Some of you might have followed my recent discussion with a homeopath. It followed a typical path, and I decided therefore to try and analyse this exchange here. Perhaps others can learn from this example when debating with homeopaths or other providers of so-called alternative medicine (SCAM).
These conversations often start ‘out of the blue’ by some falsehood being trumpeted on social media. In the present case, the encounter commenced by someone tweeting this message to me: “…remember that asthma trial whose results you faked?” As I did not even remember having ever met the man, I was perplexed. And as I have not faked the study in question nor any other results, I did not think his remark was credible or funny. My mention of the fact that the aggressor was being libellous seemed to bring an end to this unhappy dialogue.
But not for very long. When the man insulted me again – this time very publicly in a UK newspaper – I decided to look into it a bit closer. The aggressor turned out to be in charge of the well-known UK homeopathic pharmacy, Ainsworth, and thus had an overt conflict of interest in defaming my often critical stance on homeopathy. Intriguingly, he had also published his own study of homeopathy. When I assessed this research, it turned out to be both incompetent and unethical. I had hoped that he would defend his work and discuss its limitations with me in a rational fashion. Yet, at this stage, he remained silent.
I then decided to write a further post in the hope of getting some sort of response from him. Alas, my hope was disappointed again. Even when I challenged him and his ROYAL WARRANT directly, he remained silent.
It needed a seemingly unrelated post of mine for him to find his voice:
We can all go round in endless circles arguing whether the Earth is Flat, but eventually someone has to venture out in a boat to the horizon to determine the fact. A cursory reading of Hahnemann encourages every student of homoeopathy to gain their own experience empirically. We all know you and your friends on this blog are standing on the shore proclaiming the Earth to be flat, but when are you going to pedal out,to bravely cite actual cases you have treated with homoeopathy as evidence of your position? What the audience reading this wants to know is what experience and knowledge any of you actually have of the subject you spend so much time criticising?
At this stage a had grown a little weary of Mr Pinkus and his innuendos. My response was thus a little impatient:
I don’t think highly of people who
1) are too daft to spell my name correctly,
2) imply I have no experience in homeopathy,
3) pretend that I make a secret of it, while, in fact, I published this multiple times (i.e. https://www.amazon.co.uk/Scientist-Wonderland-Searching-Finding-Trouble/dp/1845407776),
4) accuse others of being flat earthers, while evidently being one themselves,
5) do all this without declaring their massive conflict of interest.
What followed was Pinkus’ increasingly irrational attempts to defame me by revealing to the world that I (and other critics of homeopathy) lacked sufficient clinical experience with homeopathy and therefore were not competent to discuss the subject. Explanations by myself and others that,
- firstly I did have knowledge and experience of homeopathy,
- and secondly no experience is required for a critical evaluation of any treatment,
all fell on deaf ears.
The conclusion of this odd discussion was Pinkus’ triumphant declaration of victory:
I came to this blog to see if anyone in the discussion had any serious intention to discuss the subject of homoeopathy. In order to do this there are certain prerequisites for a sensible debate and one of these is actual knowledge and experience of the subject matter under discussion. To this end I asked if anyone has case they treated in order to discuss the merits and demerits of the experience. No one offered one. I repeated the request and the silence changed to attacks on me even asking.
Any scientist worthy of the challenge, and certainly someone who proudly styles himself as a Professor of CAM with experience and knowledge, would be only too glad to share this with others. Sadly though I have met with rebuke and insult but no evidence to support the opposition to homoeopathy saving some incoherent rant about the needlessness of empirical experience. The cornerstone of Hahnemann’s work on homoeopathy and the one thing he advocated to other doctors. “Don’t take my word for it, prove it to yourself”
When you find the need to attack me to defend your incessant argument that homoeopathy is implausible I really cannot take you seriously.
Here we have a blog hosted by a chap who claims to be an expert on the subject but now claims he hasn’t practiced it for over 40 years. Won’t say what he did when he practised, what he learned and when asked to give at least once case he treated, refuses and creates some diversion to cover his ignorance of the question. Now that’s what I call a charlatan.
