.2% [95% CI, 76.0%-87.0%] vs 86.6% [95% CI, 84.0%-88.9%]; P = .001) and was independently associated with greater risk of death (hazard ratio, 2.08; 95% CI, 1.50-2.90) in a multivariate model that did not include treatment delay or refusal. However, there was no significant association between SCAM and survival once treatment delay or refusal was included in the model.
The authors concluded that patients who received CM were more likely to refuse additional CCT, and had a higher risk of death. The results suggest that mortality risk associated with CM was mediated by the refusal of CCT.
This new evidence confirms previous papers: SCAM-use is associated with shorter survival of cancer patients. As it is based on a large sample size, its results are more compelling. They indicate that it is not SCAM per se, but the attitude of SCAM-users to conventional therapies that is the cause of the effect. As I have said and written hundreds of times: the most serious risk of SCAM is not a direct but an indirect one: the risk of neglecting effective therapies. Essentially, this means that better information targeted at vulnerable patients must be the way forward (one of the main ambitions of this blog, I hasten to add).
On this blog, we constantly discuss the shortcomings of clinical trials of (and other research into) alternative medicine. Yet, there can be no question that research into conventional medicine is often unreliable as well.
What might be the main reasons for this lamentable fact?
A recent BMJ article discussed 5 prominent reasons:
Firstly, much research fails to address questions that matter. For example, new drugs are tested against placebo rather than against usual treatments. Or the question may already have been answered, but the researchers haven’t undertaken a systematic review that would have told them the research was not needed. Or the research may use outcomes, perhaps surrogate measures, that are not useful.
Secondly, the methods of the studies may be inadequate. Many studies are too small, and more than half fail to deal adequately with bias. Studies are not replicated, and when people have tried to replicate studies they find that most do not have reproducible results.
Thirdly, research is not efficiently regulated and managed. Quality assurance systems fail to pick up the flaws in the research proposals. Or the bureaucracy involved in having research funded and approved may encourage researchers to conduct studies that are too small or too short term.
Fourthly, the research that is completed is not made fully accessible. Half of studies are never published at all, and there is a bias in what is published, meaning that treatments may seem to be more effective and safer than they actually are. Then not all outcome measures are reported, again with a bias towards those are positive.
Fifthly, published reports of research are often biased and unusable. In trials about a third of interventions are inadequately described meaning they cannot be implemented. Half of study outcomes are not reported.
END OF QUOTE
Apparently, these 5 issues are the reason why 85% of biomedical research is being wasted.
That is in CONVENTIONAL medicine, of course.
What about alternative medicine?
There is no question in my mind that the percentage figure must be even higher here. But do the same reasons apply? Let’s go through them again:
- Much research fails to address questions that matter. That is certainly true for alternative medicine – just think of the plethora of utterly useless surveys that are being published.
- The methods of the studies may be inadequate. Also true, as we have seen hundreds of time on this blog. Some of the most prevalent flaws include in my experience small sample sizes, lack of adequate controls (e.g. A+B vs B design) and misleading conclusions.
- Research is not efficiently regulated and managed. True, but probably not a specific feature of alternative medicine research.
- Research that is completed is not made fully accessible. most likely true but, due to lack of information and transparency, impossible to judge.
- Published reports of research are often biased and unusable. This is unquestionably a prominent feature of alternative medicine research.
All of this seems to indicate that the problems are very similar – similar but much more profound in the realm of alternative medicine, I’d say based on many years of experience (yes, what follows is opinion and not evidence because the latter is hardly available).
The thing is that, like almost any other job, research needs knowledge, skills, training, experience, integrity and impartiality to do it properly. It simply cannot be done well without such qualities. In alternative medicine, we do not have many individuals who have all or even most of these qualities. Instead, we have people who often are evangelic believers in alternative medicine, want to further their field by doing some research and therefore acquire a thin veneer of scientific expertise.
In my 25 years of experience in this area, I have not often seen researchers who knew that research is for testing hypotheses and not for trying to prove one’s hunches to be correct. In my own team, those who were the most enthusiastic about a particular therapy (and were thus seen as experts in its clinical application), were often the lousiest researchers who had the most difficulties coping with the scientific approach.
For me, this continues to be THE problem in alternative medicine research. The investigators – and some of them are now sufficiently skilled to bluff us to believe they are serious scientists – essentially start on the wrong foot. Because they never were properly trained and educated, they fail to appreciate how research proceeds. They hardly know how to properly establish a hypothesis, and – most crucially – they don’t know that, once that is done, you ought to conduct investigation after investigation to show that your hypothesis is incorrect. Only once all reasonable attempts to disprove it have failed, can your hypothesis be considered correct. These multiple attempts of disproving go entirely against the grain of an enthusiast who has plenty of emotional baggage and therefore cannot bring him/herself to honestly attempt to disprove his/her beloved hypothesis.
