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

gullible consumer

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You may not like it, but we do seem to live in the age of the ‘alternative truth’. It might necessitate reconsidering some of our definitions. A lie, for instance, was formerly defined as making an untrue statement with intent to deceive. Does that definition need to be revised in the age of the ‘alternative truth’?

Laura Kuenssberg, the political editor of the BBC, seems to think so. She recently published an interesting new definition of a lie: “… outright lying … is relatively rare. It is too easily found out. Only one senior politician still in the game has ever privately told me something that was utterly, entirely, and completely untrue.” She wrote this in an article about our PM, Boris Johnson who, by old standards, would probably qualify as a habitual liar. And as the BBC political editor cannot easily call him that, she conveniently moved the goal post and defined a lie to be something “utterly, entirely, and completely untrue”.

So, here we have it, the age of alternative truths has redefined the lie!

But I am not starting to write political rants – tempting though it often is – there is enough to rant about in so-called alternative medicine (SCAM). The questions I asked myself are these: how does SCAM measure up to the new Kuenssberg definition, and how gullible have we become?

Let’s play a little game to find out, shall we?

I provide 10 statements commonly used by the SCAM fraternity, and I ask you to consider which of them is “utterly, entirely, and completely untrue”.

  1. Chiropractic manipulations have been proven to do more good than harm.
  2. Acupuncture is effective for chronic pain.
  3. Homeopathy is supported by sound evidence.
  4. Homeopathic remedies act as nano-particles.
  5. Natural means safe.
  6. Integrative medicine is in the best interest of patients.
  7. Chiropractic subluxations do exist.
  8. Detox is a concept that makes sense.
  9. SCAM practitioners treat the root causes of disease.
  10. SCAM is cost-effective.

Next, please count the number of statements that are “utterly, entirely, and completely untrue”. This will give you a figure between 0 and 10. I propose that it can be used as a measure of gullibility.

I suggest the following grading:

  • 10 – 8 = not gullible
  • 7 – 5 = gullible
  • 4 – 2 = very gullible
  • 1 – 0 = dangerously gullible.

And here you have the ‘Edzard Ernst measure of gullibility’!

 

The usage of so-called alternative medicine (SCAM) in pediatric settings has been high for some time. However, the risks of pediatric SCAM use remain under-investigated. Almost 20 years ago, I published this systematic review:

Unconventional therapies have become popular in paediatric and adolescent populations. It is therefore important to define their risks. The aim of this systematic review was to summarise the recent evidence. Computerised literature searches were carried out in five databases to identify all recent reports of adverse events associated with unconventional therapies in children. The reports were summarised in narrative and tabular form. The results show that numerous case reports and several case series have been published since 1990. Investigations of a more systematic nature are, however, rare. Most of the adverse events were associated with herbal medications. Inadequately regulated herbal medicines may contain toxic plant material, be contaminated with heavy metals, or be adulterated with synthetic drugs. The adverse events included bradycardia, brain damage, cardiogenic shock, diabetic coma, encephalopathy, heart rupture, intravascular haemolysis, liver failure, respiratory failure, toxic hepatitis and death. A high degree of uncertainty regarding a causal relationship between therapy and adverse event was frequently noted. The size of the problem and its importance relative to the well-documented risks of conventional treatments are presently unknown. Several unconventional therapies may constitute a risk to the health of children and adolescents. At present, it is impossible to provide reliable incidence figures. It seems important to be vigilant and investigate this area more systematically.

Nothing much has happened since in terms of systematic investigation. But now, a 3-year survey was carried out at the Dutch Pediatric Surveillance Unit. Pediatricians were asked to register cases of adverse events associated with pediatric SCAM usage.

In 3 years, 32 unique adverse events were registered. Twenty-two of these adverse events were indirect and not related to the specific SCAM therapy but due to delaying, changing, or stopping of regular treatment, a deficient or very restrictive diet, or an incorrect diagnosis by a SCAM therapist. These events were associated with many different SCAM therapies.

