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

fallacy

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

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

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

Let me just mention a few fairly obvious points:

My conclusion:

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

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

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

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

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

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

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

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

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

PS

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

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

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

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

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

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

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

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

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

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

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

___________________________

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

 

PS

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

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

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

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

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

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

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

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

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

Sea change?

Really?

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

Dear ‘BEYOND PILLS All Parliamentary Group

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

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

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

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

Sincerely

Edzard Ernst

 

 

PS

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

On this blog, we had more than our fair share of comments from the anti-vax clan. This article asked a question that I have often been pondering:

How to convince the unvaccinated proportion of the population of the benefits of a vaccination?

Designing more successful communication strategies, both in retrospect and looking ahead, requires a differentiated understanding of the concerns of those that remain unvaccinated. Guided by the elaboration likelihood model, this paper has two objectives: First, it explores by means of a latent class analysis how unvaccinated individuals might be characterized by their attitudes towards COVID-19 vaccination. Second, the researchers investigate to what extent (i) varying types of evidence (none/anecdotal/statistical) can be employed by (ii) different types of communicators (scientists/politicians) to improve vaccination intentions across these subgroups. To address these questions, the authors conducted an original online survey experiment among 2145 unvaccinated respondents from Germany where a substantial population share remains unvaccinated.

The results suggest three different subgroups, which differ regarding their openness towards a COVID-19 vaccination:

  • vaccination opponents (N = 1184),
  • sceptics (N = 572)
  • those in principle receptive (N = 389) to be vaccinated.

On average, neither the provision of statistical nor anecdotal evidence increased the persuasiveness of information regarding the efficacy of a COVID-19 vaccine. However, scientists were, on average, more persuasive than politicians (relatively increase vaccination intentions by 0.184 standard deviations). With respect to heterogeneous treatment effects among the three subgroups, vaccination opponents seem largely unreachable, while sceptics value information by scientists, particularly if supported by anecdotal evidence (relatively increases intentions by 0.45 standard deviations). Receptives seem much more responsive to statistical evidence from politicians (relatively increases intentions by 0.38 standard deviations).

According to the authors, these insights suggest that, in the short term, receptives and sceptics are the most promising target groups for vaccination campaigns. Yet, in the medium term, opponents need not be forgotten. While mandatory vaccinations may appear as the only strategy to target strict vaccination opponents, politicians and researchers are advised to focus on ways how to rebuild trust and address beliefs in misinformation within this population group. The inconsistency in vaccine related communication has led to a loss of trust in political and scientific decision-makers. It is therefore important to rebuild this trust through evidence-based communication. The way we understand and perceive the credibility of a source significantly impacts our processing of messages and can also significantly affect related behaviours. Using evidence to validate relevant and reliable information can therefore also be vital to build trust and credibility in the vaccines themselves and their safety.

The authors concluded that our study employed sociopsychological theory to challenge the view of the existence of a single homogeneous group of unvaccinated citizens. By drawing on a large sample of unvaccinated citizens and combining latent class analysis with experimental methods, we encourage decision-makers to carefully consider heterogeneities in the effectiveness of their communication strategies, especially regarding their communicator and employed evidence type.

In many parts of the world, vaccination rates have been declining in recent years.

Why?

This study aimed to determine the rates and reasons for parental hesitancy or refusal of vaccination for their children in Türkiye. A total of 1100 participants selected from 26 regions of Türkiye were involved in this cross-sectional study conducted between July 2020 and April 2021. Using a questionnaire, the researchers collected data on:

  • the sociodemographic characteristics of parents,
  • the status of vaccine hesitancy or refusal for their children,
  • the reasons for the hesitancy or refusal.

Using Excel and SPSS version 22.0, they analysed the data with chi-square test, Fisher’s exact test and binomial logistic regression.

Only 9.4% of the participants were male and 29.5% were aged 33-37 years. Just over 11% said they were worried about childhood vaccination, mainly because of the chemicals used in manufacturing the vaccines. The level of concern was greater among those who:

  • got information about vaccines from the internet, family members, friends, TV, radio, and newspapers,
  • used so-called alternative medicine (SCAM).