The plainly visible result of this situation is the fact that we have dozens of alternative medicine researchers who never publish a negative finding related to their pet therapy (some of them were admitted to what I call my HALL OF FAME on this blog, in case you want to verify this statement). And the lamentable consequence of all this is the fast-growing mountain of dangerously misleading (but often seemingly robust) articles about alternative treatments polluting Medline and other databases.
Why do most alternative practitioners show such dogged determination not to change their view of the efficacy of their therapy, even if good evidence shows that it is a placebo? This is the question that I have been pondering for some time. I have seen many doctors change their mind about this or that treatment in the light of new evidence. In fact, I have not seen one who has not done so at some stage. Yet I have never seen an alternative therapist change his/her mind about his/her alternative therapy. Why is that?
You might say that the answers are obvious:
- because they have heavily invested in their therapy, both emotionally and financially;
- because their therapy has ‘stood the test of time’;
- because they believe what they were taught;
- because they are deluded, not very bright, etc.;
- because they need to earn a living.
All of these reasons may apply. But do they really tell the whole story? While contemplating about this question, I thought of something that had previously not been entirely clear to me: they simply KNOW that the evidence MUST be wrong.
Let me try to explain.
Consider an acupuncturist (I could have chosen almost any other type of alternative practitioner) who has many years of experience. He has grown to be a well-respected expert in the world of acupuncture. He sits on various committees and has advised important institutions. He knows the literature and has treated thousands of patients.
This experience has taught him one thing for sure: his patients do benefit from his treatment. He has seen it happening too many times; it cannot be a coincidence. Acupuncture works, no question about it.
And this is also what the studies tell him. Even the most sceptical scientist cannot deny the fact that patients do get better after acupuncture. So, what is the problem?
The problem is that sceptics say that this is due to a placebo effect, and many studies seem to confirm this to be true. Yet, our acupuncturist completely dismisses the placebo explanation.
- Because he has heavily invested in their therapy? Perhaps.
- Because acupuncture has ‘stood the test of time’? Perhaps.
- Because he believes what he has been taught? Perhaps.
- Because he is deluded, not very bright, etc.? Perhaps.
- Because he needs to earn a living? Perhaps.
But there is something else.
He has only ever treated his patients with acupuncture. He has therefore no experience of real medicine, or other therapeutic options. He has no perspective. Therefore, he does not know that patients often get better, even if they receive an ineffective treatment, even if they receive no treatment, and even if they receive a harmful treatment. Every improvement he notes in his patients, he relates to his acupuncture. Our acupuncturist never had the opportunity to learn to doubt cause and effect in his clinical routine. He never had to question the benefits of acupuncture. He never had to select from a pool of therapies the optimal one, because he only ever used acupuncture.
It is this lack of experience that never led him to think critically about acupuncture. He is in a similar situation as physicians were 200 years ago; they only (mainly) had blood-letting, and because some patients improved with it, they had no reason to doubt it. He only ever saw his successes (not that all his patients improved, but those who did not, did not return). He simply KNOWS that acupuncture works, because his own, very limited experience never forced him to consider anything else. And because he KNOWS, the evidence that does not agree with his knowledge MUST be wrong.
I am of course exaggerating and simplifying in order to make a point. And please don’t get me wrong.
I am not saying that doctors cannot be stubborn. And I am not saying that all alternative practitioners have such limited experience and are unable to change their mind in the light of new evidence. However, I am trying to say that many alternative practitioners have a limited perspective and therefore find it impossible to be critical about their own practice.
If I am right, there would be an easy (and entirely alternative) cure to remedy this situation. We should sent our acupuncturist to a homeopath (or any other alternative practitioner whose practice he assumes to be entirely bogus) and ask him to watch what kind of therapeutic success the homeopath is generating. The acupuncturist would soon see that it is very similar to his own. He would then have the choice to agree that highly diluted homeopathic remedies are effective in curing illness, or that the homeopath relies on the same phenomenon as his own practice: placebo.
Sadly, this is not going to happen, is it?
One of the aims in running this blog has always been to stimulate critical thinking (not just in my readers but also in myself).
Critical thinking means making decisions and judgements based on (often confusing) evidence. According to the ‘National Council for Excellence in Critical Thinking’ it is the intellectually disciplined process of actively and skilfully conceptualizing, applying, analysing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action.
