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

fallacy

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I know, I have often posted nasty things about integrative medicine and those who promote it. Today, I want to make good for all my sins and look at the bright side.

Imagine you are a person convinced of the good that comes from so-called alternative medicine (SCAM). Imagine you believe it has stood the test of time, is natural, holistic, tackles the root problems of illness, etc., etc. Imagine you are such a person.

Your convictions made you support more research into SCAM because you feel that evidence is needed for it to be more generally accepted. So, you are keen to see more studies proving the efficacy of this or that SCAM in the management of this or that condition.

This, unfortunately, is where the problems start.

Not only is there not a lot of money and even fewer scientists to do this research, but the amount of studies that would need doing is monstrously big:

  • There are hundreds of different types of SCAM.
  • Each SCAM is advocated for hundreds of conditions.

Consequently, tens of thousands of studies are needed to only have one trial for each specific research question. This is tough for a SCAM enthusiast! It means he/she has to wait decades to see the light at the end of the tunnel.

But then it gets worse – much worse!

As the results of these studies come in, one after the other, you realize that most of them are not at all what you have been counting on. Many can be criticized for being of dismal quality and therefore inconclusive, and those that are rigorous tend to be negative.

Bloody hell! There you have been waiting patiently for decades and now you must realize that this wait did not take you anywhere near the goal that was so clear in your sight. Most reasonable people would give up at this stage; they would conclude that SCAM is a pipedream and direct their attention to something else. But not you! You are single-minded and convinced that SCAM is the future. Some people might even call you obsessed – obsessed and desperate.

It is out of this sense of desperation that the idea of integrative medicine was born. It is a brilliant coup that solves most of the insurmountable problems outlined above. All you need to do is to take the few positive findings that did emerge from the previous decades of research, find a political platform, and loudly proclaim:

SCAM does work.

Consumers like SCAM.

SCAM must be made available to all.

Consumers deserve the best of both worlds.

The future of healthcare evidently lies in integrated medicine.

Forgotten are all those irritating questions about the efficacy of this or that treatment. Now, it’s all about the big issue of wholesale integration of SCAM. Forgotten is the need for evidence – after all, we had decades of that! – now, the issue is no longer scientific, it is political.

And if anyone has the audacity to ask about evidence, he/she can be branded as a boring nit-picker. And if anyone doubts the value of integrated medicine, he/she will be identified as a politically incorrect dinosaur.

Mission accomplished!

Yesterday, L’EXPRESS published an interview with me. It was introduced with these words (my translation):

Professor emeritus at the University of Exeter in the United Kingdom, Edzard Ernst is certainly the best connoisseur of unconventional healing practices. For 25 years, he has been sifting through the scientific evaluation of these so-called “alternative” medicines. With a single goal: to provide an objective view, based on solid evidence, of the reality of the benefits and risks of these therapies. While this former homeopathic doctor initially thought he was bringing them a certain legitimacy, he has become one of their most enlightened critics. It is notable as a result of his work that the British health system, the NHS, gave up covering homeopathy. Since then, he has never ceased to alert us to the abuses and lies associated with these practices. For L’Express, he looks back at the challenges of regulating this vast sector and deciphers the main concepts put forward by “wellness” professionals – holism, detox, prevention, strengthening the immune system, etc.

The interview itself is quite extraordinary, in my view. While UK, US, and German journalists usually are at pains to tone down my often outspoken answers, the French journalists (there were two doing the interview with me) did nothing of the sort. This starts with the title of the piece: “Homeopathy is implausible but energy healing takes the biscuit”.

The overall result is one of the most outspoken interviews of my entire career. Let me offer you a few examples (again my translation):

Why are you so critical of celebrities like Gwyneth Paltrow who promote these wellness methods?

Sadly, we have gone from evidence-based medicine to celebrity-based medicine. A celebrity without any medical background becomes infatuated with a certain method. They popularize this form of treatment, very often making money from it. The best example of this is Prince Charles, sorry Charles III, who spent forty years of his life promoting very strange things under the guise of defending alternative medicine. He even tried to market a “detox” tincture, based on artichoke and dandelion, which was quickly withdrawn from the market.

How to regulate this sector of wellness and alternative medicines? Today, anyone can present himself as a naturopath or yoga teacher…

Each country has its own regulation, or rather its own lack of regulation. In Germany, for instance, we have the “Heilpraktikter”. Anyone can get this paramedical status, you just have to pass an exam showing that you are not a danger to the public. You can retake this exam as often as you want. Even the dumbest will eventually pass. But these practitioners have an incredible amount of freedom, they even may give infusions and injections. So there is a two-tier health care system, with university-trained doctors and these practitioners.

