malpractice
“Popularity takes the place of plausibility, tradition replaces validity, and individual experience is positioned above objective efficacy.”
This sentence (my translaation of the German original) comes from a book by Udo Endruscheit that I have been reading. It is entitled “Vom Zweifel zur Haltung: Eine Reise durch die Geschichte der Erkenntnis” (From Doubt to Conviction: A Journey Through the History of Knowledge) and outlines the epistemological development of truth from the early thinkers of antiquity to the postmodern voices of today. It traces how the concept of truth has changed, how it has been criticized, relativized, and deconstructed, and how these changes have shaped us and our thinking.
The statement was no necessarily meant to me applied to medicine, but it does aply capture a recurring epistemological pattern within large segments of so-called alternative medicine (SCAM). It describes a shift away from the truth towards criteria that are socially and psychologically compelling but scientifically nonsensical.
The substitution of popularity for plausibility is evident in the way many SCAMs have gained traction. Treatments such as homeopathy, naturopathic detox regimens, or paranormal energy-based healing have achieved global followings despite the fact that there can hardly be a mechanism of action that does not fly in the face of science. Their popularity is often driven by anecdotal endorsements, celebrity advocacy, and market forces rather than by convergence of experimental and theoretical support. Opinion counts more than truth, and the absence of plausibility in a SCAM is frequent and frequently ignored.
The elevation of tradition over validity is a defining feature of most SCAMs. Historical longevity is often presented as implicit evidence of effectiveness. “It would not have survived, if it were ineffective!” Yet, from a scientific perspective, tradition is a most unreliable indicator: ineffective or even harmful practices can persist for centuries in the absence of effectiveness and even safety. Bloodletting in pre-modern Western medicine offers a cautionary example. The critical issue is not whether a therapy is old, but whether it has been subjected to rigorous evaluation and shown to produce reproducible benefits that exceed placebo and other non-specific effects.
The dominance of individual experience over objective effectiveness is perhaps the most pervasive and psychologically persuasive cause of SCAM’s popularity. Patients’ testimonials, often sincere and seemingly compelling, are being touted as sufficient evidence of effectiveness. Yet individual experience is highly susceptible to regression to the mean, natural disease fluctuation, placebo effects, confirmation and other biases and confounders. Without proper comparisons, it is impossible to distinguish specific therapeutic effects from non-specific ones. Evidence-based medicine does not dismiss patient experience; rather, it contextualizes it with external evidence to avoid misleading us all.
The above statement by Udo Endruscheit was meant as a general characterisation of the way we currently handle and mishandle truth. As such it applies to much more than just SCAM. Yet, it also provides an apt critique of dominant tendencies within SCAM. Popularity, tradition, and personal experience are, of course, not inherently without value, but when they displace plausibility, validity, and objective effectiveness, they create a situation that is wide open to error, exploitation and often also harm.
In a nutshell: the truth matters; watering it down – as we all currently tend to do – carries serious risks in medicine as much as in life.
PS
I almost forgot!
Yes, I do recommend reading Udo’s most fascinating book.
The Journal of Evidence Based Homeopathy (JEBH)?
Yes, it does exist!
It was launched in 2023 by Willmar Schwabe India, as a twice yearly publication that presents itself as a peer-reviewed outlet for research, clinical trials, case studies, reviews, and theoretical pieces about homeopathy. Its own site describes it as a “groundbreaking” journal meant to promote the “evidence-based practice and understanding of homeopathy,” and lists the editor-in-chief as Dr. Ramachandran Valavan who seems to be on the payroll of Schwabe India. As far as I can see, the editorial board consist exclusively of Indian homeopathy supporters.
The publisher is Dr. Willmar Schwabe India Pvt. Ltd., with a Noida/Ghaziabad address in Uttar Pradesh, India. The firm is a branch of the well-known German manufacturer of homeopathic products. JEBH is a specialty homeopathy journal rather than a mainstream medical journal. Its language is strongly promotional, emphasizing “rigorous investigation,” “scientific exploration,” and “solid evidence,” but those claims are made by the journal itself rather than independently demonstrated in the material available here.
JEBH claims it is peer-reviewed. However, its articles often read like advocacy: they present homeopathy as being refined by “modern scientific exploration” and “real-world data,” and frequently treat positive case reports or reviews as confirmation of homeopathy’s validity. That style is, of course, not unusual in homeopathy publications, but from an evidence-based medicine perspective it is a ridiculous substitute for reproducible controlled data.
