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

fallacy

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Yesterday, someone (hopefully) unknown to me (hiding under the pseudonym ‘Queristfrei’) tweeted this rather bizarre comment [in German, my translation]:

This trivialisation of the unjust GDR state, in which people died for political reasons, shows how “lost” the people are who @amardeo, @Skepges, @EdzardErnst and the @Skepges respect and defend. That’s historical fabrication to the power of ten! #GWUP

Normally, I would have discarded the comment as just one of those many irrelevant idiocies posted by cranks that I am constantly exposed to on social media. However, the mention of the GWUP, the German skeptics organisation, links it to the current woke-motivated destruction of the GWUP and thus gives it special significance.

‘Woke’ and the various related terms are in fashion and polute discussions on far too many subjects. To be blunt, I don’t like ‘woke, WOKE, anti-woke, unwoke, wokerati’, etc. – so much so that, for the purpose of this post, I will invent an umbrella term that captures all of these words: ANTI-UNWOKERATI, AUWEI for short (yes, there might be a German root in this abbreviation. I know it is a silly acronym but, in my mind, the subject deserves nothing serious).

As already mentioned, I am anti-AUWEI which means I am as much anti-woke as anti-antiwoke. Or, to put it differently, I feel that the world would be a better place, if ‘woke’ had never become en vogue. Here I have listed (in no particular order) several reasons why I dislike AUWEI:

  • AUWEI means different things to different people and is thus a fertile basis for misunderstandings.
  • Every Tom, Dick and Harry uses the AUWEI terminology pretending to be an expert without expertise.
  • Much of what is said and written in the name of AUWEI is pure bullshit.
  • AUWEI has become an ideology.
  • Even worse, it is a straight jacket of the mind that makes us pre-judge a subject regardless of the evidence.
  • Worse still, it is abused by all the wrong politicians.
  • AUWEI serves many as a replacement for evidence.
  • Even worse, it often seems to be an alternative to critical thinking.
  • Most AUWEI-obsessed people seem to have lost their humor (or never had any).
  • AUWEI renders complex issues falsely simple.
  • AUWEI inhibits free thought.
  • AUWEI inhibits nuances and puts you in one camp or another – black or white.
  • AUWEI is unnecessarily devisive.
  • AUWEI invites intolerance and unproductive dispute.

Personally, I like to make up my own mind about things; to do this, I want to see the evidence. Once I have understood it, I go where the evidence leads me – not where AUWEI dictates me to go.

There are many AUWEI subjects that do not interest me and perhaps even more that I find outright silly. Personally, I don’t want AUWEI to tell me that I must have an opinion on them or quietly follow that of my AUWEI ‘peers’.

No, really; AUWEI is not for me.

A we have heard from our homeopathic friend, Dana Ullaman, homeopathy works well for plants. Unfortunatley, he was unable to provide any good evidence for his claim. To show what a nice guy I am, I herewith help him out and present a recent study on the subject:

Given the seasonal climatic characteristics, forest fires in “cerrado” areas in Central Brazil are not infrequently, with permanent damage. Due to its physicochemical qualities acting in biological regulation processes, water has been considered the primary vehicle for propagating signals from homeopathic ingredients, as suggested by previous studies carried out with solvatochromic dyes. Therefore, such inputs could, in theory, be inserted into watercourses to stimulate the regeneration of the biome destroyed by fire. This hypothesis motivated this case study.

A slow dispersion device was developed aiming at promoting continuous environmental regeneration, containing hydrocolloid and calcium carbonate as a solid base soaked in a homeopathic complex specifically designed for this purpose, composed of Arsenicum albumArnica montanaStaphysagriaIgnatia amara, and Phosphorus, all at 30cH. The case occurred in Nascentes do Rio Taquari Park, between Mato Grosso and Mato Grosso do Sul state, Brazil. It is a “cerrado” area, with multiple springs that feed the Paraguay River, occupying an area of 26,849 hectares over the Guarani and Bauru aquifers.

After the fire in early September 2020, the devices were fixed at 9 strategic points in the park (P1 to P9) over 10 days, between September 29, and October 11, 2020, in water courses close to the main springs. To assess the restoration signs of the post-fire environment, the technicians responsible for monitoring the park made observations of flora and fauna recomposition in different locations close to four device-insertion points (P3, P5, P7, P8).

