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

fallacy

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On ‘healthline’, I came across an article entitled ‘What Does a Holistic Doctor Do?‘ which I found intriguing. It explained to me the
Principles of holistic medicine 

Holistic medicine is based on several core values:

  • good health is a combination of physical, emotional, mental, spiritual, and social wellness
  • prevention first, treatment second
  • disease is caused by a problem with the whole body, rather than a single event or body part
  • the goal of treatment is to fix the underlying cause of disease, instead of just improving the symptoms
  • treatment involves a wide range of options, including education, self-care, CAM, and traditional medicine
  • a person is not defined by their condition
  • the relationship between a doctor and the person being treated determines the treatment outcome
And after this overdose of misleading and somewhat annoying platitudes, the author addressed a question that I had been wondering about for years:
What does a holistic doctor do that a traditional doctor doesn’t?

Generally, traditional doctors treat symptoms. They provide medical solutions to alleviate a disease.

A holistic doctor treats the body as one. They aim to find the cause behind the disease, instead of just fixing the symptoms. This could require multiple therapies.

For example, if you have eczema, a medical doctor may give you a prescription cream. But a holistic doctor may suggest dietary and lifestyle changes. The holistic doctor might also recommend using the cream, plus natural home remedies like oatmeal baths.

So, now we know!

This could, of course, be just laughable if it were not perpetuating such common misconceptions. And as this sort of BS is so common, I feel obliged to carry on exposing it. Let me, therefore, correct the main errors in the short paragraph:

  1. ‘Traditional doctors’ are just doctors, proper doctors; holistic healers often give themselves the title ‘doctor’ but, unless they have been to medical school, they are not doctors.
  2. ‘Doctors treat symptoms’; yes, they do. But whenever possible, they treat the cause too. Therefore they do what is possible to identify the cause. And during the last 150 years or so, they have become reasonably good at this task.
  3. ‘A holistic doctor treats the body as one.’ That’s what they claim. But in reality, they are often not trained to do so. The body is mighty complex, and many holistic practitioners are simply not trained for coping with this complexity.
  4. ‘They aim to find the cause behind the disease’. They might well aim at that, but if they are not fully trained doctors, this is an impossible aim, and they merely end up finding what they have been taught about the cause of disease. An imbalance of Yin and Yang is the imagined cause of disease in TCM, and for many chiropractors, a subluxation is the cause of disease. But such assumptions are not facts; it is merely wishful thinking which get in the way of finding true causes of disease.
  5. Eczema happens to be a superb example (thank you ‘helpline’). The oatmeal bath of the holistic practitioner is at best a symptomatic treatment. This is why a proper doctor aims to find the cause of eczema which could be an allergy, for instance. Having identified it, the doctor would then advise how to avoid the allergen. If that is possible, further treatment might not be even necessary.

When practitioners are elaborating on their concept of holism, one often only needs to read on to find that those who pride themselves on holism are, in fact, the victims of multiple errors (or perhaps they use the holism gimmick only as a sales strategy, because consumers fall easily for this ‘bait and switch’). And those doctors who are accused of lacking holism are, in fact, more likely to be holistic than the so-called holists.

 

When I yesterday reported about Charles’ new paper in a medical journal, I omitted to go into any sort of detail. Merely mumbling ‘this is bait and switch‘ and ‘there is no good evidence that social prescribing is effective‘, is not good enough. Charles deserves better! That’s why today I provide a more detailed analysis of what he wrote on social prescribing.

Social prescribing is a concept that emerged in the UK more than a decade ago [1]. It aims to connect patients to different types of community support, including social events, fitness classes, and social services. Trained professionals, often called link workers or community connections, work with healthcare providers to offer referrals to these types of support. Social prescribing largely exists to fill in healthcare treatment gaps. The basic medical treatment cannot address every concern. Primary care providers don’t always have enough time to get to know their patients and understand the complete picture of their lives.

For example, loneliness can cause stress, which can eventually affect sleep, nutrition, and physical health. Doctors may not be able to offer much help for this problem. That’s where link workers step in. They can provide more specialized support if someone struggles to meet basic wellness or social needs. They get to know a patient’s unique needs and help you take action to meet those needs by referring him or her to helpful resources in the community.[2]

Charles elaborated on social prescribing (or social prescription, as he calls it for some reason) as follows [the numbers in square brackets were added me and refer to my comments below]:

… For a long time, I have been an advocate of what is now called social prescription and this may just be the key to integrating the biomedical, the psychosocial and the environmental, as well as the nature of the communities within which we live and which have such an enormous impact on our health and wellbeing [1]. In particular, I believe that social prescription can bring together the aims of the health service, local authorities, and the voluntary and volunteer sector. Biomedicine has been spectacularly successful in treating and often curing disease that was previously incurable. Yet it cannot hold all the answers, as witnessed, for instance, by the increasing incidence of long-term disease, antibiotic resistance and opiate dependence [2]. Social prescription enables medicine to go beyond pills and procedures and to recognise the enormous health impact of the lives we lead and the physical and social environment within which we live [3]. This is precisely why I have spent so many years trying to demonstrate the vitally important psychosocial, environmental and financial added value of genuinely, sustainable urban planning, design and construction [4].

There is research from University College London, for instance, which shows that you are almost three times more likely to overcome depression if you have a hobby [5]. Social prescription enables doctors to provide their patients with a bespoke prescription that might help them at a time of need …

When we hear that a quarter of 14–16-year-old girls are self-harming and almost a third of our children are overweight or obese, it should make us realise that we will have to be a bit more radical in addressing these problems [5]. And though social prescription cannot do everything, I believe that, used imaginatively, it can begin to tackle these deep-rooted issues [6]. As medicine starts to grapple with these wider determinants of health [7], I also believe that medicine will need to combine bioscience with personal beliefs, hopes, aspirations and choices [8].