In France, you have non-medical practitioners who are fighting for recognition. Osteopaths are a good example. They are not officially recognized as a health profession. Many schools have popped up to train them, promising a good income to their students, but today there are too many osteopaths compared to the demand of the patients (knowing that nobody really needs an osteopath to begin with…). Naturopaths are in the same situation.

In Great Britain, osteopaths and chiropractors are regulated by statute. There is even a Royal College dedicated to chiropractic. It’s a bit like having a Royal College for hairdressers! It’s stupid, but we have that. We also have professionals like naturopaths, acupuncturists, or herbalists who have an intermediate status. So it’s a very complex area, depending on the state. It is high time to have more uniform regulations in Europe.

But what would adequate regulation look like?

From my point of view, if you really regulate a profession like homeopaths, it means that these professionals may only practice according to the best scientific evidence available. Which, in practice, means that a homeopath cannot practice homeopathy. This is why these practitioners have a schizophrenic attitude toward regulation. On the one hand, they would like to be recognized to gain credibility. But on the other hand, they know very well that a real regulation would mean that they would have to close shop…

What about the side effects of these practices?

If you ask an alternative practitioner about the risks involved, he or she will take exception. The problem is that there is no system in alternative medicine to monitor side effects and risks. However, there have been cases where chiropractors or acupuncturists have killed people. These cases end up in court, but not in the medical literature. The acupuncturists have no problem saying that a hundred deaths due to acupuncture – a figure that can be found in the scientific literature – is negligible compared to the millions of treatments performed every day in this discipline. But this is only the tip of the iceberg. There are many cases that are not published and therefore not included in the data, because there is no real surveillance system for these disciplines.

Do you see a connection between the wellness sector and conspiracy theories? In the US, we saw that Qanon was thriving in the yoga sector, for example…

Several studies have confirmed these links: people who adhere to conspiracy theories also tend to turn to alternative medicine. If you think about it, alternative medicine is itself a conspiracy theory. It is the idea that conventional medicine, in the name of pharmaceutical interests, in particular, wants to suppress certain treatments, which can therefore only exist in an alternative world. But in reality, the pharmaceutical industry is only too eager to take advantage of this craze for alternative products and well-being. Similarly, universities, hospitals, and other health organizations are all too willing to open their doors to these disciplines, despite the lack of evidence of their effectiveness.

 

Advocates of so-called alternative medicine (SCAM) often sound like a broken record to me. They bring up the same ‘arguments’ over and over again, no matter whether they happen to be defending acupuncture, energy healing, homeopathy, or any other form of SCAM. Here are some of the most popular of these generic ‘arguments’:

1. It helped me
The supporters of SCAM regularly cite their own good experiences with their particular form of treatment and think that this is proof enough. However, they forget that any symptomatic improvement they may have felt can be the result of several factors that are unrelated to the SCAM in question. To mention just a few:

  • Placebo
  • Regression towards the mean
  • Natural history of the disease

2. My SCAM is without risk
Since homeopathic remedies, for instance, are highly diluted, it makes sense to assume that they cannot cause side effects. Several other forms of SCAM are equally unlikely to cause adverse effects. So, the notion is seemingly correct. However, this ‘argument’ ignores the fact that it is not the therapy itself that can pose a risk, but the SCAM practitioner. For example, it is well documented – and, on this blog, we have discussed it often – that many of them advise against vaccination, which can undoubtedly cause serious harm.

3. SCAM has stood the test of time
It is true that many SCAMs have survived for hundreds or even thousands of years. It is also true that millions still use it even today. This, according to enthusiasts, is sufficient proof of SCAM’s efficacy. But they forget that many therapies have survived for centuries, only to be proved useless in the end. Just think of bloodletting or mercury preparations from past times.

4 The evidence is not nearly as negative as skeptics pretend
Yes, there are plenty of positive studies on some SCAMs This is not surprising. Firstly, from a purely statistical point of view, if we have, for instance, 1 000 studies of a particular SCAM, it is to be expected that, at the 5% level of statistical significance, about 50 of them will produce a significantly positive result. Secondly, this number becomes considerably larger if we factor in the fact that most of the studies are methodologically poor and were conducted by SCAM enthusiasts with a corresponding bias (see my ALTERNATIVE MEDICINE HALL OF FAME on this blog). However, if we base our judgment on the totality of the most robust studies, the bottom line is almost invariably that there is no overall convincingly positive result.