I understand you have made a living out of this but it must be a miserable existence old chap
I find this exchange rather typical for an argument with SCAM-fanatics. It follows a fairly standard strategy:
- aggression form a complete stranger,
- attempt of a rational defence,
- more aggression and insults
- attempts to debate the published evidence,
- silence from the aggressor who seems unable to defend his evidence,
- more aggression at an unexpected opportunity,
- further attempts to rationalise and discuss the facts,
- the aggressor questions his opponent’s competence,
- more attempts to rationalise and provide valid explanations,
- conclusion of the discussion with aggressor trying to occupy the moral high ground.
Of course, this is eerily similar to playing chess with a pigeon.
So, what, if anything, can we learn from this?
Mainly three things, I think:
- Either you don’t argue with fanatics at all,
- or you realise from the beginning what is about to happen; in this case, have fun exposing irrationality in the hope that others might profit from your experience.
- In any case, do not expect that your aggressor will be able to learn anything.
I wish people would think a bit before naming things! What is ‘natural health’? Is it the opposite of ‘unnatural health’ or of ‘natural illness’? But who am I to question the terminology of the NHS? I am not even a native English speaker!
Therefore, let me rather look at what this oddly-named school does. Here is how the ‘NHS Natural Health School‘ explain their work:
The NHS Natural Health School has been developed to meet the standards of practice, and experience that are essential for complementary therapists wishing to treat patients within an NHS healthcare setting. The school offers a wide range of approved and accredited courses, taught by highly qualified and clinically skilled lecturers who are experienced in working clinically within NHS Healthcare settings and providing complementary therapy treatments for patients with a range of complex needs including cancer diagnosis. By welcoming you into the multi-disciplinary care team, we not only prepare you as a confident, competent practitioner ready to meet the needs of a demanding industry, but we are able to support the provision of specialist care for a wide range of patients and clients who otherwise would miss out on beneficial treatments.
Courses include supervised clinical placements across hospital and community healthcare settings. All proceeds raised from the courses are reinvested into the Harrogate Hospital and Community Charity’s SROMC Complementary Therapy Fund to ensure the financial sustainability of the HDFT NHS Trust Complementary Therapy Service. For more information on the courses and education available please click the courses link above.
Naturally, I am intrigued and have a look at their courses. They include shiatsu, holistic massage and reflexology. Having published several papers on the latter, it is of particular interest to me. Reflexologists have maps of the sole of the foot where all the body’s organs are depicted. Numerous such maps have been published and, embarrassingly, they do not all agree with each other as to the location of the organs on the sole of the feet. By massaging specific zones which are assumed to be connected to specific organs, reflexologists believe to positively influence the function of these organs. Here is what the NHS Natural Health School advertise about their reflexology course:
A combination of theory and practical modules designed to equip the learner with the skills required to provide Reflexology treatments for a wide range of clients. On successful completion of the course you will be able to register with the relevant regulatory and professional associations and gain full insurance to practice.
Course content includes;
- Explore the history and origins of Reflexology
- Explore the use of various mediums used in treatment including waxes, balms, powders and oils
- Explore the philosophy of holism and its role within western bio medicine
- Reading the feet/hands and mapping the reflex points
- Relevant anatomy, physiology and pathology
- Managing a wide range of conditions
- Legal implications
- Cautions and contraindications
- Assessment and client care
- Practical reflexology skills and routines
- Treatment planning
Assessment: You will produce evidence of 30 reflexology treatments. An additional assessment of your competence will determine your readiness to undertake 72 in-depth case studies and complete a practical assessment.
Course Duration: Attendance is required at 8 Reflexology technical days over 12 months, during which time you will demonstrate a minimum of 100 practical hours.
Special Notes: The core modules; Anatomy, Physiology and Pathology, Business Practice and Principles and Practice of Complementary Therapy are normally completed concurrently as part of the diploma.
Learners who already have a Level 3 diploma in a complementary therapy may be exempt from the core modules.
A first aid certificate is required prior to completion of the diploma.