Many patients choose to see complementary practitioners for interventions such as manipulation, acupuncture and massage [9]. Surely in an era of personalised medicine, we need to be open-minded about the choices that patients make and embrace them where they clearly improve their ability to care for themselves? [10] Current NHS guidelines on pain that acknowledge the role of acupuncture and mindfulness may lead, I hope, to a more fruitful discussion on the role of complementary medicine in a modern health service [11]. I have always advocated ‘the best of both worlds’ [12], bringing evidence-informed [13] conventional and complementary medicine together and avoiding that gulf between them, which leads, I understand, to a substantial proportion of patients feeling that they cannot discuss complementary medicine with their doctors [14].

I believe it is more important than ever that we should aim for this middle ground [15]. Only then can we escape divisions and intolerance on both sides of the conventional/complementary equation where, on the one hand, the appropriate regulation of the proven therapies of acupuncture and medical herbalism [15] is opposed while, on the other, we find people actually opposing life-saving vaccinations. Who would have thought, for instance, that in the 21st century that there would be a significant lobby opposing vaccination, given its track record in eradicating so many terrible diseases and its current potential to protect and liberate some of the most vulnerable in our society from coronavirus? [16] …

My comments are as follows:

  1. Is Charles not a little generous to his own vision? Social prescribing is not nearly the same as the concept of integrated medicine which he has been pushing for years.
  2. There is no good evidence that social prescribing will reduce ‘of long-term disease, antibiotic resistance, and opiate dependence’.
  3. Here Charles produces a classic ‘strawman fallacy’. Medicine is much more than pills and procedures, and I suspect he knows it (not least because he uses proper medicine as soon as he is really ill).
  4. Charles has not so much ‘demonstrated’ the importance of ‘psychosocial, environmental and financial added value of genuinely, sustainable urban planning, design, and construction’ as talked about it.
  5. That does not necessarily mean that social prescribing is effective; correlation is not causation!
  6. There is no good evidence that social prescribing is effective against self-harm or obesity.
  7. Medicine has been trying to grapple with ‘wider issues’ for centuries.
  8. Medicine has done that for many years but we always had to be mindful of the evidence base. It would be unwise to adopt interventions without evidence demonstrating that they do more good than harm.
  9. Many patients also choose to smoke, drink, or sky-dive. Patient choice is no indicator of efficacy or harmlessness.
  10. Yes, we should embrace them where they clearly improve their ability to care for themselves. However, the evidence all too often fails to show that they improve anything.
  11. As we have seen, this discussion has been going on for decades and was not always helped by Charles.
  12. The best of both worlds can only be treatments that demonstrably generate more good than harm – and that’s called evidence-based medicine. Or, to put it bluntly: in medicine ‘best’ does not signify royal approval.
  13. ‘Evidence-informed’ is an interesting term. Proper medicine thrives to be evidence-based; royal medicine merely needs to be ‘evidence-informed’? This new term seems to imply that evidence is not all that important. Why? Perhaps because, for alternative medicine, it is largely not based on good evidence?
  14. If we want to bridge the gulf, we foremost require sound evidence. Today, plenty of such evidence is available. The problem is that it does often not show what Charles seems to think it shows.
  15. Even the best regulation of nonsense must result in nonsense.
  16. The anti-vaccination sentiments originate to an alarmingly large extent from the realm of alternative medicine.[4]

REFERENCES

[1] Brandling J, House W. Social prescribing in general practice: adding meaning to medicine. Br J Gen Pract. (2009) 59:454–6. doi: 10.3399/bjgp09X421085

[2] Social Prescribing: Definition, Examples, and More (healthline.com)

[3] Schmidt K, Ernst E. MMR vaccination advice over the Internet. Vaccine. 2003 Mar 7;21(11-12):1044-7. doi: 10.1016/s0264-410x(02)00628-x. PMID: 12559777.

Physicians who include so-called alternative medicine (SCAM) in their practice are thought to have an understanding of health and disease different from that of colleagues practicing conventional medicine. The aim of this study was to identify and compare the thoughts and concepts concerning infectious childhood diseases (measles, mumps, rubella, chickenpox, pertussis, and scarlet fever) of physicians practicing homeopathic, anthroposophic and conventional medicine.

This qualitative study used semistructured interviews. Participating physicians were either general practitioners or pediatricians. Data collection and analysis were guided by a grounded theory approach.

Eighteen physicians were interviewed (6 homeopathic, 6 anthroposophic, and 6 conventional). All physicians agreed that while many classic infectious childhood diseases such as measles, mumps, and rubella are rarely observed today, other diseases, such as chickenpox and scarlet fever, are still commonly diagnosed. All interviewed physicians vaccinated against childhood diseases.

  • A core concern for physicians practicing conventional medicine was the risk of complications of the diseases. Therefore, it was considered essential for them to advise their patients to strictly follow the vaccination schedule.
  • Homeopathic-oriented physicians viewed acute disease as a biological process necessary to strengthen health, fortify the immune system and increase resistance to chronic disease. They tended to treat infectious childhood diseases with homeopathic remedies and administered available vaccines as part of individual decision-making approaches with parents.
  • For anthroposophic-oriented physicians, infectious childhood diseases were considered a crucial factor in the psychosocial growth of children. They tended to treat these diseases with anthroposophic medicine and underlined the importance of the family’s resources. Informing parents about the potential benefits and risks of vaccination was considered important.