Signs of recovery were observed 40 days after the fire was over. A rapid pioneer plant restructuring was noted, with a significant regrowth of grass, herbaceous and shrub species, such as Mutamba (Guazuma ulmifolia), Murici (Byrsonima spp.), Inga (Inga sp.), Brachiaria (Brachiaria sp.), Jaraguá grass (Hyparrhenia rufa), Colonião grass (Panicum maximum), Gabiroba (Campomanesia sp.), and Pixirica (Miconia sp.). Some species, such as Mimosa (Mimosa sp.), Colonião grass (Panicum maximum), and Jaraguá grass (Hyparrhenia rufa), were not detected in the area before the fire, probably by the seed bank stimulation caused by the heat. There was rapid forest regeneration (4 months after the fire) and restoration of most of the burned trees, both for resisting the fire and for being free of invasive species highly aggressive to native plants, which were controlled by the action of fire. Concerning the fauna, a vast animal population was detected, especially birds, highlighting the “Tuiuiú” (Jabiru mycteria) and “Socó” (Tigrisoma lineatum) close to a water body with a waterfall area (P3). Both species belong to the “Pantanal” biome close to the park. Such species began to frequent the park’s lakes, being observed until February 2023 (the last survey date). The park’s inventory of lichens and fungi showed an unusual tolerance to fire in species that adhered to burned trees and remained active.

In this way, it is suggested that installing slow dispersion devices in watercourses can contribute to the regeneration of other “cerrado” biome areas subjected to fire, protecting the local biodiversity. More studies of this nature are needed to know the real impact of this method on the recovery of different biomes.

Convinced?

I suspect Dana might be (he seems to be particularly prone to confirmation bias) – but rational thinkers do probably have questions; let me just mention two:

  • Was there a control area with which the findings were compared?
  • Was the outcome measure objective?

As the answers are NO and NO, I fear that we need to disappoint Dana yet again:

homeopathy is a placebo treatment no matter whether we apply it to humans, animals or plants.

Dragons’ Den is a British reality television business programme, presented by Evan Davis and based upon the original Japanese series. The show allows several entrepreneurs an opportunity to present their varying business ideas to a panel of five wealthy investors, the “Dragons” of the show’s title, and pitch for financial investment while offering a stake of the company in return.

It has been reported that Giselle Boxer began selling needle-free acupuncture kits for ears after being diagnosed with myalgic encephalomyelitis (ME). She said the technique had helped improve her own health. Ms Boxer worked for advertising agency before starting her business. A researcher on the show had contacted her to ask if she would like to take part.

Entrepreneur and former footballer Gary Neville was so impressed with her pitch he made her an offer in full before the Dragons had a chance to begin asking questions. She said the impact on the business since the show aired had been “bonkers”. “It’s just been a complete whirlwind,” she said.

Acu Seed kit

The tiny beads are a needle-free form of auriculotherapy, designed to stimulate specific points of the ear to address physical and emotional health concerns. “It completely transformed my life alongside lots and lots of other things like diet, lifestyle changes, meditation, breathwork and movement,” said Ms Boxer. She has since had a child and claimed she was fully healed within a year. “It was like a full overhaul of my life,” Ms Boxer said. Her business, Acu Seeds, sells kits for people to use at home and made a £64,000 profit in its first year, she added.

On the Acu Seed website, we learn the following:

Ear seeds are a form of auriculotherapy, which is the stimulation of specific points of the ear to support physical and emotional health concerns. They are a needle-free form of acupuncture that have been used in Traditional Chinese Medicine (TCM) for thousands of years. TCM teaches that the ear is a microsystem of the whole body, where certain points on the ear correspond to different organs or body parts. Energy pathways (or ‘qi’ or vital life energy) pass through the ear and ear seeds stimulate specific points which send an abundant flow of energy to the related organ or area that needs attention. Think of it like reflexology, but for the ears instead of feet.

Ear seeds also create continual, gentle pressure on nerve impulses in the ear which send messages to the brain that certain organs or systems need support. The brain will then send signals and chemicals to the rest of the body to support whatever ailments you’re experiencing, releasing endorphins into the bloodstream, relaxing the nervous system, and naturally soothing pain and discomfort. Some people use ear seeds alongside acupuncture treatments as they may help the effects of acupuncture last longer between sessions.

I am impressed by the lingo used here:

  • support physical and emotional health concerns – the seeds support the concerns but not the health?
  • a needle-free form of acupuncture – sorry, the seeds don’t puncture anything; they exert pressure; therefore it’s called acuPRESSURE.
  • have been used in Traditional Chinese Medicine (TCM) for thousands of years – no, it was invented just a few decades ago by Paul Nogier.
  • TCM teaches that the ear is a microsystem of the whole body – TCM teaches plenty of nonsense but not this one.
  • Energy pathways (or ‘qi’ or vital life energy) pass through the ear –Qi is nothing more than a figment of the imagination of TCM advocates.
  • send an abundant flow of energy to the related organ or area – only if you believe in your own fictional form of physiology.
  • Think of it like reflexology – which btw is also nonsense.
  • nerve impulses in the ear send messages to the brain that certain organs or systems need support – only if you believe in your own fictional form of physiology.
  • The brain will then send signals and chemicals to the rest of the body – only if you believe in your own fictional form of physiology.
  • help the effects of acupuncture last longer – help the non-existing effects of acupuncture last longer?

