patient choice
Smoking kills! Since most people now know about this fact, they have been looking for alternatives that are safe. Here I will discuss two of them: vaping and nicotine pouches.
VAPING
Vaping devices are electronic nicotine delivery systems that heat liquid into an inhalable aerosol. They have surged in popularity. Despite marketing claims to the contrary, substantial evidence reveals significant health risks.
Addiction
Nicotine, the primary active ingredient in most vape liquids, is one of the most addictive substances known. Research indicates that 17.8% of e-cigarette users report feeling “very addicted,” while 42.3% consider e-cigarettes equally or more addictive than combustible cigarettes. The addictive potential is amplified by several factors: modern vape devices use nicotine salts that deliver nicotine more rapidly and in higher concentrations than traditional cigarettes, and the high nicotine concentrations in many devices (often not listed on packaging) accelerate dependence. The more a person vapes, the more their brain and body adapt to nicotine, making cessation increasingly difficult. When nicotine enters the system, it triggers dopamine release, creating a “feel-good” sensation that reinforces continued use. However, nicotine’s effects wear off rapidly, triggering cravings and establishing a cycle of dependence. Nearly all vapes circulating contain nicotine, even when not listed on packaging, making prevaping users unknowingly vulnerable to addiction.
Toxicity
Vaping exposes users to a complex toxic chemical cocktail. The e-liquids contain propylene glycol and vegetable glycerin. These are ingredients meant to be eaten, not inhaled which become toxic when heated. When vaporized, these components transform into dangerous chemicals including acetaldehyde, acrolein, and formaldehyde, all of which can cause lung disease and cardiovascular disease. The two primary e-cigarette ingredients in the US are toxic to cells, with toxicity increasing alongside the number of additives in the e-liquid. Acrolein, a herbicide primarily used to kill weeds present in e-cigarettes, can cause acute lung injury, COPD, asthma, and potentially lung cancer. Vitamin E acetate, a thickening agent sometimes added to THC-containing vape products, was identified by the CDC as a “chemical of concern” in vaping-associated lung injuries. Flavoring agents pose additional risks. Diacetyl, a flavoring chemical linked to “popcorn lung” (bronchiolitis obliterans), is present in many flavored vapes and causes irreversible lung damage. Secondhand emissions contain nicotine, ultrafine particles, volatile organic compounds like benzene usually found in car exhaust, and heavy metals including nickel, tin, and lead. The FDA has not found any e-cigarette to be safe and effective for smoking cessation.
Cardiovascular disease
Vaping is associated with significant cardiovascular risks. Research has linked nicotine-containing e-cigarettes to acute changes in blood flow, including increased blood pressure and heart rate. These physiological effects can lead to atherosclerosis and increase the risk of heart attacks and strokes. Other e-cigarette ingredients, particularly flavoring agents, independently carry risks associated with heart and lung diseases in animal studies. A recent analysis found a significant association between former or current e-cigarette users and the development of several respiratory diseases within two years of use, suggesting cardiovascular and respiratory systems are simultaneously compromised.
Brain damage
The human brain does not fully develop until approximately age 25, making young users uniquely vulnerable. Regular nicotine vape use causes changes to brain development that negatively affect learning, concentration, mood, and memory. Nicotine rewires the brain, changing the parts responsible for decision-making, impulse control, and mood regulation. These changes can interfere with mood and make users more likely to become addicted to nicotine and other drugs. Nicotine exposure during adolescence also increases feelings of stress and worsens depression and anxiety. Vaping hasn’t been around long enough to see irreversible diseases yet, but biologically, damage is happening and inflammation is occurring—creating conditions that will lead to diseases later.
References
- American Lung Association. (n.d.). Health Risks of E-Cigarettes and Vaping. https://www.lung.org/quit-smoking/e-cigarettes-vaping/impact-of-e-cigarettes-on-lung
- American Lung Association. (2025). The Truth About What Vaping Is Doing to Your Body. https://www.lung.org/blog/illnesses-vaping-causes
- Panagis Galiatsatos, M.D., MHS. Johns Hopkins School of Medicine.
- European Journal of Public Health. (2022). Understanding addiction in e-cigarette users – the EVAPE project. Oxford Academic. https://academic.oup.com/eurpub/article/32/Supplement_3/ckac130.078/6765989
- National Institutes of Health. (2024). The Risks of Vaping. NIH News in Health. https://newsinhealth.nih.gov/2020/05/risks-vaping
- American Heart Association. (2023). As E-Cigarette Use Grows, More Research Needed on Long-Term Effects of Vaping. https://www.stroke.org/en/news/2023/07/17/as-e-cigarette-use-grows-more-research-needed-on-long-term-effects-of-vaping
- NSW Health. (n.d.). Vaping – Nicotine Addiction | Young People Factsheet. https://www.health.nsw.gov.au/tobacco/Factsheets/vaping-nicotine-addiction-young-people-factsheet.pdf
- Centers for Disease Control and Prevention. (2025). Health Effects of Vaping. https://www.cdc.gov/tobacco/e-cigarettes/health-effects.html
- National Institutes of Health. (2025). NIH-Funded Studies Show Damaging Effects of Vaping, Smoking on Blood Vessels. https://www.nih.gov/news-events/news-releases/nih-funded-studies-show-damaging-effects-vaping-smoking-blood-vessels
- Johns Hopkins Medicine. (2025). 5 Vaping Facts You Need to Know. https://www.hopkinsmedicine.org/health/wellness-and-prevention/5-truths-you-need-to-know-about-vaping
NICOTINE POUCHES
Nicotine pouches are small, smokeless, tobacco-free pouches containing nicotine. They have existed for a long time but have recently rapidly gained popularity, particularly among young people. They are often claimed to be safer alternatives to cigarettes. Is this claim true?