5. The pharmaceutical industry is suppressing SCAM
SCAM is said to be so amazingly effective that the pharmaceutical industry would simply go bust if this fact became common knowledge. Therefore Big Pharma is using its considerable resources to destroy SCAM. This argument is fallacious because:

  1. there is no evidence to support it,
  2. far from opposing SCAM, the pharmaceutical industry is heavily involved in SCAM (for example, by manufacturing homeopathic remedies, dietary supplements, etc.)

6 SCAM could save a lot of money
It is true that SCAMs are on average much cheaper than conventional medicines. However, one must also bear in mind that price alone can never be the decisive factor. We also need to consider other issues such as the risk/benefit balance. And a reduction in healthcare costs can never be achieved by ineffective therapies. Without effectiveness, there can be no cost-effectiveness.

7 Many conventional medicines are also not evidence-based
Sure, there are some treatments in conventional medicine that are not solidly supported by evidence. So why do we insist on solid evidence for SCAM? The answer is simple: in all areas of healthcare, intensive work is going on aimed at filling the gaps and improving the situation. As soon as a significant deficit is identified, studies are initiated to establish a reliable basis. Depending on the results, appropriate measures are eventually taken. In the case of negative findings, the appropriate measure is to exclude treatments from routine healthcare, regardless of whether the treatment in question is conventional or alternative. In other words, this is work in progress. SCAM enthusiasts should ask themselves how many treatments they have discarded so far. The answer, I think, is zero.

8 SCAM cannot be forced into the straitjacket of a clinical trial
This ‘argument’ surprisingly popular. It supposes that SCAM is so individualized, holistic, subtle, etc., that it defies science. The ‘argument’ is false, and SCAM advocates know it, not least because they regularly and enthusiastically cite those scientific papers that seemingly support their pet therapy.

9 SCAM is holistic
This may or may not be true, but the claim of holism is not a monopoly of SCAM. All good medicine is holistic, and in order to care for our patients holistically, we certainly do not need SCAM.

1o SCAM complements conventional medicine
This argument might be true: SCAM is often used as an adjunct to conventional treatments. Yet, there is no good reason why a complementary treatment should not be shown to be worth the effort and expense to add it to another therapy. If, for instance, you pay for an upgrade on a flight, you also want to make sure that it is worth the extra expenditure.

11 In Switzerland it works, too
That’s right, in Switzerland, a small range of SCAMs was included in basic health care by referendum. However, it has been reported that the consequences of this decision are far from positive. It brought no discernible benefit and only caused very considerable costs.

I am sure there are many more such ‘arguments’. Feel free to post your favorites!

My point here is this:

the ‘arguments’ used in defense of SCAM are not truly arguments; they are fallacies, misunderstandings, and sometimes even outright lies. 

 

The ‘Münster Circle‘ is an informal association of multi-disciplinary experts who critically examine issues in and around so-called alternative medicine (SCAM). We exist since June 2016 and are the result of an initiative by Dr Bettina Schöne-Seifert, Professor and Chair of Professor and Chair of Medical Ethics at the University of Münster.

In the past, we have published several documents which have stimulated discussions on SCAM-related subjects. Yesterday, we have published our ‘MEMORANDUM INTEGRATIVE MEDICINE‘. It is a critical analysis of this subject and will hopefully make some waves in Germany and beyond.

Here is its English summary:

The merging of alternative medicine and conventional medicine has been increasingly referred to as Integrative (or Integrated) Medicine (IM) since the 1990s and has largely replaced other terms in this field. Today, IM is represented at all levels.

IM is often characterised with the thesis of the ‘best of both worlds’. However, there is no generally accepted definition of IM. Common descriptions of IM emphasise:

– the combination of conventional and complementary methods,

– the holistic understanding of medicine,

– the great importance of the doctor-patient relationship,

– the hope for optimal therapeutic success,

– the focus on the patient,

– the high value of experiential knowledge.

On closer inspection, the descriptions of IM show numerous inconsistencies. For example, medicine in the hands of doctors is stressed, but it is also emphasised that all relevant professions would be involved. Scientific evidence is emphasised, but at the same time, it is stressed that IM itself includes homeopathy as well as other unsubstantiated treatments and is only ‘guided’ by evidence, i.e. not really evidence-based. It is claimed that IM is to be understood as ‘complementary to science-based medicine’; however, this implies that IM itself is not science-based.