One the website, we also learn what for which conditions the treatment is effective:

Ear seeds may support a broad spectrum of health concerns including anxiety, stress, headaches, digestion, immunity, focus, sleep and fatigue. Our ear seed kits include the protocol ear maps for these eight health concerns and each protocol uses between 3 to 5 ear seeds. Ear seeds have also been found to support with women’s health issues like menstrual issues, libido, fertility, postpartum issues, inflammation, menopause and weight loss. The ear maps for these issues are given in our women’s health ear seed kit bundles. The specific combination of seed placements will support your chosen health concern. Further issues that they may support with are addiction, pain, tinnitus, vertigo, thyroid health and more.

Here, I am afraid, we might have a major problem:

THERE IS NO GOOD EVIDENCE TO SUPPORT ANY OF THESE CLAIMS!

I thus do wonder whether the venture of Giselle Boxer might be a case for the Advertising Standards Authority.

When I decided to write my recent post about bizarre things going on with the GWUP (the German Skeptics), I knew, of course, that it would cause a few ripples. As a member of the GWUP scientific committee, I had been on the receiving end for the best part of a year of virtually hundreds emails and other exchanges directly releted to the matter. Initially, I had decided to stay out of all this. Therefore, I had read most of this material but had not responded to it even once.

Eventually, I had come to the conclusion that I ought to resign from the GWUP. There were two main reasons for that conclusion:

  1. Even though I had had plenty of time and information to form my own opinion, I had little to contribute to the affair.
  2. At the best of time, I am not a person who fits well into or likes to belong to clubs, associations, etc., and I was getting increasingly frustrated with the whole ting.

Before formulating my resignation letter, I discussed the GWUP with a trusted friend. This changed my attitude: I now felt that, before resigning, I should give it a try and make my position public in the hope that this might help the GWUP to get their act together.

Consequently, I posted my article precisely a week ago, well-aware of the fact that this would be controversial and might lead to attacks on my integrity. Having previously survived much bigger battles than that, I was not worried – at least, here I will be dealing with rational people, I thought.

As predicted, the reactions to my blog post (which was later translated and also published in German) were multipe, often fierce, and occasionally insulting. As not predicted, my assumption about dealing with rational people was erroneous.

I received (and posted) ~ 120 comments on the blog (only discarding less than a handful that were too far below the belt) and even more on social media. Many of you asked questions, and I tried to answer them the best I could. I even added a clarification to my original post. Soon I had to realize that emotions were flying high and reached into spheres that I understand little about and had even less intention to go into.

With hindsight, would I do it again?

Probably not!

Why not? Mainly because my attempt to help the GWUP was naive. I got the feeling that the rift amongst the German skeptics is too deep, too emotional, and too irrational. More than once I got the impression that it might be beyond repair.

More worringly perhaps, I also feel that some people who think of themselves ‘skeptics’ lack some of the qualities that I consider to be hallmarks of skepticism – to name just three: openness, rationality, and (self)critical thinking.

If someone voices his/her opinion (as has happened repeatedly, e.g. on social media) that I have been mistaken in what I stated about the GWUP, openness and rationality require, in my view, that this opinion is substantiated by stating exactly where I was mistaken. Just claiming “you were misinformed”, for instance, is hardly enough! After all, my post was written not least with the intention of identifying errors and misunderstandings. I never assumed that I am infallible, and therefore I invited my critics to use my blog for pointing out any errors, mistakes, misunderstandings, sources of misinformation, etc. Quite frankly, I was reminded of Randi’s bon mot: “The first thing a cult does is tell you everyone else is lying.”

And what happened?

Were my critics able to demonstrate where I have made errors or false allegations?

No – at least, I am not aware of such demonstrations which, of course, would require written statements that can be checked not just by me but by everyone else who is in the know.

Based on this situation, I feel tempted to conclude that the multiple claims of me having made false allegations are, in fact, false allegations.

Of course, I could be wrong!

And because I could be wrong, I am issuing herewith yet another invitation: if you are in possession of facts that contradict my previous post, here is your chance to disclose them by posting a comment below.

_____________________

And where do we go from here?

I will postpone my decision to leave the GWUP for a few weeks and hope that, contrary to my pessimism, the GWUP might manage to get its act together. The more I try to understand the reasons for the rift, the more I feel that they are emotionally hyped trivialities. With a healthy dose of openness, rationality, and (self)critical thinking, the rift might still be repairable.