Nine events were deemed direct adverse events like bodily harm or toxicity and one-third of them occurred in infants. Only supplements, manual therapies, and (Chinese) herbs were involved in these nine events. In one case, there was a risk of a serious adverse event but the harm had not yet occurred.

The authors concluded that relatively few cases of adverse events associated with pediatric SCAM usage were found, mostly due to delaying or stopping conventional treatment. Nevertheless, parents, pediatricians, and SCAM providers should be vigilant for both direct and indirect adverse events in children using SCAM, especially in infants.

The number of cases seems small indeed, but there may be many further adverse events that went unreported. Here are 4 of the documented cases of severe and life-threatening consequences:

  • An 8-year-old child with autoimmune hypothyroidism had his prescribed replaced with an ineffective herbal remedy.
  • A 14-year-old child developed septic shock with multiple organ failure after receiving homeopathy for acute appendicitis.
  • A 14-year-old child needed colectomy after ineffective naturopathic treatments for colitis.
  • A 5-year-old developed secondary adrenal insufficiency after his eczema was treated with Chinese herbal remedies adulterated with large doses of corticosteroids.

In view of the risks – even if small – I suggest that, in pediatric settings, we employ only those SCAMs that are supported by solid evidence. And those are very few indeed.

Many people believe that homeopathy is essentially plant-based – but they are mistaken! Homeopathic remedies can be made from anything: Berlin wall, X-ray, pus, excrement, dental plaque, mobile phone rays, poisons … anything you can possibly think of. So, why not from vaccines?

This is exactly what a pharmacist specialized in homeopathy thought.

It has been reported that the ‘Schloss-Apotheke’ in Koblenz, Germany offered for sale a homeopathic remedy made from the Pfizer vaccine. This has since prompted not only the Chamber of Pharmacists but also the Paul Ehrlich Institute and Pfizer to issue statements. On Friday (30/4/2021) morning, the pharmacy had advertised homeopathic remedies based on the Pfizer/Biontech vaccine. The Westphalia-Lippe Chamber of Pharmacists then issued an explicit warning against it. “We are stunned by this,” said a spokesman. The offer has since disappeared from the pharmacy’s website.

On Friday afternoon, the manufacturer of the original vaccine also intervened. The Paul Ehrlich Institute released a statement making it clear that a vaccine is only safe “if it is administered in accordance with the marketing authorization.”

The Schloss-Apotheke had advertised the product in question with the following words:

“We have Pfizer/BioNTech Covid-19-Vaccine in potentized form up to D30 as globules or dilution (for discharge) in stock.”

The chamber of pharmacists countered with a warming under the heading “Facts instead of Fake News” on Facebook and Instagram:

“Whatever they might contain: These remedies are no effective protection against Covid-19.”

Pharmacy manager, Annette Eichele, of the Schloss-Apotheke claimed she had not sold homeopathic Corona vaccines and stressed that effective vaccines of this kind do not exist. According to Eichele, only an additional “mini drop” of the original Biontech vaccine had been used and “highly potentized” and prepared homeopathically. According to Eichele, Corona vaccinations that had already been administered were thus to have a “better and more correct effect with this supplementary product, possibly without causing side effects … but this is not scientifically proven”. The homeopathic product had been produced only on customer request and had been sold less than a dozen times in the past weeks. Ten grams of the remedy were sold for about 15 Euros. On Twitter, Eichele stated: „Wir haben nichts Böses getan, wir wollten nur Menschen helfen!“ (We have done nothing evil, we only wanted to help people). I am reminded yet again of Bert Brecht who observed:

“The opposite of good is not evil but good intentions”.