Fascinating! Personally I am most intrigued about the module on anatomy, physiology and pathology, because all of the three squarely contradict what reflexologists believe. But I wonder even more why there is no mention of the evidence. Have they forgotten to mention it? Unlikely; their other courses on SCAMs such as aromatherapy, holistic massage or shiatsu have similar omissions. Or does the ‘NHS Natural Health School’ not think that evidence matters to ‘competent practitioners’ of the NHS? Or perhaps this is where ‘natural health’ is different from unnatural health?
No, silly me! The reason clearly lies elsewhere: the evidence fails to show that reflexology generates more good than harm. So, the clever people from the ‘NHS Natural Health School’ decided to hide it discretely. Shrewd move! Albeit slightly embarrassing as well as just a little unethical, particularly for the NHS Harrogate, I’d say.
Just in case some readers do wonder nonetheless what the evidence does tell us about reflexology, here is the summary table from my recent book:
I cannot help but being reminded of something I stated many times before: EVEN THE MOST PROPER TEACHING OF NONSENSE CAN ONLY RESULT IN NONSENSE.
These days, I am often not sure what puzzles me more, Boris Johnson or homeopathy. Come to think of it, our PM seems, in fact, to have a lot in common with homeopathy/homeopaths. With my tongue lodged firmly in my cheek, I can see some communalities:
- They are both popular in the UK but have their origins elsewhere.
- They were both laughed at by people who are serious.
- They have both been around for far too long.
- They both are useless.
- They both have plenty of charisma.
- They both, however, have little more than that.
- They have a long history of misleading the public.
- They have both been taken to court.
- They both failed to accept the judgement when it went against them.
- They are both particularly successful with the female section of the population.
- They both thrive on personal attacks.
- They both make far-reaching claims which turn out to be false.
- They both claim to want only the best for the public.
- They both consider themselves as progressive.
- In truth, however, they are both deeply regressive.
- They both do not to think that ethics are all that important.
- They both irritate people who are rational thinkers.
- They both negate the evidence and act in overt contradiction to the evidence.
- They both tend to think that popularity is a measure of efficacy.
- They both managed to mislead even the Queen.
- Nevertheless, they both enjoy royal support (at least for the time being).
- They both seem to think that the laws (of the land/of nature) do not apply to them.
- They are both only bearable when highly diluted.
- They are both a complete waste of money.
- They are both dangerous when the public follow their advice.
Have I forgotten anything?
Do tell me, please.
On this blog, we have often noted that (almost) all TCM trials from China report positive results. Essentially, this means we might as well discard them, because we simply cannot trust their findings. While being asked to comment on a related issue, it occurred to me that this might be not so much different with Korean acupuncture studies. So, I tried to test the hypothesis by running a quick Medline search for Korean acupuncture RCTs. What I found surprised me and eventually turned into a reminder of the importance of critical thinking.
Even though I found pleanty of articles on acupuncture coming out of Korea, my search generated merely 3 RCTs. Here are their conclusions:
The results of this study show that moxibustion (3 sessions/week for 4 weeks) might lower blood pressure in patients with prehypertension or stage I hypertension and treatment frequency might affect effectiveness of moxibustion in BP regulation. Further randomized controlled trials with a large sample size on prehypertension and hypertension should be conducted.
The results of this study show that acupuncture might lower blood pressure in prehypertension and stage I hypertension, and further RCT need 97 participants in each group. The effect of acupuncture on prehypertension and mild hypertension should be confirmed in larger studies.
Bee venom acupuncture combined with physiotherapy remains clinically effective 1 year after treatment and may help improve long-term quality of life in patients with AC of the shoulder.
So yes, according to this mini-analysis, 100% of the acupuncture RCTs from Korea are positive. But the sample size is tiny and I many not have located all RCTs with my ‘rough and ready’ search.
But what are all the other Korean acupuncture articles about?
Many are protocols for RCTs which is puzzling because some of them are now so old that the RCT itself should long have emerged. Could it be that some Korean researchers publish protocols without ever publishing the trial? If so, why? But most are systematic reviews of RCTs of acupuncture. There must be about one order of magnitude more systematic reviews than RCTs!