The authors concluded that parents in Türkiye have several reasons for hesitating or refusing to vaccinate their children, key among which are concerns about the chemical composition of the vaccines and their ability to trigger negative health conditions such as autism. This study used a large sample size across Türkiye, although there were differences by region, the findings would be useful in designing interventions to counter vaccine hesitancy or refusal in the country.

The fact that SCAM users are more likely to be against vaccinations has been reported often and on this blog we have discussed such findings regularly, e.g.:

The questinon I ask myself is, what is the cause and what the effect? Does vaccination hesitancy cause people to use SCAM, or does SCAM use cause vaccination hesitancy? I think that most likely both is true. In addition the two are linked via a common trait, namely that of falling for conspiracy theories. We know that someone believeing in one such theory is likely to believe in other such notions as well. In my view, both vaccination heaitancy and SCAM can qualify to be called a conspiracy theory.

According to chiropractic belief, vertebral subluxation (VS) is a clinical entity defined as a misalignment of the spine affecting biomechanical and neurological function. The identification and correction of VS is the primary focus of the chiropractic profession. The purpose of this study was to estimate VS prevalence using a sample of individuals presenting for chiropractic care and explore the preventative public health implications of VS through the promotion of overall health and function.

A brief review of the literature was conducted to support an operational definition for VS that incorporated neurologic and kinesiologic exam components. A retrospective, quantitative analysis of a multi-clinic dataset was then performed using this operational definition.

The operational definition used in this study included:

  • (1) inflammation of the C2 (second cervical vertebra) DRG,
  • (2) leg length inequality,
  • (3) tautness of the erector spinae muscles,
  • (4) upper extremity muscle weakness,
  • (5) Fakuda Step test,
  • radiographic analysis based on the (6) frontal atlas cranium line and (7) horizontal atlas cranium line.

Descriptive statistics on patient demographic data included age, gender, and past health history characteristics. In addition to calculating estimates of the overall prevalence of VS, age- and gender-stratified estimates in the different clinics were calculated to allow for potential variations.

A total of 1,851 patient records from seven chiropractic clinics in four states were obtained. The mean age of patients was 43.48 (SD = 16.8, range = 18-91 years). There were more females (n = 927, 64.6%) than males who presented for chiropractic care. Patients reported various reasons for seeking chiropractic care, including, spinal or extremity pain, numbness, or tingling; headaches; ear, nose, and throat-related issues; or visceral issues. Mental health concerns, neurocognitive issues, and concerns about general health were also noted as reasons for care. The overall prevalence of VS was 78.55% (95% CI = 76.68-80.42). Female and male prevalence of VS was 77.17% and 80.15%, respectively; notably, all per-clinic, age, or gender-stratified prevalences were ≥50%.

The authors concluded that the results of this study suggest a high rate of prevalence of VS in a sample of individuals who sought chiropractic care. Concerns about general health and wellness were represented in the sample and suggest chiropractic may serve a primary prevention function in the absence of disease or injury. Further investigation into the epidemiology of VS and its role in health promotion and prevention is recommended.

This is one of the most hilarious pieces of ‘research’ that I have recently encountered. The strategy is siarmingly simple:

  • invent a ficticious pathology (VS) that will earn you plently of money;
  • develop criteria that allow you to diagnose this pathology in the maximum amount of consumers;
  • show gullible consumers that they are afflicted by this pathology;
  • use scare mongering tactics to convince consumers that the pathology needs treating;
  • offer a treatment that, after a series of expensive sessions, will address the pathology;
  • cash in regularly while this goes on;
  • when the consumer has paid enough, declare that your fabulous treatment has done the trick and the consumer is again healthy.

The strategy is well known amongst practitioners of so-called alternative medicine (SCAM), e.g.:

  • Traditional acupuncturists diagnose a ficticious imbalance of yin and yang only to normalise it with numerous acupuncture sessions.
  • Naturopaths diagnose ficticious intoxications and treat it with various detox measures.
  • Iridologists diagnose ficticious abnormalities of the iris that allegedly indicate organ disstress and treat it with whatever SCAM they can offer.

As they say:

No disease can be more surely, effectively, and profitably treated than a condition that the unsuspecting customer did not have in the first place!

 

PS

Sadly, such behavior exists in convertional medicine occasionally too, but SCAM relies almost entirely on it.