 

On 17/2/2020 I posted this article:

The drop in cases and deaths due to COVID-19 infections in India has been attributed to India’s national policy of using homeopathy. Early in the epidemic, the national “Ministry of AYUSH, recommended the use of Arsenic album 30 as preventive medicine against COVID-19. Its prophylactic use has been advised in states like Karnataka, Tamil Nadu, Kerala, and Maharashtra. The ‘OFFICIAL HOMEOPATHY RESOURCE’ is now claiming that homeopathy is the cause of the observed outcome…

If you click on the link, you will find that the OFFICIAL HOMEOPATHY RESOURCE has now removed the original. No problem! Thanks to Alan Henness, we can still access it; he announced in a tweet that he has archived a copy. So, here is the full article again:

India’s National Policy of Using Homeopathic Medicine To Prevent COVID is Dramatically Working

A dramatic plunge in cases and deaths of COVID in India can be attributed to India’s national policy of using homeopathy.

Early in the epidemic, the national “Ministry of AYUSH, (medical alternatives), in its guidelines, issued an advisory to states across India recommending the use of a traditional homeopathic drug, Arsenic album 30 as a form of preventive medicine against COVID-19. Its prophylactic use has been advised in states like Karnataka, Tamil Nadu, Kerala and Maharashtra and in some places, it has been used in high-risk areas. In places like Bhopal, claims were raised when doctors said that mild COVID cases were successfully treated with homeopathy.” [Times of India]

And now the results of that policy and use are clear, even though scientists in the conventional paradigm are mystified as to why the drop is so dramatic. They know nothing about homeopathy and its history of successfully treating epidemics.

India has a population of 1 billion, 300 million people. Relative to this massive population the number of cases per day and especially the number of deaths per day are now exceptionally low. According to the Daily Mail:

“Scientists are trying to work out why coronavirus cases in India are falling when at one point it looked like the country might overtake the US as the worst-hit nation.
In September the country was reporting some 100,00 new cases per day, but that went into decline in October and is now sitting at around 10,000 per day – leaving experts struggling to explain why.”

But why?

Why did the original disappear?

The reason seems obvious:

Saturday’s official toll recorded another 2,600 deaths and 340,000 new infections in India, bringing the total number of cases to 16.5 million, second only to the US. There have been 190,000 deaths attributed to Covid in India since the start of the pandemic. These figures are dramatic but most likely they are gross underestimates of the truth.

The egg on the face of homeopathy gets bigger if we consider things like the COVID-19 advice from ‘HOMEOPATHY INTERNATIONAL’, or the fact that UK’s biggest provider of homeopathy training encouraged the use of homeopathic potions made with phlegm to protect against and treat Covid-19. The egg finally turns into a veritable omelette, once we learn that the leading academic journal in homeopathy, HOMEOPATHY, promoted the idea that homeopathic have a place in the fight against the pandemic – not just once but repeatedly – and that the leading UK homeopath, Elizabeth Thompson, recommended homeopathy for COVID-19 infections after herself falling ill with the virus.

No, I do not feel the slightest tinge of Schadenfreude, about all this. I am writing about it because I still hope that it will prevent some people from risking their health with useless therapies and perhaps even stop some charlatans to make ridiculously irresponsible claims about them.  So, please do me a favor and heed my message:

The promotion of homeopathy and other ineffective therapies costs many lives!

Indian homeopaths aimed at evaluating the efficacy of individualized homeopathy (IH) for atopic dermatitis (AD). They conducted a double-blind, randomized, placebo-controlled, short-term, preliminary trial in an Indian homeopathy hospital. Patients were randomized to either IH (n = 30) or identical-looking placebo (n = 30) using computerized randomization and allocation. Outcomes were patient-oriented scoring of AD (PO-SCORAD; primary endpoint), Dermatological Life Quality Index (DLQI) score, and AD burden score for adults (ADBSA; secondary endpoints), measured monthly for 3 months. An intention-to-treat sample was analyzed after adjusting baseline differences.

On PO-SCORAD, improvement was higher in IH against placebo, but nonsignificant statistically (pmonth 1 = 0.433, pmonth 2 = 0.442, pmonth 3 = 0.229). Secondary outcomes were also nonsignificant – both DLQI and ADBSA (p > 0.05). Four adverse events (diarrhea, injury, common cold) were recorded.