To give you a taster, here is the first section of a recent editorial published in the JEMH:
The Journal of Evidence-Based Homeopathy (JEBH) continues to strengthen its mission of uniting classical homeopathy with modern scientific exploration. This issue exemplifies how research, provings, and clinical observations converge to validate and refine homeopathic practice. The original articles section presents a diverse set of contributions from clinical case management to digital tools aiding repertorization. The featured case on Natrum muriaticum exemplifies the precision of individualized prescribing in addressing emotional and mental health concerns , while an insightful review on repertory software underscores the evolving integration of technology in clinical decision-making …
I wonder: does anyone know of another so-called “evidence-based” medical journal that is fully controlled, financed and run by a BIG PHARMA firm?
I don’t!
The JEBH confirms what we all suspected:
HOMEOPATHY IS UNIQUE.
The Nazi relic of the German Heilpraktiker – alternative health practitioner, who practise so-called alternative medicine (SCAM)) – is a topic that I wrote about repeatedly, e.g.:
- Prison sentence for a German HEILPRAKTIKER who issued false vaccination certificates
- Another death caused by a ‘Heilpraktiker’, non-medically trained alternative practitioner?
- A German Heilpraktiker was sent to jail for fraud
The path to becoming a Heilpraktiker is as unique as it is scandelously unregulated. By law, the profession requires no mandatory curriculum, no accredited school attendance, and no state-regulated university degree. Technically, anyone over the age of 25 holding a basic middle-school education (Hauptschulabschluss) can sit for the exam (the Heilpraktikerüberprüfung), even without any education or training at all. While some candidates choose to prepare by voluntarily attending a private and expensive school (a Heilpraktikerschule) for one to three years, the lack of standardized educational oversight leaves massive gaps in crucial medical and professional subjects.
Chief among these neglected subjects is, in my view, medical ethics. For those who do attend a school, average ethics instruction ranges from minimal to non-existent. Because private institutes design their own proprietary curricula, ethics is rarely taught as a standalone subject. Instead, it is briefly touched within broader modules concerning Berufs- und Gesetzeskunde (Professional and Legal Studies).
This systemic omission is directly tied to the narrow scope of the state licensing exam. Conducted by local health departments (Gesundheitsamt), the examination is explicitly designed around Gefahrenabwehr, i.e. the prevention of immediate danger to public health. The state’s priority is ensuring that applicants know what they are legally forbidden to do, such as managing highly infectious diseases, prescribing prescription-only medications, or practicing dentistry.
Consequently, broader ethical education is completely sidelined. Vital topics like the biomedical principles of patient autonomy, managing clinical conflicts of interest, and the complexities of informed consent are virtually absent. While some voluntary professional associations have established a code of conduct (Berufsordnung für Heilpraktiker), learning and understanding these ethical guidelines is entirely voluntary and self-guided.
Beyond ethics, maany other critical subjects are severely neglected in the Heilpraktiker schools, e.g.:
- Evidence-Based Medicine (EBM) and Scientific Literacy: students are rarely taught how to critically appraise clinical research, differentiate between correlation and causation, or recognize the cognitive biases inherent in anecdotal “success stories.”
- Pharmacology and Interaction Risks: While forbidden from prescribing prescription drugs, practitioners heavily utilize herbs and other dietary supplements. The study of how these substances interact with each other and a patient’s conventional pharmaceutical regimens is usually overlooked.
- Emergency Medicine and Differential Diagnosis: Because training lacks mandatory, standardized clinical rotations, practical competency in identifying red flags, such as atypical cardiac symptoms or early-stage oncological presentations, is dangerously variable.
The Heilpraktiker system offers unparalleled freedom of practice. At the same time, there is a near total lack of rigorous educational standards. This huge and dangerous imbalance leaves practitioners ill-equipped and put the public at unacceptable risks. Here are some examples of what can thus happen:
- The Klaus Ross / 3-Bromopyruvat (3-BP) Tragedy (2016): In one of Germany’s most notorious SCAM scandals, a Heilpraktiker operating a “Biological Cancer Center” in Brüggen treated terminally ill cancer patients with 3-Bromopyruvat, an unapproved, highly experimental chemical compound. Using an inaccurate kitchen scale to mix the powder himself, he administered massive overdoses via intravenous infusions. At least three patients died within days of the treatment, leading to his conviction for negligent homicide.