All physicians agreed that parent-delivered loving care of a sick child could benefit the parent-child relationship. Additionally, all recognized that existing working conditions hindered parents from providing such care for longer durations of time.

The authors concluded that the interviewed physicians agreed that vaccines are an important aspect of modern pediatrics. They differed in their approach regarding when and what to vaccinate against. The different conceptual understandings of infectious childhood diseases influenced this decision-making. A survey with a larger sample would be needed to verify these observations.

The authors (members of a pro-SCAM research group) stress that the conventional physicians saw many risks in the natural course of classic childhood illnesses and appreciated vaccinations as providing relief for the child and family. By contrast, the physicians trained in homeopathy or anthroposophic medicine expected more prominent unknown risks because of vaccinations, due to suppression of the natural course of the disease. Different concepts of disease lead to differences in the perceptions of risk and the benefit of prevention measures. While prevention in medicine aims to eliminate classic childhood diseases, anthroposophic and homeopathic literature also describes positive aspects of undergoing these diseases for childhood development.

This paper thus provides intriguing insights into the bizarre thinking of doctors who practice homeopathy and anthroposophical medicine. The authors of the paper seem content with explaining and sometimes even justifying these beliefs, creeds, concepts, etc. They make no attempt to discuss the objective truths in these matters or to disclose the errors in the thought processes that underly homeopathy and anthroposophical medicine. They also tell us that ALL  the interviewed physicians vaccinated children. They, however, fail to provide us with information on whether these doctors all recommend vaccinations for all patients against all the named infectious diseases. From much of previous research, we have good reasons to fear that their weird convictions often keep them from adhering strictly to the current immunization guidelines.

 

On 10/1/2021 THE GUARDIAN reported about some bizarre anthroposophic treatments in Germany. About a month before, we had discussed the issue here on this blog. The GUARDIAN article prompted the following press release, dated 12/1/2021, by the ‘International Federation of Anthroposophic Medical Associations’ (oddly abbreviated IVAA):

IVAA welcomes the reporting by The Observer, a sister paper of The Guardian, on the care of Covid-19 patients in German anthroposophic hospitals, including critically ill patients in the intensive care ward. The article rightly highlights how these treatments are provided in addition to state-of-the-art conventional treatments, how anthroposophic medicine is fully integrated into the German health care system and how anthroposophy “enjoys a high level of social acceptance and institutional support in German-speaking countries”. The World Health Organization’s Traditional Medicine Strategy has indeed set integration of traditional and complementary medicine into health care systems as one of its strategic goals.

While the article is generally biased against anthroposophic medicine and only quotes two known opponents of anthroposophy, it nevertheless provides welcome reporting on integrative medicine that is highly popular with patients in Europe.

There are many peer-reviewed studies on anthroposophic medicine and anthroposophic medications have been in use for decades, showing an excellent safety profile. The Observer’s critique that patients should provide consent for such treatments does not hold because the treatments are not experimental, are provided in addition to standard care, based on long clinical experience and in hospitals openly publicizing their integrative medicine approach. As the article reports, German insurance companies pay flat-rate payments for hospital treatment of coronavirus patients; the additional anthroposophic treatments are thus financed out of hospital budgets and are cost-neutral for insurance companies.

Unfortunately, and as correctly reported by The Observer, individual supporters of anthroposophic medicine have sided with demonstrations against corona measures; this does in no way reflect the official position of anthroposophic medicine and IVAA member organizations have clearly distanced themselves.

END OF PRESS RELEASE

One does not need to be a champion in critical thinking to realize that this press release deserves a few comments.

  1. The claim that anthroposophic medicine (AM) is ‘fully integrated into the German healthcare system‘ is misleading. In Germany, AM belongs to the special therapeutic measures (‘besondere Therapierichtungen’) which indicates almost the opposite of ‘fully integrated’.
  2. Similarly, AM is not ‘highly accepted’ but belongs to the fringe of so-called alternative medicine (SCAM). There are only very few anthroposophic hospitals in Germany, and most Germans would not even know what AM is.
  3. The press release claims that ‘there are many peer-reviewed studies on anthroposophic medicine‘. The link it provides leads to an AM organization’s list of references. For infections, this list references the following 9 papers:  (1) Martin DD. Fever: Views in Anthroposophic Medicine and their Scientific Validity. Evid Based Complement Alternat Med. 2016;2016(1):13 pages.(2) Soldner G, Stellman HM. Individual Paediatrics: Physical, Emotional and Spiritual Aspects of Diagnosis and Counseling – Anthroposophic-homeopathic Therapy, Fourth edition. 4 edition. CRC Press; 2014. 984 S. (3) Glöckler M, Goebel W. A Guide to Child Health: A Holistic Approach to Raising Healthy Children. Floris Books; 2013. (4) Goebel MW, Michael MK, Glöckler MM. Kindersprechstunde: ein medizinisch-pädagogischer Ratgeber. Verlag Urachhaus; 2016. (5) Szoeke H, Marodi M, Sallay Z, Székely B, Sterner M-G, Hegyi G. Integrative versus Conventional Therapy of Chronic Otitis Media with Effusion and Adenoid Hypertrophy in Children: A Prospective Observational Study. Forsch KomplementärmedizinResearch Complement Med. 2016;23(4):231–239. (6) Hamre HJ, Glockmann A, Schwarz R, Riley DS, Baars EW, Kiene H, u. a. Antibiotic use in children with acute respiratory or ear infections: prospective observational comparison of anthroposophic and conventional treatment under routine primary care conditions. Evid Based Complement Alternat Med. 2014;2014(Article ID 243801). (7) Hamre HJ, Fischer M, Heger M, Riley D, Haidvogl M, Baars E, u. a. Anthroposophic vs. conventional therapy of acute respiratory and ear infections. Wien Klin Wochenschr. 2005;117(7–8):256–268. (8) Hamre HJ, Glockmann A, Fischer M, Riley DS, Baars E, Kiene H. Use and Safety of Anthroposophic Medications for Acute Respiratory and Ear Infections: A Prospective Cohort Study. Drug Target Insights. 14. September 2007;2:209–19. (9) Jeschke E, Lüke C, Ostermann T, Tabali M, Huebner J, Matthes H. Verordnungsverhalten anthroposophisch orientierter Ärzte bei akuten Infektionen der oberen Atemwege. Forsch KomplementärmedizinResearch Complement Med. 2007;14(4):207–215.                                                                       These are mostly NOT peer-reviewed papers, and none yields anything close to conclusive findings about the alleged efficacy of AM treatments. The truth is that there is no good evidence to support AM.
  4.  The mention that AM remedies have been used for decades is a fallacy (appeal to tradition).
  5.  Yes, AM remedies are safe – mainly because they, like homeopathic remedies, usually contain no active ingredients.
  6.  Patients should provide consent for such treatments to ALL treatments, experimental or not.
  7. Clinicians practicing AM have long been known to hold an anti-vax attitude which has also caused problems in the past.