The authors concluded that there was a small, but nonsignificant direction of effect towards homeopathy, which renders the trial inconclusive. A properly powered robust trial is indicated.

Thee questions:

  1. Why use statistics only to ignore its results?
  2. Why discredit research into so-called alternative medicine (SCAM) in this way?
  3. Who on earth would publish such misleading conclusions?

This article was published in Complementary Medicine Research which claims to be an international peer-reviewed journal that aims to bridge the gap between conventional and complementary/alternative medicine on a sound scientific basis, promoting their mutual integration. It boasts that “experts of both conventional medicine and complementary/alternative medicine cooperate on the journal’s editorial board, ensuring a high standard of scientific quality”. Its editor is Harald Walach who we have met several times before.

I had a look at the long list of members of the editorial board and was unable to see many ‘experts in conventional medicine’. If that is so, the journal’s peer review process is bound to turn into a farcical procedure where any rubbish will pass.

The journal reminds authors that “published research must comply with internationally-accepted standards for research practice and reporting.” I believe that the internationally accepted standards of research reporting include something about not misleading the public by claiming that the absence of an effect is a small effect in favor of homeopathy. By revealing that there was no significant effect, the authors of this study demonstrate that IH was not effective as a treatment of AD. It is in my mind unethical to try to disguise this result by making it look like a small positive effect or claiming the result was inconclusive.

High standard of scientific quality?

No, quite the opposite!

Epidemiological studies on the association between coffee intake, arguably a herbal remedy, and cancer risk have yielded inconsistent results. To summarize and appraise the quality of the current evidence, researchers conducted an umbrella review of existing findings from meta-analyses of observational studies.

They searched PubMed, Embase, Web of Science and the Cochrane database to obtain systematic reviews and meta-analyses of associations between coffee intake and cancer incidence. For each association, they estimated the summary effect size using the fixed- and random-effects model, the 95% confidence interval, and the 95% prediction interval. We also assessed heterogeneity, evidence of small-study effects, and excess significance bias.

Twenty-eight individual meta-analyses including 36 summary associations for 26 cancer sites were retrieved for this umbrella review. A total of 17 meta-analyses were significant at P ≤ 0.05 in the random-effects model. For the highest versus lowest categories, 4 of 26 associations had a more stringent P value (P ≤ 10− 6). Associations for five cancers were significant in dose-response analyses. Most studies (69%) showed low heterogeneity (I2 ≤ 50%). Three and six associations had evidence of excessive significance bias and publication bias, respectively. Coffee intake was inversely related to the risk of liver cancer and endometrial cancer and was characterized by dose-response relationships. There were no substantial changes when the researchers restricted analyses to a meta-analysis of cohort studies.

The authors concluded that there is highly suggestive evidence for an inverse association between coffee intake and risk of liver and endometrial cancer. Further research is needed to provide more robust evidence for cancer at other sites.

This is an interesting analysis that begs many questions. Let me just make four brief points:

  1. Correlation is not causation! Epidemiological studies throw up all sorts of associations that are too often mistaken as causal relationships. The question of whether coffee causes a decrease in the risk of certain cancers is as yet unanswered. The authors mention dose relationships which would, of course, increase the likelihood of a causal effect. Yet, they do not prove it.
  2. Another argument that would strengthen the possibility of a causal effect would be a plausible mechanism of action. However, the biological mechanism of how coffee might affect the risk remains unclear. Coffee contains a range of biologically active chemicals, including caffeine and phenolic compounds. In so-called alternative medicine (SCAM), coffee is also claimed to be a ‘detox‘ remedy. Yet it is unclear how exactly they might reduce the risk.
  3. The studies were all about the oral consumption of coffee. None considered anal application, like in Gerson therapy.
  4. The only way to find out whether coffee does, in fact, reduce the risk of certain cancers is to conduct prospective controlled clinical trials. Such studies are, however, not easy to conduct, particularly if designed such that their findings are truly reliable.