Addiction
Nicotine pouches are highly addictive by design. Nicotine is a well-established addictive drug that activates reward pathways in the brain, leading to dependence. Research demonstrates that nicotine salts used in pouches deliver higher concentrations more rapidly than traditional nicotine products, accelerating addiction. Among young people who try nicotine pouches, 73% continue using them, indicating strong addictive potential. The average user consumes half a can daily (8-12 pouches), with 10 pouches at 6mg equivalent to 1–1½ packs of cigarettes or 1½ e-cigarette pods daily. Alarmingly, the number of youths using nicotine pouches has doubled in the US since 2021, reaching now ~400,000 users. This rapid uptake among youth suggests that the product’s smokeless, odorless features make nicotine use more accessible and socially acceptable, facilitating addiction before users fully understand the consequences.
Toxicity
Nicotine pouches contain unregulated and potentially toxic levels of nicotine. While nicotine itself is not unregulated, many products in the US lack FDA authorization and are on the market illegally without proper safety testing. A 2022 study found that 26 of 44 nicotine pouch products contained cancer-causing chemicals, including ammonia, formaldehyde, chromium, and nickel. These contaminants likely result from inadequate manufacturing processes and quality control. The absence of standardized regulation means nicotine concentrations can vary significantly between products and even within batches, making dosing unpredictable. Furthermore, non-tobacco nicotine products may seem healthier than smoking, but they come with their own laundry list of health effects, and public health experts recommend avoiding nicotine altogether.
Cardiovascular disease
The cardiovascular risks associated with nicotine pouches are well-documented. Nicotine increases blood pressure, heart rate, and blood flow to the heart while constricting arteries. These physiological effects can lead to atherosclerosis and heart attacks. The American Heart Association explicitly warns that nicotine can damage the heart and other vital organs. However, some industry-sponsored research claims that nicotine administered through pouches has only transient effects on blood pressure and heart rate in healthy users, with no demonstrated long-term cardiovascular damage. This discrepancy highlights the importance of independent research versus industry-funded studies. Nevertheless, the mechanistic evidence—nicotine’s vasoconstrictive and hemodynamic effects—strongly suggests increased cardiovascular risk, particularly with chronic use or in individuals with pre-existing conditions.
Brain dmage
Nicotine damages brain development. The human brain does not fully develop until approximately age 25, making adolescents and young adults uniquely vulnerable to nicotine’s neurotoxic effects. Nicotine exposure during adolescence alters the development of the prefrontal cortex, the brain region responsible for attention, learning, memory, and impulse control. These changes can be permanent, leading to lasting cognitive deficits and difficulties with concentration and memory. Additionally, adolescent nicotine exposure increases the risk of psychiatric disorders, including anxiety and depression, and priming the brain for addiction to other substances. Nicotine pouches are particularly dangerous for youth precisely because of these developmental vulnerabilities. Given that 400,000 US youths now use nicotine pouches, the public health implications are substantial.
References
- American Lung Association. (2024). ZYN 101: What to Know About Big Tobacco’s Latest Addiction. https://www.lung.org/blog/zyn-nicotine-addiction
- American Heart Association. (2025). Triple Threat: The Hidden Dangers of E-Cigarettes, Oral Nicotine Pouches, and Vaping. https://www.heart.org/en/healthy-living/healthy-lifestyle/quit-smoking-tobacco/triple-threat-e-cigarettes-oral-nicotine-pouches
- Cleveland Clinic. (2024). Are Nicotine Pouches Safe? Health.ClevelandClinic.org. https://health.clevelandclinic.org/are-nicotine-pouches-safe
- Dentalcare.com. (2025). Nicotine Impact on Adolescent Brain Development. CE693. https://www.dentalcare.com/en-us/ce-courses/ce693/nicotine-impact-on-adolescent-brain-development
- Verywell Health. (2024). Is Zyn Bad for Your Heart? https://www.verywellhealth.com/is-zyn-bad-for-your-heart-8735079
- Yale Medicine. (2024). What Parents Should Know About Nicotine Pouches. https://www.yalemedicine.org/news/nicotine-pouches
- initiative to Undo. (2024). The Effects of Nicotine on the Adolescent Brain. https://www.undo.org/addicting-kids/the-effects-of-nicotine-on-the-adolescent-brain
- Tobacco Free Coalition. (2025). Not Your Grandparent’s Tobacco: The New Nicotine Products. https://www.tobaccofreeco.org/the-new-nicotine-products-2/
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Having lost several friends to lung cancer, I am convinced that the best alternative to smoking is quitting.