- The “BG-Mun” Fake Cancer Cure Scandal (Schrobenhausen): A Heilpraktiker, working alongside a businessman, defrauded desperately ill cancer patients by selling a fake “miracle serum” called BG-Mun for up to €5,900 per package. The practitioner explicitly pressured patients to abandon their conventional oncological treatments (like chemotherapy), promising that the serum would reverse tumor growth. Chemical testing later revealed the expensive liquid was nothing but worthless dilutions of glucose and basic amino acids. Multiple patients, including a 52-year-old esophagus cancer patient who went public with the story, died after their cancers metastasized following their cessation of proper medical care.
- Severe Complications from Autologous Blood Therapy (Eigenbluttherapie): A widespread SCAM among Heilpraktiker involves drawing a patient’s blood, mixing it with ozone, oxygen, or homeopathic remedies, and reinjecting it back into the muscle or vein to “stimulate the immune system.” Due to insufficient training in strict clinical hygiene, numerous documented cases have occurred where patients suffered from sepsis, internal abscesses, and systemic bacterial infections requiring emergency ICU hospitalizations.
- Misdiagnosis of Life-Threatening Emergencies: Because the Heilpraktiker exam does not mandate clinical training, practitioners have no clinical experience and frequently miss time-critical medical diagnoses. Documented cases include patients presenting with atypical chest pain being treated with acupuncture for “energy blockages” rather than being immediately referred to a hospital for an evolving myocardial infarction. Similarly, early-stage, highly curable melanomas or other malignancies have been misidentified as benign skin lesions or metabolic imbalances, delaying life-saving surgeries until the diseases reached terminal stages.
- Ineffective SCAMs for Acute Psychiatric Crises: Some Heilpraktiker choose to specialize in psychotherapy (Heilpraktiker für Psychotherapie). Scandals have arisen where patients suffering from severe clinical depression or acute psychotic episodes were treated solely with Bach flower remedies, St. John’s wort, or talking therapy rooted in esoteric ideas. The rejection of conventional psychiatric intervention and pharmaceutical stabilization in these acute phases has directly led to preventable self-harm and suicides.
So, why does Germany put up with the Heilpraktiker?
Despite repeated and fierce criticism, the German Heilpraktiker is sustained by a combination of law, politics, and tradition. The primary legal shield is Article 12 of the German Basic Law, which guarantees freedom of occupation (Berufsfreiheit). Because the state’s entry exam pretends to screen for immediate public danger (Gefahrenabwehr), courts pretend the system is legally sufficient; completely banning the profession would trigger severe constitutional challenges.
Furthermore, as often discussed on this blog, SCAM enjoys immense public popularity in Germany. Millions of Germans value the Heilpraktiker for the long and empathetic consultations that the overburdened conventional insurance system rarely permits. This widespread voter support, coupled with a highly organised political lobby, makes outright abolition a political non-starter.
Thus Germany continues to have a two-tier health system. This paradox exposes a profound cultural contradiction in the German psyche, which is famously stereotyped as risk-averse, highly bureaucratized, and obsessed with systemic order. While Germany tends to regulate everything from highway speeds to the exact composition of its beer, its tolerance of the Heilpraktiker system represents a massive, hazardous blind spot.
By clinging to an outdated Nazi-law out of political convenience and romanticized cultural traditions, the state has allowed this two-tier medical landscape to persist – one built on rigorous science, and another shielded by a legal loophole. In trying to uphold the constitutional freedom of occupation, the German legislative framework inadvertently compromises a far more fundamental duty: the protection of the public from dangerous quacks. This leaves a nation known for “playing it safe” in the ironic position of legally sanctioning pseudo-scientific nonsense within its healthcare system.
A fuller analysis of the Heilpraktiker can be found in my book “Vorsicht Heilpraktiker” [in German].
Because homeopathic remedies are usually diluted to the point where none of the original substance remains (often beyond Avogadro’s number), the ethical concerns with this treatment must focus on veracity (truth-telling), patient autonomy, beneficence, and justice. Here are some of the problems that ensue**:
Violations of Veracity and Informed Consent
Informed consent is an essential element of medical ethics and dictates that a patient must be given full, accurate, and evidence-based information regarding a treatment’s nature, mechanisms, risks, and efficacy to make an autonomous decision.
Homeopathy operates on two main principles: “like cures like” (Law of Similars) and the “law of minimum dose” (the more diluted a substance, the more potent it becomes). Scientifically, these principles contradict established kowledge of chemistry, physics, and pharmacology. Presenting these concepts nevertheless as scientifically valid violates veracity.
