The aim of this study is to explore experiences and perceived effects of the Rosary on issues around health and well-being, as well as on spirituality and religiosity. A qualitative study was conducted interviewing ten Roman Catholic German adults who regularly practiced the Rosary prayer. As a result of using a tangible prayer cord and from the rhythmic repetition of prayers, the participants described experiencing stability, peace and a contemplative connection with the Divine, with Mary as a guide and mediator before God. Praying the Rosary was described as helpful in coping with critical life events and in fostering an attitude of acceptance, humbleness and devotion.
The article impressed me so much that it prompted me to design a virtual study for which I borrowed Walach’s abstract. Here it is:
The aim of this study is to explore experiences and perceived effects of train-spotting on issues around health and well-being, as well as on spirituality. A qualitative study was conducted interviewing ten British adults who regularly practiced the art of train-spotting. As a result of using a tangible train-spotter diary and from the rhythmic repetition of the passing trains, the participants described experiencing stability, peace, and a contemplative connection with the Divine, with Mary as a guide and mediator before the almighty train-spotter in the sky. Train-spotting was described as helpful in coping with critical life events and in fostering an attitude of acceptance, humbleness, and devotion.
These virtual results are encouraging and encourage me to propose the hypothesis that Rosary use and train-spotting might be combined to create a new wellness program generating a maximum holistic effect. We are grateful to Walach et al for the inspiration and are currently applying for research funds to test our hypothesis in a controlled clinical trial.
The integration of so-called alternative medicine (SCAM) into cancer care may reduce the adverse effects of anti-neoplastic treatment but also cause new problems and non-adherence to conventional treatment. Therefore, its net benefit is questionable.
The aim of this randomized controlled study was to investigate the impact of integrative open dialogue about SCAM on cancer patients’ health and quality of life (QoL).
Patients undergoing curative or palliative anti-neoplastic treatment were randomly assigned to standard care (SC) plus SCAM or SC alone. A nurse specialist facilitated SCAM in one or two sessions. The primary endpoint was the
frequency of grade 3–4 adverse events (AE) eight weeks after enrollment. Secondary endpoints were the frequency of grade 1–4 AE and patient-reported QoL, psychological distress, perceived information, attitude towards and use of SCAM 12 and 24 weeks after enrollment. Survival was analyzed post-hoc.
Fifty-seven patients were randomized to SCAM and 55 to SC. No significant differences were found in terms of AEs of cancer patients. A trend towards better QoL, improved survival, and a lower level of anxiety was found in the SCAM group.
The authors concluded that integration of SCAM into daily oncology care is feasible. IOD-CAM was not superior to SC in reducing the frequency of grade 3-4 AEs, but it did not compromise patient safety. Implementation of SCAM
may improve the QoL, anxiety, and emotional well-being of the patients by reducing the level of nausea, vomiting and diarrhea. Finally, SCAM potentially improves the patients’ self-care, which contributes to
increased treatment adherence and improved survival.
This is an interesting paper with a very odd conclusion. The positive trends found failed to be statistically significant. Why employ statistics only to ignore them in our interpretation of the findings?
I can well imagine that the integration of effective treatments into cancer care improves the outcome. I have no problem with this at all – except it is not called INTEGRATIVE MEDICINE but EVIDENCE-BASED MEDICINE!!! If we integrate dubious treatments into cancer care, it’s called INTEGRATIVE MEDICINE, and it’s unlikely to do any good.
In my view, this small study showed just one thing:
Integrative medicine does not reduce adverse effects in cancer patients.
Prince Charles has claimed that people struggling to return to full health after having the coronavirus should practice yoga. This is what the GUARDIAN reported about it on Friday:
In a video statement on Friday to the virtual yoga and healthcare symposium Wellness After Covid, the heir apparent said doctors should work together with “complementary healthcare specialists” to “build a roadmap to hope and healing” after Covid. “This pandemic has emphasised the importance of preparedness, resilience and the need for an approach which addresses the health and welfare of the whole person as part of society, and which does not merely focus on the symptoms alone,” Charles said. “As part of that approach, therapeutic, evidenced-informed yoga can contribute to health and healing. By its very nature, yoga is an accessible practice which provides practitioners with ways to manage stress, build resilience and promote healing…”
… Charles, who has previously espoused the benefits of yoga, is not the only fan in the royal family. His wife, the Duchess of Cornwall, has said “it makes you less stiff” and “more supple”, while Prince William has also been pictured doing yogic poses. In 2019, the Prince of Wales said yoga had “proven beneficial effects on both body and mind”, and delivered “tremendous social benefits” that help build “discipline, self-reliance and self-care”.
