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

neglect

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I was recently invited to give a lecture to the local medical association in Graz Austria. It was a pleasure to be in Austria again and a delight to visit the beautiful town of Graz. They had given me the following subject:

Mythen in der sogenannten Alternativmedizin [Myths of so-called alternative medicine (SCAM)]

In my lecture, I thought it prudent to relate to the situation of SCAM in Austria which is rather special:

  • The seem to Austrians love the SAM; the 1-year prevalence of use is 36%!
  • In Austria, SCAM is only allowed to be practised by doctors.
  • Often SCAM is paid for by patients out of their own pocket.
  • For many, SCAM is a question of belief.
  • SCAM is being promoted by VIPs and loved by journalists; one politician even sells his own brand of dietary supplements!
  • In Austria, SCAM is heavily promoted by the Austrian Medical Association who currently runs courses and issues several SCAM diplomas.

The Austrian newspaper DER STANDARD then decided to interview me on these issues. The interview has been published today, and I thought I might take the liberty of translating the central part for you:

Q: In Austria, the Medical Association offers diplomas in various alternative methods. Why is this problematic?

A: I am aware of no less than 11 such diplomas offered by the Austrian Medical Association. While in England, France or Germany, for example, homeopathy has been considerably restricted by the medical profession due to the largely negative evidence, in Austria it continues to be promoted by the medical associations. This makes Austrian medicine the laughing stock of the rest of the world. More importantly, it violates the principles of evidence-based medicine. And even more importantly, it seems to me that the Austrian Medical Association is neglecting its ethical duty towards patients for purely pecuniary reasons.

Q: But the Medical Association is only complying with the regulations.

A: The Medical Association boasts that the quality of medical care and patient safety are at the centre of its work. In view of these diplomas, this mission almost sounds like a bad joke. They claim that the diplomas comply with the regulations. But firstly, this is a question of interpretation and secondly, regulations can – I would say must – be changed if they run counter to the quality of medical care. Finally, according to its own statements, the Association is obliged to adapt the Austrian healthcare system to changing conditions. This means nothing other than that it must take account of changing evidence – for example in the field of homeopathy.

Q: And what do the many doctors who use homeopathy say?

A: They often claim that they are only following the wishes of their patients when they prescribe homeopathic remedies. This may be true, but it is certainly not a valid argument. It ignores the fact that it is a doctor’s damned duty to provide patients with evidence-based information and to treat them accordingly. After all, medicine is not a supermarket where customers can simply choose whatever they happen to like.

It should also be emphasised that the practitioners of homeopathy also earn a good living from it. The fact that there is resistance from them when it comes to prioritising evidence rather than earnings in this area is thus hardly surprising.

But of course there are also a few doctors who use homeopathy primarily because they are fully convinced of its effectiveness. I think that these colleagues should consider self-critically whether they are not violating their ethical duty to be at the cutting edge of current knowledge and to act accordingly.

Perhaps unsurprisingly, my lecture prompted a lively discussion. Those doctors in the audience who spoke were unanimously in favour of my arguments. I was later told that many of those people who are responsible for the 11 diplomas were in the audience. Sadly, none of them felt like discussing any of the issues with me.

Perhaps the interview succeeds in starting a critical discussion about SCAM in Austria?

While the evidence base on web-based cancer misinformation continues to develop, relatively little is known about the extent of such information on the world’s largest e-commerce website, Amazon. Multiple media reports indicate that Amazon may host on its platform questionable cancer-related products for sale, such as books on purported cancer cures. This context suggests an urgent need to evaluate Amazon.com for cancer misinformation.

This study sought to

  • (1) examine to what extent are misleading cancer cure books for sale on Amazon.com’
  • (2) determine how cancer cure books on Amazon.com provide misleading cancer information.