So, the answer to the question DOES COFFEE CONSUMPTION PREVENT CANCER? will remain unanswered for some time, I am afraid. Meanwhile, I suggest we enjoy our coffee per oral (and avoid it per anal).

In staunch defiance of the evidence and common sense, Prince Charles has long defended homeopathy. Apparently, he not only uses it himself but also employs it for his animals. Claiming that his cattle don’t know about placebo effects, he seems convinced it works better than a placebo. Homeopaths are naturally delighted to have his royal support, not least the ones from India where homeopathy has been hugely popular for many years.

From the beginning of the pandemic, many Indian enthusiasts have claimed that homeopathy can effectively prevent and treat COVID-19 infections. In parts of India, homeopathy was thus employed on a population basis in an attempt to prevent the spread of the disease. There were voices that warned of a disaster but the  Indian enthusiasm for homeopathy as an effective anti-COVID-19 therapy won the day.Image

When Prince Charles fell ill with COVID-19, Indian officials did not hesitate to claim that his quick recovery was due to the homeopathic treatment he had received. Charles’ officials denied this but in India, the story was reported widely and lent crucial support to the myth that homeopathy would provide a solution to the pandemic. Subsequently, Indian officials began to rely even more on the alleged power of homeopathy.

Today, the consequences of these actions are becoming tragically visible: With more than 15 million confirmed cases, India is experiencing a catastrophic tsunami of COVID-19 infections. Its healthcare system is close to collapse, and the high prevalence of the virus provides dangerously fertile grounds for the development of mutants. One does not need to be a clairvoyant to predict that, in turn, these will cause problems on a global basis.

Why am I telling you all this?

I think this depressing sequence of events shows in exemplary fashion what damage ill-informed VIP support for an ineffective therapy can do. Many people tend to feel that Charles’ passion for homeopathy might perhaps be laughable but is essentially harmless. I beg to differ. I am not saying that Charles instructed Indian officials to employ homeopathy the way they did. I am even emphasizing that Charles’ officials denied that homeopathy had anything to do with his speedy recovery after his illness. But I am saying that Charles’ life-long promotion of homeopathy combined with his quick recovery motivated Indian officials, even more, to ignore the evidence and decide to heavily rely on homeopathy.

This decision has cost uncounted lives and will cause many more in the near future. I submit that the seemingly harmless promotion of unproven or disproven treatments such as homeopathy can be a deadly dangerous game indeed.

 

Energy healing is an umbrella term for a range of paranormal healing practices. Their common denominator is the belief in a mystical ‘energy’ that can be used for therapeutic purposes. Forms of energy healing have existed in many ancient cultures. The ‘New Age’ movement has brought about a revival of these ideas, and today energy healing systems are amongst the most popular alternative therapies in the US as well as in many other countries.

Energy healing relies on the esoteric belief in some form of ‘energy’ which is distinct from the concept of energy understood in physics and refers to some life force such as chi in Traditional Chinese Medicine, or prana in Ayurvedic medicine. Some proponents employ terminology from quantum physics and other ‘cutting-edge’ science to give their treatments a scientific flair which, upon closer scrutiny, turns out to be but a veneer of pseudo-science. The ‘energy’ that energy healers refer to is not measurable and lacks biological plausibility.

The purpose of this study was to evaluate the effects of energy healing (EH) therapy prior to and following posterior surgical correction for adolescent idiopathic scoliosis (AIS) compared to controls.

Patients were prospectively randomized to one of two groups: standard operative care for surgery (controls) vs. standard care with the addition of three EH sessions. The outcomes included visual analog scales (VAS) for pain and anxiety (0-10), days until conversion to oral pain medication, and length of hospital stay. For the experimental group, VAS was assessed pre- and post-EH session.

