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

holistic

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In recent weeks, I have been thinking a lot about ‘INTEGRATIVE MEDICINE‘. Skeptics mostly see it as a way of smuggling quackery into conventional healthcare. This is undoubtedly true and important. But it occurred to me that there also is a somewhat different perspective that has so far been neglected. Let me try to explain by recounting a story. It is fictive, of course, but the fiction is based on the observation of many cases during previous decades.

The story is about a doctor – let’s call him George – who, to be frank, is not the most gifted of his colleagues. Already at medical school, he was not as dedicated as his teachers would have hoped. In fact, medicine had not been his first choice at all. Yet he ended up as a general practitioner and eventually became a partner in a practice with 5 GPs.

Over the years, it became clear that George lacked something to be a good doctor. He knew his stuff, alright, got most of the diagnoses correct, and made not too many mistakes. But something was not quite right. One could say that, relative to his colleagues, he lacked kindness, dedication, compassion, and empathy. He often found it unnecessary to respect his patients. Sometimes, he even joked about them and about what he perceived as their stupidity.

If we view medicine as being both a science and an art, one might conclude that George was just about alright with the science but notably deficient in the art of healthcare. Most of his patients were aware that something was amiss; many even avoided him and tried to consult one of his colleagues instead. On more than one occasion, patients had told George that they were disappointed with his attitude. Some had even told him to the face that he lacked kindness. Such conversations made George think. He had to admit to himself that his colleagues were better at building good relationships with their patients. Eventually, George decided that something ought to change.

As it happened, George’s wife had a friend who was a Reiki healer. One day, he asked the healer – let’s call her Liz – whether she would like to try working alongside the GPs in his practice. Liz was delighted and accepted. George did not believe for a minute that Reiki was more than hocus-pocus, but he knew that Liz was kind and had loads of the compassion that he was so obviously lacking.

Hence force George and Liz formed a team: George looked after his patients the best he could and whenever he felt that more empathy and compassion were required, he would send the patient to Liz. This partnership changed everything. The patients were content, George was happy, and Liz was beaming.

As some patients frowned at the idea of Reiki, George soon recruited an aromatherapist as well. After that, a lay homeopath and a reflexologist were employed. George’s GP partners (who made little use of the alternative practitioners) were sure that none of these therapies had any specific effects (incidentally, a belief not shared by the practitioners in question who felt they were doing wonders). But for George, the therapists clearly did supplement his limited interpersonal skills. Patients were delighted and the GP practice began to thrive. As for George, he became an increasingly outspoken and prominent advocate of INTEGRATED MEDICINE. The fact that there was no evidence to support it did hardly matter to him; what counted was that it rendered his own incompetence less visible.

About a year later, George convinced his slightly bewildered partners to rename their practice ‘THE INTEGRATIVE HEALTH CENTRE’.

End of story

In case you did not get my point, let me make it more bluntly: INTEGRATIVE MEDICINE can be a way for some doctors to delegate the art of medicine to quacks. Good doctors don’t need to do this because they are able to show compassion and treat their patients as whole human beings. Less gifted doctors, however, find INTEGRATIVE MEDICINE a practical solution to their own incompetence.

So, is INTEGRATIVE MEDICINE a good compromise then?

No, certainly not!

The last thing we need in healthcare is for doctors to start delegating the art of medicine to others. It would be a serious mistake, nothing less than abandoning the core values of medicine to charlatans.

But what is the solution?

Obviously, it is to make sure all doctors are competent. We need to select medical students adequately, tell them much more about the importance of kindness, compassion, empathy, holism, etc., and teach them how to show and use these qualities. We need to train doctors to be competent in both the science and the art of medicine. This has to begin in medical school and must continue throughout their professional career. We need to make sure that doctors like George understand the message; if they prove to be unable to do so, we should direct them to professions where compassion is not essential.

The worst solution we can possibly envisage is to allow charlatans to cover up the incompetence of people like George and call it INTEGRATED MEDICINE.

 

Camilla spent ten days at the end of October in a sophisticated meditation and fitness center in southern India. Life has recently been hectic for the Queen Consort: at 75, she has been in a non-stop succession of various ceremonies for the funeral of Elizabeth II, always one step behind her husband, not to mention her new status as sovereign… Enough to block her chakras in no time.

She came to the resort with her bodyguards and a handful of friends and was able to take advantage of the tailor-made treatments concocted for her by the master of the house, Dr Issac Mathai, who created this high-end holistic centre on a dozen hectares of scented gardens near Bangalore. The program includes massages, herbal steam baths, yoga, naturopathy, homeopathy, meditation, and Ayurvedic treatments to “cleanse, de-stress, soothe and revitalize the mind, body and soul”, as the establishment’s website states.