The investigators searched “cancer cure” on Amazon.com and retrieved the top 1000 English-language book search results. They reviewed the books’ descriptions and titles to determine whether the books provided misleading cancer cure or treatment information. They considered a book to be misleading if it suggested scientifically unsupported cancer treatment approaches to cure or meaningfully treat cancer. Among books coded as misleading, they conducted an inductive latent thematic analysis to determine the informational value the books sought to offer.

Nearly half (494/1000, 49.4%) of the sampled “cancer cure” books for sale on Amazon.com appeared to contain misleading cancer treatment and cure information. Overall, 17 (51.5%) out of 33 Amazon.com results pages had 50% or more of the books coded as misleading. The first search result page had the highest percentage of misleading books (23/33, 69.7%). Misleading books (n=494) contained eight themes:

  • (1) claims of efficacious cancer cure strategies (n=451, 91.3%),
  • (2) oversimplifying cancer and cancer treatment (n=194, 39.3%),
  • (3) falsely justifying ineffective treatments as science based (n=189, 38.3%),
  • (4) discrediting conventional cancer treatments (n=169, 34.2%),
  • (5) finding the true cause of cancer (n=133, 26.9%),
  • (6) homogenizing cancer (n=132, 26.7%),
  • (7) discovery of new cancer treatments (n=119, 24.1%),
  • (8) cancer cure suppression (n=82, 16.6%).

The authors concluded that the results demonstrate that misleading cancer cure books are for sale, visible, and prevalent on Amazon.com, with prominence in initial search hits. These misleading books for sale on Amazon can be conceived of as forming part of a wider, cross-platform, web-based information environment in which misleading cancer cures are often given prominence. Our results suggest that greater enforcement is needed from Amazon and that cancer-focused organizations should engage in preemptive misinformation debunking.

This is an excellent paper that is long overdue. The plethora of dangerous books on so-called alternative medicine (SCAM) targeted at lay people is nothing short of a scandal. It was high time that we expose it, because it kills vulnerable patients. It is difficult, if not impossible, to quantify the damage done by such books but I am sure it runs in the thousands.

I have been aware of this scandal for a long time, in fact, it was the main motivation for publishing my own book on the subject. Obviously, it is not much more than a drop in the ocean.

Tragically, this scandal is not confined to just cancer. It relates to all potentially serious conditions. What could be more despicable and unethical than earning money through making desperately ill patients suffer? As the authors point out, Amazon urgently needs to address this problem. Failing this, Amazon should be legally held responsible, in my view.

‘DOC Check’ just published an interesting article. Allow me to translate some passages for you:

In 2023, the German Federal Insititute for Drugs and Devices (BfArM) stated: ‘To date no homeopathic medicinal product has been authorised by the BfArM based on a study submitted by the applicant.’ So why are homeopathic medicines still covered by statutory health insurance? Jörg Windeler, then head of IQWiG (the German equivalent of NICE), gave an indication in 2019: ‘It is simply a way of attracting customers. Homeopathy is popular, and customers are more likely to go to the health insurance fund that pays for homeopathy.’ This laissez-faire attitude is expensive. And not just in terms of the cost of medicines.

If you delve a little deeper into the world of homeopathic medicine, further grey areas emerge. They concern the doctors’ fees that are charged as part of the therapy.

In Germany, the normal billing of fees by doctors follows strict rules. To rule out fraud, they are subject to a plausibility check by the health insurance. Among other things, the time profiles are checked to ensure that the practitioner is billing the number of examinations correctly. There are also fee budgets. If these are exceeded, doctors will only receive a pro rata payment for their services.

Doctors have different possibilities for homeopathic services. One popular version is the billing option that the German Central Association of Homeopathic Doctors (DZVhÄ) offers its members. In this case, the plausibility checks of the insurance are not carried out. Furthermore, the services are extra-budgetary. This is possible because the DZVhÄ has concluded selective contracts via its own management company, MGL Managementgesellschaft für Gesundheitsleistungen mbH.