 

 

Following on from my recent post about chiropractic denial, I feel like elaborating a little on an argument that is regularly used by those who try to defend the indefensible:

YOU ARE NOT COMPETENT TO CRITICIZE!

The notion is extremely popular not just with chiropractors but with virtually all practitioners of so-called alternative medicine (SCAM).

  • Discuss with a chiropractor the merits of chiropractic, and she will soon ask you for your qualifications in the subject. If you are not a qualified chiropractor, she will say something like: sorry, but you are not qualified to discuss this because chiropractic is a complex subject that requires a lot of study to fully understand.
  • Discuss with a homeopath the merits of homeopathy, and she will soon ask you for your qualifications in the subject. If you are not a qualified homeopath, she will say something like: sorry, but you are not qualified to discuss this because homeopathy is a complex subject that requires a lot of study to fully understand.
  • Discuss with a energy healer the merits of energy healing, and she will soon ask you for your qualifications in the subject. If you are not a qualified energy healer, she will say something like: sorry, but you are not qualified to discuss this because energy healing is a complex subject that requires a lot of study to fully understand.
  • Discuss with a osteopath the merits of osteopathy, and she will soon ask you for your qualifications in the subject. If you are not a qualified osteopath, she will say something like: sorry, but you are not qualified to discuss this because osteopathy is a complex subject that requires a lot of study to fully understand.
  • Discuss with a acupuncturist the merits of acupuncture, and she will soon ask you for your qualifications in the subject. If you are not a qualified acupuncturist, she will say something like: sorry, but you are not qualified to discuss this because acupuncture is a complex subject that requires a lot of study to fully understand.
  • etc. I’m sure you get the drift.

The first question to ask oneself here is this: what are these SCAM qualifications? Once you look into it, you might find – depending on national differences – that they consist of a series of courses that are more akin to brain-washing than to proper study. In other words, the arrogant pretence of SCAM practitioners to have more knowledge than the opponent is nil and void. What they do have is mostly pseudo-knowledge aquired during the brain-wash they assumed to be study.

But this is not what I wanted to explore today. I am more interested in another aspect of the ‘YOU ARE NOT COMPETENT TO CRITICIZE’ argument.

It has the effect that, from the persective of the SCAM practitioner, criticism voiced by people who are not experts in the SCAM in question can be dismissed. These people are simply not competent to criticize!

Consequently, criticism can only be considered, if it originates from someone who is an accepted expert in the SCAM. This means that:

  • Only a well-versed chiropractor can legitimately criticize chiropractic.
  • Only a well-versed homeopath can legitimately criticize homeopathy.
  • Only a well-versed energy healer can legitimately criticize energy healing.
  • Only a well-versed osteopath can legitimately criticize osteopathy.
  • Only a well-versed acupuncturist can legitimately criticize acupuncture.
  • etc. I’m sure you get the drift.

To perfect this culture of avoiding criticism, a final step is essential: a definition of what constitutes a ‘well-versed’ practitioner. A ‘well-versed’ SCAM practitioner is someone who is fully trained and understands and subscribes to the assumptions on which the SCAM in question is based. ‘Fully trained’ means, of course, that he/she went through the process of brain washing where the dogmas of the SCAM in question are internalized.

Should someone disagree with them (i.e. begin to criticize the SCAM) he/she is thus easily identified as being a heritic who is insufficiently ‘well-versed’ and incompetent to criticize. Consequently his/her criticism can be declared as invalid and can be ignored: a heritic would, of course, disagree – what else do you expect? – but that has no relevance because the maveric does not understand the subtleties of the SCAM and is quite simply incompetent.

Bob’s your uncle!

Criticism has been successfully averted.

No legitimate criticism of SCAM has ever been formulated.

SCAM practitioners are thus on the right track and should carry on as always.

 

 

PS

In order to make a clear point, I occasionally exaggerate – but only slightly.

 

TOXIN BUILDUP CAN CAUSE:

  • Brain Fog
  • Irritability
  • Exhaustion
  • Stress Induced Muscle Aches
  • Inability to Concentrate
  • Tiredness
  • Restlessness
  • And Many More Problems

At least this is what we are being told on the Nuunu website which appeared in my emails recently (how did they know that I am full of toxins?). Here is some more of the infinite wisdom promoted by Nuubu:

Improve your body and mind with a natural Asian solution!

  • Traditional Wisdom: Nuubu was inspired by Centuries-old traditional Asian knowledge, passed on by generations. True trust is earned by passing a test of time. Nuubu is made of natural herbs and herbal extracts. Forget about harmful, toxic chemicals and embrace the soothing power of nature!
  • Detox Through Sweat: Nuubu is a revolutionary detox foot patch that can greatly increase your sense of wellbeing. Nuubu supports the body’s natural way of removing toxins through activated sweat glands.
  • Holistic Approach: Tackle the cause, not the symptoms – your body is riddled by toxic elements, which may harm your wellbeing and increase stress. Using sweat detox and vitamin infusion Nuubu helps you to strengthen your mind, body and soul!