Why so many?
Perhaps I can contribute to the answer of this question; perhaps I am even guilty of the bonanza.
In the period between 2008 and 2010, I had several Korean co-workers on my team at Exeter, and we regularly conducted systematic reviews of acupuncture for various indications. In fact, the first 6 systematic reviews include my name. This research seems to have created a trend with Korean acupuncture researchers, because ever since they seem unable to stop themselves publishing such articles.
So far so good, a plethora of systematic reviews is not necessarily a bad thing. But looking at the conclusions of these systematic reviews, I seem to notice a worrying trend: while our reviews from the 2008-2010 period arrived at adequately cautious conclusions, the new reviews are distinctly more positive in their conclusions and uncritical in their tone.
Let me explain this by citing the conclusions of the very first (includes me as senior author) and the very last review (does not include me) currently listed in Medline:
penetrating or non-penetrating sham-controlled RCTs failed to show specific effects of acupuncture for pain control in patients with rheumatoid arthritis. More rigorous research seems to be warranted.
Electroacupuncture was an effective treatment for MCI [mild cognitive impairment] patients by improving cognitive function. However, the included studies presented a low methodological quality and no adverse effects were reported. Thus, further comprehensive studies with a design in depth are needed to derive significant results.
Now, you might claim that the evidence for acupuncture has overall become more positive over time, and that this phenomenon is the cause for the observed shift. Yet, I don’t see that at all. I very much fear that there is something else going on, something that could be called the suspension of critical thinking.
Whenever I have asked a Chinese researcher why they only publish positive conclusions, the answer was that, in China, it would be most impolite to publish anything that contradicts the views of the researchers’ peers. Therefore, no Chinese researcher would dream of doing it, and consequently, critical thinking is dangerously thin on the ground.
I think that a similar phenomenon might be at the heart of what I observe in the Korean acupuncture literature: while I always tried to make sure that the conclusions were adequately based on the data, the systematic reviews were ok. When my influence disappeared and the reviews were done exclusively by Korean researchers, the pressure of pleasing the Korean peers (and funders) became dominant. I suggest that this is why conclusions now tend to first state that the evidence is positive and subsequently (almost as an after-thought) add that the primary trials were flimsy. The results of this phenomenon could be serious:
- progress is being stifled,
- the public is being misled,
- funds are being wasted,
- the reputation of science is being tarnished.
Of course, the only right way to express this situation goes something like this:
BECAUSE THE QUALITY OF THE PRIMARY TRIALS IS INADEQUATE, THE EFFECTIVENESS OF ACUPUNCTURE REMAINS UNPROVEN.
It is hard to deny that many practitioners of so-called alternative medicine (SCAM) advise their patients to avoid ‘dangerous chemicals’. By this they usually mean prescription drugs. If you doubt how strong this sentiment often is, you have not followed the recent posts and the comments that regularly followed. Frequently, SCAM practitioners will suggest to their patients to not take this or that drug and predict that patients would then see for themselves how much better they feel (usually, they also administer their SCAM at this point).
Lo and behold, many patients do indeed feel better after discontinuing their ‘chemical’ medicines. Of course, this experience is subsequently interpreted as a proof that the drugs were dangerous: “I told you so, you are much better off not taking synthetic medicines; best to use the natural treatments I am offering.”
But is this always interpretation correct?
I seriously doubt it.
Let’s look at a common scenario: a middle-aged man on several medications for reducing his cardiovascular risk (no, it’s not me). He has been diagnosed to have multiple cardiovascular risk factors. Initially, his GP told him to change his life-style, nutrition and physical activity – to which he was only moderately compliant. Despite the patient feeling perfectly healthy, his blood pressure and lipids remained elevated. His doctor now strongly recommends drug treatment and our chap soon finds himself on statins, beta-blockers plus ACE-inhibitors.