The ‘best of both worlds’ thesis impresses many. However, if one investigates what is meant by ‘best’, one finds that this term is not interpreted in nearly the same way as in conventional medicine. Many claims of IM are elementary components of all good medicine and thus cannot be counted among the characterising features of IM. Finally, it is hard to ignore the fact that the supporters of IM use it as a pretext to introduce unproven or disproven modalities into conventional medicine. Contrary to promises, IM has no discernible potential to improve medicine; rather, it creates confusion and entails considerable dangers. This cannot be in the interest of patients.

Against this background, it must be demanded that IM is critically scrutinised at all levels.

________________________

 

One of my recent posts prompted the following comment from a chiropractor: “… please don’t let me stop you…while we actually treat patients“. It was given in the context of a debate about the evidence for or against chiropractic spinal manipulations as a treatment of whiplash injuries. My position was that there is no convincing evidence, while the chiropractor argued that he has been using manipulations for this indication with good results. Here I do not want to re-visit the pros and cons of that particular debate. Since similar objections have been put to me so many times, I want rather to raise several more principal points.

Before I do this, I need to quickly get the personal stuff out of the way: the comment implies that I  don’t really know what I am talking about because I don’t see patients and thus don’t understand their needs. The truth is that I started my professional life as a clinician, then I went into basic science, then I went back into clinical medicine (while also doing research), and eventually, I became a full-time clinical researcher. I have thus seen plenty of patients, certainly enough to empathize with both the needs of patients and the reasoning of clinicians. In fact, these provided the motives for my clinical research during the last decades of my professional career (more details here).

Now about the real issue that is at stake here. When offered by a clinician to a scientist, the comment “… please don’t let me stop you…while we actually treat patients” is an expression of an arrogant feeling of superiority that clinicians often harbor vis a vis professionals who are not at the ‘coal face’ of healthcare. Stripped down to its core, the argument implies that science is fairly useless because the only knowledge worth having stems from dealing with patients. In other words, it is about the tension that so often exists between clinical experience and scientific evidence.

Many clinicians feel that experience is the best guide to correct decision-making.

Many scientists feel that experience is fraught with errors, and only science can lead us towards optimal decisions.

Such arguments emerge regularly on this blog and are constant company to almost any type of healthcare. The question is, who is right and who is wrong?

As I indicated, I can empathize with both positions. I can see that, in the context of making therapeutic decisions in a busy clinic, for instance, the clinician’s argument weighs heavily and can make sense, particularly in areas where the evidence is mixed, weak, or uncertain.

However, in the context of this blog and other discussions focused on critical evaluation of the science, I am strongly on the side of the scientist. In fact, in this context, the argument “… please don’t let me stop you…while we actually treat patients” seems ridiculous and resembles an embarrassing admission of having no rational argument left for defending one’s own position.

To put my view of this in a nutshell: it is not a question of either or; for optimal healthcare, we obviously need both clinical experience AND scientific evidence (an insight that is not in the slightest original, since it is even part of Sackett’s definition of EBM).

One of my previous posts was about a press release announcing a ‘WORLDWIDE DECLARATION’, and I promised to comment about the actual declaration. This post firstly reproduces this document and secondly provides a few comments on it. Here is the document:

DEFINITIONS

Traditional, complementary and integrative healthcare (TCIH) refers to the respectful collaboration between various systems of healthcare and their health professionals with the aim of offering a person-centred and holistic approach to health.

ABOUT US

We represent a worldwide community of users and health professionals of TCIH with a large diversity of backgrounds and experiences with a common commitment to the advancement and
promotion of TCIH.