Access to participation in these selective contracts is gained via a ‘homeopathy diploma’, which is awarded by the DZVhÄ after 6 weeks of training. Trainee homeopaths have to fork out around 3,000 Euros to obtain this document – but the expense is well worth it. Once a doctor has obtained the homeopathy diploma, he/she participates in the selective contract. Subsequently, the health insurance pay fixed fees beyond the hotly contested pot. Only a few rules have to be adhered to: a time frame of at least 60 minutes for an initial homeopathic history and at least 30 minutes for a follow-up session. There is no evidence that these time limits are strictly monitored.

This uniquely lax construction in the German healthcare system is a potential gateway for abuse and fee fraud. It is easy to cheat on the time used for medical histories without a plausibility check. A practitioner can even conduct the initial homeopathic history and the ‘conventional medical’ consultation in parallel. The conventional medical service could then be billed via the health insurance, the homeopathic service again via the DZVhÄ route.

We asked the DZVhÄ in an editorial enquiry whether they were aware of this problem and how they ensure that everything is carried out correctly. The association remained silent – a tactic they have been using for years. The DZVhÄ only get vocal when they suspect attacks on their business model.

It would be interesting to know the volume of fees billed in Germany via the DZVhÄ’s selective contracts. Unfortunately, these figures are difficult to determine. A homeopath receives 97 Euros for the initial consultation. If each of the approximately 7,000 members of the DZVhÄ took an initial medical history on 200 working days per year, this would translate into a fee volume of more than 130 million Euros per year. This does not include follow-up sessions and so-called ‘repertorisations’. In other words, 200 million Euros could quickly be spent of doctors’ fees. Admittedly, these figures are speculative. However, the DZVhÄ could easily clarify the matter – if only they wanted to do so.

German health politicians ignore these hidden costs of homeopathy. They like to point to the notion that ‘only’ around 22 million Euros are spend on homeopathics.

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It would be a mistake, I think, to assume that financial reasons provide the only motivations for German doctors to use homeopathy. There are, in my experience, several others:

  • Some occasionally  use homeopathy as a placebo for patients where they feel a placebo is the best solution.
  • Some use homeopathy for patients want it.
  • Some use homeopathy because they are not fully aware of what it is.
  • Some use homeopathy because they are ill-informed about the evidence.

Very few German doctors who I know have ever used it because they are convinced that it is effective.

I only just came across the announcements for two conferences that made me almost speachless:

No 1 Homeopathy in Cancer Care – Aug. 29, 2024

Hosted by the newly formed Special Interest Group (SIG) on Research in Homeopathy in Cancer Care, this webinar aims to shed light on the role of homeopathy in cancer care, focusing on both its research status and practical applications in supportive treatment.

Supportive and palliative care are pivotal components of cancer treatment, offering avenues to enhance quality of life and potentially extend survival rates. Homeopathy emerges as a prominent integrative modality embraced by patients worldwide, notably in Europe, India, and Latin America. Despite varying perspectives on its efficacy, homeopathy’s emphasis on empathic listening and its unique approach to symptom management garner significant attention.

In the United States, homeopathy’s popularity surged during the 1990s, with over 5 million people reported to have used it by 2015. While some attribute its effects to a placebo response, clinical studies suggest tangible benefits in cancer care, particularly in alleviating symptoms like fatigue, anxiety, and hot flashes. Homeopathy is one of the leading integrative oncology modalities in Europe. Observations from France reveal that homeopathy supplements conventional treatments in about 30% of cancer patients, yielding notable improvements in symptomatology. Homeopathy was the most commonly used integrative therapy in cancer care in Belgium and in the top five in six other countries Turkey, Czech Republic, Sweden, Italy, Spain, and Greece. (Molassiotis 2005)

The speakers are:

Dr. Moshe Frenkel is a clinical associate professor at the University of Texas and founder of the Integrative Medicine Clinic, at The University of Texas M. D. Anderson Cancer Center, Houston Texas where he served as a full faculty until he returned to Israel in 2010. Up to 2014 Dr Frenkel was chairing the clinical practice committee of The Society of Integrative Oncology and was acting as the chair of The Israeli Society of Complementary Medicine (A section of The Israel Medical Association) until 2016.  Currently, Dr Frenkel is the medical director of the Integrative Oncology Service in RAMBAM Medical Center Oncology Department, a comprehensive oncology center and the largest in Northern Israel, as well as leading a feasibility study in homeopathy in cancer care.