Our previously healthy man has thus been turned into a patient with all sorts of symptoms. His persistent cough prompts his GP to change the ACE-inhibitor to a Ca-channel blocker. Now the patients cough is gone, but he notices ankle oedema and does not feel in top form. His GP said that this is nothing to worry about and asks him to grin and bear it. But the fact is that a previously healthy man has been turned into a patient with reduced quality of life (QoL).
This fact takes our man to a homeopath in the hope to restore his QoL (you see, it certainly isn’t me). The homeopath proceeds as outlined above: he explains that drugs are dangerous chemicals and should therefore best be dropped. The homeopath also prescribes homeopathics and is confident that they will control the blood pressure adequately. Our man complies. After just a few days, he feels miles better, his QoL is back, and even his sex-life improves. The homeopath is triumphant: “I told you so, homeopathy works and those drugs were really nasty stuff.”
When I was a junior doctor working in a homeopathic hospital, my boss explained to me that much of the often considerable success of our treatments was to get rid of most, if not all prescription drugs that our patients were taking (the full story can be found here). At the time, and for many years to come, this made a profound impression on me and my clinical practice. As a scientist, however, I have to critically evaluate this strategy and ask: is it the correct one?
The answer is YES and NO.
YES, many (bad) doctors over-prescribe. And there is not a shadow of a doubt that unnecessary drugs must be scrapped. But what is unnecessary? Is it every drug that makes a patient less well than he was before?
NO, treatments that are needed should not be scrapped, even if this would make the patient feel better. Where possible, they might be altered such that side-effects disappear or become minimal. Patients’ QoL is important, but it is not the only factor of importance. I am sure this must sound ridiculous to lay people who, at this stage of the discussion, would often quote the ethical imperative of FIRST DO NO HARM.
So, let me use an extreme example to explain this a bit better. Imagine a cancer patient on chemo. She is quite ill with it and QoL is a thing of the past. Her homeopath tells her to scrap the chemo and promises she will almost instantly feel fine again. With some side-effect-free homeopathy see will beat the cancer just as well (please, don’t tell me they don’t do that, because they do!). She follows the advice, feels much improved for several months. Alas, her condition then deteriorates, and a year later she is dead.
I know, this is an extreme example; therefore, let’s return to our cardiovascular patient from above. He too followed the advice of his homeopath and is happy like a lark for several years … until, 5 years after discontinuing the ‘nasty chemicals’, he drops dead with a massive myocardial infarction at the age of 62.
I hope I made my message clear: those SCAM providers who advise discontinuing prescribed drugs are often impressively successful in improving QoL and their patients love them for it. But many of these practitioners haven’t got a clue about real medicine, and are merely playing dirty tricks on their patients. The advise to stop a prescribed drug can be a very wise move. But frequently, it improves the quality, while reducing the quantity of life!
The lesson is simple: find a rational doctor who knows the difference between over-prescribing and evidence-based medicine. And make sure you start running when a SCAM provider tries to meddle with necessary prescribed drugs.
Dr Alice Hodkinson is a GP in Cambridge, England. She says of herself that she is interested in supporting people to make informed choices about their own health, reduce the burden of illness and lighten the load of medication on patients and the country’s National Health Service. She is studying medical ethics and law at King’s College London.
Even though we live in the same town, I don’t know Dr Hodkinson personally and never met her. My only contact with her is the one depicted here: on Twitter I had posted my recent article entitled ‘A new, comprehensive review: HOMEOPATHY = PLACEBO THERAPY‘. This prompted the following exchange:
At the very least homeopathy and placebos don’t cause harm that medicines do.
Edzard Ernst @EdzardErnst
have you heard of something called ‘risk/benefit balance’?
Which is precisely where homeopathy wins over toxins I prescribe as medication.
Edzard Ernst @EdzardErnst
oh really? I do worry about the students you teach
I worry about the over-use of toxins that harm. Lots of ppl get much better when meds are stopped. They come back from the dead and live much happier. Lots of evidence for this.