THE HEALTHCARE WE DESIRE

• Focuses on the whole person, including physical, mental, social and spiritual dimensions
• Is patient-centred and supports self-healing and health creation
• Is participative and respects individual choices
• Is evidence-based by integrating clinical experience and patient values with the best available research information
• Respects cultural diversity and regional differences
• Is an integral part of community and planetary health
• Uses natural and sustainable resources that are respectful of the health of our planet
• Integrates traditional, complementary and biomedical practices in a supportive and collaborative manner

We appreciate the benefits of conventional / biomedicine. At the same time we recognize its limitations, including:

• The insufficient therapeutic options that biomedicine provides, especially for chronic / non-communicable diseases (NCDs)
• Frequent side effects of biomedical treatments and rising antimicrobial resistance
• Fragmentation of care from increased specialization and the limits of a disease-based model

We are inspired by countries that are successfully integrating TCIH into their healthcare systems. However, we are concerned about:

• Countries that prevent, limit or undervalue the practice of TCIH
• Uninformed or unbalanced media reporting of TCIH
• Insufficient public funding of TCIH research
• Risk of reduced availability of TCIH and unregulated practices in some countries

OUR CALL TO ACTION

All countries

• Ensure full access to TCIH as part of the right to health for all
• Include TCIH into national health systems
• Provide accreditation of TCIH healthcare professionals in accordance with international training standards to ensure high quality care
• Ensure access and safety of TCIH medicines through specific regulatory pathways
• Fund research on TCIH and disseminate reliable information on TCIH to the public

All healthcare professionals

• Foster respectful collaboration between all healthcare professions towards achieving a person-centred and holistic approach to healthcare

_____________________________

And here are my comments.

  • “TCIH”: in the realm of so-called alternative medicine it seems popular to create a new name for the subject at hand; this one is yet another one in a long line of innovations – sadly, it is as nonsensical as most of the previous ones.
  • Person-centred and holistic approach to health: all good healthcare has these qualities.
  • We represent a worldwide community: really? Who exactly are you then, and what is your ligitimization?
  • Whole person, including physical, mental, social and spiritual dimensions: all good healthcare has these qualities.
  • Patient-centred and supports self-healing and health creation: all good healthcare has these qualities.
  • Respects individual choices: all good healthcare has these qualities.
  • Evidence-based: either they do not know what this term means or they are deliberately misleading the public.
  • Integral part of community and planetary health: all good healthcare has these qualities.
  • Natural and sustainable resources that are respectful of the health of our planet: like Rhino horn and similar ingredients of TCM products?
  • Insufficient therapeutic options that biomedicine provides: yes, conventional medicine is far from perfect, but adding something even less perfect to it cannot improve it.
  • Frequent side effects of biomedical treatments and rising antimicrobial resistance: yes, conventional medicine is far from perfect, but adding something even less perfect to it cannot improve it.
  • Full access to TCIH as part of the right to health for all: the ‘right to health for all’ means the right to the most effective therapies not the right to the most bizarre quackery.
  • Accreditation of TCIH healthcare professionals: giving respectability to every quack would not render healthcare better or safer but worse and more dangerous.
  • Access and safety of TCIH medicines through specific regulatory pathways: regulating access to unproven treatments is nothing less than a recipe for disaster.
  • Research on TCIH: yes in some areas, research might be worthwhile, but it must be rigorously testing TCIH and not promoting it uncritically.
  • Disseminate reliable information on TCIH to the public: thank you! This is my main aim in writing the ~2500 posts on this blog. Yet I do often get the impression that this gets disappointingly little support – and frequently the exact opposite – from enthusiasts of TCIH.

I reported about the activities of Eurocam before (see here) and I was distinctly underwhelmed with this quackery lobby group. Now they have published a press release about a ‘worldwide declaration’ in favor of integrated medicine. Here is my translation of the press release (I will comment on the actual declaration at a later stage):

With a declaration, Eurocam and the European Federation of Homeopathic Patient’s Association, among others, call for an open scientific discourse, more research funds, and more promotion of young researchers in the field of integrative medicine. The declaration is supported by the German Central Association of Homeopathic Physicians and the Homeopathy Research Institute (HRI), among others. Integrative medicine combines conventional and complementary elements in health care for the benefit of patients. The goal is patient-centred and holistic health care. Already 130 organisations have committed themselves to these goals in the medical care of the population in the Declaration.

Integrative medicine integrates complementary and conventional methods

In addition, the Declaration advocates health care that takes the whole person into account in its psychological, mental, social and spiritual dimensions. Integrative medicine in the sense of the Declaration is patient-centred and supports the body’s own regulatory abilities. In addition, it is participatory and respects individual decisions with regard to medical care. It is committed to the evidence of medical procedures, which is based on experience, patient preferences and research findings. It incorporates cultural diversity and regional differences as well as the concepts of community health and planetary health. Integrative medicine uses natural and sustainable resources and integrates complementary and conventional medical procedures.