My conclusion: this press release was written in true anthroposophic style and spirit: ill-informed, in disregard of medical ethics, based on wishful thinking and aimed at misleading the public.

So sorry, I have been neglecting THE ALTERNATIVE MEDICINE HALL OF FAME of late. I was reminded of its existence when writing my post about Adrian White the other day. Reading the kind comments I received on it, I not only decided to make Adrian an honorary member (for his latter part of his career as an acupuncture researcher, but also to reactivate the idea of the HALL OF FAME in more general terms. And in the course of doing just this, I noticed that I somehow forgot to admit Prof Michael Frass, an omission which I regret and herewith rectify. A warm welcome to both!

In case you are unaware what THE ALTERNATIVE MEDICINE HALL OF FAME is, let me explain: it is a group of researchers who manage to go through (part of) their professional life researching their particular SCAM without ever publishing a negative conclusion about it, or who have other outstanding merits in misleading the public about so-called alternative medicine (SCAM). As of today, we thus have the following experts in the HALL:

Adrian White (acupuncturist, UK)

Michael Frass (homeopath, Austria)

Jens Behnke (research officer, Germany)

John Weeks (editor of JCAM, US)

Deepak Chopra (entrepreneur, Us)

Cheryl Hawk (US chiropractor)

David Peters (osteopathy, homeopathy, UK)

Nicola Robinson (TCM, UK)

Peter Fisher (homeopathy, UK)

Simon Mills (herbal medicine, UK)

Gustav Dobos (various, Germany)

Claudia Witt (homeopathy, Germany and Switzerland)

George Lewith (acupuncture, UK)

John Licciardone (osteopathy, US)

I must say, this is an assembly of international SCAM experts to be proud of – even if I say so myself!

The new member I am proposing to admit today is Dr Jenice Pellow. She is a lecturer in the Department of Complementary Medicine at the University of Johannisburg and already once featured on this blog. But now it seems time to admit this relatively little-known researcher into my HALL OF FAME. Dr Pellow has 11 Medline-listed papers on so-called alternative medicine (SCAM). Allow me to show you some key findings from their abstracts:

  1. Complementary and alternative medicine (CAM) offers parents various treatment options for this condition [ADHD], including dietary modifications, nutritional supplementation, herbal medicine, and homeopathy. CAM appears to be most effective when prescribed holistically and according to each individual’s characteristic symptoms.
  2. The homeopathic medicine reduced the sensitivity reaction of cat allergic adults to cat allergen, according to the SPT. Future studies are warranted to further investigate the effect of Cat saliva and Histaminum and their role as a potential therapeutic option for this condition.
  3. Findings suggest that daily use of the homeopathic complex does have an effect over a 4-wk period on physiological and cognitive arousal at bedtime as well as on sleep onset latency in PI sufferers. Further research on the use of this complex for PI is warranted before any definitive conclusions can be drawn.
  4. The homeopathic complex used in this study exhibited significant anti-inflammatory and pain-relieving qualities in children with acute viral tonsillitis. No patients reported any adverse effects. These preliminary findings are promising; however, the sample size was small and therefore a definitive conclusion cannot be reached. A larger, more inclusive research study should be undertaken to verify the findings of this study.
  5. results suggest the homeopathic complex, together with physiotherapy, can significantly improve symptoms associated with CLBP due to OA.
  6. This small study showed the potential benefits of individualized homeopathic treatment of binge eating in males, decreasing both the frequency and severity of binging episodes. 
  7. There have been numerous trials and pharmacological studies of specific herbal preparations related to the treatment of low sexual desire.
  8. Most of the evaluated medicinal plants showed evidence of efficacy in relieving menstrual pain in at least one RCT.
  9. Results indicated that most participants made use of both complementary and conventional medicines for their infant’s colic; the most commonly used complementary medicine products were homeopathic remedies, probiotics and herbal medicines.
  10. Promising evidence for the following single supplements were found [for allergic rhinitis]: apple polyphenols, tomato extract, spirulina, chlorophyll c2, honey, conjugated linoleic acid, MSM, isoquercitrin, vitamins C, D and E, as well as probiotics. Combination formulas may also be beneficial, particularly specific probiotic complexes, a mixture of vitamin D3, quercetin and Perilla frutescens, as well as the combination of vitamin D3 and L. reuteri. 
  11. Despite a reported lack of knowledge regarding complementary medicine and limited personal use, participants had an overall positive attitude towards complementary medicine. 