When a practitioner administers or sells a homeopathic remedy without explicitly stating that it contains no active ingredients and performs no better than a placebo in clinical trials, the patient’s autonomy is compromised. In other words, patients are making a healthcare choice based on deception or omission.
Maleficence
While homeopathics are physically inert and thus unlikely to cause direct harm, homeopathy poses a severe threat via indirect harm.
The most critical ethical issue occurs when patients use homeopathy for severe, progressive, or life-threatening conditions (such as cancer, severe infections, or chronic diseases like diabetes). Delaying or entirely replacing evidence-based medicine with placebo treatments (i.e. homeopathy) violates the duty of non-maleficence (do no harm). It can lead to preventable suffering, worsening of the condition, or even death in extreme cases.
Homeopathic “Vaccines” (Homeoprophylaxis) is an apt example. Some homeopaths offer all sorts of homeopathic vaccinations as alternatives to standard immunizations. Marketing these as effective protection against potentially deadly diseases like measles, polio, or pertussis erodes public herd immunity, leaves individuals entirely unprotected, and can endanger us all. This is a massive failure of both individual and public health ethics.
Beneficence
Beneficence requires healthcare providers to act in the best interest of the patient by offering treatments that provide a tangible, therapeutic benefit.
While the empathetic, unhurried nature of a homeopathic consultation can provide psychological comfort, homeopaths cannot ethically justify charging high fees for what is essentially a placebo wrapped in pseudo-medicine. Relying on a mechanism that depends on the patient remaining ignorant of the treatment’s true nature is fundamentally paternalistic and violates modern standards of beneficence.
Justice and the Exploitation of Vulnerability
The ethical principle of justice involves fairness, equity, and the responsible distribution of healthcare resources. It is regularly violated in the realm of homeopathy.
Homeopathic remedies are cheap to manufacture, yet they are marketed at unjustifiably inflated prices. Targeting vulnerable populations, such as the chronically ill, parents anxious about medication side effects in their children, or low-income individuals seeking cheap alternatives, is an ethical violation of justice.
When public the health insurance programs of certain countries, or mainstream pharmacies fund or promote homeopathic products alongside effective medicines, they misallocate resources and mislead the public. In other words, they give a false stamp of authority to quackery, draining resources that could support evidence-based public health initiatives.
So, how unethical is homeopathy? My short answer is: VERY!
** for a more detailed discussion, please have a look at our book.
I was reminded of a paper that I published a long time ago – 23 years to be precise. It is entitled THE LECTURE FROM HELL. As it is not available online, let me give you a slightly revised version of it here:
When it comes to giving lectures, I have certainly made every mistake there is, and therefore I consider myself qualified to write this personal account on how to deliver THE LECTURE FROM HELL. I do this in the hope that others might learn from my imperfections.
In preparing for a lecture, it is best to be cool and leave things to the last minute. You are so gifted and competent that a few scribbles made on the way to the venue will easily suffice for fascinating your audience. Don’t bother enquiring who they are; what you have to say will capture the attention of a lay audience as much as that of a highly specialised one.
The kind people who have invited you will certainly have suggested a topic. Don’t get irritated by that; you know best what you can and want to talk about and, after all, it is always best to stick to what you know. If your subject is palliative cancer care, for instance, it should not be too difficult, after a few introductory sentences, to shift the attention to the most revealing survey you conducted on 10 back pain patients 25 years ago – cancer patients suffer from back pain too!
From the outset, you need to show the audience that you are better than they are. A good way of achieving this aim is to display your knowledge of as many acronyms as possible. Making abundant use of abbreviations has the added advantage that it could hide a few glitches in your arguments (or spelling). People might even think you are talking about palliative care after all.
Another golden rule is never produce evidence for your statements. Some people use visual aids to produce the evidence, but this is both tiring and confusing (and it would, of course, require much more preparation than you allowed for). If you want to use visual aids, use photographs of your kids (pets if you are childless) or your last holiday in Corfu. This will add the personal touch that people crave. Surely, if they had wanted evidence they would have gone to a library, not to your lecture.
It is advisable to spend as much time as possible with lengthy preliminaries, particularly if you are not really covering the subject as printed in the programme. Mention that you first met Cathy (who just introduced you) when you were both in nursery and give a full and colourful account of your relationship since then. If you haven’t actually been to nursery with Cathy, perhaps you could talk about the car accident you saw en route and what it made you think of. Or you could take the holistic approach, ask everyone to stand up, do a few relaxation exercises and feel the flow of energy in the body, room or universe. The obvious aim is to leave as little time as possible for the proper lecture. Thus, you can pretend to know much more about your subject than you had time to disclose and you can end your unfinished lecture with the upbeat exclamation ‘‘yeah! perhaps another time’’.