Carl Sagan explained it best: “It seems to me what is called for is an exquisite balance between two conflicting needs: the most skeptical scrutiny of all hypotheses that are served up to us and at the same time a great openness to new ideas. Obviously those two modes of thought are in some tension. But if you are able to exercise only one of these modes, whichever one it is, you’re in deep trouble. If you are only skeptical, then no new ideas make it through to you. You never learn anything new. You become a crotchety old person convinced that nonsense is ruling the world. (There is, of course, much data to support you.) But every now and then, maybe once in a hundred cases, a new idea turns out to be on the mark, valid and wonderful. If you are too much in the habit of being skeptical about everything, you are going to miss or resent it, and either way you will be standing in the way of understanding and progress. On the other hand, if you are open to the point of gullibility and have not an ounce of skeptical sense in you, then you cannot distinguish the useful as from the worthless ones.”
Critical thinking is not something one is born with; but I strongly believe that most people can be taught this skill. This study suggests that I may be right. The researchers measured the relationship between student’s religion, gender, and propensity for fantasy thinking with the change in belief for paranormal and pseudoscientific subjects following a science and critical thinking course. Student pre-course endorsement of religious, paranormal, and pseudo-scientific beliefs ranged from 21 to 53%, with religion having the highest endorsement rate. Pre-course belief in paranormal and pseudo-scientific subjects was correlated with high scores in some fantasy thinking scales and showed a gender and a religion effect with females having an 11.1% higher belief across all paranormal and pseudo-science subcategories. Students’ religion, and frequency of religious service attendance, was also important with agnostic or atheist students having lower beliefs in paranormal and pseudo-science subjects compared to religious students. Students with either low religious service attendance or very high attendance had lower paranormal and pseudoscientific beliefs.
Following the critical thinking course, overall beliefs in paranormal and pseudo-scientific subcategories lowered 6.8–28.9%, except for superstition, which did not significantly change. Change in belief had both a gender and religion effect with greater reductions among religious students and females.
The link between religion and alternative medicine is relatively well-established. A 2014 study, for instance, showed an association between alternative medicine use and religiosity. The finding that females have an 11.1% higher belief in the paranormal and pseudo-science is new to me, but it would tie in with the well-documented fact that women use alternative medicine more frequently than men.
The most important finding, however, is clearly that critical thinking can be taught.
That must be good news! As discussed previously, critical thinkers experience fewer bad things in life than those of us who do not have acquired that skill. This cannot come as a surprise – being able to tell useful concepts from worthless ones should achieve exactly that.
It has been reported that, between 1 January 2018 and 31 May 2018, there have been 587 laboratory confirmed measles cases in England. They were reported in most areas with London (213), the South East (128), West Midlands (81), South West (62), and Yorkshire/Humberside (53). Young people and adults who missed out on MMR vaccine when they were younger and some under-vaccinated communities have been particularly affected.
Public Health England (PHE) local health protection teams are working closely with the NHS and local authorities to raise awareness with health professionals and local communities. Anyone who is not sure if they are fully vaccinated should check with their GP practice who can advise them.
Dr Mary Ramsay, Head of Immunisation at PHE, said:
“The measles outbreaks we are currently seeing in England are linked to ongoing large outbreaks in Europe. The majority of cases we are seeing are in teenagers and young adults who missed out on their MMR vaccine when they were children. Anyone who missed out on their MMR vaccine in the past or are unsure if they had 2 doses should contact their GP practice to catch-up. This serves as an important reminder for parents to take up the offer of MMR vaccination for their children at 1 year of age and as a pre-school booster at 3 years and 4 months of age. We’d also encourage people to ensure they are up to date with their MMR vaccine before travelling to countries with ongoing measles outbreaks. The UK recently achieved WHO measles elimination status and so the overall risk of measles to the UK population is low, however, we will continue to see cases in unimmunised individuals and limited onward spread can occur in communities with low MMR coverage and in age groups with very close mixing.”
And what has this to do with alternative medicine?
More than meets the eye, I fear.
The low vaccination rates are obviously related to Wakefield’s fraudulent notions of a link between MMR-vaccinations and autism. Such notions were keenly lapped up by the SCAM-community and are still being trumpeted into the ears of parents across the UK. As I have discussed many times, lay-homeopaths are at the forefront of this anti-vaccination campaign. But sadly the phenomenon is not confined to homeopaths nor to the UK; many alternative practitioners across the globe are advising their patients against vaccinations, e. g.:
- Governments take action to prevent vaccination-rates from falling
- Use of alternative medicine is associated with low vaccination rates
- Integrative medicine physicians tend to harbour anti-vaccination views
- Vaccination: chiropractors “espouse views which aren’t evidence based”
- Faith-healing as an alternative to vaccination?
- Recommending homeoprophylaxis is unethical, irresponsible and possibly even criminal
- Chiropractors are undermining public health
- CAM use is risk factor for the failure to immunize children
- Let’s be blunt: homeopathy is bogus – but homeoprophylaxis is worse, much worse!