Fifty patients were enrolled-28 controls and 22 EH patients. The controls had a median of 12 levels fused vs. 11 in the EH group (p = 0.04). Pre-operative thoracic and lumbar curve magnitudes were similar (p > 0.05). Overall VAS pain scores increased from pre- to post-operative (p < 0.001), whereas the VAS anxiety scores decreased immediately post-operative (p < 0.001). The control and pre-EH assessments were statistically similar. Significant decreases in VAS pain and anxiety scores from pre to post-EH assessments were noted for the EH group. Both groups transitioned to oral pain medication a median of 2 days post-operative (p = 0.11). The median days to discharge were four in the controls and three in the EH group (p = 0.07).

The authors concluded that EH therapy resulted in a decrease in patient’s pre-operative anxiety. Offering this CAM modality may enhance the wellbeing of the patient and their overall recovery when undergoing posterior surgical correction for AIS.

I am getting tired of explaining that this trial design tells us as good as nothing about the effects of the tested therapy per se. As we have discussed ad nauseam on this blog, A+B is always more than B alone. Such trials appear to be rigorous and fool many people, but they are unable to control for context effects, like placebo or attention. Therefore, I need to re-write the conclusions:

The placebo effect and the extra attention associated with EH therapy resulted in a decrease in patients’ pre-operative anxiety. EH itself is most likely bar any effect. Further studies in this area are not required.

Low back pain must be one of the most frequent reasons for patients to seek out some so-called alternative medicine (SCAM). It would therefore be important that the information they get is sound. But is it?

The present study sought to assess the quality of web-based consumer health information available at the intersection of LBP and CAM. The investigators searched Google using six unique search terms across four English-speaking countries. Eligible websites contained consumer health information in the context of CAM for LBP. They used the DISCERN instrument, which consists of a standardized scoring system with a Likert scale from one to five across 16 questions, to conduct a quality assessment of websites.

Across 480 websites identified, 32 were deemed eligible and assessed using the DISCERN instrument. The mean overall rating across all websites 3.47 (SD = 0.70); Summed DISCERN scores across all websites ranged from 25.5-68.0, with a mean of 53.25 (SD = 10.41); the mean overall rating across all websites 3.47 (SD = 0.70). Most websites reported the benefits of numerous CAM treatment options and provided relevant information for the target audience clearly, but did not adequately report the risks or adverse side-effects adequately.

The authors concluded that despite some high-quality resources identified, our findings highlight the varying quality of consumer health information available online at the intersection of LBP and CAM. Healthcare providers should be involved in the guidance of patients’ online information-seeking.

In the past, I have conducted several similar surveys, for instance, this one:

Background: Low back pain (LBP) is expected to globally affect up to 80% of individuals at some point during their lifetime. While conventional LBP therapies are effective, they may result in adverse side-effects. It is thus common for patients to seek information about complementary and alternative medicine (CAM) online to either supplement or even replace their conventional LBP care. The present study sought to assess the quality of web-based consumer health information available at the intersection of LBP and CAM.

Methods: We searched Google using six unique search terms across four English-speaking countries. Eligible websites contained consumer health information in the context of CAM for LBP. We used the DISCERN instrument, which consists of a standardized scoring system with a Likert scale from one to five across 16 questions, to conduct a quality assessment of websites.

Results: Across 480 websites identified, 32 were deemed eligible and assessed using the DISCERN instrument. The mean overall rating across all websites 3.47 (SD = 0.70); Summed DISCERN scores across all websites ranged from 25.5-68.0, with a mean of 53.25 (SD = 10.41); the mean overall rating across all websites 3.47 (SD = 0.70). Most websites reported the benefits of numerous CAM treatment options and provided relevant information for the target audience clearly, but did not adequately report the risks or adverse side-effects adequately.

Conclusion: Despite some high-quality resources identified, our findings highlight the varying quality of consumer health information available online at the intersection of LBP and CAM. Healthcare providers should be involved in the guidance of patients’ online information-seeking.

Or this one:

Background: Some chiropractors and their associations claim that chiropractic is effective for conditions that lack sound supporting evidence or scientific rationale. This study therefore sought to determine the frequency of World Wide Web claims of chiropractors and their associations to treat, asthma, headache/migraine, infant colic, colic, ear infection/earache/otitis media, neck pain, whiplash (not supported by sound evidence), and lower back pain (supported by some evidence).