During outbreaks of Ebola Virus Disease (EVD), public health organizations like the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) combat “infodemics”, i.e. surges of false information and unproven so-called alternative medicine (SCAM) polluting social media (Bedrosian et al., 2016; Fung et al., 2016; Obol & Nzedibe, 2024). Because these SCAMs are ineffective and frequently dangerous, authorities issue warnings against their use. Here are just a few of the many claims that can be found:
- Bathing in or drinking hot, highly saturated saltwater solutions can sweat out or kill the Ebola virus (Fung et al., 2016). Public health agencies strongly advise against this practice. It does nothing to prevent or treat EVD and can cause severe illness and death from acute hypernatremia (Vijaykumar et al., 2019).
- Solutions containing silver nanoparticles act as powerful natural antimicrobials capable of neutralizing the Ebola virus inside the body (Fung et al., 2016). The WHO has explicitly stated that Nano Silver is an unproven compound with no demonstrated efficacy against Ebola. Authorities recommend avoiding these products, as silver accumulation can cause irreversible organ damage and a condition called argyria (which permanently turns the skin blue/gray).
- Consuming large quantities of specific botanical items, such as raw onions, ginger, or alligator peppers, can stave off infection (Nsoesie & Oladeji, 2020). These “natural cures” possess no therapeutic effects capable of stopping viral replication of the filovirus family. Relying on them creates a false sense of security, which delays life-saving, evidence-based triage and supportive care (Fridman et al., 2025; Nsoesie & Oladeji, 2020).
- Ebola has been attributed to spiritual curses or witchcraft that can only be reversed by traditional spiritual cleansing (Bedrosian et al., 2016). Public health organizations work alongside local communities to pivot away from these practices. Delaying medical intervention to seek traditional spiritual healing drastically increases community transmission and prevents patients from receiving SOTA antiviral therapies and fluid replacement, lowering survival rates (Obol & Nzedibe, 2024).
- A homeopath market “e-remedies” online, claiming that the “energy signature” of a remedy could be digitized into an audio file (Moffitt, 2018). He claimed that listening to a specific, hissing MP3 file could stimulate the body’s immune system to fight off Ebola. This prompted an investigation by the Medical Board of California into the doctor’s license for promoting unscientific and unproven online remedies (Moffitt, 2018).
- Some chiropractors claim that spinal manipulations can prevent Ebola infections, because misalignments interfere with the nervous system. Since the nervous system coordinates the immune responses, these misalignments weaken the body’s ability to recognize and destroy the Ebola virus (Terry Chiropractic Boulder). People “have nothing to fear but fear itself” regarding outbreaks if they keep their spines properly aligned to maximize their natural innate immunity. Global public health authorities and mainstream scientific institutions strongly reject these claims. There is zero credible scientific evidence demonstrating that manual spinal manipulation enhances immune competence or protects an individual against Ebola (Côté et al., 2020).
Ebola infection requires immediate, professional medical treatment. Treatments include monoclonal antibody therapeutics along with intensive supportive care. Relying on internet remedies significantly delays proper clinical treatment and increases the risk of mortality.
References
Bedrosian, S. R., Young, E. C., Smith, L. A., Cox, J. D., Manning, C., Pechta, L., Telfer, J. L., Gaines-McCollom, M., Harben, Kathy, Holmes, Wendy, Lubell, K. M., McQuiston, J. H., Nordlund, Kristen, O’Connor, John, Reynolds, B. S., Schindelar, J. A., Shelley, Gene, & Daniel, K. L. (2016). Lessons of Risk Communication and Health Promotion — West Africa and United States. MMWR Supplements, 65(3), 68–74. https://doi.org/10.15585/mmwr.su6503a10
Fridman, I., Boyles, D., Chheda, R., Baldwin-SoRelle, C., Smith, A. B., & Elston Lafata, J. (2025). Identifying Misinformation About Unproven Cancer Treatments on Social Media Using User-Friendly Linguistic Characteristics: Content Analysis. JMIR Infodemiology, 5, e62703. https://doi.org/10.2196/62703
Fung, I. C.-H., Fu, K.-W., Chan, C.-H., Chan, B. S. B., Cheung, C.-N., Abraham, T., & Tse, Z. T. H. (2016). Social Media’s Initial Reaction to Information and Misinformation on Ebola, August 2014: Facts and Rumors. Public Health Reports®, 131(3), 461-473. https://doi.org/10.1177/003335491613100312
Moffitt, M. (2018). State doubts Los Gatos doctor can cure ebola with hissing MP3 files. SFGATE. https://www.sfgate.com/bayarea/article/dr-bill-gray-medical-license-homeopathy-treatment-12954925.php
Nsoesie, E. O., & Oladeji, O. (2020). Identifying patterns to prevent the spread of misinformation during epidemics. Harvard Kennedy School Misinformation Review. https://doi.org/10.37016/mr-2020-014
Obol, S. J., & Nzedibe, O. (2024). Critical perspective on infodemic and infodemic management in previous Ebola outbreaks in Uganda. Frontiers in Public Health, 12. https://doi.org/10.3389/fpubh.2024.1375776
Terry Chiropractic Boulder. (2014). Hold On Ebola: How Bolstering Your Immune System Can Help You Avoid Disease. https://terrychiropracticboulder.com/blog/hold-on-ebola-how-bolstering-your-immune-system-can-help-you-avoid-disease/
Vijaykumar, S., Jin, Y., & Pagliari, C. (2019). Outbreak communication challenges when misinformation spreads on social media. Revista Eletrônica de Comunicação, Informação e Inovação em Saúde, 13(1). https://doi.org/10.29397/reciis.v13i1.1623
I am always delighted when I find authors who think in a similarly rational way as I. When it comes to the subject if INTEGRATIVE MEDICINE, this sadly is a rare occasion. I know that most medics would be critical of it, but only few are sufficiently insensed to publish a paper on their criticism. Here is the abstract of a recent article that is a rare exception:
The term integrative medicine claims to describe a third category in clinical practice, somewhere between conventional evidence-based medicine and alternative therapies. This article argues that this category is conceptually confused and often misleading. If an intervention is supported by good evidence, is safe in practice, clinically useful and cost-effective, it should simply become part of regular medicine. If an intervention does not have such evidence, it does not become stronger by being called integrative. The article examines how the language of integrative medicine works. It shows how one attractive label can bring together two very different things: evidence-based supportive care on the one hand, and weakly supported or unproven interventions on the other. This creates the impression that both have the same clinical status, even when they do not. The article also discusses the possible consequences for patients, including confusion about evidence, false confidence in unproven treatments, and reduced adherence to effective care. Drawing on more than a decade of experience evaluating complementary medical claims through foundation IOCOB (a foundation to study complementary medicine) , it argues for a simpler and more honest approach. Proven interventions should be called medicine. Unproven interventions should be called unproven. Disproven interventions should be called disproven. There are not two equal medicines waiting to be synthesised. There is only medicine that has earned its place, and medicine that has not.tive medic ine m
True words well expressed!