- Are mothers being taught by homeopaths to become anti-vaxers?
- Some naturopaths are clearly a danger to public health
Considering these facts, I wish Dr Mary Ramsay, Head of Immunisation at PHE, would have had the courage to add to her statement: IT IS HIGH TIME THAT ALTERNATIVE PRACTITIONERS DO MORE THAN A MEEK LIP SERVICE TO THE FACT THAT VACCINATIONS SAVE LIVES.
I have been alerted to this website; it is truly remarkable! Here is but one example, the section with advice on ‘reducing the risk of vaccine damage’:
START OF QUOTE
1. Give vitamin A before the measles vaccine (MMR).Vitamin A has been shown to reduce death in measles sufferers by 50% so will support the body in its dealing with the measles vaccine. The WHO is now giving out Vitamin A pills along with the vaccine! Consider high doses (5,000 IU or more) the day before, on the day and the day after vaccination.
2. Give increased vitamin C before and after all vaccines. Vitamin C is known to help eliminate heavy metals. Consider high doses (3,000-5,000 mg per day) the day before, day of, and day after.
3. Consider detox programs after vaccination. These include homeopathy (before and after each vaccination), supplements, especially vitamin C, probiotics etc. It can take up to a year to detox the system but it is worth the investment (Autistic children are usually highly toxic – See Treating Autism).
4. Reconsider the routine use of Calpol or similar before or after vaccination. A rise in body temperature is the immune systems healthy response to any attack. Suppressing this reaction will impair its’ ability to deal with the load imposed upon it by the vaccine. Links have been made with the use of Calpol etc after the MMR and autism because the body needs to raise a high temperature to deal with measles. Complications can arise if temperature is bought down too early in cases of measles. See ‘Dealing with Fever Naturally’ under the Health section of this site.
5. Avoid antibiotic use where possible.
Delay vaccines, especially the MMR, within up to 6 months of antibiotics.
The strength of the gut is compromised and the gut is 70% of the immune system. Autistic children often have Gut and Bowel disorders. Antibiotics during pregnancy & breast feeding can also compromise the child’s immune system.
Try not to use antibiotics, as there are links with increased asthma in the vaccinated and also with the overuse of antibiotics in children. Asthma kills 1,300 people a year in the UK and rates have doubled in the last 40 years. This is far higher than the mortality rates as a result of contracting contagious diseases before the vaccines! In the years leading up to the vaccination program between 30-50 people died of measles, for example. Nearly 200 children under 14 years now die of Asthma. Asthma UK puts this this condition down to lack of childhood infections! For most children, as they recover from illness, their immune system is strengthened. The UK, US, New Zealand, Cuba and Australia lead the world with Asthma (Vaccinated populations). Asthma UK says that ‘the goal would be to find a suitable vaccine to provide the beneficial effects of early life infection’!!!
6. Use Probiotics to strengthen the gut, in capsule form rather than from a drinking yogurt product which usually contains sugar and other additives.
7. Consider giving long term Vit B6 as “One of the components of the MMR is Neomycin. This is an antibacterial drug that is used to suppress gastrointestinal bacteria before surgery to avoid infection. …This antibiotic interferes with the absorption of Vitamin B6. An error in the uptake of Vitamin B6 can cause a rare form of epilepsy and children become mentally retarded. Vitamin B6 is the major vitamin for processingamino acids, which are the building blocks of all proteins and a few hormones. There are studies around which support the theory of treating autistic children with Vitamin B6.”
END OF QUOTE
Let me briefly comment on these 7 points.
- I am not aware of good evidence supporting this claim.
- I am not aware of good evidence supporting this claim.
- I am not aware of good evidence supporting this claim.
- I am not aware of good evidence supporting this claim.
- I am not aware of good evidence supporting this claim.
- I am not aware of good evidence supporting this claim.
- I am not aware of good evidence supporting this claim.
Of course, I may have missed some important evidence; if that is the case, I would appreciate someone showing it to me in the comments section below, so that we can all benefit from it.
The above advice is from the ‘ARNICA’ group (as the name suggests, they are close to or even led by homeopaths). They believe that the non-vaccinated child is potentially healthier than the vaccinated child.
They also claim they want to reduce the fear often felt by parents with their young children on health issues, whether that is to learn how to look after children when they have a fever, or to suggest ways to reduce the adverse reactions from vaccines.
I respectfully suggest that they are dismally failing in their aims. In fact, they seem to promote fear and issue bogus advice.
Personally, I find our good friend Dana Ullman truly priceless. There are several reasons for that; one is that he is often so exemplarily wrong that it helps me to explain fundamental things more clearly. With a bit of luck, this might enable me to better inform people who might be thinking a bit like Dana. In this sense, our good friend Dana has significant educational value.