Elio Rossi, MD will provide a brief overview of his practice and discuss symptom management, particularly focusing on radio dermatitis and leading homeopathic remedies that he utilizes. Director of the homeopathy outpatient clinic at the Campo di Marte public hospital in Lucca Italy, was established in 1998 and to date more than 7,500 patients have been consecutively examined. Of these 1100 are cancer patients who required an ‘integrated’ homeopathic treatment to reduce the adverse effects of anti-cancer therapies and improve their quality of life.  Works as a homeopathic doctor and expert in integrative medicine, collaborating with a local oncologist. Collaborated as Co-Chair, in the organization of many national and international congresses on Integrative Oncology (2017, 2019), specific sessions within other congresses organized in Italy (ECIM 2012 Florence, WCIMH 2023 Rome) and regional workshops, which have been attended by hundreds of CIM experts and oncologists.

Jean Lionel Bagot, MD will share insights from his practice, focusing on homeopathic remedies for fatigue and potential remedies for skin afflictions. A specialist in integrative cancer supportive care treatments in private practice as well as coordinating doctor of the Outpatients Department for Integrative Care in Groupe Hospitalier Saint Vincent Strasbourg, France; President of the International Homeopathic Society of Supportive Care in Oncology (SHISSO); Scientific officer of the French Society for Integrative Oncology (SFOI); Associated Member of the University College of Integrative and Complementary Medicine (CUMIC); Lecturer in the Medicine and Pharmacy Faculty in Strasbourg University.

Elizabeth Thompson, MD will have the opportunity to briefly describe her previous NHS practice and discuss symptom management, specifically addressing hot flushes and leading homeopathic remedies. Homeopathic Physician in NHS, NCIM Founder, CEO & Integrative Medicine Doctor, National Centre for Integrative Medicine (NCIM) www.ncim.org.uk, Chair, Integrative and Personalized Medicine Congress, London, June 2022. Past President ECIM 2021 and Board Member European Society Integrative Medicine, Council Member British Society of Integrative Oncology, Council Member College of Medicine.

No 2: “Pushing the Boundaries” Yes to Life Annual Conference 2024, 28th September

Integrative Medicine is a living, rapidly expanding science, with new understandings and potential being unveiled on a daily basis. This year’s conferences – one online in the Summer, and one in-person in the Autumn – share the title ‘Pushing the Boundaries’, as we have decided to devote them both to looking at the latest developments in Integrative Medicine, across the board. So that includes new techniques, new scientific understandings, and new applications for existing therapies, and you’ll be hearing fresh insights from some of your most trusted clinicians and scientists, and led into unfamiliar territory by pioneering speakers who may be as yet unfamiliar. The conferences are being co-created by Patricia Peat from Cancer Options and the Peat Institute and Yes to Life, with the aim of sending our audiences home with a wealth of resources on which to be able to draw for their own needs. Both events will be priced for accessibility, and the in-person Autumn Conference will include an extensive Exhibition that will offer yet more knowledge and resources to delegates.

The speakers are:

  • Dr Penny Kechagioglou MBBS (Honours), MRCP, CCT (Clin Onc), MPH, MBA Clinical oncologist
  • Dr Britt Cordi PhD
  • Dr Robert Verkerk MSc DIC PhD FACN​
  • Robin Daly Yes to Life Founder and Chairman
  • Patricia Peat Founder of Cancer Options
  • Mark Sean Taylor  Patient Led Oncology Founder

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Yes, you remembered correctly: some of the speakers have in the past featured on this blog, e.g.:

Crucially, we have encountered the YES TO LIFE charity:

But please do not let me spoil your enthusiasm of attending these meetings!