Integrative medicine: Opportunities especially for chronic diseases and side effects

The supporters of the Declaration see opportunities for integrative medicine above all in chronic and non-communicable diseases, as well as in the frequent side effects of conventional therapies and increasing antibiotic resistance. Conventional medicine is characterised by fragmentation and divisional thinking within medical care, as well as by the increasing specialisation of the health professions. The holistic view of the patient is thus left out. Against this backdrop, the Declaration advocates anchoring integrative medicine as a legal entitlement in health care and integrating it into national health care systems. International training standards should be adapted with integrative medicine in mind, and research projects should be promoted. At the same time, balanced and high-quality patient information is needed.

________________________________

This press release requires a few short comments, in my view:

  • “Integrative medicine combines conventional and complementary elements in health care for the benefit of patients.” Anyone who cares to research for longer than 10 minutes will find that very often the complementary elements are unproven and disproven treatments.
  • “The goal is patient-centred and holistic health care.” By integrating unproven and disproven treatments into routine care, medicine cannot become more patient-centred but must get less effective and more expensive.
  • “The Declaration advocates health care that takes the whole person into account in its psychological, mental, social and spiritual dimensions.” Any good healthcare aims at doing this.
  • “Individual decisions with regard to medical care” are respected in all forms of healthcare.
  • “Side effects of conventional therapies and increasing antibiotic resistance” are regrettable phenomena and much research is going on to minimize them. So-called alternative medicine (SCAM) has not yet been shown to offer a single solution to these problems.
  • “The holistic view of the patient is left out” in conventional medicine. One of the most popular fallacies with SCAM advocates is the strawman fallacy.

I find the text almost comical. It reveals thought processes that lack even the most fundamental rules of logic. One really does get the impression that it had been written by people who are deplorably naive, misinformed, and quite frankly stupid.

 

It is not often that I publish a paper with a philosopher in a leading journal of philosophy. In fact, it is the first time, and I am rather proud of it – so much so that I must show my readers (the article is freely available via the link below and I encourage everyone to read the full text) the abstract of our article entitled WHY HOMOEOPATHY IS PSEUDOSCIENCE (Synthese (2022) 200:394):

Homoeopathy is commonly recognised as pseudoscience. However, there is, to date, no systematic discussion that seeks to establish this view. In this paper, we try to fill this gap. We explain the nature of homoeopathy, discuss the notion of pseudoscience, and provide illustrative examples from the literature indicating why homoeopathy fits the
bill. Our argument contains a conceptual and an empirical part.

In the conceptual part, we introduce the premise that a doctrine qualifies as a pseudoscience if, firstly, its proponents claim scientific standing for it and, secondly, if they produce bullshit to defend it, such that, unlike science, it cannot be viewed as the most reliable knowledge on its topic. In the empirical part, we provide evidence that homoeopathy fulfils both criteria. The first is quickly established since homoeopaths often explicitly claim scientificity.

To establish the second, we dive into the pseudo-academic literature on homoeopathy to provide evidence of bullshit in the arguments of homoeopaths. Specifically, we show that they make bizarre ontological claims incompatible with natural science, illegitimately shift the burden of proof to sceptics, and mischaracterise, cherry-pick, and misreport the evidence. Furthermore, we demonstrate that they reject essential parts of established scientific methodology and use epistemically unfair strategies to immunise their doctrine against recalcitrant evidence.

And here is our conclusion:

At the beginning of the paper, we noted that homoeopathy is commonly named one of the prototypical pseudosciences. However, there has been, to date, no comprehensive discussion as to what makes it a pseudoscience. Moreover, the problem is not trivial since the most well-known and influential demarcation criteria, such as Popper’s falsifiability criterion and Kuhn’s problem-solving criterion, cannot account for it, as we have shown. We have tried to fill this research gap using a novel bullshitology-based approach to the demarcation problem. Following this approach, we have argued that homoeopathy should be regarded as pseudoscience because its proponents claim scientific standing for it and produce argumentative bullshit to defend it, thus violating important epistemic standards central to science.

A study by an international team of researchers estimated the proportion of healthcare interventions tested within Cochrane Reviews that are effective according to high-quality evidence.

They selected a random sample of 2428 (35%) of all Cochrane Reviews published between 1 January 2008 and 5 March 2021 and extracted data about interventions within these reviews that were compared with placebo, or no treatment, and whose outcome quality was rated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). They then calculated the proportion of interventions whose effectiveness was based on high-quality evidence according to GRADE, had statistically significant positive effects and were judged as beneficial by the review authors. They also calculated the proportion of interventions that suggested harm.