Most lecturers find the ensuing discussion period the most challenging part of their task. Not you! First, you have wisely ensured that there is no time left. Thus, the discussion slot will either be completely cancelled or it will be refreshingly brief. When the first difficult question comes your way, remember the important principle: you are so much cleverer than anyone else in this room! Make sure you show it. Arrogance has always been a perfect shield for hiding incompetence.
Another good strategy is to ridicule the person who dared ask the awkward question. Thus, they end up with egg on their face instead of you. If all else fails and you really don’t know how to answer, the best approach is to say: ‘‘this is a bit too complex right now; perhaps I could explain this to you later over coffee’’. Just ensure that you are safely on the way home when the coffee break starts.
Generally speaking, the overriding principles of a truly diabolically bad talk are quite simple. Lectures are neither the time nor place for transmitting knowledge to those who came to listen. Their predominant purpose is to massage the lecturer’s ego and increase their income. If you keep this in mind, you will stop worrying about things like evidence, structure and delivery and simply enjoy the outing.
I was reminded of this article because I saw the title of a recently published paper: HOW TO GIVE A BAD TALK. It starts as follows: “It is crucial to know how to communicate your work by delivering an effective talk, but our training for doing so is limited, so it is a skill often learned by watching others — who sometimes do it badly”.
Sadly, I could not read on; the journal asked almost 30 Euros for the privilege! So, I will never know what else I can do to give a truly poor lecture. Yet, I did learn something important: the knowledge of how to give a bad talk does not always come cheap!
I recently coined a new term: Chutzpah-Based Medicine (CBM). It requires a bit of an explanation which I herewith try to deliver. Medical decisions should rely on a rational hierarchy: systematic reviews at the top, followed by randomised clinical trials, observational studies, and way down at the bottom we anecdotal experience and opinion. The new paradigm of “Chutzpah-Based Medicine” (CBM) turns this pyramid upside down.
In CBM, double-blind trials are replaced by double-down charisma. Why wait 10 years for evidence when you can assert a medical breakthrough in 15 seconds on video with dynamic lighting, an unbuttoned linen shirt, and absolute, unshakable certainty? Here is an overview of the core tenets and leading luminaries of this revolutionary field.
The Dogmas of CBM
- The Confidence-to-Evidence Ratio: The validity of any health claim is directly proportional to the volume, velocity, and eye contact with which it is delivered.
- The “Big Pharma Secret” Axiom: If a treatment worked and had evidence, it would evidently be mainstream. Therefore, the total absence of evidence is the ultimate proof that “They” are trying to suppress it.
- Quantum Syllogism: If you insert the word “quantum” before anything, biology no longer applies, and anything becomes possible.
Four Ambassadors of CBM
- Gwyneth Paltrow
The undisputed pioneer of High-End CBM. Paltrow proved that with enough aesthetic minimalism and raw audacity, one can sell jade eggs, vaginal steaming, and “psychic vampire repellent” as essential wellness routines. Scientific consensus is but a sign of unrefined taste. See also previous posts, e.g.:
- Time for Gwyneth Paltrow’s ‘Emotional Detox Bath Soak’
- We all have misungerstood good old Gwyneth Paltrow. At heart, she is a true sceptic!
- What is it with Gwyneth Paltrow and the vagina?
- Rectal ozone therapy? Gwyneth seems to like it!
- Dr. Mehmet Oz
Before entering politics, Dr. Oz laid the groundwork for CBM. He demonstrated that a cardiothoracic surgeon could look directly into a camera and declare green coffee bean extract a “miracle burn in a bottle” without blinking. “Magic” is, according to Oz, a valid clinical outcome. See also previous posts, e.g.:
- It seems to me that Dr. Mehmet Oz is breaking the law!
- Donald Trump nominated SCAM promoter, Mehmet Oz, to lead the Centers for Medicare and Medicaid Services (CMS)
- Columbia University cut ties with Dr. Mehmet Oz … or did they?