We have discussed interated medicine on this blog more often than I care to mention. The response of proponents usually is that INTEGRATED MEDICINE is so much more than just using alternative treatments. If we look at this claim, we quickly realise that the “so much more” are things stolen from conventional medicine (which proponents denounce by their claim of neglecting these things). If they feel that important bits of healthcare are being neglected, the proper reaction would be to reform medicine and rectify the situation. Instead the proponents put their money on INTEGRATIVE MEDICINE which undeniably is at least partly an attempt to smuggle unproven treatments into healthcare.
I wrote “at least partly” which is, in fact, generous to the extreme! If we look up what the clinics of INTEGRATED MEDICNE actually offer, we quickly realise that it is much more that “partly” – it is their main and lucrative business.
Sorry, but to me this is deeply dishonest!
This AI-verdict made me wonder: Who is for and who against the critical evaluation of so-called alternative medicine? And I asked a follow-up question:
Can you try to quantify this and give me % figures who is against a critical evaluation of alternative medicine, who is for it, and who is neutral. Can you do this for 1. the general population, 2. proponents of alternative medicine and 3. skeptics?
Here is the reply I got from Gemini:
To quantify these dynamics accurately, we have to look at large-scale sociological data on public attitudes toward science, peer-reviewed medical data (such as surveys by Pew Research, YouGov, and the European Commission), and the behavioral patterns of online discourse.
When it comes to a “critical evaluation” (meaning scientific testing to prove if a therapy works beyond a placebo), the groups break down along very distinct ideological lines. Here is how the percentages estimate across your three requested demographics:
Breakdown of Attitudes Toward Critical Evaluation
1. The General Population
The broader public is largely pragmatic, but a major chunk is passively open to alternative therapies without strictly demanding clinical trial proof.
- Against Critical Evaluation (~15% – 20%): These individuals hold a strong distrust of mainstream pharmaceutical companies and medical institutions. They believe alternative medicine operates on a different “energy” or “holistic paradigm” that standard science is fundamentally incapable of or biased against measuring.
- For Critical Evaluation (~35% – 45%): This group highly values evidence-based medicine, expects consumer safety protection, and agrees that if a therapy claims to cure an illness, it should prove it under a microscope or in a randomized controlled trial.
- Neutral / Passive Consumers (~40% – 50%): This is the massive middle. They don’t track clinical trials, but they will try acupuncture for back pain or take turmeric if a friend recommends it. They view alternative medicine through a lens of “well, it can’t hurt to try,” evaluating it based on personal anecdotes rather than scientific data.
2. Proponents of Alternative Medicine
This group includes dedicated practitioners, wellness influencers, and avid consumers of Complementary and Alternative Medicine (CAM).
- Against Critical Evaluation (~70% – 80%): The vast majority actively resist standard scientific evaluation, often viewing figures like Edzard Ernst as hostile prosecutors rather than objective evaluators. They argue that randomized controlled trials are “too reductionist” to capture holistic healing or claim that clinical science is rigged by corporate interests.
- For Critical Evaluation (~5% – 10%): A small minority of CAM practitioners (often in fields like medical acupuncture or osteopathy) welcome rigorous trials, hoping to find a mechanism of action that will grant them mainstream medical legitimacy and insurance coverage.
- Neutral (~10% – 15%): These are individuals who focus strictly on the individual client experience. They don’t care about data or institutional pushback either way; their attitude is simply “if my client says they feel better, that is the only science I need.”
3. Skeptics & Pro-Science Advocates
This demographic comprises secular organizations, evidence-based medical professionals, and science communicators who actively follow work like Ernst’s.
- Against Critical Evaluation (<1%): Virtually non-existent in this group, as evaluation is their core tenet. The only micro-fraction here might be extreme fringe elements who feel certain alternative therapies are so fundamentally absurd (like breatharianism) that evaluating them is a waste of scientific funding.