END OF QUOTE
Yoga is a complex subject because it entails a host of different techniques, attitudes, and life-styles. There have been numerous clinical trials of various yoga techniques. They tend to suffer from poor study design as well as incomplete reporting and are thus no always reliable. Several systematic reviews have summarised the findings of these studies. A 2010 overview included 21 systematic reviews relating to a wide range of conditions. Nine systematic reviews arrived at positive conclusions, but many were associated with a high risk of bias. Unanimously positive evidence emerged only for depression and cardiovascular risk reduction. There is no evidence that yoga speeds the recovery after COVID-19 or any other severe infectious disease, as Charles suggested.
Yoga is generally considered to be safe. However, a large-scale survey found that approximately 30% of yoga class attendees had experienced some type of adverse event. Although the majority had mild symptoms, the survey results indicated that patients with chronic diseases were more likely to experience adverse events. It, therefore, seems unlikely that yoga is suited for many patients recovering from a COVID-19 infection.
The warning by the Vatican’s chief exorcist that yoga leads to ‘demonic possession’ might not be taken seriously by rational thinkers. Yet, experts have long warned that many yoga teachers try to recruit their clients into the more cult-like aspects of yoga.
Perhaps the most remarkable expression in Charles’ quotes is the term ‘EVIDENCE-INFORMED‘. It crops up regularly when Charles (or his advisor Dr. Michael Dixon) speaks or writes about so-called alternative medicine (SCAM). It is a clever term that sounds almost like ‘evidence-based’ but means something entirely different. If a SCAM is not evidence-based, it can still be legitimately put under the umbrella of ‘evidence-informed’: we know the evidence is not positive, we were well-informed of this fact, we nevertheless conclude that yoga (or any other SCAM) might be a good idea!
In my view, the regular use of the term ‘evidence-informed’ in the realm of SCAM discloses a lack of clarity that suits all snake-oil salesmen very well.
 Ernst E, Lee MS: Focus on Alternative and Complementary Therapies Volume 15(4) December 2010 274–27
 Matsushita T, Oka T. A large-scale survey of adverse events experienced in yoga classes. Biopsychosoc Med. 2015 Mar 18;9:9. doi: 10.1186/s13030-015-0037-1. PMID: 25844090; PMCID: PMC4384376.
After yesterday’s post entitled ‘What does a holistic doctor do that a traditional doctor doesn’t?‘, I thought it would only be fair to turn the question around and ask: What does a proper doctor do that a holistic healer doesn’t? The answers will upset a lot of practitioners of alternative medicine (SCAM), but so be it.
So, what does a proper doctor do that a holistic healer doesn’t?
I suggest several answers and hope that the readers of this blog will contribute to further points. Many of them center around safeguarding the public:
- Proper doctors avoid confusing or misleading the public with titles they do not have.
- They do have rigorous education and training.
- They avoid making false therapeutic claims.
- They adhere to the ethical standards of their profession.
- They resist the temptation to advertise their services to the consumer.
- They do their best to identify the cause of their patient’s symptoms.
- They treat the causes of disease whenever possible.
- They avoid pretending that they always have all the answers.
- They abide by the rules of evidence-based medicine.
- They are aware that almost any effective treatment comes with adverse effects.
- They try to keep abreast with the rapid advances in medicine.
- They know that a patient is more than a diagnostic label.
- They try to treat patients holistically.
At this stage, I can hear some readers shout in anger:
- Ahh, but that is rubbish!
- I know doctors who are not at all like that!
- You are idealizing your profession!
- This is little more than wishful thinking!
Yes, I know that many patients are disappointed and have had a bad experience with conventional medicine. That is one of the reasons many try SCAM. I know that many doctors occasionally fail to live up to the ideal that I depicted above. And I fear that some do so more often than just occasionally.