- Dr. Joseph Mercola
He is a true titan of digital CBM mastering the art of building a multi-million-dollar supplement empire by warning millions that modern medicine is a toxic conspiracy, while conveniently offering his own unapproved tanners, liposomal vitamins, and other SCAMs as the sole salvation. See also previous posts, e.g.:
- The ‘moral and intellectual decay’ of COVID disinformants
- The anti-vaccination movement is financed by the dietary supplement industry
- Deepak Chopra
Chopra brought profound philosophical chutzpah to CBM by blending endocrinology with poetic quantum bollox. By asserting that human bodies are “localized energy fields” capable of “quantum healing,” he elevated clinical vagueness into a high-margin spiritual enterprise. See also previous posts, e.g.:
- Deepak Chopra – Karma can be a real bitch!
- The ‘LOVETUNER’: Have a look at this, and you will never again think that Deepak Chopra is a charlatan
- Deepak Chopra’s finest hour
- Deepak Chopra enters my ‘ALT MED HALL OF FAME’
While Evidence-Based Medicine requires years of arduous testing, CBM offers immediate answers, simple villains, and premium-priced remedies. Why let a clinical trial get in the way of an excellent means of getting rich quickly?
Drugging soldiers seems to be an odd idea. Yet, it is not without precedent, e.g.:
- Nazi Germany (WWII): The Wehrmacht and Luftwaffe were systematically supplied with Pervitin (methamphetamine), with tens of millions of tablets issued to keep soldiers and pilots awake, alert and aggressive during the war.
- Britain/US (WWII air operations): Allied air forces issued amphetamine and caffeine tablets to bomber crews and other soldiers to counter fatigue on long missions, representing a state‑sanctioned stimulant program for performance enhancement.
- US (Vietnam War): soldiers were routinely given Dexedrine (dextroamphetamine) and other psychoactive drugs to sustain long patrols and suppress combat stress; hundreds of millions of tablets were thus distributed with official approval.
- Soviet Union (Cold War): State‑run sports programmes, closely tied to military and security structures, systematically administered anabolic steroids and testosterone derivatives to elite athletes to boost strength and recovery, normalising pharmacological enhancement in a militarised setting.
Now, the US Defence Secretary Pete Hegseth’s recent “High-T” initiative mandates annual testosterone screening for US troops aged 30 and older, coupled with optional hormone replacement therapy (TRT). This is a striking case of policy outrunning clinical evidence. While announced as a readiness initiative to keep the joint force on the “leading edge of lethality,” the proposal glosses over critical medical, ethical, and operational realities.
First, the medical rationale for mass screening is weak, to put it mildly. Established clinical guidelines recommend testing only men presenting with specific symptoms and risk factors, not broad, asymptomatic populations. Screening hundreds of thousands of personnel annually risks over-diagnosis and over-treatment, particularly in a young force where borderline-low values are common, highly fluctuating, and often transient. In a word: the “High-T initiative” is nonsense.
Second, oral testosterone undecanoate (TU) shares general testosterone risks, e.g. erythrocytosis, prostate effects (worsening BPH symptoms, small PSA rises, contraindication in prostate cancer), suppression of spermatogenesis and infertility, acne, fluid retention, mood changes, and possible lipid alterations. Compared with transdermal or injectable formulations, oral TU offers convenience but requires strict baseline and ongoing monitoring of blood pressure, haematocrit, PSA, and testosterone levels, and is best reserved for men without uncontrolled hypertension, high cardiovascular risk, or near-term fertility plans, and only after considering safer first-line options. In particular, TRT-induced suppression of spermatogenesis presents a serious threat to fertility for service members of reproductive age, introducing severe clinical trade-offs without clear medical indications. In a word: the “High-T initiative” is likely to do more harm than good.
Third, the policy dangerously blurs the line between therapeutic medicine and performance enhancement. Mass-screening healthy soldiers and offering TRT to asymptomatic individuals normalizes the pharmacological optimization of the force. This sets a dangerous precedent: once hormonal levels are treated as adjustable parameters for “readiness,” the boundary between standard healthcare and state-sponsored enhancement dissolves. In a word: the “High-T initiative” is unethical.
Fourth, the operational logistics remain unresolved. Mandating annual blood draws will strain military medical systems, must generate an influx of equivocal results, and will create a massive administrative trail of counselling, monitoring, and liability. In a word: the “High-T initiative” is unpractical.
Fifth, the policy’s ambiguity regarding female service members exposes a glaring double standard: the Pentagon has not clarified whether women will be screened for sex-hormone deficiencies, or if this “restorative” care is reserved strictly for men. In a word: the “High-T initiative” is sexist.