Edzard Ernst @EdzardErnst
” Lots of ppl get much better when meds are stopped.” surely this is a sign that they never needed them; in other words, it is the mistake of the GP who did the prescription
It’s a sign meds’ aren’t reviewed and they do harm. Water doesn’t harm, unless in excess. Promoting water as a cure might be harmful, yet there are sooooo many conditions where medicine has no answers, and for these, homeopathy comes up trumps.
Edzard Ernst @EdzardErnst
I am sooooooo pleased you are not my GP!
I’m bored. Go poison yourself on prescribed medication!
END OF EXCHANGE
I don’t know why this shocks me more than any of the often much more disagreeable disputes I have with other proponents of homeopathy on Twitter or on this blog. Perhaps it is because it occurred with a person who is a doctor like myself, or because it happened with a complete stranger, or because it was with someone who is, for all I know, an entirely reasonable clinician in other medical matters, or because Dr Hodkinson is studying medical ethics? I really don’t know.
Or perhaps nobody have ever told me to poison myself?
I have often felt that practitioners of so-called alternative medicine (SCAM) tend to be foolishly overconfident, often to the point of being dangerous. In a word, they are plagued by hubris.
Here is an example of osteopathic hubris:
The aim of this study was to determine the impact of visceral osteopathy on the incidence of nausea/vomiting, constipation and overall quality of life (QoL) in women operated for breast cancer and undergoing adjuvant chemotherapy in Centre Georges François Leclerc, CGFL.
Ninety-four women operated for a breast cancer stage 1-3, in complete resection and to whom a 3 FEC 100 chemotherapy was prescribed, were randomly allocated to experimental or placebo group. Experimental group underwent a visceral osteopathic technique and placebo group was subjected to a superficial manipulation after each chemotherapy cycle. Rate of grade ≥1 nausea/vomiting or constipation, on the first 3 cycles of FEC 100, were reported. QoL was evaluated using the EORTC QLQ-C30 questionnaire.
Rate of nausea/vomiting episodes of grade ≥1 was high in both experimental and placebo group. Constipation episodes of grade ≥1 were also frequent. No significant differences were found between the two groups concerning the rate of nausea/vomiting (p = 0.569) or constipation (p = 0.204) according to clinician reported side-effects but patient reported impact of constipation and diarrhoea on quality of life was significantly lower in experimental group (p = 0.036 and p = 0.038, respectively).
The authors concluded that osteopathy does not reduce the incidence of nausea/vomiting in women operated for breast cancer and undergoing adjuvant chemotherapy. In contrast, patient reported digestive quality of life was significantly ameliorated by osteopathy.
Several studies have assessed the diagnostic reliability of the techniques involved. The totality of this evidence fails to show that they are sufficiently reliable to be of practical use.
Other studies have tested whether the therapeutic techniques used in visceral osteopathy are effective in curing disease or alleviating symptoms. The totality of this evidence fails to show that visceral osteopathy works for any condition.
The treatment itself is probably safe, yet the risks of visceral osteopathy are nevertheless considerable: if a patient suffers from symptoms related to her inner organs, a visceral osteopath is likely to misdiagnose them and subsequently mistreat them. If the symptoms are due to a serious disease, this would amount to medical neglect and could, in extreme cases, cost the patient’s life.
The key message here should be that visceral osteopathy lacks plausibility. So why test its effectiveness for any condition, especially chemo-induced nausea where there is no conceivable mechanism of action and no hint that it might work?
The answer, I am afraid, might be quite simple: osteopathic hubris!
A chiro, a arms dealer and a Brexit donor meet in a bar.
The arms dealer: my job is so secret, I cannot tell my neighbour what I do.
The Brexit donor: I have to keep things so close to my chest that not even my wife knows what I am doing.
The chiro: that’s nothing; my work is so secret that not even I know what I am doing.
CHILDISH, I KNOW!
But I am yet again intrigued by a survey aimed at finding out what chiropractors are up to. One might have thought that, after 120 years, they know what they are doing.
This survey described the profiles of chiropractors’ practice and the reasons, nature of the care provided to their patients and extent of interprofessional collaborations in Ontario, Canada. The researchers randomly recruited chiropractors from a list of registered chiropractors (n=3978) in active practice in 2015. Of the 135 randomly selected chiropractors, 120 were eligible, 43 participated and 42 completed the study.