I do mean it: can someone please attend?

I offter a guest post to any critical thinker who wants to write up his/her experience.

GOOD LUCK

Pharmacists often advise patients on the use of over-the counter (OTC) medications, including homeopathics. Yet, little is known about student pharmacist education about homeopathy. The objectives of this study were to:

  1. describe homeopathic topics being taught in pharmacy schools,
  2. evaluate faculty views about pharmacists’ roles in counseling patients about homeopathic products.

An explanatory sequential mixed methods approach was used. Online surveys were distributed to 3,300 pharmacy practice faculty members representing all schools accredited in the US. Frequencies were calculated to describe faculty characteristics and their responses. Moreover, 18 interviews of faculty involved with teaching homeopathy were conducted to learn about homeopathy teaching and expectations about roles of pharmacists in counseling patients.

Survey data were collected from 365 respondents. Over half (84 of 137) of the responding pharmacy schools reported teaching
homeopathy to pharmacy students. In addition, the responses from most of the interviewed faculty were summarized into two themes
which emphasized that pharmacists should be knowledgeable and able to counsel patients effectively to ensure they benefit from
taking homeopathic products.

The authors concluded that over half of US pharmacy schools are teaching students about homeopathy topics. Further, there was support for pharmacists being able to counsel effectively about homeopathic products.

Oh, dear!

The sampling method of “3,300 pharmacy practice faculty members representing all schools accredited in the US” seems nonsensical. It means, if I understand it correctly, that some schools will be represented multiple times, while others are not represented at all. The response rate (~11%) is dismal which means that the data allow no generalisable conclusion whatsoever.

If we forget about these fatal flaws for just a minute and take the findings of the survey seriously, we are perhaps surprised that over half of the schools teach homeopathy. This fact in itself might, however, not necessarily be a bad thing. The students could simply learn that (and why) homeopathy is an obsolete therapy. What makes me shudder is this statement: “pharmacists should be knowledgeable and able to counsel patients effectively to ensure they benefit from taking homeopathic products”.

How can you teach students to counsel patients in such a way that they benefit from an ineffective therapy?, I wonder.

This paper employs a governmentality framework to explore resistance by sceptics to homeopathy’s partial settlement in the public health systems of England and France, resulting in its defunding in both countries in 2018 and 2021, respectively. While partly dependent upon long-standing problematisations – namely, that homeopathy’s ability to heal is unproven, its mechanisms implausible, and its consequences for patients potentially dangerous – the defunding of homeopathy was also driven by the conduct of  sceptics towards so-called alternative medicine (SCAM), who undermined homeopathy’s position in strikingly different ways in both contexts. This difference, we suggest, is a consequence of the diverging regulatory arrangements surrounding homeopathy (and SCAMs more generally) in England and France—and the ambivalent effects of SCAM’s regulation. If law and regulation have been a key component of SCAM’s integration and (partial) acceptance over the past four decades, the fortunes of homeopathy in England and France highlight their unpredictability as techniques of governmentality: just as the formal regulatory systems in England and France have helped to normalise homeopathy in different ways, they have also incited and galvanised opposition, providing specific anchor-points for resistance by SCAM sceptics.

The authors state that they approach the sceptics’ actions as a form of resistance to the normalising power of governmentality—a resistance that is also shaped by the possibilities and spaces offered by legal orderings. From a Foucauldian perspective, resistance is immanent to relations of power: the two presuppose one another. If regimes of governmentality have increasingly let SCAMs ‘in’ as a means of normalising them, then this paper attends to some of the resistances the modes of SCAM’s regulation have incited and shaped, and how resistance to SCAM has taken different forms in different regulatory contexts. At times, resistance has emanated from some SCAM healers themselves, who regard their practice as inimical to the standardisation and bureaucratisation required by formal regulation. In the case of homeopathy, much resistance has come from those outside of the SCAM professions. Such resistance seemingly rejects per se the notion that ‘good’ homeopathy (or SCAMs more generally) can be distinguished from ‘bad’—and, hence, the idea that state institutions should grant any form of legitimacy to such practices. By grounding our analysis in a governmentality perspective, we invite a closer consideration of the means by which homeopathy’s regulation (and its conditional acceptance by formal institutions)—a core component of its normalisation—has incited irritations, aggravations and resistances which have paradoxically helped to challenge its place in the national healthcare systems of England and France.