Natural Body Toxin Removal:
Amazing
New Way to Improve Your Life

  • A Secret to a Stress-Free Living

    Tired? Stressed? Fatigued? You are not alone – our lifestyles are extremely taxing on our bodies and minds alike. Headaches, bad sleep and stress are the unfortunate hallmarks of fast-moving modern life. Active ingredients that are found in the Nuubu foot patch are known for their ability to remove accumulating harmful elements from your body, which can greatly improve your sense of wellbeing!*

  • Traditional Medicine gets Modern Upgrade

    According to Japanese traditional knowledge, the human body has over 360 acupuncture points, with more than 60 points found on the soles of the foot. Nuubu combines tried-and-true Asian techniques with a sleek and modern approach – attach the herbal-remedy based patches to your feet and wait a few hours for the toxin removal through your sweat glands. It has never been that easy!

  • Natural Approach

    Are you tired of hazardous man-made chemicals being used in every aspect of your life? There is a better way to harmonize your lifestyle! Nuubu foot patches are made using natural herbs similar to ones found in the remote East-Asian mountainsides. Forget the harmful toxicity and side effects!

Traditional Wisdom

Traditional Asian wisdom that has been passed down through the ages is what inspired the Nuubu Patches. The test of time is what allows us to provide you with a product that you can trust. Forget about hazardous, dangerous drugs and enjoy nature’s calming influence instead.

Only the most natural herbs and herbal extracts are used to make the Nuubu Patches. We have blended together ancient herbal therapies to create the ultimate in cleansing wellness.

The soothing herbal aroma of Mother Nature’s finest plants and botanicals allow you to know that the Nuubu Patches are doing their job and providing you with optimal wellness.

______________________

I hope you are as impressed as I am!

So, I searched for the evidence?

Does detox work? Specifically, does the Nuubu reduce my:

  • Brain Fog
  • Irritability
  • Exhaustion
  • Stress Induced Muscle Aches
  • Inability to Concentrate
  • Tiredness
  • Restlessness
  • And Many More Problems

No matter how hard I searched, I did not find any evidence. Eventually, I had to conclude that the patch does not work.

Hold on!

The website might be correct with one claim: it helps you to strengthen your mind

… to such an extend that you will

never fall for the lies of detox entrepreneurs!

Some articles are just too remarkable for me to alter them in any way. This one impresses already by its title: “Ameliorative effects of homeopathic medicines in the management of different cancers“. By way of a ‘Christmas treat’, here its summary:

Homeopathy is a commonly used complementary and alternative system of medicine for the treatment of various sorts of ailments throughout the world. Homeopathic medicines are made up of potential therapeutic natural products that are primarily acknowledged for their low doses as well as extended patient survival results. Homeopathic medicines are derived from plants such as arnica (mountain herb), red onion, poison ivy, stinging nettle, and belladonna (deadly nightshade); minerals including white arsenic as well as from animals such as crushed whole bees. Homeopathic medicines are synthesized as sugar pellets to be placed under the tongue and may also be used in the form of gels, ointments, drops, tablets, and creams. Homeopathic medicines can be used to treat various disorders including migraine, depression, gastrointestinal diseases, joint pain, inflammation, different sorts of injuries, flu, arthritis as well as sciatica.

Cancer is the 2nd major reason behind global mortalities. It is revealed that developing countries around the world shoulder most of the cancer burden. According to a survey conducted in 2020, low- and middle-income countries face 70% of the total mortalities worldwide which accounts for approximately 10 million people of these countries. Homeopathic medicines ensure low-cost cancer treatment with little or no side effects on the bodies of humans and animals. Besides, it is applied as a supportive and palliative therapy in a broad range of cancer patients to enhance the body’s fight against cancer, alleviate discomfort resulting from disease or conventional treatments as well as improve the general well-being of the patients. In this chapter, our primary focus will be on the anti-cancerous effects of homeopathic medicines against different cancerous conditions in the body along with their mechanism of action.

Let me just mention a few fairly obvious points:

My conclusion:

Those who advocate homeopathy don’t know what it is, while those who know what it is, don’t advocate it.

As promised, here is my translation of the article published yesterday in ‘Le Figaro’ arguing in favour of integrating so-called alternative medicine (SCAM) into the French healthcare system [the numbers in square brackets were inserted by me and refer to my comments listed at the bottom].