Sixth, the political optics are highly suspect. The initiative directly mirrors broader administration efforts to liberalize testosterone prescribing, raising concerns that ideology, rather than rigorous military medicine, is driving policy. In a word: the “High-T initiative” is ideological.
Unsurprisingly, many experts have criticised the initiative sharply, e.g.:
- Stuart Phillips, a medical professor at McMaster University, told The Washington Post: “A blanket policy like we’re going to screen everybody over the age of 30 is kind of a ridiculous notion.”
- Adriane Fugh-Berman, a Georgetown University professor of pharmacology and physiology, warned: Hegseth’s claims are “non‑evidence‑based and could cause harm.”
Overall, Hegseth’s policy is out-running clinical evidence, and his stupidity is out-doing common sense. There is no doubt in my mind that his testosterone obsession is extremely ill-advised and – if not urgently stopped – will do an abundance of harm.
My previous post provided tips for examining health claims. An area where health claims need to be examined cautiously is supplements, and one UK firm seems to deserve scrutiny more than most. British Supplements, was founded around 2015 by Chris Boyle. Rather than positioning himself as a traditional executive or scientist, Boyle markets himself as a rebellious outsider fighting against a corrupt health industry. He heavily promotes a narrative of “us versus them,” framing himself as a truth-teller. He regularly uses his platform to criticize mainstream competitors like Holland & Barrett, alleging they sell “private-label junk” filled with binders and excipients.
There is no publicly available record of any formal professional background, medical training, scientific schooling, or nutritional education for Chris Boyle. As far as I can see, he does not hold degrees or certifications in biochemistry, pharmacology, dietetics, medicine, or any related fields. In his public branding and communication, Boyle’s lack of formal scientific or medical training is not something he attempts to hide; rather, he weaponizes it as part of his “rebel outsider” persona to build trust with customers who are skeptical of the traditional medical and regulatory establishment.
Boyle’s firm is an online seller of mushroom and herbal products marketed under a “Clean Genuine” label. Operating with an antagonistic, anti-establishment brand voice, the company has constructed a conspiratorial marketing ecosystem designed to bypass UK advertising laws. It has fast grown into a highly profitable, multi-million-pound operation. Despite its “underdog” and “persecuted outsider” marketing narrative, it is now a major player in the direct-to-consumer wellness market, fueled by heavy advertising on social media and public transport. Recently, the company has even taken out a nationwide bus-advertising deal. To sell products like Turkey Tail and Lion’s Mane for serious illnesses without violating UK regulations, Boyle employs a “half-censorship” tactic. By partially starring out crucial terms, he tells customers that he is forced to censor the text due to a corrupt alliance between “Big Pharma” and the UK government.
His website employs customer reviews to make forbidden clinical claims. British Supplements encourages customers to leave detailed, condition-specific feedback, structuring its website collections such that searching for terms like “cancer” highlights these reviews. While the UK Advertising Standards Authority (ASA) demands that customer testimonials used in marketing are legally considered advertisements and must be clinically backed, the company falsely claims that “Article 10 of the Human Rights Act 1998” protects this type of “free speech”, dismissing regulators as tools of a “United Kingdom of North Korea.”
The brand positions itself within a broader web of alternative-medicine conspiracies. On social media and review platforms like Trustpilot, Boyle aggressively attacks critics. Negative reviewers are routinely insulted, with Boyle publicly labeling them as “woke,” “Karens,” “femboys,” or suffering from “mental breakdowns.”
This aggressive stance is more than just an offensive marketing strategy; it represents a growing public health challenge. By promoting unproven remedies to severely ill patients and actively cultivating distrust in evidence-based medicine and regulatory bodies, British Supplements not only financially exploit vulnerable consumers, it also endager the health of those who might believe in their unsubstantiated claims.
The Medical Journalists’ Association (MJA) has outlined six practical tips to help scrutinise health claims responsibly and accurately. They are primarily meant for journalists but, I think, they are also usefull for the general public, particularly when dealing with health claims in the realm of so-called alternative medicine (SCAM):
Check the source
Assess whether the claim originates from credible, peer-reviewed research and a reputable institution. Be wary of press releases, anecdotal reports, or media outlets known for sensationalism. Specifically for claims about SCAM, we might also add caution regarding the many third class SCAM journals.
Look for conflicts of interest
Investigate who funded the research and whether any authors or organisations stand to profit from the findings. Industry sponsorship can introduce bias, even in otherwise well-conducted studies. For claims about SCAM, we should remember that financial interest might be secondary to ideological ones.