Each chiropractor recorded information for up to 100 consecutive patient encounters, documenting patient health profiles, reasons for encounter, diagnoses and care provided. Descriptive statistics summarised chiropractor, patient and encounter characteristics, with analyses accounting for clustering and design effects. Thus data on 3523 chiropractor-patient encounters became available. More than 65% of participating chiropractors were male, mean age 44 years and had practised on average 15 years. The typical patient was female (59% of encounters), between 45 and 64 years (43%) and retired (21%) or employed in business and administration (13%). Most (39.4%) referrals were from other patients, with 6.8% from physicians. Approximately 68% of patients paid out of pocket or claimed extended health insurance for care. Most common diagnoses were back (49%, 95% CI 44 to 56) and neck (15%, 95% CI 13 to 18) problems, with few encounters related to maintenance/preventive care (0.86%, 95% CI 0.2 to 3.9) and non-musculoskeletal problems (1.3%, 95% CI 0.7 to 2.3). The most common treatments included spinal manipulation (72%), soft tissue therapy (70%) and mobilisation (35%).
The authors concluded that this is the most comprehensive profile to date of chiropractic practice in Canada. People who present to Ontario chiropractors are mostly adults with a musculoskeletal condition. Our results can be used by stakeholders to make informed decisions about workforce development, education and healthcare policy related to chiropractic care.
I am so sorry to have mocked this paper. I shouldn’t have, because it actually does reveal a few interesting snippets:
- Only 7% of referrals come from real doctors.
- The vast majority of all patients receive spinal manipulations.
- About 6% of them are under 14 years of age.
- Chiropractors seem to dislike surveys; only 35% of those asked complied.
- 23% of all consultations were for general or unspecified problems,
- 8% for neurologically related problems,
- 5% for non-musculoskeletal problems (eg, digestive, ear, eye, respiratory, skin, urology, circulatory, endocrine and metabolic, psychological).
- Chiropractors rarely refer patients to other clinicians; this only happened in less than 3% of encounters.
- Apart from manipulation, chiropractors employ all sorts of other dubious therapies (ultrasound 3%, acupuncture 3%, , traction 1%, interferential therapy 3%, soft laser therapy 3%).
- 68% of patients pay out of their own pocket…
… NO WONDER, THEY DO NOT SEEM TO BE IN NEED OF ANY TYPE OF TREATMENT: 54% of all patients reported being in “excellent/very good overall health”!
Apparently, Hahnemann gave a lecture on the subject of veterinary homeopathy in the mid-1810s. Ever since, homeopathy has been used for treating animals. Von Boennighausen was one of the first influential proponents of veterinary homeopathy. However, veterinary medical schools tended to reject homoeopathy, and the number of veterinary homeopaths remained small. In the 1920ies, veterinary homoeopathy was revived in Germany. Members of the “Studiengemeinschaft für tierärztliche Homöopathie” (Study Group for Veterinary Homoeopathy) which was founded in 1936 started to investigate this approach systematically.
Today, veterinary homeopathy is still popular in some countries. Prince Charles has become a prominent advocate who claims to treat his own life stock with homeopathy. In many countries, veterinary homeopaths have their own professional organisations. Elsewhere, however, veterinarians are banned from practicing homeopathy. In the UK, only veterinarians are allowed to use homeopathy on animals (but anyone regardless of background can use it on human patients) and there is a British Academy of Veterinary Homeopathy. In the US, homeopathic vets are organised in the Academy of Veterinary Homeopathy.
If this sounds promising, we should not forget that, as discussed so often on this blog, homeopathy lacks plausibility the evidence for veterinary homeopathy fails to be positive (see for instance here). But, hold on, there is a new study, perhaps it will change everything?
This ‘study‘ was aimed at providing an initial insight into the existing prerequisites on dairy farms for the use of homeopathy (i.e. the consideration of homeopathic principles) and on homeopathic treatment procedures (including anamnesis, clinical examination, diagnosis, selection of a remedy, follow-up checks, and documentation) on 64 dairy farms in France, Germany and Spain.