So-called unconventional healthcare practices (osteopathy, naturopathy, acupuncture, homeopathy and hypnosis, according to the Ministry of Health) are a cause for concern for the health authorities and Miviludes, which in June 2023 set up a committee to support the supervision of unconventional healthcare practices, with the task of informing consumers, patients and professionals about their benefits and risks, both in the community and in hospitals. At the time, various reports, surveys and press articles highlighted the risks associated with NHPs, without pointing to their potential benefits [1] in many indications, provided they are properly supervised. There was panic about the “booming” use of these practices, the “explosion” of aberrations, and the “boost effect” of the pandemic [2].

But what are the real figures? Apart from osteopathy, we lack reliable data in France to confirm a sharp increase in the use of these practices [3]. In Switzerland, where it has been decided to integrate them into university hospitals and to regulate the status of practitioners who are not health professionals, the use of NHPs has increased very slightly [4]. With regard to health-related sectarian aberrations, referrals to Miviludes have been stable since 2017 (around 1,000 per year), but it should be pointed out that they are a poor indicator of the “risk” associated with NHPs (unlike reports). The obvious contrast between the figures and the press reports raises questions [5]. Are we witnessing a drift in communication about the risks of ‘alternative’ therapies? [6] Is this distortion of reality [7] necessary in order to justify altering the informed information and freedom of therapeutic choice of patients, which are ethical and democratic imperatives [8]?

It is the inappropriate use of certain NHPs that constitutes a risk, more than the NHPs themselves! [9] Patients who hope to cure their cancer with acupuncture alone and refuse anti-cancer treatments are clearly using it in a dangerous alternative way [10]. However, acupuncture used to relieve nausea caused by chemotherapy, as a complement to the latter, is recommended by the French Association for Supportive Care [11]. The press is full of the dangers of alternative uses, but they are rare: less than 5% of patients treated for cancer according to a European study [12]. This is still too many. Supervision would reduce this risk even further [13].

Talking about risky use is therefore more relevant than listing “illusory therapies”, vaguely defined as “not scientifically validated” and which are by their very nature “risky” [14]. What’s more, it suggests that conventional treatments are always validated and risk-free [15]. But this is not true! In France, iatrogenic drug use is estimated to cause over 200,000 hospital admissions and 10,000 deaths a year [16]. Yes, some self-medication with phytotherapy or aromatherapy does carry risks… just like any self-medication with conventional medicines [17]. Yes, acupuncture can cause deep organ damage, but these accidents occur in fewer than 5 out of every 100,000 patients [18]. Yes, cervical manipulations by osteopaths can cause serious or even fatal injuries, but these exceptional situations are caused by practitioners who do not comply with the decree governing their practice.[19] Yes, patients can be swindled by charlatans, but there are also therapeutic and financial abuses in conventional medicine, such as those reported in dental and ophthalmology centres. [20]

Are patients really that naive? No. 56% are aware that “natural” remedies can have harmful side-effects, and 70% know that there is a risk of sectarian aberrations or of patients being taken in by a sect [21]. In view of the strong demand from patients, we believe that guaranteeing safe access to certain NHPs is an integral part of their supervision, based on regulation of the training and status of practitioners who are not health professionals, transparent communication, appropriate research, the development of hospital services and outpatient networks of so-called “integrative” medicine combining conventional practices and NHPs, structured care pathways with qualified professionals, precise indications and a safe context for treatment.[22] This pragmatic approach to reducing risky drug use [17] has demonstrated its effectiveness in addictionology [23]. It should inspire decision-makers in the use of NHPs”.