Examine the study design
Consider whether the research used appropriate methods – such as randomisation, control groups, and adequate sample sizes – to support its conclusions. Observational studies, or case reports, or trials with the often-discussed ‘A+B versus B’ design, for example, cannot prove causation.
Consider the magnitude and relevance of effects
Distinguish between statistical significance and clinical importance. A tiny effect may be statistically significant in a large trial but meaningless in practice. Also ask whether the study population is representative and the outcome can be generalised.
Look for independent replication
Single studies should be treated cautiously until confirmed by other researchers. Consistent findings across multiple studies increase confidence in a claim.
Beware of over-interpretations
Scrutinise whether the authors or media coverage extrapolate beyond what the data support. For instance, generalising from animal studies to humans, or implying benefits without evidence of improved health outcomes.
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If I may, I will add an 7th to the six by the MJA. It is one that I have issued many times previously and that is, I think, essential in SCAM:
If it sounds too good to be true, it probably is!
Exaggerated or false health claims are endemic in SCAM. These 7 tips might be useful in disclosing them and in minimising the harm they can do.
Medical ethics rests on 4 core principles: autonomy, beneficence, non-maleficence, and justice, along with the crucial rule of veracity (truth-telling). In the realm of chiropractic, the most significant ethical issues/problems generally fall into the following ethical categories:
- Compromised Informed Consent & Veracity
Informed consent requires that a patient fully understands the nature, risks, benefits, and scientific backing of a treatment before proceeding.
1.1.The “Subluxation” Theory: A sizable segment of the chiropractic community still adheres to the erroneous belief that spinal “vertebral subluxations” cause a disruption in the body’s “innate intelligence,” leading to systemic disease. From an ethical standpoint, promoting an unproven, pseudo-scientific premise as medical fact violates veracity and compromises patient autonomy, as patients cannot give truly informed consent based on erroneous concepts.
1.2. Over-claiming Scope of Efficacy: While evidence might support spinal manipulation for acute lower back pain (if one were to interpret the dtat optimistically), most chiropractors claim they can treat many other illnesses, including non-musculoskeletal conditions such as asthma, allergies, infantile colic, ADHD, and high blood pressure. Marketing these services without robust clinical trial backing misleads vulnerable populations.
- Violations of Non-Maleficence
The principle of non-maleficence requires practitioners to avoid inflicting unnecessary harm or exposing patients to disproportionate risks.
2.1. Cervical Manipulation and Stroke Risk: One of the most severe ethical concerns involves high-velocity, low-amplitude (HVLA) thrusts to the upper neck, the hallmark modality of chiropractors. This procedure has been linked to vertebral artery dissection (VAD), which can cause strokes and deaths. The ethical failure is most obvious when chiropractors perform these adjustments without warning the patient of this and other adverse outcomes.
2.2. Paediatric Chiropractic: Performing spinal adjustments on infants and toddlers (whose spines are primarily cartilage and still developing) poses distinct physical risks. Because infants cannot consent and the evidence of benefit for childhood ailments is practically non-existent, this behaviour violates non-maleficence.
- Secondary Harm: Delay of Standard Medical Care
Harm does not only come from physical injury; it also comes from omitting or delaying necessary medical treatment.
3.1. Anti-Vaccine and Anti-Medicine Sentiments: A large proportion of the chiropractic profession advise patients against conventional medicine, pharmaceuticals, and vaccination. When a chiropractor discourages a patient from seeking standard medical care, they are actively contributing to potentially life-threatening delays in care.
- Violations of Beneficence and Justice
Beneficence means acting in the patient’s best interest, while justice involves the fair and equitable distribution of healthcare resources.
4.1. The “Maintenance Care” Business Model: A common predatory practice of chiropractors involves convincing patients that they require lifelong, regular spinal adjustments to “stay aligned” and prevent disease, often locked into expensive upfront contracts. Recommending continuous, costly treatments that lack clinical evidence of long-term benefit shifts the focus from patient welfare (beneficence) to practitioner financial gain.
4.2.Over-Utilization of X-rays: Some chiropractic clinics mandate full-spine X-rays for every new patient, regardless of symptoms, and repeat them frequently to “prove” alignment changes. Exposing patients to unnecessary ionizing radiation for marketing or diagnostic justification is a direct violation of both non-maleficence and the ethical use of healthcare resources.
For a more detailed account of the ethical problems in so-called alternative medicine, please see our book on this very subject.