According to present and former editors of THE LANCET and the NEW ENGLAND JOURNAL OF MEDICINE, “evidence based medicine” can no longer be trusted. There is obviously no irony in Ernst and his ilk “banking” on “evidence” that has no firm footing except their personal belief systems: https://medium.com/@drjasonfung/the-corruption-of-evidence-based-medicine-killing-for-profit-41f2812b8704
Ernst is a fundamentalist whose God is reductionistic science, a 20th century model that has little real meaning today…but this won’t stop the new attacks on me personally…
END OF COMMENT
Where to begin?
Let’s start with some definitions.
- Evidence is the body of facts that leads to a given conclusion. Because the outcomes of treatments such as homeopathy depend on a multitude of factors, the evidence for or against their effectiveness is best based not on experience but on clinical trials and systematic reviews of clinical trials (this is copied from my book).
- EBM is the integration of best research evidence with clinical expertise and patient values. It thus rests on three pillars: external evidence, ideally from systematic reviews, the clinician’s experience, and the patient’s preferences (and this is from another book).
Few people would argue that EBM, as it is applied currently, is without fault. Certainly I would not suggest that; I even used to give lectures about the limitations of EBM, and many experts (who are much wiser than I) have written about the many problems with EBM. It is important to note that such criticism demonstrates the strength of modern medicine and not its weakness, as Dana seems to think: it is a sign of a healthy debate aimed at generating progress. And it is noteworthy that internal criticism of this nature is largely absent in alternative medicine.
The criticism of EBM is often focussed on the unreliability of the what I called above the ‘best research evidence’. Let me therefore repeat what I wrote about it on this blog in 2012:
… The multifactorial nature of any clinical response requires controlling for all the factors that might determine the outcome other than the treatment per se. Ideally, we would need to create a situation or an experiment where two groups of patients are exposed to the full range of factors, and the only difference is that one group does receive the treatment, while the other one does not. And this is precisely the model of a controlled clinical trial.
Such studies are designed to minimise all possible sources of bias and confounding. By definition, they have a control group which means that we can, at the end of the treatment period, compare the effects of the treatment in question with those of another intervention, a placebo or no treatment at all.
Many different variations of the controlled trial exist so that the exact design can be adapted to the requirements of the particular treatment and the specific research question at hand. The over-riding principle is, however, always the same: we want to make sure that we can reliably determine whether or not the treatment was the cause of the clinical outcome.
Causality is the key in all of this; and here lies the crucial difference between clinical experience and scientific evidence. What clinician witness in their routine practice can have a myriad of causes; what scientists observe in a well-designed efficacy trial is, in all likelihood, caused by the treatment. The latter is evidence, while the former is not.
Don’t get me wrong; clinical trials are not perfect. They can have many flaws and have rightly been criticised for a myriad of inherent limitations. But it is important to realise that, despite all their short-comings, they are far superior than any other method for determining the efficacy of medical interventions.
There are lots of reasons why a trial can generate an incorrect, i.e. a false positive or a false negative result. We therefore should avoid relying on the findings of a single study. Independent replications are usually required before we can be reasonably sure.
Unfortunately, the findings of these replications do not always confirm the results of the previous study. Whenever we are faced with conflicting results, it is tempting to cherry-pick those studies which seem to confirm our prior belief – tempting but very wrong. In order to arrive at the most reliable conclusion about the efficacy of any treatment, we need to consider the totality of the reliable evidence. This goal is best achieved by conducting a systematic review.
In a systematic review, we assess the quality and quantity of the available evidence, try to synthesise the findings and arrive at an overall verdict about the efficacy of the treatment in question. Technically speaking, this process minimises selection and random biases. Systematic reviews and meta-analyses [these are systematic reviews that pool the data of individual studies] therefore constitute, according to a consensus of most experts, the best available evidence for or against the efficacy of any treatment.
END OF QUOTE
Other criticism is aimed at the way EBM is currently used (and abused). This criticism is often justified and necessary, and it is again the expression of our efforts to generate progress. EBM is practised by humans; and humans are far from perfect. They can be corrupt, misguided, dishonest, sloppy, negligent, stupid, etc., etc. Sadly, that means that the practice of EBM can have all of these qualities as well. All we can do is to keep on criticising malpractice, educate people, and hope that this might prevent the worst abuses in future.
Dana and many of his fellow SCAMers have a different strategy; they claim that EBM “can no longer be trusted” (interestingly they never tell us what system might be better; eminence-based medicine? experience-based medicine? random-based medicine? Dana-based medicine?).
The claim that EBM can no longer be trusted is clearly not true, counter-productive and unethical; and I suspect they know it.
Why then do they make it?