  1. Reports about things going wrong usually do not include benefits. For instance, for a report about rail strikes it would be silly to include a paragraph on the benefits of rail transport. Moreover, it is possible that the benefits were not well documented or even non-existent.
  2. No, there was no panic but some well-deserved criticism and concern.
  3. Would it not be the task of practitioners to provide reliable data of their growth or decline?
  4. The situation in Switzerland is often depicted by enthusiasts as speaking in favour of SCAM; however, the reality is very different.
  5. Even if reports were exaggerated, the fact is that the SCAM community does as good as nothing to prevent abuse.
  6. For decades, these therapies were depicted as gentle and harmless (medicines douces!). As they can cause harm, it is high time that there is a shift in reporting and consumers are informed responsibly.
  7. What seems a ‘distortion of reality’ to enthusiasts might merely be a shift to responsible reporting akin to that in conventional medicine where emerging risks are taken seriously.
  8. Are you saying that informing consumers about risks is not an ethical imperative? I’d argue it is an imperative that outweighs all others.
  9. What if both the inappropriate and the appropriate use involve risks?
  10.  Sadly, there are practitioners who advocate this type of usage.
  11. The recommendation might be outdated; current evidence is far less certain that this treatment might be effective (“the certainty of evidence was generally low or very low“)
  12. The dangers depend on a range of factors, not least the nature of the therapy; in case of spinal manipulation, for instance, about 50% of all patients suffer adverse effects which can be severe, even fatal.
  13. Do you have any evidence showing that supervision would reduce this risk, or is this statement based on wishful thinking?
  14. As my previous comments demonstrate, this statement is erroneous.
  15. No, it does not.
  16. Even if this figure is correct, we need to look at the risk/benefit balance. How many lives were saved by conventional medicine?
  17. Again: please look at the risk/benefit balance.
  18. How can you be confident about these figures in the absence of any post-marketing surveillance system? The answer is, you cannot!
  19. No, they occur even with well-trained practitioners who comply with all the rules and regulations that exist – spoiler: there hardly are any rules and regulations!
  20. Correct! But this is a fallacious argument that has nothing to do with SCAM. Please read up about the ‘tu quoque’ and the strawman’ fallacies.
  21. If true, that is good news. Yet, it is impossible to deny that thousands of websites try to convince the consumer that SCAM is gentle and safe.
  22. Strong demand is not a substitute for reliable evidence. In any case, you stated above that demand is not increasing, didn’t you?
  23. Effectiveness in addictionology? Do you have any evidence for this or is that statement also based on wishful thinking?

My conclusion after analysing this article in detail is that it is poorly argued, based on misunderstandings, errors, and wishful thinking. It cannot possibly convince rational thinkers that SCAM should be integrated into conventional healthcare.

PS

The list of signatories can be found in the original paper.

“Le Figaro” has published two articles (one contra and one pro) authored by ‘NoFakeMed’ (an association of health professionals warning of the danger of fake medicine) signed by a long list of healthcare professionals (including myself) who argue that so-called alternative medicine (SCAM) should be excluded from public healthcare. It relates to the fact that, since last June, a committee set up by the French government has been bringing together opponents and supporters of SCAM. At the heart of the debate is the question of how SCAMs should be regulated, and the place they should occupy in the realm of healthcare. Should they be included or excluded?

Here is the piece arguing for EXCLUSION (my translation):

They’re called alternative medicine, complementary medicine, parallel medicine, alternative medicine, SCAM, and other fancy words. The authorities prefer to call them “non-conventional healthcare practices” (NCSP), or “non-conventional health practices” (NCHP). The choice of terminology is more than just a parochial quarrel: it’s a question of knowing what quality of medicine we want, and whether we agree to endorse illusory techniques whose main argument is their popularity. This raises the question of how to regulate these practices. Some people want to force them into the healthcare system, hospitals, health centres and nursing homes. And they are prepared to use all manner of oratory and caricature to legitimise questionable practices.

Unconventional healthcare practices are on the up, and the number of practitioners and practices has been rising steadily since the 2000s; there are now around 400 therapeutic NHPs. But their success is often due to a lack of understanding of the philosophy behind them, and their lack of effectiveness beyond context effects. This was seen in the debate surrounding homeopathy, which lost much of the confidence placed in it as soon as it stopped to be reimbursed in France and was confronted with the work of popularising it on its own merits among the general public. The ethical imperative of respect for patients means providing them with reliable information so that they can make a free and informed choice.

This raises the question of the place or otherwise to be given to NHPs within the healthcare system. Although there are many different names for them, they are all practices that claim to relate to care and well-being, without having been proven to be effective, and based on theories that are not supported by scientific evidence. Admittedly, the evidence is evolving, and a practice can demonstrate its usefulness in healthcare. This is true, for instance, of hypnosis, whose usefulness as a tool in certain situations is no longer debated since it has become possible to measure and explain both its benefits and its limitations.

However, there is no question of legitimising the entire range of NHPs on the pretext that they are supposedly harmless. Many of them do have adverse effects, sometimes serious, either directly or because they lead to a lack of care. These effects also exist with conventional treatments, but the risks must always be weighed against the proven benefits. The risks associated with NHPs are therefore unacceptable, given their ineffectiveness.

Furthermore, there are abuses associated with NHPs, even if (fortunately!) they are not frequent. Sectarian aberrations are not systematically linked to NHPs, but here again the risk is unacceptable. In its 2021 activity report, Miviludes indicates that 25% of referrals concern the field of health, and that 70% of these relate to SCAM. The number of health-related referrals has risen from 365 in 2010 to 842 in 2015, and exceed 1,000 in 2021.