I admit that 11 papers in 7 years is not an overwhelming output for a University lecturer. However, please do consider the fact that all of them – particularly the ones on homeopathy which is be the particular focus of Jenice (after all, she is a homeopath) – chime a happy tune for SCAM. I therefore think that Jenice should be admitted to THE ALTERNATIVE MEDICINE HALL OF FAME and hope you agree.

Welcome to  ALTERNATIVE MEDICINE HALL OF FAME, Jenice!

As though the UK does not have plenty of organisations promoting so-called alternative medicine (SCAM)! Obviously not – because a new one is about to emerge.

In mid-January, THE COLLEGE OF MEDICINE AND INTEGRATED HEALTH (COMIH) will launch the Integrated Medicine Alliance bringing together the leaders of many complementary health organisations to provide patients, clinicians and policy makers with information on the various complementary modalities, which will be needed in a post COVID-19 world, where:

  1. patient choice is better respected,
  2. requirements for evidence of efficacy are more proportionate to the seriousness of the disease and the safety of the intervention,
  3. and where benefit versus risk are better balanced.

We already saw this in 2020 with the College advocating from the very beginning of the year that people should think about taking Vitamin D, while the National Institute for Clinical Excellence continued to say the evidence was insufficient, but the Secretary of State has now supported it being given to the vulnerable on the basis of the balance between cost, benefit and safety.

Elsewhere we learn more about the Integrated Medicine Alliance (IMA):

The IMA is a group of organisations and individuals that have been brought together for the purpose of encouraging and optimising the best use of complementary therapies alongside conventional healthcare for the benefit of all.

The idea for this group was conceived by Dr Michael Dixon in discussion with colleagues associated with the College of Medicine, and the initial meeting to convene the group was held in February 2019.

The group transitioned through a number of titles before settling on the ‘Integrated Medicine Alliance’ and began work on developing a patient leaflet and a series of information sheets on the key complementary therapies.

It was agreed that in the first instance the IMA should exist under the wing of the College of Medicine, but that in the future it may develop into a formal organisation in its own right, but inevitably maintaining a close relationship with the College of Medicine.

The IMA also offers ‘INFORMATION SHEETS’ on the following modalities:

I find those leaflets revealing. They tell us, for example that the Reiki practitioner channels universal energy through their hands to help rebalance each of the body’s energy centres, known as chakras. About homeopathy, we learn that a large corpus of evidence has accumulated which stands the most robust tests of modern science. And about naturopathy, we learn that it includes ozone therapy but is perfectly safe.

Just for the fun of it – and free of charge – let me try to place a few corrections here:

  • Reiki healers use their hands to perform what is little more than a party trick.
  • The universal energy they claim to direct does not exist.
  • The body does not have energy centres.
  • Chakras are a figment of imagination.
  • The corpus of evidence on homeopathy is by no means large.
  • The evidence is flimsy.
  • The most robust tests of modern science fail to show that homeopathy is effective beyond placebo.
  • Naturopathy is a hotchpotch of treatments most of which are neither natural nor perfectly safe.

One does wonder who writes such drivel for the COMIH, and one shudders to think what else the IMA might be up to.

I often hear that my ambitions to inform the public and inspire critical thinking are hopeless: there are simply too many quacks trumpeting nonsense, and their collective influence is surely bigger than mine. This can be depressing, of course. And because I often feel that I am fighting an unwinnable battle, stories like this are so importand and up-lifting.

Denby Royal was a ‘holistic nutritionist’, then she became a critic of so-called alternative medicine (SCAM). Here is the story about her transformation:

… I had gone to holistic nutrition school. I was running my own nutrition consulting business. And suddenly I didn’t believe in any of it anymore. How did this flip flop come to pass?

… As a holistic nutritionist, I was an active participant in what I now consider alternative medicine tomfoolery, specifically pushing supplements on a clientele of the “worried well” who often mistook wellness enthusiasts like me for medical experts. I want to be clear that I wasn’t knowingly deceiving anyone—I really did believe in the solutions I was offering my clients… To holistic nutrition enthusiasts and people who believe in a certain kind of alt wellness, these “natural” and “holistic” products seem more trustworthy than what mainstream medicine offers. The truth is, they often lack sufficient, peer-reviewed, reliable scientific evidence of their supposed effectiveness.

Did I have rock-solid evidence that these products would do what their labels promised they would do? Not really. Sure, I read studies here and there that found specific health benefits for some of the products. But I rarely mentioned the fine print (if I knew it at all)—that the sample sizes of many of these studies often were so small that the results couldn’t be generalized to a larger population, that the studies’ authors sometimes noted that more research was needed to support any findings on the effects they found, or that systematic reviews later found that many studies were poorly constructed or at risk for bias, making their findings even less compelling than they seemed initially. And in some cases, study authors themselves note that their findings are merely jumping off points, and that more long-term studies are needed in order to draw more solid conclusions…

Was I relying on strong, valid evidence? Nah, not really. But at the time, I thought what I had was better than strong evidence: Faith in a lifestyle and a dogmatic belief that all things traditional and mainstream were unhealthy or harmful, and therefore, that all things unconventional and alternative were curative and would bring about “wellness.”

In an effort to expand my product knowledge I researched a lot of the different supplements available. I was using all the best bias-confirming websites where other homeopathic medicine enthusiasts evangelized their favorite remedies, their enthusiasm and insistence, and anecdotal evidence standing in for what typically shows us that a product is safe and effective—clinical trials and FDA approval.