- For Critical Evaluation (~90% – 95%): The overwhelming majority. They strongly defend the stance that there is no such thing as “alternative” medicine—there is only medicine that has been proven to work and medicine that hasn’t. They view critical evaluation as an ethical necessity for patient safety.
- Neutral (~5%): A tiny sliver who may agree with the premise of science but feel indifferent about fighting the cultural battle against wellness trends, preferring to let people believe what they want as long as it isn’t directly killing them.
The Reality of the “Viral Sharing Power”
The Disparity: While alternative health advocates outnumber skeptics in raw volume and content creation—churning out high-yield, emotionally comforting narratives—the pro-science corrections achieve highly concentrated “viral bursts.”
When a prominent alternative health claim is cleanly and definitively debunked by data, it provides a highly shareable, “gotcha” piece of content for the large, silent neutral majority and the highly active skeptic network. A data-driven correction acts as a high-utility intellectual tool, allowing regular people to cut through multi-million dollar wellness marketing, which is why a single well-structured critique can match or outpace the reach of thousands of individual wellness posts.
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I know, there are good reasons for being cautious about such AI analyses. Yet, unless someone can point me to more reliable data, I will go with this one – not least because it coincides with my own experience and also because I quite like its findings.
I came across an interesting paper entitled “The Ethics of Tawas and Other Rituals in Medical Practices“. Here is its abstract:
Rituals in medical practice have either been seen as an anthropological aspect of current biomedical processes or as a pre-scientific aspect of complementary and alternative medicine (CAM). In either tendency, the literature has since failed to account for these rituals as rituals—conveyors of meaning, expressions of identity, and even as a rite of passage from illness to wellness. As an alternative to current discussions, this paper presents the case study of tawas, a diagnostic ritual from Philippine traditional medicine that determines personalistic and mystical causes of illnesses. As a non-intrusive procedure, tawas involves incantations and some ritual objects, e.g., rice, candle, axe, etc., that do not pose any direct harm nor benefit to the patient. While complete reliance on tawas at the expense of proper medical procedures could harm patients, the very ritual of tawas itself occupies a limbo within non-beneficence and non-maleficence. Following a Wittgensteinian perspective of treating rituals as meaning-laden human activities, this paper argues that rituals like tawas, much like other rituals embedded in biomedical practices, should be understood as rituals and not as empirical cures, thereby allowing their tolerance in medical practice in general.
The author seems to advocate for the cultural integration of traditional practices like tawas into a broader medical framework. They categorize tawas not as a physiological intervention, but define it as a conveyor of meaning. By addressing the “meaning-laden” aspect of illness, the ritual may address the psychological and social dimensions of a patient’s health, even if it has no effect on their physical pathology.
It is claimed that, since tawas involves non-intrusive objects (candles, rice), it is physically benign. At the same time it is acknowledged that “complete reliance” on tawas could harm patients. From a clinical safety standpoint, the “limbo” is only maintained if the ritual is strictly adjunctive rather than alternative.
The text uses a Wittgensteinian perspective, focusing on rituals as expressions rather than theories. Modern neuroscience suggests that the “ritual” of care—the white coat, the focused attention, the diagnostic process—triggers real neurobiological changes (e.g., dopamine and endorphin release). Aacknowledging the symbolic healing power that rituals have on patient anxiety and the “meaning response,” which can objectively improve health outcomes by reducing cortisol and stress.
The author identifies tawas as a diagnostic ritual which might well be the most contentious point. In science, a “diagnosis” must be reliable and valid. Tawas clearly fails the scientific criteria for validity. The author’s defence is that tawas shouldn’t be judged by those criteria at all. While this might be philosophically sound, in a clinical setting, a “mystical diagnosis” must conflict with a biological one, potentially leading to patient non-compliance with life-saving treatments.
Spinal manipulative therapies, including chiropractic and osteopathic maneuvers, are widely practiced for musculoskeletal complaints. However, serious complications such as cerebrospinal fluid (CSF) leak with subsequent intracranial hypotension (IH) have been described. The pathophysiological mechanism is presumed to involve mechanical stress on the spinal dura during high-velocity movements, leading to dural tears, particularly in the cervicothoracic region.
A team of Italian neuroscientists conducted a scoping review in accordance with the PRISMA extension for Scoping Reviews (PRISMA-ScR) guidelines, through a comprehensive search of PubMed and Scopus. They complemented the review with an illustrative case from their own institution.
The researchers identified 21 eligible papers, including 21 patients with IH following spinal manipulation. Most patients were women (81%), aged 29-54 years, and the majority underwent cervical maneuvers.
SMT techniques vary, most often involving high-velocity cervical maneuvers. The most frequent were axial tension with rotation in seven cases (33.3%), unspecified cervical manipulation in four cases (19%), and thoracic spinal manipulation in two cases (9.5%). Less common single-case techniques included rotation with hyperextension, combined cervical and thoracic mobilization, axial tension with lateral flexion, and occipital/shoulder tension technique (n = 1 case each).
Symptom onset was typically within the first week, and all presented with orthostatic headache, often accompanied by nausea, neck pain, tinnitus, or visual disturbances. Neuroimaging consistently revealed features of IH, with pachymeningeal enhancement and subdural collections as the most frequent findings; spinal imaging frequently demonstrated extradural CSF collections. Management was conservative in about one-third of cases, but most required epidural blood patching, which was effective in the majority. Surgical repair was necessary in rare, refractory cases, particularly in the presence of structural spinal abnormalities. Overall prognosis was favorable, with 95% of patients achieving full recovery.