Conventional medicine is of course not immune to such aberrations, and Miviludes estimates that 3,000 doctors are linked to a sectarian aberration. But the health professional associations have tackled the problem head-on, notably by setting up a partnership with Miviludes and multiple safeguards (verification of diplomas and authorisation to practise, obligation to undergo continuing training, codes of ethics and public health codes, professional justice, declaration of links of interest, etc.). The professional associations have raised awareness of sexual and gender-based violence, universities are providing training in critical reading of scientific articles, and community initiatives are flourishing to improve public information.

We agree that the choices of our patients must be respected, and everyone has recourse to the wellness practices of their choice. But, at the same time, patients have the right when they consult a healthcare professional, a hospital or a health centre, to know that they will be looked after by healthcare professionals offering conscientious, dedicated, evidence-based care.

In view of the current challenges facing our healthcare system, the response must not be to offer more pseudo-medicine on the pretext that people are already using it. The real answer is to rely on evidence, to provide resources for more research, to continue with research, to rely on social work, not to neglect mental health, to improve disease prevention, and to keep pressure groups at bay, whether they come from pharmaceutical companies or the promoters of esoteric, costly and sometimes dangerous practices.

___________________________

Tomorrow, I will translate and comment on the pro-piece that ‘Le Figaro’ today published alongside this article.

 

PS

The list of signatories can be found in the origninal paper.

I just found this on ‘X’ (formerly Twitter):

We’re delighted to announce the launch of the #BeyondPills All Parliamentary Group in Westminster. Chaired by Danny Kruger MP and co-chaired by Lord Crisp, this new body aims to tackle #overreliance on pills, reducing the number of unnecessary and inappropriate prescriptions.

It turns out that I did not study the website of College of Quackery and Integrated Health as regualarly as I should have. Because there, the launch had been announced some time ago under the title ‘Beyond Pills All Party Parliamentary Group (APPG) launches to stop over-prescribing‘:

Now, in December 2023, we have an exciting development to report: the launch of the Beyond Pills All Party Parliamentary Group (APPG), in which the Beyond Pills Campaign joins forces with the former APPG for Prescribed Drug Dependence. We’re delighted to announce that the APPG’s former Chair, Danny Kruger MP, joins the new Beyond Pills APPG as Chair.

Danny Kruger said of the launch: ‘There is a natural synergy with our objectives and the APPG for Prescribed Drug Dependence is a great supporter of social prescribing, which we feel can make a valuable contribution to addressing this public and personal health crisis, both in terms of helping to prevent overprescribing and also to treating people who are suffering from the debilitating symptoms of dependence.’

The Beyond Pills Campaign now becomes a founder member of the Beyond Pills Alliance (BPA), alongside the Council for Evidence-based Psychiatry (CEP-UK). Setting up the BPA will, in the near future, give us the opportunity to invite other organisations with a similar goal of reducing overreliance on pills to join the Alliance.

The Beyond Pills APPG has the following Mission and Objectives:
MISSION: To move UK healthcare beyond an over-reliance on pills by combining social prescribing, lifestyle medicine, psychosocial interventions and safe deprescribing. As well as reducing unnecessary and inappropriate prescribing, this integrated approach will improve outcomes and reduce health inequalities.

Elsewhere, Dr. Michael Dixon, who seems to be in charge of the ‘beyond pills’ activities, explained: ‘The Beyond Pills All Party Parliamentary Group heralds a sea change in public perception and medical practice from “a pill for every ill” to recognising that there is so much that we can do for ourselves which will not only help us to heal but also stop us getting ill in the first place.’

Sea change?

Really?

This made me think – and eventually, I respond by writing this short ‘open letter’ to the group:

Dear ‘BEYOND PILLS All Parliamentary Group

please let me begin by stating that I am all in favour of reducing over-prescribing. Who isn’t? The clue is in the name ‘over– prescribing’! Yet, at the same time, I would like to alert you to the fact that your group’s name ‘beyond pills‘ is of questionable merit.

It implies that conventional medicine consits only or predominantly of prescribing pills. My own career as a clinician – long ago now –  was in physical medicine and rehabilitation, a discipline that certainly does not rely on pills. Many other areas of healthcare also do not exclusively rely on pills; take surgery or psychosomatic medicine, for instance. As for the rest of the physicians, they will, no doubt, have learnt in medical school that over-prescribing is wrong, dangerous, and not evidence-based.

By putting ‘beyond pills’ on your banner, you either disclose your ignorance of the facts, or you deliberately undermine trust in conventional medicine. Some less benevolent than I might even get the impression that you employ the ‘strawman fallacy‘ in order to push a hidden agenda.

I hope these lines might motivate you to reconsider and alter the irresponsible name of your initiative – how about ‘evidence-based medicine’?

Sincerely

Edzard Ernst

 

 

PS

In case anyone wants to use my ‘open letter’ on other sites or publication, I herewith grant permission to reproduce it.

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