According to Healthcare.gov, a primary care provider in the US is “a physician (MD or DO), nurse practitioner, clinical nurse specialist or physician assistant, as allowed under state law, who provides, coordinates or helps a patient access a range of healthcare services.” A growing movement exists to expand who can act as a primary care privider (PCP). Chiropractors have been a part of this expansion, but is that wise? This is the question recently asked by Katie Suleta of THE AMERICAN COUNCIL ON SCIENCE AND HEALTH In it, she explains that:

  • chiropractors would like to act as PCPs,
  • chiropractors are not trained in pharmacology,
  • chiropractors receive some training in supplements,
  • chiropractors wish to avoid pumping the body full of “synthetic” hormones and substances.

Subsequently, she adresses the chiropractic profession’s stance on vaccines.

First, look at similar professional organizations to establish a reasonable expectation. The American Medical Association has firmly taken a stance on vaccines and provides resources for physicians to help communicate with patients. There is no question about where they stand on the topic, whether it be vaccines in general or COVID-19 vaccines specifically. Ditto the American Osteopathic Association and American Association of Colleges of Osteopathic Medicine. There is a contingent of vaccine-hesitant MDs and DOs. There is also an anti-vax contingent of MDs and DOs. The vaccine hesitant can be considered misguided and cautious, while anti-vaxxers often have more misinformation and an underlying political agenda. The two groups pose a threat but are, thankfully, the minority. They’re also clearly acting against the recommendations of their professional organizations.

Let’s now turn to the American Chiropractic Association (ACA). Unlike the American Medical Association or American Osteopathic Association, they seem to take no stance on vaccines. None. Zip. Zilch. As of this writing, if you go to the ACA website and search for “vaccines,” zero results are returned. Venturing over to the ACA-CDID, there is a category under their “News and Articles” section for ‘Vaccines.’ This seems promising! However, when you click on it, it returns one article on influenza vaccines from Fox News from 2017. It’s not an original article. It’s not a perspective piece. No recommendations are to be found—nothing even on the COVID-19 vaccines. Basically, there is effectively nothing on ACA-CDID’s website either. We’re oh for two.

The last one we’ll try is DABCI University. No, it’s not a professional organization, but it does train DCs. The words ‘university’ and ‘internist’ are involved, so they must talk about vaccines…right? Wrong again. While there is a lot of content available only to paying members and students, the sections of their website that are publicly available are noticeably short on vaccine information. There is a section dedicated to articles, currently including five whole articles, and not a single one talked about vaccines. One report addresses the pharmacokinetics of coffee enemas, but none talks about one of the most fundamental tools PCPs have to help prevent illness.

Why It’s Important

Chiropractic was defined by DD. Palmer, its founder, as “a science of healing without drugs.” It relies on spinal manipulation. In traditional chiropractic, there is no room for medications at all. A rift has developed within the profession, and some chiropractors, those seeking that internal medicine certification, “try to avoid pumping the body with synthetic hormones and other prescriptions.”

During the COVID-19 pandemic, several prominent chiropractors publicly pushed anti-vaccine views. To highlight just a few prominent examples: Vax Con ’21Mile Hi Chiro, and Ben Tapper. Vax Con ’21 was organized and orchestrated by the Chiropractic Society of Wisconsin. It featured Judy Mikovits, of Plandemic fame, as a speaker and touted her book with a forward written by Robert F. Kennedy Jr. It offered continuing education units (CEUs) to DCs to attend this anti-vaccine conference that peddled misinformation about COVID-19 vaccines and other prevention measures. Healthcare providers are often required to complete a certain number of continuing education units to maintain licensure, ensuring that they stay current and sharp as healthcare evolves or, in this case, devolves.

This conference was not unique in this either. Mile Hi Chiro was just held in Denver in September of this year, had several questionable speakers (including RFK and Ben Tapper of Disinformation Dozen fame), and offered continuing education. If professional conferences offer continuing education units for attendees and push vaccine misinformation, that should concern everyone. Especially if the profession in question wants to act as PCPs.