Because they feel that it entitles them to argue that homeopathy (or any other form of SCAM) cannot be held to EBM-standards. If EBM is unreliable, surely, nobody can ask the ‘Danas of this world’ to provide anything like sound data!!! And that, of course, would be just dandy for business, wouldn’t it?
So, let’s not be deterred or misled by these deliberately destructive people. Their motives are transparent and their arguments are nonsensical. EBM is not flawless, but with our continued efforts it will improve. Or, to repeat something that I have said many times before: EBM is the worst form of healthcare, except for all other known options.
In Germany, homeopathy had been an undisputed favourite for a very long time. Doctors prescribed it, Heilpraktiker recommended it, patients took it and consumers, politicians, journalists, etc. hardly ever questioned it. But recently, this has changed; thanks not least to the INH and the ‘Muensteraner Kreis‘, some Germans are finally objecting to paying for the homeopathic follies of others. Remarkably, this might even have led to a dent in the sizable profits of homeopathy producers: while in 2016 the industry sold about 55 million units of homeopathic preparations, the figure had decreased to ‘just’ ~53 million in 2017.
Enough reason, it seems, for some manufacturers to panic. The largest one is the DHU (Deutsche Homoeopathische Union), and they recently decided to go on the counter attack by investing into a large PR campaign. This article (in German, I’m afraid) explains:
…Unter dem Hashtag #MachAuchDuMit lädt die Initiative Anwenderinnen und Anwender ein, ihre guten Erfahrungen in Sachen Homöopathie zu teilen. “Über 30 Millionen zufriedene Menschen setzen für ihre Gesundheit auf Homöopathie und vertrauen ihr. Mit unserer Initiative wollen wir das Selbstbewusstsein der Menschen stärken, sich für die Homöopathie zu entscheiden oder mindestens für eine freie Wahl einzustehen,” so Peter Braun, Geschäftsführer der DHU…
“Die Therapiefreiheit, die in unserem Slogan mit “Meine Entscheidung!” zum Ausdruck kommt, ist uns das wichtigste in dieser Initiative”, unterstreicht Peter Braun. Und dafür lohnt es sich aktiv zu werden, wie der Schweizer weiß. 2017 haben sich die Menschen in der Schweiz per Volksabstimmung für das Konzept einer integrativen Medizin entschieden. Neben der Schulmedizin können dort auch weitere Therapieverfahren wie Homöopathie oder Naturmedizin zum Einsatz kommen.
In Deutschland will die DHU mit ihrer Initiative Transparenz schaffen und die Homöopathie hinsichtlich Fakten und Erfolge realistisch darstellen. Dafür besteht offensichtlich Bedarf: “Wir als DHU haben in der jüngsten Vergangenheit dutzende spontane Anfragen bekommen, für die Homöopathie Flagge zu zeigen”.
Was die Inhalte der Initiative angeht betont Peter Braun, dass es dabei nie um ein “Entweder-Oder” zwischen Schulmedizin und anderen Therapieverfahren gehen soll: “Die Kombination der jeweils am besten für den Patienten passenden Methode im Sinne von “Hand-in-Hand” ist das Ziel der modernen integrativen Medizin. In keiner Art und Weise ist eine Entscheidung für die Homöopathie eine Entscheidung gegen die Schulmedizin. Beides hat seine Berechtigung und ergänzt sich in vielen Fällen.”
For those who do not read German, I will pick out a few central themes from the text.
Amongst other things, the DHU proclaim that:
- Homeopathy has millions of satisfied customers in Germany.
- The campaign aims at defending customers’ choice.
- The campaign declares to present the facts realistically.
- The decision is “never an ‘either or’ between conventional medicine (Schulmedizin) and other methods”; combining those therapies that suit the patient best is the aim of modern Integrative Medicine.
It is clear to anyone who is capable of critical thinking tha
t these 4 points are fallacious to the extreme. For those to whom it isn’t so clear, let me briefly explain:
- The ‘appeal to popularity’ is a classical fallacy.
- Nobody wants to curtail patients’ freedom to chose the therapy they want. The discussion is about who should pay for ineffective remedies. Even if homeopathy will, one day, be no longer reimbursable in Germany, consumers will still be able to buy it with their own money.
- The campaign has so far not presented the facts about homeopathy (i. e. the remedies contain nothing, homeopathy relies on implausible assumptions, the evidence fails to show that highly diluted homeopathic remedies are effective beyond placebo).
- Hahnemann called all homeopaths who combined his remedies with conventional treatments ‘traitors’ (‘Verraeter’) and coined the term ‘Schulmedizin’ to defame mainstream medicine.