Guests are required to follow an individualized, meat-free diet, with organic food from the resort’s vegetable gardens, based on lots of salads or soups – Camilla is said to be a fan of sweet corn soup with spinach. Cigarettes and mobile phones are not allowed, although it is assumed that Camilla must have some privileges due to her status… and the basic rate for the suites, which starts at $950 a night – the price of the rooms varies between $260 and $760, the rate including a consultation with the doctors.

Charles and Camilla have been fans of the Soukya Centre in India for a decade. The place corresponds in every way to their deep-rooted convictions about health. Like her husband, Camilla is a follower of organic food, she also practices yoga and treats her face with creams made from nettle and bee venom. For his part, Charles has long been an advocate of alternative medicine, homeopathy, acupuncture, aromatherapy, and also hypnosis… He even set up a foundation to support complementary medicine by lobbying the British health service to include it in complementary therapies for certain patients, which caused an uproar among the pundits of traditional medicine.

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If you suspected I was (yet again) sarcastic about the royal couple, you are mistaken. The text above is only my (slightly shortened) translation of an article published in the French magazine LE POINT (even the title is theirs). I found the article amusing and interesting; so, I looked up the Indian health center. Here are some of the things I found:

The 1st impression is that they are not shy about promotion calling themselves THE WORLD’S BEST AYURVEDA TREATMENT CENTER. The doctor in charge was once a ‘Consultant Physician’ at the Hale Clinic in London, where he treated a number of high-profile people. As his professional background, he offers this:

M.D. (Homeopathy); Hahnemann Post-Graduate Institute of Homeopathy, London M.R.C.H, London; Chinese Pulse Diagnosis and Acupuncture, WHO Institute of Traditional Chinese Medicine, Nanjing, China; Trained (Mind-Body Medicine Programme) at Harvard Medical School, USA

The approach of the center is described as follows:

The fundamental principle underlying Holistic Treatment is that the natural defense and immune system of an individual when strengthened, has the potential to heal and prevent diseases. In the age of super-specialisation where human beings are often viewed as a conglomeration of organs, it is crucial to understand ourselves as multi-dimensional beings with a body, mind and spirit. These interconnected dimensions need to be in perfect harmony to ensure real well-being.

And about homeopathy, they claim this:

Homeopathy originated in 1796 in Germany, and was discovered by Dr. Samuel Hahnemann, a German scientist. Homeopathy is popular today as a non-intrusive, holistic system of medicine. Instead of different medicines for different parts of the body, one single constitutional remedy is prescribed. As a system of medicine, Homeopathy is highly scientific, safe, logical and an extremely effective method of healing. For over 200 years people have used Homeopathy to maintain their good health, and also to treat and cure a wide range of illnesses like allergies, metabolic disorders, atopic dermatitis, Rheumatoid arthritis, Auto-immune disorders.

At this stage, I felt I had seen enough. Yes, you are right, we did not learn a lot from this little exploration. No, hold on! We did learn that homeopathy is highly scientific, safe, logical, and extremely effective!

 

The question, however, is should we believe it?

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

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

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

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

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

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

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

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

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

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

But what would adequate regulation look like?

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

What about the side effects of these practices?

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

My point here is this:

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

 

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

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

Here is its English summary:

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

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

– the combination of conventional and complementary methods,

– the holistic understanding of medicine,

– the great importance of the doctor-patient relationship,

– the hope for optimal therapeutic success,

– the focus on the patient,

– the high value of experiential knowledge.

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

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

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

________________________

 

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

DEFINITIONS

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

ABOUT US

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

THE HEALTHCARE WE DESIRE

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

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

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

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

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

OUR CALL TO ACTION

All countries

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

All healthcare professionals

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

_____________________________

And here are my comments.

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

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

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

Integrative medicine integrates complementary and conventional methods

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

Integrative medicine: Opportunities especially for chronic diseases and side effects

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

________________________________

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

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

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

 

One should never assume that one has seen everything so-called alternative medicine (SCAM) has to offer. New interventions pop up all the time. The ingenuity of the SCAM entrepreneur is limitless. Here is a particularly audacious innovation:

Aura sprays deliver healing gemstone energies to your body, emotions, memory, and mind via your aura.

They give you:

  • Instant relief from negative, harmful, or unwanted energies.
  • Support that you cannot get from herbs and medicines.
  • Deep nourishment to help you overcome weakness and depletion.