Despite training in a system that believes “the body has an innate intelligence, and the power to heal itself if it is functioning properly, and that chiropractic care can help it do that,” without medications, but frequently with supplements, roughly 58% of Oregon’s chiropractors were vaccinated against COVID-19. That said, their training and inclination, along with the silence of their professional organizations and the chiropractic conferences featuring anti-vaccine sentiment, make them a profession that, at the very least, doesn’t consider vaccinations or medications viable health alternatives. We’re now talking about an entire profession that wants to be PCPs.

Irrespective of your belief about the efficacy of COVID-19 vaccination, the germ theory of disease remains unchallenged. Anyone unwilling to work to treat and prevent infectious diseases within their community with the most effective means at our disposal should not be allowed to dispense medical advice. Chiropractors lack the basic training that a PCP should have. I’ve said it before and I’ll say it again: I want healthcare accessible for everyone. But, if you’re looking for a PCP, consider going to an MD, DO, NP, or PA – they come fully equipped for your primary care needs.

Regular readers of this blog will be aware that I have discussed the thorny issue of chiros and vaccinations many times before, e.g.:

I agree with Katie Suleta that the issue is important and thank her for raising it. I also agree with her conclusion that, if you’re looking for a PCP, consider going to an MD, DO, NP, or PA – they come fully equipped for your primary care needs.

Do not consult chiropractors. 

On the occasion of a talk that I recently gave in Italy, I was interviewed by VANITY FAIR ITALY. I gave it in English and it was published in Italian. As I don’t expect many readers to be fluent in Italian and since it was a good interview, in my view, I thought I give you here the English original:

 

1.How can we exactly define «alternative medicine»?

There is much confusion and a plethora of definitions, none of which is fully satisfactory. In fact, the term “alternative medicine” itself is nonsensical: if a therapy works, it belongs to evidence-based medicine; and if it doesn’t work, it cannot possibly be an alternative. I therefore have long been calling it “so-called alternative medicine” (SCAM). The definition I use for SCAM with lay audiences is simple: SCAM is an umbrella term for a diverse range of therapeutic and diagnostic methods that have little in common, other than being excluded from mainstream medicine.

2.Who uses it and why?

Predominantly women! Statistics say about 30-70% of the general population use SCAM. And with patient populations, the percentage can be close to 100%. They use it because they are told over and over again that SCAM is natural and thus safe, as well as effective for all sorts of conditions.

3.Focusing on terminology, is there a difference between «complementary» and «alternative» medicine?

Theoretically, there is a big difference between «complementary» and «alternative» medicine. The former is supposed to be used as an add-on to, while the latter is a replacement of mainstream medicine. In practice, this dividing line is very blurred; most SCAMs are used in both ways, depending on the actual situation and circumstance.

4.Are users different from non-users?

Yes, there has been much research on this and my reading of it is that SCAM users tend to be less intelligent, more religious, more superstitious, less trusting in science, and more prone to conspiracy theories, for instance.

5.Which forms of alternative medicine are the most popular?

There are certain national differences, but in most European countries herbal medicine, acupuncture, chiropractic, osteopathy, homeopathy, aromatherapy, and reflexology are amongst the most popular SCAMs.

6.Does it work?

With such a wide range – someone once counted over 400 modalities and my last book evaluated 202 of them (Alternative Medicine: A Critical Assessment of 202 Modalities (Copernicus Books): Amazon.co.uk: Ernst, Edzard: 9783031107092: Books) – it is impossible to answer with yes or no. In addition we need to consider the conditions that are being treated. Acupuncture, for example, is touted as a panacea, but might just work for pain. If you take all this into account, I estimate that less than 3% of the therapeutic claims that are being made for SCAM are supported by sound evidence.

Is it safe?

Again, impossible to say. Some treatments are outright dangerous; for instance, chiropractic neck manipulations can injure an artery and the patient suffers a stroke of which she can even die. Other treatments are assumed to be entirely harmless; for example homeopathy. But even that is untrue: if a cancer patient relies exclusively on homeopathy for a cure, she might easily hasten her death. Sadly, such things happen not even rarely.

Do its benefits outweigh its risks?

That depends very much on the treatment, the disease, and the precise situation. Generally speaking, there are very few SCAMs that fulfill this condition.

You said that these were the research questions that occupied all your life in Exeter. Did you find the answers?