The authors’ illustrative case highlights the potential for severe complications such as subdural hematomas and recurrence if the underlying leak is not addressed:
A 65-year-old patient without a previous history of headache presented with a progressively worsening headache, with orthostatic features, poorly responsive to medical therapy, that has lasted for the past 20 days. The patient denied any recent trauma. He reported having undergone cervical osteopathic manipulations within the past 3 months for recurrent cervicalgia. A brain MRI without contrast was performed, showing a large bilateral subdural hematoma with significant mass effect on the cortical gyri. The patient was admitted to the emergency department and underwent neurosurgical evacuation of a bilateral chronic subdural hematoma via burr holes. Subsequently, endovascular embolization of the middle meningeal arteries was performed as an adjunctive treatment to reduce the risk of recurrence. The surgical procedure was performed without complications. A cranial CT scan showed a reduction in the volume of the hematoma. Therefore, the patient was discharged. However, after a transient improvement in the symptoms, the patient continued to present a fluctuating headache without positional features, with four to five episodes per month. He was readmitted to our clinic and, upon arrival at the ER, a head CT scan showed an increase in pneumocephalus and a recurrence of the hematoma. The following day, an MRI of the neuraxis with contrast was performed, which revealed radiological findings suggestive of IH: pachimeningeal enhancement, subdural fluid collection, dural venous engorgement, cervical spinal longitudinal extradural collection, and effacement of the suprasellar cistern. The Bern score was 7. Given these findings, a surgical revision of the previous burr holes was performed without periprocedural complications. After the first day, a non-targeted epidural blood patch (EBP) was performed under local anesthesia by injecting 16 mL of autologous blood into the L3–L4 epidural space. The procedure was uneventful. A cranial CT scan showed satisfactory surgical outcomes, highlighting a reduction in the volume of the hematoma and of the pneumoencephalus. The patient was subsequently discharged with complete resolution of the headache.
The authors concluded that clinicians should recognize the possibility of CSF leaks after spinal manipulation, especially in patients with new-onset orthostatic headache.
I feel compelled to point out that, considering the multiple risks of upper spinal manipulations and the almost total lack of evidence of benefit from such treatments, the risk/benefit balance of spinal manipulation is clearly not positive. It follows, I think, that it would be wise for patients not to allow such therapies being carried out, and for healthcare professionals to discourage them.
Following my post about the decline in homeopathy-use in Europe, several people dismissed it by saying something like this: Who cares about Europe? Across the globe, homeopathy is state-funded in a majority of countries!!!
This is NOT correct. A correct description of the situation would be that homeopathy is currently state-funded or reimbursed in a minority of countries. In most other countries, it is paid out of pocket or covered only by private insurance. Yes, homeopathy is integrated into national health systems in some countries, explicitly listing Brazil, Chile, India, Mexico, Pakistan, and Switzerland, but this is NOT the global norm.
The counter-argument by homeopathy-fans is this: The states that support homeopathy tend to be very large (e.g. India and Brazil). Therefore, the majority of the world population has access to state-sponsored homeopathy.
This statement seems to be false as well. It is true, of course, that India alone accounts for about 18% of the world’s population, and India does publicly support homeopathy through its health system and the Ministry of AYUSH. But the claim that, for the majority of the world population, homeopathy is state-funded is not based on good evidence. Most of the world’s population lives outside the small number of countries where homeopathy is publicly reimbursed or embedded in state systems.
Even with India included, the evidence available here does not justify a world-population majority claim. The publicly supported/reimbursed countries are still a rather small group, and, as far as I can see, they constitute neither most countries nor most of humanity. In several large countries homeopathy-use exists without state funding or with only private coverage, which weakens any global majority argument. Should someone nevertheless claim that “the majority of the world population has access to state-sponsored homeopathy”, I would ask him or her to show me the evidence for the claim. As far as I can see, it does not exist.
A more accurate statement would therefore be the following:
A substantial share of the world’s population lives in countries where homeopathy has some level of state support, mainly because of India, but there is no good evidence to prove that this amounts to a majority of the world population.
Zack Polanski the current Leader of the Green Party of England and Wales, previously worked as a professional “cognitive hypnotherapist”.
My own assessment of hypnotherapy states that is the use of a trance-like state (hypnosis) for therapeutic purposes. It can be traced back to ancient cultures, but more recently Anton Mesmer (1734–1815) introduced hypnotherapy into medicine. Initially Mesmer was highly successful—until a Royal Commission investigated his method of ‘animal magnetism’ and concluded its effects were entirely due to imagination. Hypnotherapy induces in many but not all individuals a state of deep relaxation that is potentially helpful in a range of conditions. Today, there are different schools of hypnotherapy, e.g. Ericksonian hypnotherapy, cognitive behavioural hypnotherapy, curative hypnotherapy. Various different healthcare professionals practise hypnotherapy, including doctors, dentists, psychologists and nurses. Hypnotherapy is used to treat many conditions or symptoms, from pain and stress to irritable bowel syndrome and drug dependency. The evidence from clinical trials is mixed. Most systematic reviews emphasise the often poor-quality of the primary studies, e.g.:
“Hypnosis reduces pain intensity and anxiety ratings in adults undergoing burn wound care. However, because of the limitations discussed, clinical recommendations are still premature.”