And you can choose from an entire range:

7-Color-Ray Diamond Spray $34.95 – $89.95

Energy Clearing Spray $24.95 – $59.95

Electromagnetic Radiation EMR Clearing $24.95 – $59.95

Sparkler Diamond Spray $34.95

I was particularly fascinated by the EMR spray and found further relevant information about it:

Electromagnetic radiation (EMR) floods our environment and is potentially harmful. GEMFormulas’ EMR Clearing spray clears this energetic toxin from the body and teaches it to become immune. This is essential if we are to thrive in a modern world.

Use this spray to help clear your body and aura of harmful electromagnetic radiation frequencies, which can weaken tissue, inhibit cellular function, and interfere with normal energy flows in the body.

**Harmful electromagnetic radiation is emitted by computers, cell phones, motors, microwave ovens, and other electrical appliances.**

Use When You Are Feeling:

  • Weakened in the vicinity of electromagnetic fields.
  • Dermatological symptoms such as redness, tingling, and burning sensations.
  • Symptoms typical of EHS (Electromagnetic Hypersensitivity) such as fatigue, tiredness, concentration difficulties, dizziness, nausea, heart palpitations, and digestive disturbances.
  • A range of non-specific, medically unexplained symptoms.

And When You Want to:

  • Become more resilient to the effects of potentially harmful EMR.
  • Build immunity to EMR, heal from damage caused by EMR, and protect yourself from further EMR damage.
  • Clear harmful EMR residues from your body and aura.
  • Maximize your health potential.

Ideal For People Who:

  • Work with computers all day long.
  • Live near sources of high electromagnetic radiation.
  • Suspect they have Electromagnetic Hypersensitivity (EHS).
  • Plan to become pregnant.
  • Are trying to heal from another affliction.

Additional Benefits: Clear Therapeutic Gemstones and Crystals

You can also use the spray to clear electromagnetic radiation that therapeutic gemstone necklaces naturally accumulate during normal wear in areas of high electromagnetic fields, when stored too close to computers or other electronic devices, and when worn while you are holding a cell phone.

I am tempted!

Not that I plan to become pregnant but I am trying to heal from another affliction: gullibility.

________________________

Seriously: how can anyone fall for such nonsense???

But obviously, some people do and pay good money to ruthless con artists (if you look on the Internet, there are dozens of firms offering such quackery).

Even after 30 years of research, so-called alternative medicine (SCAM) has a sheer inexhaustible ability to amaze me.

The tales of Kate Moss’s excesses are legendary. Sex and drugs and rock ‘n’ roll have always been an integral part of the supermodel’s life. Stories of wild behavior, random sexual encounters, and copious drug use seemed endless. Now, it seems she is adding a new element to her tumultuous career:

Quackery.

The supermodel is the latest in the long line of VIPs jumping on the quackery bandwagon by marketing her very own brand of over-priced nonsense. She was reported to have worked with Victoria Young, a homeopath and “spiritual guide”, on the products. There’s a Dawn Tea at £20 for 25 tea bags, “inspired by Kate’s English garden” – “With ingredients like hibiscus, rosemary, and nettle leaf, this first step of the Dawn Ritual gently energizes and strengthens the body”. There’s also a Dusk Tea.

There is also a 100ml bottle called Sacred Mist for £120. It is described as “a unique eau de parfum blended with essential oils for the body and surroundings.” There’s a 30ml bottle for £105 called Golden Nectar, which is pro-collagen. CBD oil drops to “holistically support body, mind, and soul”. A 50ml face cream for £95. A 100ml face cleanser for £52.

The website of Moss’ new enterprise claims that “COSMOSS draws on the extraordinary life experience of Kate Moss — someone whose career and image has touched on and influenced so many others and yet has taken her own, rich journey of transformation gradually and privately. COSMOSS is a celebration of every day exactly as it is, with all its imperfections. Each product has been meticulously crafted with wellbeing in mind, using potent, natural substances. Each ritual opens a door to balance, restoration, and love; each fragrance and infusion recentres and completes. COSMOSS is self-care created for life’s modern journeys to make them beautiful, mesmerising and magical.”

In a far cry from her past, Moss explained: “I’ve been meditating, doing yoga, just being much healthier. All the stuff that can make you feel more grounded and balanced.”

Personally, I am glad to hear that Kate is off cocaine and now into other, less harmful ‘natural substances’. Her customers wellbeing might not improve, but I suspect her bank account might.