The authors further explain that SCAM sceptics’ initial resistance to homeopathy began to emerge in a coordinated fashion in the mid 2000s, and can best be described as a cumulative build-up of dispersed sceptic activism and campaigning on the part of a loose coalition of prominent non-state, non-official individuals, often, but not always, from outside the medical profession itself. It included high profile scientists and academics such as Edzard Ernst and David Colquhoun, and sceptic campaigning groups, such as Sense About Science (SAS), which was founded in 2002. In other words, the multifaceted nature of their campaigning and the dispersal of their targets appeared to be a reaction to the diffuse, decentred provision and regulation of homeopathy in England and the involvement of a broad range of actors ‘beyond the state’.

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I find this version of events interesting (I encourage you to read the full text of the paper) and somewhat amusing, as I hardly recognise it. The way I experienced and recall this story is roughly as follows:

  • In the 1970/80s EBM had become the generally accepted norm and logic  in healthcare. It had begun to generate significant, tangible advantages for the fate of suffering patients.
  • Thus many areas of medicine came under scrutiny and those that were non-compliant with EBM were rightly criticised.
  • From the early 1990s, I and others started to apply the principles of EBM to homeopathy (and other SCAMs).
  • This soon made it obvious that homeopathy was lacking convincing evidence of efficacy.
  • Now, it was merely a question of time that the regulators had to act accordingly.
  • England and France happened to do this first, but, in my view, it is virtually inevitable that other countries will follow – not because of any organised activism but because ethical medicine must always follow the evidence and cannot tolerate quackery.

I disagree with the authors of the above paper; there was no coordinated resistance, cumulative build-up, activism, coalition of individuals, multifacetet campaigning to speak of. The actions that occurred were merely the inevitable consequence of the scientific evidence that emerged from the 1990s onwards. In other words, the principles of EBM were simply taking their course. The defunding is thus not unique to homeopathy but has happened (and will continue to happen) in many other areas of healthcare that do not demonstrably generate more good than harm.

The authors of the above article mention my name repeatedly and seem to imply that I assumed the role of a key activist. Interestingly, they do not cite a single of my papers, presumably because none of them can demonstrate the points they are trying to make. The truth is that, until my retirement from academia in 2012/13, my role was merely that of a researcher. The activism that did happen consisted mostly of diverse and unfunded actions of rationalists who felt that homeopathy was making a mockery of EBM.

Looking back, I am still surprised that these actions were achieved almost entirely by altruistic amateurs. I even feel a little ashamed that the vast majority of doctors seemed to care so little (and were put to shame by the amateurs) about upolding the values of EBM, the best interest of patients and the importance of medical ethics.

 

 

In the last 2 years of the pandemic, a wide range of cases of post-COVID functional gastrointestinal disorders (PC-FGIDs) has been reported. This case series aimed to investigate the role of homeopathic intervention in the treatment of PC-FGIDs.

This is a retrospective analysis of the clinical data of individuals who had suffered from PC-FGIDs that were diagnosed based on clinical symptoms using the Gastrointestinal Symptoms Rating Scale (GSRS) and treated exclusively with individualized homeopathic medicines. Cases that had undergone regular monthly assessment using the GSRS and had a Post-COVID-19 Functional Status (PCFS) score for up to 3 months were considered.

Thirty cases were screened and twelve were included according to the study criteria. The mean age of seven women and five men was 36 years. GSRS and PCFS scores showed marked improvement in each of 10 cases within the 3-month treatment period.

The authors concluded that homeopathic intervention proved beneficial in 10 of 12 patients with PC-FGIDs. The findings may help researchers plan future controlled clinical studies in this field.