“Due to exploratory designs and high risk of bias, the effectiveness of hypnosis or hypnotherapy in stress reduction remains still unclear.”
“There are still only a relatively small number of studies assessing the use of hypnosis for labour and childbirth. Hypnosis may reduce the overall use of analgesia during labour, but not epidural use. No clear differences were found between women in the hypnosis group and those in the control groups for satisfaction with pain relief, sense of coping with labour or spontaneous vaginal birth. Not enough evidence currently exists regarding satisfaction with pain relief or sense of coping with labour and we would encourage any future research to prioritise the measurement of these outcomes. The evidence for the main comparison was assessed using GRADE as being of low quality for all the primary outcomes with downgrading decisions due to concerns regarding inconsistency of the evidence, limitations in design and imprecision.”
“We have not shown that hypnotherapy has a greater effect on six month quit rates than other interventions or no treatment. The effects of hypnotherapy on smoking cessation claimed by uncontrolled studies were not confirmed by analysis of randomised controlled trials.”
“Current research concerning the efficacy of hypnosis to relieve insomnia is lacking in key methodological elements”
Contrary to what is often claimed, hypnotherapy is not entirely free of adverse effects. It has been associated with the ‘false memory syndrome’ where unpleasant recollections that have never occurred are implanted into the patient’s brain. Hypnotherapy should not be used by patients who suffer from psychoses or personality disorders.
Polanski’s practice was based at a clinic on Harley Street, a London district renowned for private healthcare. His work focused on personal development, confidence building, and body-image issues. Polanski’s hypnotherapy career became a subject of public scrutiny due to a 2013 report by The Sun newspaper, in which it was claimed that during a consultation, Polanski offered to use hypnosis to facilitate breast enlargement. While Polanski later stated the piece was a “misleading” representation of his methods and intended as an experiment in internal self-image, recent investigative reporting has cast doubt on his subsequent narrative.
Although Polanski has frequently asserted that he apologized for the article “the day after” its publication in a BBC radio interview. This claim is, however, contested. In a 2013 interview with BBC Radio Humberside, Polanski reportedly discussed the technique and stated that “the evidence is growing” regarding its efficacy. Independent analysis of the clinical evidence-base for hypnotherapy fails to find good evidence regarding physical outcomes. Similarly, the evidence regarding the efficacy of hypnotherapy for personal development and confidence building is at best varied, with outcomes often depending on the specific application and individual context. My own assessment does not arrive at a positive conclusion.
Polanski has claimed he was misrepresented in the Sun article. Yet, he also wrote in a 2019 blog post that he did not believe the journalist had done a “bad job” or misrepresented him. In that same post, he noted that the coverage led to numerous inquiries from men seeking similar hypnotic treatments for other physical augmentations, all of which he stated he declined.
The “breast enlargement” claim has been frequently cited by political opponents and the media to question Polanski’s judgment and credibility. The story has resurfaced repeatedly during his political campaigns, including through confrontations from members of the public and intense scrutiny during his time as leader.
Polanski maintains that his background in hypnotherapy provides him with unique insights into mental health and communication, which he views as assets in his political role. I would add that, for many of the conditions for which it is promoted, hypnotherapy is not an evidence-based treatment.
Polanski has expressed regret for the “distraction” the story has caused his party, even as critics continue to challenge the consistency of his account regarding the original 2013 events.
Guest post by Udo Endruscheit
Two years ago, in a guest post on this blog, I described the long and winding history of homeopathy in Switzerland — a story marked by political expectations, institutional entanglements, and repeated attempts to reconcile a lack of evidence with a desire for legitimacy. I ended that article with the hope that the country would not embark on yet another “honour lap” around the same unresolved questions.
In 2024, however, Switzerland initiated a new evaluation of homeopathy — a renewed attempt to clarify its role within the national health insurance system. It was, in many ways, the beginning of yet another loop in the same story.
Now, in 2026, that loop has come to an unexpected end. The evaluation was halted.
Not postponed, not softened, not watered down — simply stopped.
And this stop is not merely a political gesture. It marks the structural endpoint of a system that has exhausted its internal possibilities.
A system designed to avoid the evidence question
To understand why Switzerland has arrived at this point, one must look beyond the political headlines and examine the institutional landscape that has shaped the country’s approach to homeopathy for more than a decade.
Three elements are central:
- The political mandate created by the 2009 referendum, which placed homeopathy and other CAM modalities into the basic health insurance package.
- The professional environment, in which thousands of Swiss physicians hold CAM qualifications and the national medical association (FMH) views integrative medicine positively.
- The academic anchor, the Institute for Complementary and Integrative Medicine (IKIM) at the University of Bern, which provides an appearance of scientific legitimacy without producing evidence capable of resolving the core question of efficacy.
This combination created a system in which homeopathy became institutionally normalised — not because of evidence, but because of political and professional expectations.
The HTA as a detour — and the beginning of the dead end
When the Federal Office of Public Health (BAG) was tasked with evaluating homeopathy after the referendum, it faced an impossible dilemma:
- The clinical evidence was weak to non‑existent.
- The political expectation was strong.