This is regrettable and occasionally it is unacceptable. Medicine is populated not by perfect people; it is run by humans like you and me. Humans are fallible. Doctors have bad days just like you and me. If that happens regularly, we need to address the problems that may the cause of the deficit. If necessary, the case has to go before a disciplinary hearing. There are thousands of experts who are dedicated to improving healthcare in the hope of generating progress.
The point I was trying to make is that there is such a thing as an ideal physician. It relies on:
- rigorous training,
- ethical codes,
- post-graduate education,
- swift disciplinary procedures,
- advances brought about through colossal research efforts,
- etc., etc.
Do ‘holistic healers’ offer all of these safeguards?
The sad answer is no.
For those who disagree, let’s briefly look at a recent example.
- Mr. Lawler died because of a tear and dislocation of the C4/C5 intervertebral disc caused by a considerable external force.
- The pathologist’s report also showed that the deceased’s ligaments holding the vertebrae of the upper spine in place were ossified.
- This is a common abnormality in elderly patients and limits the range of movement of the neck.
- There was no adequately informed consent by Mr. Lawler.
- Mr. Lawler seemed to have been under the impression that the chiropractor, who used the ‘Dr’ title, was a medical doctor.
- There is no reason to assume that the treatment of Mr. Lawler’s neck would be effective for his pain located in his leg.
- The chiropractor used an ‘activator’ that applies only little and well-controlled force. However, she also employed a ‘drop table’ which applies a larger and not well-controlled force.
As far as I can see, most of the safeguards and standards that apply to conventional medicine were not in place to safeguard Mr. Lawler. And that includes a timely disciplinary hearing of the case. Mr. Lawler died in 2017! The CCG has been dragging its feet ever since, and, as far as I know, the chiropractor was meanwhile allowed to practise. The HEARING BEFORE THE PROFESSIONAL CONDUCT COMMITTEE OF THE GENERAL CHIROPRACTIC COUNCIL has now been scheduled to commence on 19 April 2021.
I know, it’s just an example. But it should make us think.
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
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:
- ‘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.
- ‘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.
- ‘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.
- ‘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.
- 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.
For some time now, I have been using the umbrella term ‘so-called alternative medicine’ (SCAM). As I explain below, I think it is relatively well-suited. But this is not to say that it is the only name for it. Many other umbrella terms have been used in the past.
Is there perhaps one that you prefer?
- Fringe medicine is rarely used today. It denotes the fact that the treatments under this umbrella are not in the mainstream of healthcare. Some advocates seem to find the word derogatory, and therefore it is now all but abandoned.
- Unorthodox medicine is a fairly neutral term describing the fact that medical orthodoxy tends to shun most of the treatments in question. Strictly speaking, the word is also incorrect; the correct term would be ‘heterodox medicine’.
- Unconventional is also a neutral term but it is open to misunderstandings: any new innovation in medicine might initially be called unconventional. It is therefore less than ideal.
- Traditional medicine describes the fact that most of the modalities in question have been around for centuries and thus have a long tradition of usage. However, as the term is sometimes also used for conventional medicine, it is confusing and far from ideal.
- Alternative medicine is the term everyone seems to know and which is most commonly employed in non-scientific contexts. In the late 1980s, some experts pointed out that the word could give the wrong impression: most of the treatments in question are not used as a replacement but as an adjunct to conventional medicine.
- Complementary medicine became subsequently popular based on the above consideration. It accounts for the fact that the treatments tend to be used by patients in parallel with conventional medicine.
- Complementary and alternative medicine (CAM) describes the phenomenon that many of the treatments can be employed either as a replacement of or as an adjunct to conventional medicine.
- Holistic medicine denotes the fact that practitioners often pride themselves to look after the whole patient – body, mind, and spirit. This could lead to the erroneous impression that conventional clinicians do not aim to practice holistically. As I have tried to explain repeatedly, any good healthcare always has been holistic. Therefore, the term is misleading, in my view.
- Natural medicine describes the notion that many of the methods in question are natural. The term seems attractive and is therefore good for business. However, any critical analysis will show that many of the treatments in question are not truly natural. Therefore this term too is misleading.
- Integrated medicine is currently popular and much used by Prince Charles and other enthusiasts. As we have discussed repeatedly on this blog, the term is nevertheless highly problematic.