There is a lot wrong here.

In fact, it is hard to find anything that is right!

What is true is that post-COVID functional gastrointestinal disorders have become a big problem.

What is questionable or plainly wrong is the following:

  • The underlying assumption that homeopathy can cure post-COVID functional gastrointestinal disorders is implausible.
  • A case series cannot meaningfully investigate the role of a treatment in managing any condition.
  • A retropective analysis can do this even less.
  • Treating seriously ill patients exclusively (i.e. not applying any other therapeutic measures) with individualized homeopathic medicines is surely unethical.
  • Selecting cases for this analysis can introduce bias.
  • A sample size of 12 is too small for producing a generalisable finding.
  • Attributing the observed improvement to the homeopathic treatment is unwarranted; there are many other factors, not least the natural history of the condition.

For all we know, the 12 patients might have improved more dramatically if they had NOT received any homeopathy at all.

My conclusion is this:

The editor of the journal HOMEOPATHY, the peer-reviewers of this paper, the authors of the article and their institutions should all bow their heads in shame – this is certainly one of the worst and most dangerously misleading paper I have come across in a long time!

 

 

 

Alternative cancer clinics (I’d prefer to call them SCAM cancer clinics), that provide treatments associated with hastening death, actively seek to create favorable views of their services online. An unexplored means where such clinics can shape their public appeal is their Google search results.

For this study, a team of researchers retrieved the Google listing and Google reviews of 47 prominent SCAM cancer clinics. They then conducted a content analysis to assess the information cancer patients are faced with online.

The results show that Google listings of alternative treatment providers rarely declare that the clinic is a SCAM clinic versus a conventional primary cancer treatment provider (12.8% declared; 83.0% undeclared). The clinics were highly rated (median, 4.5 stars of 5). Reasons for positive reviews included:

  • treatment quality (n = 519),
  • care (n = 420),
  • outcomes (n = 316).

288 reviews claimed that the clinics cured or improved cancer. Negative reviews presented SCAM clinics to:

  • financially exploit patients with ineffective treatment (n = 98),
  • worsen patients’ condition (n = 72),
  • provide poor care (n = 41),
  • misrepresent outcomes (n = 23).

The authors concluded that the favorable Google listing and reviews of alternative clinics contribute to harmful online ecosystems. Reviews provide compelling narratives but are an ineffective indicator of treatment outcomes. Google lacks safeguards for truthful reviews and should not be used for medical decision-making.

These findings suggest that the Google listings and reviews of SCAM cancer clinic create a favorable online impression to prospective patients. Google listings and reviews are thus part of a most effective multi-level propaganda network promoting SCAM even for the most desperately ill of all patients. As discussed some time ago, in the UK, such misinformation can even be traced back to King Charles. In nearly all cases, these clinics were labeled as speciality primary cancer options. Only a few clinics were marked as an ‘alternative’ option. Positive reviews stated that alternative treatments can cure cancer or prolong life, even in terminal cases. Positive reviews also undermine evidence-based cancer treatments in favor of SCAM. They generate an impression that dangerously misleads patients. As we have seen repeatedly on this blog, the results can be devastating, e.g.:

Vaccine hesitancy has been defined as a continuum of attitudes, ranging from accepting vaccines with doubts to rejecting them. For good reasons, the topic has featured regularly on this blog, e.g.:

This new study aimed to explore the heterogeneity of a childhood-vaccine-hesitant group by using a person-oriented approach, i.e. latent profile analysis.

A non-representative cross-sectional sample of vaccine-hesitant Slovenians (N = 421, Mage = 35.21, 82.9% women) was used to identify differences based on their

  • reliance on personal research (“self” researching instead of relying on science),
  • over-confidence in knowledge,
  • endorsement of conspiracy theories,
  • complementary and alternative medicine,
  • trust in the healthcare system.