When their arguments and reasoning started to sink in, I realized that my faith in the healing powers of supplements may have been overzealous at best, unfounded at worst. My world crumbled like a piece of raw gluten-free paleo cheesecake. It started to sink in: Where there was a morsel of convincing medical information blended with enough compelling nonsense and communicated with enough conviction, I believed it, hook, line, and sinker.

When I started to notice the holes in the fabric of holistic nutrition, the fabric looked, well, pretty threadbare. I subsequently disconnected from social media and distanced myself from the entire culture. I took a good look at how I was personally and publicly communicating my relationships with food and wellness. After spending my twenties experimenting with all kinds of specialty diets, I was left feeling exhausted, anxious, underweight, overweight, and fed-up.

And so that last domino fell when I took away the thing that was propping it up for me: social media. Instagram is a playground for wellness influencers, including, at the time, me. My Instagram account was the best way to advertise my nutrition consulting business, so maintaining a certain persona there felt completely crucial to my success, and eventually, my identity. It was a world full of beautifully curated accounts of thin yogis gathering wild herbs in nature or making raw desserts with ingredients that cost more than my entire monthly food budget. I started to feel like the alternative wellness community I was part of—myself included—was an echo chamber, where we stockpiled likes and positive comments to build a wall that would keep out ideas that challenged our status quo. In fact, the more reassurance I received from my online community, the harder I believed in our gospel.

As I was disentangling my beliefs from everything I was learning by looking at the actual evidence, I realized that my education to become a holistic nutritionist hadn’t prepared me to understand health and wellness as completely and comprehensively as I’d once thought. Sure, I’d spent a some time studying the pathology of disease, and a little longer learning about how each bodily system works to get your human suit from point A to point B, but I am only slightly closer to being a medical professional than I am to becoming a professional cricket player. First of all, in total, my entire formal education as a holistic nutritionist was 10 months long. Second of all, that education was intended to complement—not replace—traditional medical treatment. But as soon as I finished the program, I could immediately start taking on clients. And lots of potential clients out there are just like the way I used to be—wishing they looked or felt different and in search of the panacea, willing (if not eager) to defer to an expert.

There may have been many people willing to look to me as an expert, but here’s the thing: in my school, there were no residency or clinical hours required to prepare us for the real world or to take on clients—unlike dietitians here in Canada, who must obtain a bachelor’s degree in Nutritional and Food Sciences, qualify to complete a rigorous post-degree internship program and register with a provincial dietetics organization, or get a master’s degree. We received a certificate, and that was that. It was a credential that wholeheartedly fell short of resembling anything close to making me an authority on the subject of health as it relates to food and diet. But most people in the general public can’t be expected to understand the ins and outs of how experts are credentialed and licensed—many of us assume that someone calling themselves something that we associate with authority is, in fact, an authority we can trust.

The brief education that I received to become a holistic nutritionist did provide me with valuable stepping stones and a general understanding of how the body works. My program discouraged students from saying “treat,” “heal,” “prevent,” or “cure.” Generally speaking holistic nutrition programs don’t provide the training and medical education that registered dietitians receive, which enables them to give sound, ethical medical nutrition advice, nor are they required by law, the way dietitian programs are, to provide it. In fact, in 2015 graduates of the Canadian School of Natural Nutrition were barred from identifying as Registered Holistic Nutritionists, and since then must use the title “Holistic Nutritional Consultant.”

… With what I do have from my classroom education, I can analyze a lifestyle that needs some fine-tuning and provide guidance on how to structure a solid meal plan. That’s about it. After years of self-diagnosis and hashtagging all my fad-diet escapades (for this, I greatly apologize to all those I have alienated with my profuse self-righteousness), I can at least say I have a deep appreciation for those who are actually on the front lines in the fight against unproven medical remedies and the potential damage it may do to those who use it to the exclusion of traditional medicine.

The influence of these remedies is not harmless, and I have seen firsthand in many different examples and situations how it can lure people away from real, evidence-based help in their times of need. I am fortunate enough that within my practice I had enough foresight to turn away individuals who required more guidance than I was capable of giving. But along the way I made many embarrassing and conjectural recommendations. Like I said, I was far from knowingly deceiving anyone. I firmly held the belief that alternative medicine, no matter the cost, was an investment in a healthful future. My own medicine cabinet, an arsenal full of supplements, tincture, and powders, was a personal testament to how deeply I was devoted to holistic nutrition.

This essay is a firm farewell from a world I disconnected from long ago. The person that over years I let myself become through naiveté, not doing my own research, and a misguided desire to be different. So here I am now, officially having left the church of woo, bidding the world of alternative health adieu.

_________________________________

Reading Denby’s account, I was reminded of many themes we have previously discussed on this blog. One issue that perhaps needs more focus is this notion:

I was far from knowingly deceiving anyone.”

I have not yet met a SCAM practitioner who says:

“I am in the business of  deceiving my patients.”

The reasons for this are simple:

  1. if they knowingly deceive, they would not tell us,
  2. and if they don’t know that they are deciving their patients, they cannot possibly admit to it.

The way Denby repeatedly assures us that she was far from knowingly deceiving anyone sounds charmingly naive and is, in my experience, very typical for SCAM practitioners. It depicts them as honorable people. Yet, in actual fact, it is neither charming nor honorable. It merely demonstrates the fact that they were perhaps not ruthlessly dishonest but all the more dangerous.