- Integrative medicine is the word used in the US for integrated medicine.
- CAIM (complementary/alternative/integrative medicine) is a term that some US authors recently invented. I find this attempt to catch all the various terms in one just silly.
- So-called alternative medicine (SCAM) is the term I tend to use. It accounts for two important facts: 1) if a treatment does not work, it cannot possibly serve as an adequate alternative; 2) if a therapy does work, it should be part of conventional medicine. Thus, there cannot be an ‘alternative medicine’, as much as there cannot be an alternative chemistry or an alternative physics.
Yet,some advocates find ‘SCAM’ derogatory. Intriguingly, my decision to use this term was inspired by Prince Charles, arguably the world’s greatest champion of this sector of healthcare. In his book ‘HARMONY’, he repeatedly speaks of ‘so-called alternative treatments’.
You don’t believe me?
In this case – and in order to save you the expense of buying Charles’ book for checking – let me provide you with a direct quote: “Some so-called alternative treatments seek to work with these functions to aid recovery…” (page 225).
And who would argue that Charles is dismissive about alternative medicine?
Osteopathy is hugely popular in France. Despite the fact that osteopathy has never been conclusively shown to generate more good than harm, French osteopaths have somehow managed to get a reputation as trustworthy, evidence-based healthcare practitioners. They tend to treat musculoskeletal and many other issues. Visceral manipulation is oddly popular amongst French osteopaths. Now the trust of the French in osteopathy seems to have received a serious setback.
‘LE PARISIEN‘ has just published an article about the alleged sexual misconduct of one of the most prominent French osteopaths and director of one of the foremost schools of osteopathy in France. Here are some excerpts from the article that I translated for readers who don’t speak French:
The public prosecutor’s office of Grasse (Alpes-Maritimes) has opened a judicial investigation against Marc Bozzetto, the director and founder of the school of osteopathy in Valbonne, accused of rape and sexual assault.
In total, “four victims are targeted by the introductory indictment,” said the prosecutor’s office, stating that Marc Bozzetto had already been placed in police custody since the beginning of the proceedings. The daily paper ‘Nice-Matin’ has listed six complaints and published the testimony of a seventh alleged victim.
This victim claims to have been sexually assaulted in 2013, alleging that, during a professional appointment, Bozzetto had massaged her breasts and her intimate area. “He told me that everything went through my vagina and clitoris, that I had to spread my legs and let the energy flow through my clitoris. That I had to learn how to give myself pleasure on my own,” she told Nice-Matin. The newspaper also recorded the testimonies of a former employee, a top-level sportswoman, an employee from the world of culture, and a former student.
“I take note that a judicial inquiry is open. To date, he has neither been summoned nor indicted,” said Karine Benadava, the Parisian lawyer of the 80-year-old Bozzetto. Her client had already responded following initial accusations from students: “This is a normal feeling for women, but if all the women who work on the pelvis complain, you can’t get away with it and you have to stop working as a pelvic osteopath,” replied Bozzetto. In another interview, he had declared himself “furious” and unable to understand the reaction of these two students.
The school of osteopathy trains about 300 students each five years and presents itself as the first holistic osteopathy campus in France.
Such stories of sexual misconduct of practitioners of so-called alternative medicine (SCAM) are sadly no rarety, particularly those working in the area of manual therapy. They remind me of a case against a Devon SCAM practitioner in which I served as an expert witness many years ago. Numerous women gave witness that he ended up having his fingers in their vagina during therapy. He did not deny the fact but tried to defend himself by claiming that he was merely massaging lymph-nodes in this area. It was my task to elaborate on the plausibility of this claim. The SCAM practitioner in question was eventually sentenced to two years in prison.
It stands to reason that SCAM practitioners working in the pelvic area are at particularly high risk of going atray. The above case might be a good occasion to have a public debate in France and ask: IS VISCERAL OSTEOPATHY EVIDENCE-BASED? The answer is very clearly NO! Surely, this is a message worth noting in view of the current popularity of this ridiculous, costly, and dangerous charlatanry.
And how does one minimize the risk of sexual misconduct of SCAM professionals? The most obvious answer would be, by proper education during their training. In the case mentioned above, this might have been a problem: if the director is into sexual misconduct, what can you expect of the rest of the school? In many other cases, the problem is even greater: many SCAM practitioners have had no training at all, or no training in healthcare ethics to speak of.