The use of homeopathy was assessed via a standardised questionnaire during face-to-face interviews. The results revealed that homeopathic treatment procedures were applied very heterogeneously and differed considerably between farms and countries. Farmers also use human products without veterinary prescription as well as other prohibited substances.
The authors of this ‘study’ concluded that the subjective treatment approach using the farmers’ own criteria, together with their neglecting to check the outcome of the treatment and the lack of appropriate documentation is presumed to substantially reduce the potential for a successful recovery of the animals from diseases. There is, thus, a need to verify the effectiveness of homeopathic treatments in farm practices based on a lege artis treatment procedure and homeopathic principles which can be achieved by the regular monitoring of treatment outcomes and the prevailing rate of the disease at herd level. Furthermore, there is a potential risk to food safety due to the use of non-veterinary drugs without veterinary prescription and the use of other prohibited substances.
So did this ‘study’ change the evidence on veterinary homeopathy?
This ‘study’ is hardly worth the paper it is printed on.
Who conceives such nonsense?
And who finances such an investigation?
The answer to the latter question is one of the few provided by the authors: This project has received funding from the European Union’s Seventh Framework Programme for research, technological development and demonstration under Grant Agreement No 311824 (IMPRO).
Time for a constructive suggestion! Could the European Union’s Seventh Framework Programme with their next research project in veterinary homeopathy please evaluate the question why farmers in the EU are allowed to use disproven therapies on defenceless animals?
I have written about this more often than I care to remember, and today I do it again.
Because it is important!
And most experts now agree with this conclusion; except, of course, the chiropractors themselves. This recent article in THE CHRONICLE OF CHIROPRACTIC is most illuminating in this context:
It was only a matter of time before the attack on the chiropractic care of children spread to the United States from Australia and Canada and its also no surprise that insurance companies would jump on the bandwagon first. According to Blue Cross and Blue Shield Children under the age of 5 years should not receive chiropractic care (spinal manipulation) ” . . . because the skeletal system is not mature at this time.”
The Blues further contend that:
“Serious adverse events may be associated with pediatric spinal manipulation in children under the age of 5 years due to the risks of these procedures in children this age.”
The Blues claims that their determination is based on standards of care – though they do not state which ones.
“This determination was based on standards of care in pediatric medicine as well as current medical evidence.”
This is not the first time Blue Cross attacked the chiropractic care of children. In 2005 CareFirst Blue Cross claimed that:
“Spinal manipulation services to treat children 12 years of age and younger, for any condition, is considered experimental and investigational.”
The ridiculous and false claims by Blue Cross come on the heels of a ban placed on spinal manipulation of infants by the Chiropractic Board of Australia (see related story) and attacks on chiropractors who care for children in Canada by chiropractic regulatory boards there.
There is in fact plenty of evidence to support the chiropractic care of infants and children and there are practice guidelines (the highest level on the research hierarchy pyramid) that support such care.
The real issue is not whether or not evidence exists to support the chiropractic care of children – the real issue is power and the lack of any necessity for evidence for those with the power.
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What can we learn from this outburst?
- Chiropractors often take much-needed critique as an ‘attack’. My explanation for this phenomenon is that they sense how wrong they truly are, get defensive, and fear for their cash-flow.
- When criticised, they do not bother to address the arguments. This, I believe, is again because they know they are in the wrong.
- Chiropractors are in denial as to what they can and cannot achieve with their manipulations. My explanation for this is that they might need to be in denial – because otherwise they would have to stop practising.
- They often insult criticism as ridiculous and false without providing any evidence. The likely explanation is that they have no reasonable evidence to offer.
- All they do instead is stating things like ‘there is plenty of evidence’. They don’t like to present the ‘evidence’ because they seem to know that it is worthless.
- Lastly, in true style, they resort to conspiracy theories.
To any critical thinker their behaviour thus makes one conclusion virtually inescapable: DON’T LET A CHIROPRACTOR NEAR YOUR KIDS!