The DHU campaign has only started recently, but already it seems to backfire big way. Social media are full with comments pointing out how pathetic it truly is, and many Germans have taken to making fun at it on social media. Personally, I cannot say I blame them – not least because the latest DHU campaign reminds me of the 2012 DHU-sponsored PR campaign. At the time, quackometer reported:
A consortium of pharmaceutical companies in Germany have been paying a journalist €43,000 to run a set of web sites that denigrates an academic who has published research into their products.
These companies, who make homeopathic sugar pills, were exposed in the German newspaper Süddeutsche Zeitung in an article, Schmutzige Methoden der sanften Medizin (The Dirty Tricks of Alternative Medicine.)
This story has not appeared in the UK media. And it should. Because it is a scandal that directly involves the UK’s most prominent academic in Complementary and Alternative Medicine.
The newspaper accuses the companies of funding the journalist, Claus Fritzsche, to denigrate critics of homeopathy. In particular, the accusation is that Fritzsche wrote about UK academic Professor Edzard Ernst on several web sites and then linked them together in order to raise their Google ranking. Fritzsche continually attacks Ernst of being frivolous, incompetent and partisan…
This story ended tragically; Fritzsche committed suicide.
My impression is that the PR-campaigns of homeopaths in general and the DHU in particular are rather ill-fated. Perhaps they should just forget about PR and do what responsible manufacturers should aim at doing: inform the public according to the best evidence currently available, even if this might make a tiny dent in their huge profits.
Regular readers of this blog will find plenty of things that are familiar to them in my new book ‘SCAM’. Many of the thoughts in there were originally conceived on this blog; and quite a few ideas might even be inspired by your comments. In this way, SCAM can be seen as a big ‘thank you’ to all of my readers.
SCAM, of course, stands for ‘So-Called Alternative Medicine’ which might be the name best suited to my field of research. In the book, I explain why I chose this terminology:
Why do I call it SCAM? Why not just ‘alternative medicine’ or one of the many other possible names for it? … Mainly because, whatever it is, it is it is not an alternative:
- if a therapy does not work, it cannot be an alternative to medicine;
- if a therapy does work, it does not belong to alternative medicine but to medicine.
Therefore, I think, that so-called alternative medicine or SCAM is not a bad term to use.
I would be lying to you, if I said I did not want you all to buy my new book – which author does not want people to purchase his product? So, to entice you to do exactly that (and while you are at it, get one for your sister, cousin, grandma, etc. as well), here are two tiny snippets from ‘SCAM’, the preface and the postscript:
I should perhaps start with a warning: this book might unsettle you. If you are a true believer in so-called alternative medicine (SCAM), you may find the things I am about to tell you disturbing. My book was not written for true believers. In my experience, they often are emotionally or intellectually unable to rationalise and to change their minds. Any attempt at opening their eyes and making them think critically might therefore be a waste of time.
This book was written for everyone who has an interest in SCAM and is open to consider the evidence. Yet it is not a guide-book that tells you which SCAM can be employed what condition. It is a compilation of 50 essays about SCAM in more general terms. I ordered them loosely under seven headings and have tried to write them in such a way that they can be read independently. This necessitated a certain amount of repetition of crucial themes which, I hope, is forgivable. My main aim in publishing this book is to stimulate your ability to think critically about healthcare in general and, of course, about SCAM in particular.
The book is based on my 25 years of research in SCAM. It quotes numerous investigations by my team and by other researchers. It also discusses many recently published examples of pseudo-science, misleading information and unethical SCAM-promotion. The text avoids technical language and should be easily understood by anyone. The ‘glossary’ at the end of the book provides additional explanations of more complex issues and terminology. Throughout the book, I use hints of irony, touches of sarcasm, and sometimes even a degree of exaggeration. This makes certain points clearer and might even make you smile from time to time…
Some people say that I am fighting a losing battle and insist that SCAM cannot be defeated. It will be around for ever, they say.
I quite agree with the latter parts of this statement. Humans seem to need some degree of irrationality in their lives, and SCAM certainly offers plenty of that. Moreover, conventional medicine is never going be totally perfect. Therefore, disgruntled consumers will always search elsewhere, and many of them will then find SCAM.
However, I disagree with the first part of the above assumption: I did not write this book with the aim of fighting a battle against SCAM. I can even see several positive sides of SCAM. For instance, the current SCAM-boom might finally force conventional healthcare professionals to remember that time, compassion and empathy are some of their core values which cannot be delegated to others. Whatever the current popularity signifies, it is a poignant criticism of what is going on in conventional healthcare – and we would be ill-advised to ignore this criticism.
In the preface, I stated that my main aim in publishing this book was to stimulate my readers’ ability to think critically about SCAM and healthcare generally. My book is therefore not a text against but as a plea for something. If reading it has, in fact, made some of my readers a little less gullible, it … could improve both their health and their bank balance.