The analysis revealed three profiles of vaccine-hesitant individuals. The most hesitant profile—vaccine rejecting—expressed the greatest reliance on personal research, expressed the highest endorsement of conspiracy theories and complementary and alternative medicine, showed moderate overconfidence in their knowledge, and expressed the highest levels of distrust in the healthcare system. Furthermore, the researchers found differences in sociodemographic structure and noted that the identified profiles differed in their attitudes regarding MMR, HPV, and Seasonal Influenza vaccinations.

The authors concluded as follows: our findings not only further confirm the heterogeneous nature of vaccine-hesitant groups but also offer critical insights for public health interventions. By acknowledging the existence of distinct profiles within the vaccine-hesitant population, strategies can be tailored to address the nuanced beliefs and attitudes of these subgroups more effectively.

The authors suggest the following approaches:
  • Skeptics who already express a certain level of trust in healthcare, may be most receptive to messages from medical professionals. Given that skeptics are typically older, higher-educated men, interventions could focus on leveraging their existing trust in healthcare professionals and providing detailed, evidence-based information to address their specific concerns.
  • Self-directed researchers, who are characterized by high endorsement of CAM and conspiracy theories and moderate over-confidence, could benefit from interventions involving trusted community figures or CAM medicine experts who can bridge the gap between traditional and CAM perspectives. In addition, reaching out to younger women in this group through online platforms and providing credible information that counteracts misinformation could be effective.
  • Conventionalists, who have the highest trust in the healthcare system and tend to include more educated individuals with a left-leaning political orientation, may respond well to public health messages that emphasize the collective benefits of vaccination. Campaigns could focus on reinforcing their positive views on the efficacy, safety, and importance of vaccines while leveraging their trust in physicians and public health institutions.

The effectiveness of targeted interventions for each specific subgroup could then also be examined, employing insights from the present study. For instance, tailored communication strategies could be tested to determine which messages and messengers are the most effective in regard to changing attitudes and behaviors within each profile.

Individuals with large followings can influence public opinions and behaviors, especially during a pandemic. In the early days of the COVID pandemic, US president Donald J Trump endorsed the use of unproven therapies. Subsequently, a death attributed to the wrongful ingestion of a chloroquine-containing compound occurred.

This paper investigated Donald J Trump’s speeches and Twitter posts, as well as Google searches and Amazon purchases, and television airtime for mentions of hydroxychloroquine, chloroquine, azithromycin, and remdesivir. Twitter sourcing was catalogued with Factba.se, and analytics data, both past and present, were analyzed with Tweet Binder to assess average analytics data on key metrics. Donald J Trump’s time spent discussing unverified treatments on the United States’ 5 largest TV stations was catalogued with the Global Database of Events, Language, and Tone, and his speech transcripts were obtained from White House briefings. Google searches and shopping trends were analyzed with Google Trends. Amazon purchases were assessed using Helium 10 software.

From March 1 to April 30, 2020, Donald J Trump made 11 tweets about unproven therapies and mentioned these therapies 65 times in White House briefings, especially touting hydroxychloroquine and chloroquine. These tweets had an impression reach of 300% above Donald J Trump’s average. Following these tweets, at least 2% of airtime on conservative networks for treatment modalities like azithromycin and continuous mentions of such treatments were observed on stations like Fox News. Google searches and purchases increased following his first press conference on March 19, 2020, and increased again following his tweets on March 21, 2020. The same is true for medications on Amazon, with purchases for medicine substitutes, such as hydroxychloroquine, increasing by 200%.

The authors concluded that individuals in positions of power can sway public purchasing, resulting in undesired effects when the individuals’ claims are unverified. Public health officials must work to dissuade the use of unproven treatments for COVID-19.

Trump is by no means the only politician who misled the public in matters of healthcare through ignorance, or stupidity, or both. Other recent examples that we previously discussed include, for instance:

Yes, Trump is not the only, but he is the most influential and might well be the most ignorant one:

For this reason alone – and there are many more – I hope he will not soon become merely a dark and scary chapter in the history of the US.

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