Let me explain this with a deliberately extreme example:

  • A man with a chronic condition – say type 2 diabetes – consults a SCAM practitioner who is knowingly deceiving him claiming that her SCAM effectively treats his condition. The patient follows the advice but, since he is not totally convinced (deception is rarely perfect), consults his doctor who puts him straight. This patient will therefore survive.
  • The same chap consults a SCAM practitioner who is deeply convinced of the effectiveness of her SCAM and thus not knowingly deceiving her patient when she claims that it is effective for his diabetes. Her conviction is so strong that the patient blindly believes her. Thus he stops his conventional medication and hopes for the best. This patient could easily die.

In a nutshell:

‘Honest’ conviction might render a quack more socially acceptable but also more dangerous to her patients.

 

There are of course 2 types of osteopaths: the US osteopaths who are very close to real doctors, and the osteopaths from all other countries who are practitioners of so-called alternative medicine. This post, as all my posts on this subject, is about the latter category.

I was alerted to a paper entitled ‘Osteopathy under scrutiny’. It goes without saying that I thought it relevant; after all, scrutinising so-called altermative medicine (SCAM), such as osteopathy is one of the aims of this blog. The article itself is in German, but it has an English abstract:

Osteopathic medicine is a medical specialty that enjoys a high level of recognition and increasing popularity among patients. High-quality education and training are essential to ensure good and safe patient treatment. At a superficial glance, osteopathy could be misunderstood as a myth; accurately considered, osteopathic medicine is grounded in medical and scientific knowledge and solid theoretical and practical training. Scientific advances increasingly confirm the empirical experience of osteopathy. Although more studies on its efficacy could be conducted, there is sufficient evidence for a reasonable application of osteopathy. Current scientific studies show how a manually executed osteopathic intervention can induce tissue and even cellular reactions. Because the body actively responds to environmental stimuli, osteopathic treatment is considered an active therapy. Osteopathic treatment is individually applied and patients are seen as an integrated entity. Because of its typical systemic view and scientific interpretation, osteopathic medicine is excellently suited for interdisciplinary cooperation. Further work on external evidence of osteopathy is being conducted, but there is enough knowledge from the other pillars of evidence-based medicine (EBM) to support the application of osteopathic treatment. Implementing careful, manual osteopathic examination and treatment has the potential to cut healthcare costs. To ensure quality, osteopathic societies should be intimately involved and integrated in the regulation of the education, training, and practice of osteopathic medicine.

This does not sound as though the authors know what scutiny is. In fact, the abstract reads like a white-wash of quackery. Why might this be so? To answer this question, we need to look no further than to the ‘conflicts of interest’ where the authors state (my translation): K. Dräger and R. Heller state that, in addition to their activities as further education officers/lecturers for osteopathy (Deutsche Ärztegesellschaft für Osteopathie e. V. (DÄGO) and the German Society for Osteopathic Medicine e. V. (DGOM)) there are no conflicts of interest.

But, to tell you the truth, the article itself is worse, much worse that the abstract. Allow me to show you a few quotes (all my [sometimes free] translations).

  • Osteopathic medicine is a therapeutic method based on the scientific findings from medical research.
  • [The osteopath makes] diagnostic and therapeutic movements with the hands for evaluating limitations of movement. Thereby, a blocked joint as well as a reduced hydrodynamic or vessel perfusion can be identified.
  • The indications of osteopathy are comparable to those of general medicine. Osteopathy can be employed from the birth of a baby up to the palliative care of a dying patient.
  • Biostatisticians have recognised the weaknesses of RCTs and meta-analyses, as they merely compare mean values of therapeutic effects, and experts advocate a further evidence level in which statictical correlation is abandonnened in favour of individual causality and definition of cause.
  • In ostopathy, the weight of our clinical experience is more important that external evidence.
  • Research of osteopathic medicine … the classic cause/effect evaluation cannot apply (in support of this statement, the authors cite a ‘letter to the editor‘ from 1904; I looked it up and found that it does in no way substantiate this claim)
  • Findings from anatomy, embryology, physiology, biochemistry and biomechanics which, as natural sciences, have an inherent evidence, strengthen in many ways the plausibility of osteopathy.
  • Even if the statistical proof of the effectiveness of neurocranial techniques has so far been delivered only in part, basic research demonstrates that the effects of traction or compression of bogily tissue causes cellular reactions and regulatory processes.

What to make of such statements? And what to think of the fact that nowhere in the entire paper even a hint of ‘scrutiny’ can be detected? I don’t know about you, but for me this paper reflects very badly on both the authors and on osteopathy as a whole. If you ask me, it is an odd mixture of cherry-picking the evidence, misunderstanding science, wishful thinking and pure, unadulterated bullshit.

You urgently need to book into a course of critical thinking, guys!

We are all prone to fall victim to the ‘post hoc ergo propter hoc’ fallacy. It describes the erroneous assumption that something that happened after an event was cased by that event. The fallacy is essentially due to confusing correlation with causation:

  • the sun does not rise because the rooster has crowed;
  • yellow colouring of the 2nd and 3rd finger of a smoker is not the cause of lung cancer;
  • some children developing autism after vaccinations does not mean that autism is caused by vaccination.

As I said, we are all prone to this sort of thing, even though we know better. Scientists, journal editors and reviewers of medical papers, however, should not allow themselves to be fooled by overt cases of the ‘post hoc ergo propter hoc’ fallacy. And if they do, they have lost all credibility – just like the individuals involved in a recent paper on animal homeopathy.

Pododermatitis in penguins usually occurs after changes in normal activity that result from being held captive. It is also called ‘bumlefoot’ (which fails to reflect the seriousness of the condition) and amounts to one of most frequent and important clinical complications in penguins kept in captivity or in rehabilitation centres.