I was alerted to an article in which some US doctors, including the famous Andrew Weil, promote the idea that so-called alternative medicine (SCAM) has a lot to offer for people recovering from Covid-19 infections. There would be a lot to argue about their recommendations, but today I will not go into this (I find it just too predictable how SCAM proponents try to promote SCAM on the basis of flimsy evidence; perhaps I am suffering from ‘BS for Covid fatigue’?). What did, however, strike me in their paper was a definition of INTEGRATIVE MEDICINE (IM) that I had not yet come across:
Integrative medicine is defined as healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies.
Ever since the term IM became fashionable, there have been dozens of definitions of the term (almost as though IM proponents were not quite sure themselves what they were promoting). And ever since I first heard about IM, I felt it was a thinly disguised attempt to smuggle unproven treatments into the routine of evidence-based medicine (EBM). In 2002, I published my 1st comment on the subject. In it, I warned that IM must not become an excuse for using every conceivable untested treatment under the banner of holism. Nineteen years on, this is exactly what has happened, and one definition of IM after the next is soaked in platitudes, falsehoods and misunderstandings.
So, let’s see how reasonable this new definition is. I will try to do this by briefly discussing each element of the two sentences.
- IM is healing-oriented medicine: this is a transparently daft platitude. Does anyone know a medicine that is not oriented towards healing? Healing is the process of becoming well again, especially after a cut or other injury, or of making someone well again. Healing is what medicine has always been and always be aimed at. In other words, it is not something that differentiates IM from other forms of healthcare.
- IM takes account of the whole person: This is the little holistic trick that IM proponents like to adopt. It implies that normal medicine or EBM is not holistic. This implication is wrong. Any good medicine is holistic, and if a sector of healthcare fails to account for the whole person, we need to reform it. (Here are the conclusions of an editorial I published in 2007 entitled ‘Holistic heath care?‘: good health care is likely to be holistic but holistic health care, as it is marketed at present, is not necessarily good. The term ‘holistic’ may even be a ‘red herring’ which misleads patients. What matters most is whether or not any given approach optimally benefits the patient. This goal is best achieved with effective and safe interventions administered humanely — regardless of what label we put on them.) Creating a branch of medicine that, like IM, pretends to have a monopoly on holism can only hinder this process.
- IM includes all aspects of lifestyle: really, all of them? This is nonsense! Good physicians take into account the RELEVANT lifestyles of their patients. If, for instance, my patient with intermittent claudication is a postman, his condition would affect him differently from a patient who is a secretary. But all lifestyles? No! I fear this ‘over the top’ statement merely indicates that those who have conceived it have difficulties differentiating the important from the trivial.
- IM emphasizes the therapeutic relationship: that’s nice! But so do all other physicians (except perhaps pathologists). As medical students, we were taught how to do it, some physicians wrote books about it (remember Balint?), and many of us ran courses on the subject. Some conventional clinicians might even feel insulted by the implication that they do not emphasize the therapeutic relationship. Again, the IM brigade take an essential element of good healthcare as their monopoly. It almost seems to be a nasty habit of theirs to highjack a core element of healthcare and declare it as their invention.
- IM is informed by evidence: that is brilliant, finally there emerges a real difference between IM and EBM! While proper medicine is BASED on evidence, IM is merely INFORMED by it. The difference is fundamental, because it allows IM clinicians to use any un- or disproven SCAM. The evidence for homeopathy fails to show that it is effective? Never mind, IM is not evidence-based, it is evidence-informed. IM physiciance know homeopathy is a placebo therapy (if not they would be ill-informed which would make them unethical), but they nevertheless use homeopathy (try to find an IM clinic that does not offer homeopathy!), because IM is not EBM. IM is evidence-informed!
- IM makes use of all appropriate therapies: and the last point takes the biscuit. Are the IM fanatics honestly suggesting that conventional doctors use inappropriate therapies? Does anyone know a branch of health care where clinicians systematically employ therapies that are not appropriate? Appropriate means suitable or right for a particular situation or occasion. Are IM practitioners the only ones who use therapies that are suitable for a particular situation? This last point really does count on anyone falling for IM not to have the slightest ability to think analytically.