Of 1567 eligible interventions, 87 (5.6%) had high-quality evidence on first-listed primary outcomes, positive, statistically significant results, and were rated by review authors as beneficial. Harms were measured for 577 (36.8%) interventions, 127 of which (8.1%) had statistically significant evidence of harm. Our dependence on the reliability of Cochrane author assessments (including their GRADE assessments) was a potential limitation of our study.

The authors drew the following conclusions: While many healthcare interventions may be beneficial, very few have high-quality evidence to support their effectiveness and safety. This problem can be remedied by high-quality studies in priority areas. These studies should measure harms more frequently and more rigorously. Practitioners and the public should be aware that many frequently used interventions are not supported by high-quality evidence.

Proponents of so-called alternative medicine (SCAM) are fond of the ‘strawman’ fallacy; meaning they like to present a picture of conventional medicine that is overtly negative in order for SCAM to appear more convincing (Prince Charles, for instance, uses this trick every single time he speaks about SCAM). Therefore I am amazed that this paper has not been exploited in that way by them. I was expecting headlines such as

Evidence-based medicine is not supported by evidence

or

Less than 6% of all conventional treatments are supported by sound evidence.

etc.

Why did they not have a field day with this new paper then?

As the article is behind a paywall, it took me a while to get the full paper (thanks Paul). Now that I have read it, I think I understand the reason.

In the article, the authors provide figures for specific types of treatments. Let me show you some of the percentages of interventions that met the primary outcome (high quality, statistically significant effect, and authors interpret as effective):

  • pharmacological 73.8%
  • surgical 4.6%
  • exercise 5.8%
  • diet 1.2%
  • alternative 0.0%
  • manual therapies 0.0%

So, maybe the headlines should not be any of the above but:

No good evidence to support SCAM?

or

SCAM is destroying the evidence base of medicine.

 

In a previous post, I reported about the ‘biggest ever’, ‘history-making’ conference on integrative medicine. It turns out that it was opened by none other than Prince Charles. Here is what the EXPRESS reported about his opening speech:

Opening the conference, Charles said:

“I know a few people have seen this integrated approach as being in some way opposed to modern medicine. It isn’t. But we need to combine this with a personal approach that also takes account of our beliefs, hopes, culture and history. It builds upon the abilities of our minds and bodies to heal, and to live healthy lives by improving diet and lifestyle.”

Dr. Michael Dixon, Chair of the College of Medicine, said:

“Medicine, as we know it, is no longer affordable or sustainable. Nor is it able to curb the increase in obesity, mental health problems and most long-term diseases. A new medical mindset is needed, which goes to the heart of true healthcare. The advantages and possibilities of social prescription are limitless. An adjustment to the system now will provide a long-term, sustainable solution for the NHS to meet the ever-increasing demand for funding and healthcare professionals.”

_______________________

Charles very kindly acknowledges that not everyone is convinced about his concept of integrated/integrative medicine. Good point your royal highness! But I fear Charles did not quite understand our objections. In a nutshell: it is not possible to cure the many ills of conventional medicine by adding unproven and disproven therapies to it. In fact, it distracts from our duty to constantly improve conventional medicine. And pretending it is all about diet and lifestyle is simply not true (see below). Moreover, it is disingenuous to pretend that diet and lifestyle do not belong to conventional healthcare.

Dr. Dixon’s concern about the affordability of medicine is, of course, justified. But the notion that “the advantages and possibilities of social prescription are limitless” is a case of severe proctophasia, and so is Dixon’s platitude about ‘adjusting the system’. His promotion of treatments like AcupunctureAlexander TechniqueAromatherapyHerbal Medicine, Homeopathy, Hypnotherapy, Massage, Naturopathy, Reflexology, Reiki, Tai Chi, Yoga Therapy will not adjust anything, it will only make healthcare less efficient.

I do not doubt for a minute that doctors are prescribing too many drugs and that we could save huge amounts by reminding patients that they are responsible for their own health while teaching them how to improve it without pills. This is what we learn in medical school! All we need to do is remind everyone concerned. In fact, Charles and his advisor, Michael, could be most helpful in achieving this – but not by promoting a weird branch of healthcare (integrative/integrated medicine or whatever other names they choose to give it) that can only distract from the important task at hand.

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