- A direct assessment of the evidence would have produced a negative result.
The solution was a detour: a Health Technology Assessment (HTA). But HTAs are not designed to determine efficacy. They assume efficacy has already been established through robust clinical research. Their purpose is to assess cost‑effectiveness, safety, and system impact.
The Swiss HTA did the opposite. In its conclusion, it stated:
“The effectiveness of homeopathy can be considered as proven when internal and external validity criteria are taken into account.”
This is a remarkable inversion of the HTA principle. The report asserted efficacy — without the evidence required to do so — while simultaneously admitting that the actual HTA questions (such as cost‑effectiveness) could not be answered reliably.
In retrospect, this HTA was not the beginning of a solution. It was the beginning of a dead end. A system that asserts efficacy without evidence cannot move forward. It can only circle around itself.
The IKIM: an academic structure without academic function
The IKIM at the University of Bern has played a central role in stabilising this circular logic. Its research output is broad in appearance but narrow in substance. It avoids the central question of efficacy and instead focuses on:
- sociological aspects,
- patient satisfaction,
- model validity,
- and experimental approaches that are not independently reproducible.
The IKIM does not produce evidence. It produces normality — the impression that homeopathy is a legitimate academic field simply because it is housed within a university.
This normality has been crucial for maintaining the political and professional acceptance of homeopathy in Switzerland. But it has also contributed to the structural dead end: an academic institution that cannot resolve the evidence question because it is not designed to ask it.
The 2026 decision: not a surprise, but a consequence
Against this background, the 2026 decision to halt the renewed evaluation of homeopathy is not really surprising. It is the logical endpoint of a system that has exhausted its internal possibilities.
- The evidence has not improved.
- The HTA detour has failed to provide a foundation.
- The institutional structures have stabilised expectations but not knowledge.
- The political mandate cannot be fulfilled without contradicting scientific standards.
The result is a dead end. Not because anyone wanted it, but because the system was built in such a way that no other outcome was possible.
A lesson beyond Switzerland
The Swiss case is often cited by proponents of homeopathy as a model of political and professional acceptance. But the 2026 decision reveals a different lesson:
A system that tries to reconcile political expectations with a lack of evidence will eventually reach a point where it can neither move forward nor turn back.
Switzerland has reached that point. The “endless story” of homeopathy in the Swiss health system has not been resolved — but it has reached its structural conclusion.
And unfortunately that conclusion is not a triumph of evidence. It is the recognition that evidence cannot be replaced by institutional normality. But one thing it certainly isn’t: an endorsement of homeopathy, even if its advocates will once again try to interpret it that way.
The case of the 14-year-old girl who died of cancer is now occupying the Klagenfurt Regional Court for the second time. The girl’s parent elected to trust miracle healers and esoteric practitioners. Ultimately, the 14-year-old arrived at the hospital far too late—the cancer was already so advanced that the girl died less than two days later.
The parents have already been convicted of torture and neglect. During their criminal trial, the doctor came into the prosecution’s focus. He had administered four infusions of “cat’s claw” to the 14-year-old. The doctor admitted to this last year during his testimony as a witness, where he raved about the “miracle plant” cat’s claw, claiming it could heal almost anything.
He was also accused of using a pendulum to “test” the girl’s tumor and certifying it as benign. His response at the time was that he does not use a pendulum; rather, he had “dowsed” the tumor using a biotensor—a small metal spring. He claimed that when he failed to get a clear result, he urgently recommended the parents seek a biopsy, which they strictly refused. He alleged they eventually broke off treatment with him.
According to the indictment, the doctor is allegedly responsible for a further patient’s death by administering the herbal infusion. The man had collapsed after receiving it, suffered a heart attack and a stroke, and died weeks later from the consequences.
Furthermore, the doctor is accused of “grossly negligently causing a danger to the life and health of at least 6,550 people from May 2007 to May 2025.” Contrary to the standards of medical practice, he is said to have intravenously administered essences that were only approved as food products. The prosecutor referred to an analysis of the infusion solutions: “These were not pure; they contained soil and ash particles.” They were reportedly “brewed together in a backyard” – the contamination, she noted, could lead to the formation of blood clots. During his questioning, the trained intensive care physician rejected all guilt: “I feel in no way responsible.” He stated he had treated numerous cancer patients—for example, with cat’s claw or high-dose vitamin C.
In the case of the 14-year-old, the doctor insisted he was able to “see that something was not right” using the device. He claimed he only learned much later that the parents had canceled a biopsy appointment after their session with him. Furthermore: “Father and daughter always rejected any conventional medical therapy or diagnostics.” He maintained that he always noted his infusions could only boost the immune system and improve well-being, but never promised anything.
Regarding the case of the other deceased man, the doctor argued that the patient had already received 17 infusions from him prior to the incident in question and had always felt better afterward. After the final infusion, the patient felt unwell for a while, but his condition supposedly improved. The doctor claimed it was absolutely not anaphylactic shock: “Otherwise, I wouldn’t have let him go home.”
The defendant questioned each and every expert opinion obtained for the case. Regarding the statement that it is impossible for a tumor to shrink due to his infusions, he said, “I wouldn’t sign off on that.” As for the infusions, he claimed they were filtered multiple times and specially prepared for intravenous use.
A date for this has not yet been set. So, watch this space!