What motivates a doctor to work as an integrative medical practitioner? This is a question I asked myself often. Despite trying to find answers through several methods, I was not very successful. The question does not seem well-researched at all. Here is what I found so far:

Our own 1996 survey of GPs participating in a course at Exeter that was aimed at familiarizing them with so-called alternative medicine (SCAM) found that the main perceived advantage of SCAM, apart from the potential intrinsic value of the techniques themselves, was the time available for establishing a good therapeutic relationship with the patient.

A UK survey from 2001 suggested that doctors are motivated by issues ranging from feeling a responsibility to respond to their patients’ interests and needs to developing “another string to their bow.” Some are attracted to its study in its own right, others by a wish to focus some of their energy away from conventional medical practice, which they may find stressful and unfulfilling. Doctors studying complementary and alternative medicine often call on different personality traits and report a variety of positive benefits from training, including welcoming the opportunity to engage their feelings, trust their intuition, and enjoy therapeutic touch. Comments from attendees at one homoeopathic course were “I started to enjoy seeing patients again,” “Training had improved my conventional history taking,” and “Having another approach made treating heart-sink patients easier.”

A German focus group in 2008 with 17 GP suggested that scientific evidence and patient preference were the main criteria used by these doctors in deciding whether to apply a SCAM or not.

An interview study published in 2011 with Australian doctors provided some details. The researchers invited 43 doctors to participate. Twenty-three agreed to take part in either a face-to-face (n = 7) or telephone (n = 16) interviews. Here is the passage entitled “Motivations to work as an integrative medical practitioner” from their paper:

‘Family of origin health beliefs and practices’ were an important influence on the doctors’ philosophical approach and their decisions to work as an integrative medical practitioner.

…When I grew up it was not uncommon that I would see my aunties and uncles preparing all sorts of things. My auntie laying me on her lap and putting breast milk in my ear and drinking chamomile tea for a sore belly…there was lots of things that influenced me. (Female, 23 years in practice)

…There is a long tradition in [country of origin] of using a herbalist. I heard things from my mum and my grandma and those ideas were there. (Male, 16 years in practice)

The ‘personal or close family illness experiences’ reported by doctors were also influential in motivating them to practice integrative medicine. These experiences included non-conventional approaches to health and illness and the use of CAM as treatment modalities.

…I had my own illness – depression and a very bad back. I’d been on medication for years and I got sick of taking medications and I was given a prognosis of chronic illness with relapses and I really didn’t like it. So I started to look elsewhere and that took me in to the world of mind-body medicine. (Female, 24 years in practice)

Other doctors cited ‘professional experiences’, often early in their careers, of different theoretical approaches to medicine as being a powerful stimulus to practice integrative medicine. These included being inspired by a medical lecturer, an interesting, usually non-conventional experience during a placement as a medical student, and professional experiences of CAM modalities during their residency or early medical career.

…We had this subject Medical Studies 3, where there was a discussion of the French fur trapper in the Yukon who had shot himself in the stomach and the local doctor who was experimenting with various emotional states. There was just that sort of moment, of thinking, that’s the sort of area that I want to work in. (Male, 26 years in practice)

…I found myself doing a clinical attachment at a hospital in Switzerland that used integrated medicine, they had a course and I thought I’ll just do this for interest. I came in contact with an Indian person who did homeopathy and I found his stories quite interesting. (Male, 22 years in practice)

‘Dissatisfaction with the conventional approach to medicine’, which was perceived to be too illness focused or commercialized, was also cited by some doctors as a precursor to adopting an integrative approach to medical practice.

…More and more I’m realising that medicine is a personalised thing. We need to learn the art of treating people individually rather than en masse as a sick lung or a sick toe or a sick whatever because it doesn’t work like that. (Male, 22 years in practice)

…Medicine was hijacked by the market; i.e.: big pharmaceutical companies. And they have seduced the government, the colleges, the universities, general practice, everybody. GPs, in my opinion, have been deskilled. (Female, 19 years in practice).

An Australian survey from 2021 suggested that GPs were attracted to SCAM because they thought it to be relatively safe and effective, offering additional, holistic benefits to patients.

___________________________

Collectively these investigations suggest that doctors’ motivation to work as integrated medical practitioners vary greatly. They seem to include:

  • positive evidence for SCAM’s safety and efficacy,
  • having the time to establish a good therapeutic relationship,
  • wanting to use all therapeutic options,
  • dissatisfaction with conventional medicine,
  • patient preferences,
  • wanting to practice in a more human and holistic way,
  • personal and professional experiences.

But surely, there are other factors as well (from my personal experience in dealing with doctors of integrative medicine, I could list a few that are less than flattering). In any case, I would be most interested to hear your thought and read more published evidence that you might know about.

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