This short analysis confirms yet again that IM is little more than a smokescreen behind which IM advocates try to smuggle nonsense into routine healthcare. The fact that, during the last two decades, the definition constantly changed, while no half decent definition emerged suggests that they themselves don’t quite know what it is. They like moving the goal post but seem unsure in which direction. And their latest attempt to define IM indicates to me that IM advocates might not be the brightest buttons in the drawer.
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.
… 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:
- if they knowingly deceive, they would not tell us,
- 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.
The authors of this review wanted to determine similarities and differences in the reasons for using or not using so-called alternative medicine (SCAM) amongst general and condition-specific populations, and amongst populations in each region of the globe.
Quantitative or qualitative original articles in English, published between 2003 and 2018 were reviewed. Conference proceedings, pilot studies, protocols, letters, and reviews were excluded. Papers were appraised using valid tools and a ‘risk of bias’ assessment was also performed. Thematic analysis was conducted. Reasons were coded in each paper, then codes were grouped into categories. If several categories reported similar reasons, these were combined into a theme. Themes were then analysed using χ2 tests to identify the main factors related to reasons for CAM usage.
A total of 231 publications were included. Reasons for SCAM use amongst general and condition-specific populations were similar. The top three reasons were:
- (1) having an expectation of benefits of SCAM (84% of publications),
- (2) dissatisfaction with conventional medicine (37%),
- (3) the perceived safety of SCAM (37%).
Internal health locus of control as an influencing factor was more likely to be reported in Western populations, whereas the social networks was a common factor amongst Asian populations (p < 0.05). Affordability, easy access to SCAM and tradition were significant factors amongst African populations (p < 0.05). Negative attitudes towards SCAM and satisfaction with conventional medicine were the main reasons for non-use (p < 0.05).
The authors concluded that dissatisfaction with conventional medicine and positive attitudes toward SCAM, motivate people to use SCAM. In contrast, satisfaction with conventional medicine and negative attitudes towards SCAM are the main reasons for non-use.
At this point, I thought: so what? This is all very obvious and does not necessitate an extensive review of the published literature. What it actually shows is that the realm of SCAM is obsessed with conducting largely useless surveys, a phenomenon, I once called ‘survey mania‘. But a closer look at the review does reveal some potentially interesting findings.
In less developed parts of the world, like Africa, SCAM use seems to be determined by affordability, accessibility and tradition. This makes sense and ties in with my impression that consumers in such countries would give up SCAM as soon as they can afford proper medicine.
This notion seems to be further supported by the reasons for not using SCAM. Asian consumers claim overwhelmingly that this is because they consider SCAM ineffective and unsafe.
In our review of 2011 (not cited in the new review), we looked at some of the issues from a slightly different angle and evaluated the expectations of SCAM users. Seventy-three articles met our inclusion criteria of our review. A wide range of expectations emerged. In order of prevalence, they included:
- the hope to influence the natural history of the disease;
- the desire to prevent disease and promote health/general well-being;
- the hope of fewer side effects;
- the wish to be in control over one’s health;
- the hope for symptom relief;
- the ambition to boost the immune system;
- the hope to receive emotional support;
- the wish to receive holistic care;
- the hope to improve quality of life;
- the expectation to relief of side effects of conventional medicine;
- the desire for a good therapeutic relationship;
- the hope to obtain information;
- the hope of coping better with illness;
- the expectation of supporting the natural healing process;
- the availability of SCAM.
All of these aspects, issues and notions might be interesting, even fascinating to some, but we should not forget three important caveats:
- Firstly, SCAM is such a diverse area that any of the above generalisations are highly problematic; the reasons and expectations of someone trying acupuncture may be entirely different from those of someone using homeopathy, for instance.
- Secondly (and more importantly), the ‘survey mania’ of SCAM researchers has not generated the most reliable data; in fact, most of the papers are hardly worth the paper they were printed on.
- Thirdly (and even more importantly, in my view), why should any of this matter? We have known about some of these issues for at least 3 decades. Has this line of research changed anything? Has it prevented consumers getting exploited by scrupulous SCAM entrepreneurs? Has it made consumers, politicians or anyone else more aware of the risks associated with SCAM? Has it saved many lives? I doubt it!