We published more on SCAM than any other research group, and we found mostly disappointing answers. But still, I am proud of having found at least some of the most pressing answers. Even negative answers can make an important contribution to our knowledge.

7.What is the problem with the placebo effect?

All therapies can prompt a placebo effect. Thus an ineffective treatment can easily appear to be effective through generating a placebo effect. This is why we need to rely on properly conducted, if possible placebo-controlled trials, if we want to know what works and what not.

8.Is it true that some alternative medicines can cause significant harm?

see above

9.What about herbal remedies? What do studies show about them?

Many of our modern drugs originate from plants, Therefore, it is not surprising that we find herbal remedies that are effective. But careful! This also means that plants can kill you – think of hemlock, for instance. In addition herbal medicine can interact powerfully with synthetic drugs. So, it is wise to be cautious and get responsible advice.

10.Which alternative therapies are overrated and why?

In my view, almost all SCAMs are over-rated. If you go on the Internet, you find ~5 000 000 websites on SCAM. 99% of them try to sell you something and are unreliable or even dangerous. We need to be aware of the fact that SCAM has grown into a huge business and many entrepreneurs are out to get your money based on bogus claims.

11.On the contrary, which therapies could be seen as an integration in routine care?

The best evidence can be found in the realm of herbal medicine, for instance St John’s Wort. Some mind-body interventions can be helpful; also a few massage techniques might be worth a try. Not a lot, I’m afraid.

12.Would you tell us what happened in 2005 with Prince Charles?

He complained about my actions via his private secretary to my University. A 13 month investigation followed. At the end, I was found not guilty but my funding, my team, my infrastructure had been dismantled. So, in effect, Charles managed to close down what was the only research group that looked critically and systematically into SCAM. A sad story – not so much for me but for progress and science, I think.

3.Why is alternative medicine still a controversial subject?

Mainly because the gap between the claims and the evidence is so very wide – and getting wider all the time.

14.Would you suggest the «right way» to approach it?

I often recommend this: if it sounds too good to be true, it probably is! I might add that, if you want reliable advice, don’t listen to those who profit from giving it.

‘The Cult of Chiropractic’ is the title of a video that has just been released. I think it is very good and, if you are interested in the subject at all, I recommend you have a look. You can watch it here:

The Cult of Chiropractic : r/h3h3productions (reddit.com)

The video is not just well-done, it also is fun and informative. I learned a few things from it that I did not yet know. It also brings Simon Singh and myself together after we had not met for several years; and that is always a pleasure!

But back to ‘The Cult of Chiropractic’ and the question whether this assumption is true. Some time ago, I published a post about so-called alternative medicine and cultism. I listed a few questions we should ask ourselves to determine whether chiropractic is a cult. Let me adapt them slightly:

  1. Is chiropractic based on dogma? The answer is yes – think, for instance, of the assumptions that subluxations exist.
  2. Does chiropractic demand acceptance of its dogma or doctrine as truth? For straight chiropractors, the answer is yes.
  3. Is the dogma set forth by a single guru or promulgator? Yes, DD Palmer.
  4. Is chiropractic supposed to cure all ills? For many chiros, the answer is yes.
  5. Is belief used by chiropractors as a substitute for evidence? Yes.
  6. Do chiropractors determine their patients’ lifestyle? Yes.
  7. Do chiros exploit their patients financially? Yes.
  8. Does chiropractors impose rigid rules and regulations? Yes.
  9. Do chiros practice deception? Yes.
  10. Do chiropractors have their own sources of information/propaganda? Yes.
  11. Do chiros cultivate their own lingo? Yes.
  12. Do chiros discourage or inhibit critical thinking? Yes.
  13. Are questions about the values of chiropractic discouraged or forbidden? Yes.
  14. Do the proponents of chiropractic reduce complexities into platitudinous buzz words? Yes
  15. Do chiros assume that health problems are the result of not adhering to the dogma? Yes.
  16. Do chiros instill fear into members who consider leaving? Yes.
  17. Do chiros depict conventional medicine as ineffective or harmful? Yes.
  18. Do chiros ask others to recruit new members to their cult? Yes.

Based on these 18 questions, I conclude that chiropractic is indeed a cult. What about you? Even if you disagree, please have a look at the excellent  video, ‘THE CULT OF CHIROPRACTIC’.

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