Methods: A review of 200 chiropractor websites and 9 chiropractic associations’ World Wide Web claims in Australia, Canada, New Zealand, the United Kingdom, and the United States was conducted between 1 October 2008 and 26 November 2008. The outcome measure was claims (either direct or indirect) regarding the eight reviewed conditions, made in the context of chiropractic treatment.

Results: We found evidence that 190 (95%) chiropractor websites made unsubstantiated claims regarding at least one of the conditions. When colic and infant colic data were collapsed into one heading, there was evidence that 76 (38%) chiropractor websites made unsubstantiated claims about all the conditions not supported by sound evidence. Fifty-six (28%) websites and 4 of the 9 (44%) associations made claims about lower back pain, whereas 179 (90%) websites and all 9 associations made unsubstantiated claims about headache/migraine. Unsubstantiated claims were made about asthma, ear infection/earache/otitis media, neck pain,

Conclusions: The majority of chiropractors and their associations in the English-speaking world seem to make therapeutic claims that are not supported by sound evidence, whilst only 28% of chiropractor websites promote lower back pain, which is supported by some evidence. We suggest the ubiquity of the unsubstantiated claims constitutes an ethical and public health issue.

The findings were invariably disappointing and confirmed those of the above paper. As it is nearly impossible to do much about this lamentable situation, I can only think of two strategies for creating progress:

  1. Advise patients not to rely on Internet information about SCAM.
  2. Provide reliable information for the public.

Both describe the raison d’etre of my blog pretty well.

Recently, I came across a newspaper asking: “Which vaccine do you trust most?” It turned out that there was a clear favourite according to public opinion. In the present climate of heated debates about COVID vaccines, this seems to make sense.

Or doesn’t it?

What determines public opinion?

There are probably many determinants, but most are dominated by what the public is being told about a subject. If, for instance, the press incessantly reports bad things about a certain vaccine and mostly good news about another, public opinion will reflect exactly that.

What I am trying to point out is this: the man and woman in the street have no expertise in vaccines. They mostly think what they are being told about them. So, public opinion is largely determined by journalists who write about the subject. If then a newspaper presents the public opinion about a vaccine, it is all but a foregone conclusion. The paper might as well just repeat what they have been telling their readers. By presenting a ‘public opinion’ about vaccines they actually go one step further: they amplify their own opinion by pretending it is not of their making but that of the public.

All this seems fairly obvious, once you start thinking about it.

So, why do I go on about it?

If this phenomenon occurs with vaccines, it also occurs with other issues, for instance, so-called alternative medicine (SCAM). We often hear that the public is in favour of this or that type of SCAM. It is supposed to convince us and politicians that SCAM is good. If thousands or even millions are in favour of it, it must be good! Who am I to disagree with the public?

But, as we have just seen with the example of the vaccines, public opinion is merely a reflection of what the press tells people. The man and the woman in the street are not competent to reliably estimate the risk-benefit ratios of St John’s wort, Arnica, glucosamine, acupuncture, etc. etc. They can judge such issues as little as they can judge the risk-benefit balance of a vaccine. They rely on information from the outside, and that information usually reaches them by the press.

What am I aiming at?

Public opinion sounds impressive, and in the realm of SCAM, it often determines much. If the public opinion is in favour of homoeopathy, for instance, politicians are likely to lend their support to it. Yet, public opinion is just OPINION! It cannot be used as an indicator for the efficacy or safety of medical interventions, and it cannot be the reason for using or rejecting them.

It follows, I think, that journalists have a huge responsibility to inform the public correctly on SCAM (and any other matter). On this blog, we have seen numerous instances of journalists who could have done better, e.g.:

Public opinion, it seems to me, can only be meaningful, if the information fed to the public is sound. And when it comes to SCAM, this condition is often not met.

 

 

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