The RCC is a relatively new organisation. It is a registered charity claiming to promote “professional excellence, quality and safety in chiropractic… The organisation promotes and supports high standards of education, practice and research, enabling chiropractors to provide, and to be recognised for providing, high quality care for patients.”
I have to admit that I was not impressed by the creation of the RCC and lately have not followed what they are up to – not a lot, I assumed. But now they seem to plan a flurry of most laudable activities:
The Royal College of Chiropractors is developing a range of initiatives designed to help chiropractors actively engage with health promotion, with a particular focus on key areas of public health including physical activity, obesity and mental wellbeing.
Dr Mark Gurden, Chair of the RCC Health Policy Unit, commented:
“Chiropractors are well placed to participate in public health initiatives. Collectively, they have several million opportunities every year in the UK to support people in making positive changes to their general health and wellbeing, as well as helping them manage their musculoskeletal health of course.
Our recent AGM & Winter Conference highlighted the RCC’s intentions to encourage chiropractors to engage with a public health agenda and we are now embarking on a programme to:
- Help chiropractors recognise the importance of their public health role;
- Help chiropractors enhance their knowledge and skills in providing advice and support to patients in key areas of public health through provision of information, guidance and training;
- Help chiropractors measure and recognise the impact they can have in key areas of public health.
To take this work forward, we will be exploring the possibility of launching an RCC Public Health Promotion & Wellbeing Society with a view to establishing a new Specialist Faculty in due course.”
END OF QUOTE
A ‘Public Health Promotion & Wellbeing Society’. Great!
As this must be new ground for the RCC, let me list a few suggestions as to how they could make more meaningful contributions to public health:
- They could tell their members that immunisations are interventions that save millions of lives and are therefore in the interest of public health. Many chiropractors still have a very disturbed attitude towards immunisation: anti-vaccination attitudes still abound within the chiropractic profession. Despite a growing body of evidence about the safety and efficacy of vaccination, many chiropractors do not believe in vaccination, will not recommend it to their patients, and place emphasis on risk rather than benefit. In case you wonder where this odd behaviour comes from, you best look into the history of chiropractic. D. D. Palmer, the magnetic healer who ‘invented’ chiropractic about 120 years ago, left no doubt about his profound disgust for immunisation: “It is the very height of absurdity to strive to ‘protect’ any person from smallpox and other malady by inoculating them with a filthy animal poison… No one will ever pollute the blood of any member of my family unless he cares to walk over my dead body… ” (D. D. Palmer, 1910)
- They could tell their members that chiropractic for children is little else than a dangerous nonsense for the sake of making money. Not only is there ‘not a jot of evidence‘ that it is effective for paediatric conditions, it can also cause serious harm. I fear that this suggestion is unlikely to be well-received by the RCC; they even have something called a ‘Paediatrics Faculty’!
- They could tell their members that making bogus claims is not just naughty but hinders public health. Whenever I look on the Internet, I find more false than true claims made by chiropractors, RCC members or not.
- They could tell their members that informed consent is not an option but an ethical imperative. Actually, the RCC do say something about the issue: The BMJ has highlighted a recent UK Supreme Court ruling that effectively means a doctor can no longer decide what a patient needs to know about the risks of treatment when seeking consent. Doctors will now have to take reasonable care to ensure the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments. Furthermore, what counts as material risk can no longer be based on a responsible body of medical opinion, but rather on the view of ‘a reasonable person in the patient’s position’. The BMJ article is available here. The RCC feels it is important for chiropractors to be aware of this development which is relevant to all healthcare professionals. That’s splendid! So, chiropractors are finally being instructed to obtain informed consent from all their patients before starting treatment. This means that patients must be told that spinal manipulation is associated with very serious risks, AND that, in addition, ~ 50% of all patients will suffer from mild to moderate side effects, AND that there are always less risky and more effective treatments available for any condition from other healthcare providers.
- The RCC could, for the benefit of public health, establish a compulsory register of adverse effects after spinal manipulations and make the data from it available to the public. At present such a register does not exist, and therefore its introduction would be a significant step in the right direction.
- The RCC could make it mandatory for all members to adhere to the above points and establish a mechanism of monitoring their behaviour to make sure that, for the sake of public health, they all do take these issues seriously.
I do realise that the RCC may not currently have the expertise and know-how to adopt my suggestions, as these issues are rather new to them. To support the RCC in their praiseworthy endeavours, I herewith offer to give one or more evidence-based lectures on these subjects (at a date and place of their choice) in an attempt to familiarise the RCC and its members with these important aspects of public health. I also realise that the RCC may not have the funds to pay professorial lecture fees. Therefore, in the interest of both progress and public health, I offer to give these lectures for free.
I can be contacted via this blog.