This veterinary case study reports the use of oral homeopathic treatment on acute and chronic pododermatitis in five Magellanic penguins in a zoological park setting. During treatment, the patients remained in the penguins’ living area, and the effect of the treatment on the progression of their lesions was assessed visually once weekly. The treatment consisted of a combination of Arnica montana and Calcarea carbonica.

After treatment, the appearance of the lesions had noticeably improved: in the majority of penguins there was no longer evidence of infection or edema in the feet. The rate of recovery depended on the initial severity of the lesion. Those penguins that still showed signs of infection nevertheless exhibited a clear diminution of the size and thickness of the lesions. Homeopathic treatment did not cause any side effects.

The authors concluded that homeopathy offers a useful treatment option for pododermatitis in captive penguins, with easy administration and without side effects.

So, the homeopathic treatment happened before the recovery and, according to the ‘post hoc ergo propter hoc’ fallacy, the recovery must have been caused by the therapy!

I know, this is a tempting conclusion for a lay person, but it is also an unjustified one, and the people responsible for this paper are not lay people. Pododermitis does often disappear by itself, particularly if the hygenic conditions under which the penguins had been kept are improved. In any case, it is a potentially life-threatening condition (a bit like an infected bed sore in an immobilised human patient) that can be treated, and one should certainly not let a homeopath deal with it.

I think that the researchers who wrote the article, the journal editor who accepted it for publication, and the referees who reviewed the paper should all bow their heads in shame and go on a basic science course (perhaps a course in medical ethics as well) before they are let anywhere near research again.

Prof. Shailendra Ramchandra Vishampayan is the 1st author of the paper we discussed yesterday. He was kind enough to repeatedly join us in the comments section, and I was therefore keen to learn more about him. On his website, he says about himself that he is a renowned academician and famous homeopath, enriched with decades of ideal experiences and quality services. He is registered medical practitioner (M.D), performs all the duties of registered medical practitioner following the law of land in India. Globally he is considered as homeopath and known as “Dr.V”. He is a registered member of Society of Homeopaths (overseas).

Dr. V, is a practicing homeopath with clinical experience of over 20 years. In course of his years of practice he had successfully helped more than 250 happy families globally, with various kinds of cases like thyroid, immune compromised, epilepsy, endocrine disorders, paediatric, gynaecological disorders addictions, psychiatric disorder, children with special needs, pets and plants.

He is famous for his path breaking concept and novel idea of creating an organization called ‘Folk Homeopathy ‘, which is dedicated to professional enrichment of homeopathic practitioners helping them to improve their clinical acumen with spot on prescription.

His practical approach in solving cases has earned him accolades and fame throughout the globe.

Dr. V is the author of ‘Kinder Garten Materia Medica’ a reference book for beginners widely used by homeopathic students in India. It is a book with unique combination of pictorial and pneumonic.

He is a Professor (PG) at D.Y.Patil Homeopathy Medical College (Pune). He has a teaching experience of over 16 years in teaching UG and PG. He has drawn large number of followers through webinars which is accessible throughout the globe. He has given more than 50 international seminar ,workshops and webinars in countries like USA, Ireland, Malaysia, with presentations on Homeopathic approach to female hormonal imbalance cases at OMICS Conference of Alternative Medicine, presentation on Psychiatric cases at Asian Homeopathic League. And various presentation at University of Cyberjaya, Malaysia, California Homeopathic Medical society, San Diego and also at Corte Madera, 98th FOH Congress, Liverpool and Kinvara Co Galway, Ireland.

And on the same site, we also learn that ‘Dr V’ is particularly adept at treating diabetes:

India is now considered as the diabetes capital of the world. Approximately 8.7 percent of Indians between the age of 20 to 70 years are diabetic. This translates to approximately 62.5 million diabetics living in India, according to estimates by the World Health Organisation (W.H.O.) The economic burden of managing this disease is also substantial since this is a combination of cost of treatment and loss of productivity in such a high number of diabetics. Diabetes can affect multiple organ systems resulting in a wide range of serious issues in patients. Many of these complications in a diabetic do not have any specific treatment with conventional medicines. However, an indication of the popularity of homeopathy amongst diabetics is that the doctors at our clinic treat approximately two hundred cases of diabetes or diabetes related issues every day. We have, in fact, developed specific diabetes management protocols for patients based on the experience of thousands of cases we have seen over four decades.

This is interesting, I thought, and conducted a few Medline searches to see whether there is any evidence to show that homeopathy is an effective therapy for diabetes. I am afraid, I found no papers of ‘Dr V’ to suggest such an effect. But what I did find was certainly fascinating.

Last year, Italian diabetologists published an review entitled ‘Alternative treatment or alternative to treatment? A systematic review of randomized trials on homeopathic preparations for diabetes and obesity‘. Here is what they reported:

The searches failed to retrieve any trial comparing homeopathic remedies with placebo or any active drug for the treatment of either diabetes or obesity.

These authors commented that

… if homeopathy is used as an alternative to available and effective treatments, the consequences can be catastrophic, particularly in some conditions such as insulin-requiring diabetes. In conclusion, there is no scientific evidence on efficacy and no demonstration of safety of homeopathy in diabetes and obesity…

I agree with my Italian colleagues and I have previously expressed this view bluntly; I even entitled one of my posts ‘This is how homeopathy could kill millions‘.

‘Dr V’ will probably point out that he is a fully qualified doctor and uses homeopathy merely as an adjunct to conventional anti-diabetic treatments; thus he kills nobody.

I certainly hope this is so! But, even in this case, I must still ask: WHERE IS THE EVIDENCE THAT HOMEOPATHY IS AN EFFECTIVE ADJUNCT TO CONVENTIONAL MEDICINE?

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