progress
The General Chiropractic Council (GCC) has signed a memorandum of understanding with NHS England, the Crown Prosecution Service and the National Police Chiefs’ Council to collaborate where there is suspected criminal activity on the part of a GCC member in relation to the provision of clinical care or care decision-making.
I find this interesting and most laudable!
But I also have seven questions, e.g.:
- Does it amount to criminal activity in relation to the provision of clinical care or care decision-making, if a chiropractor explains that the patient’s problem is caused by a subluxation of the spine, an entity that does not even exist? Apparently this happens every day.
- Does it amount to criminal activity in relation to the provision of clinical care or care decision-making, if a chiropractor treats a patient without prior informed consent? Apparently, this happens regularly.
- Does it amount to criminal activity in relation to the provision of clinical care or care decision-making, if a chiropractor fails to warn a patient that his/her manipulations can cause harm and even put him/her in a wheelchair? Apparently this (the lack of warning) happens all the time, and some chiropractors even insist that their manipulations are entirely safe.
- Does it amount to criminal activity in relation to the provision of clinical care or care decision-making, if a chiropractor claims that spinal manipulations are effective for curing the patient’s problem, while the evidence does not support the claim? Apparently this happens more often than not.
- Does it amount to criminal activity in relation to the provision of clinical care or care decision-making, if a chiropractor persuades a patient to have expensive long-term maintenance therapy for preventing health problems, while the evidence for that appoach is less than convincing? Apparently this happens rather frequently.
- Does it amount to criminal activity in relation to the provision of clinical care or care decision-making, if the chiropractor issues advice that is both outside his/her competence and detrimental to the health of the patient (for instance, advising parents not to vaccinate their kids)? Apparently this happens a lot.
- Does it amount to criminal activity in relation to the provision of clinical care or care decision-making, if a chiropractor advises a patient not to do what a real doctor told him/her to do? Apparently this is far from a rare occurance.
I would be most grateful, if the GCC would take the time to answer the above questions.
Many thanks in advaance.
“Crusade Against Naturopathy” (Kreuzzug gegen Naturheilkunde) is the title of a recent article (in German – so, I translated for you) published in ‘MULTIPOLAR‘. It is a defence of – no, not naturopathy – quackery. The authors first defend the indefencible Heilpraktiker. Subsequently, they address what they call ‘The Homeopathy Controversy‘. This is particularly ridiculous because homeopathy is not a form of naturopathy. Yes, it uses some natural materials, but it also employs any synthetic substance that you can think of.
The section on homeopathy contains many more amusing surprises; therefore, I have translated it for you [and added a few numers in square brackets that refer to my brief comments below]:
According to a representative survey conducted by the Allensbach Institute for Public Opinion Research in 2023, 35 per cent of homeopathy users are fully convinced of its effectiveness, while 55 per cent rate it as partially effective. Only nine per cent of respondents described homeopathic medicines as completely ineffective. [1]
Nevertheless, Health Minister Karl Lauterbach announced at the beginning of 2024 that he wanted to abolish homeopathy as a health insurance benefit. Stefan Schmidt-Troschke, paediatrician and managing director of the ‘Gesundheit Aktiv Association’, then launched a petition for the preservation of homeopathic medicines as statutory benefits in statutory health insurance. The petition was signed by more than 200,000 people. In March 2024, the cancellation of homeopathy and anthroposophic medicines as additional statutory benefits was revoked. [2]
Shortly afterwards, in May 2024, the ‘German Medical Assembly’ passed a motion against homeopathy to bring about a total ban for doctors. Dr Marc Hanefeld, official supporter of the ‘Informationsnetzwerk Homöopathie’, was behind the motion. Doctors should be banned from practising homeopathy in future, as well as billing via statutory and private health insurance. [3]
The case of the Charité University Hospital in Berlin shows just how much influence opponents of homeopathy have: for years, the hospital’s website stated ‘that homeopathic medicine can cure or improve even the most serious conditions’. After fierce protests – including from the health journalism portal MedWatch – the statement was removed. [4]
My comments:
- Effectiveness is not something to be quantified by popular votes. Responsible healthcare professionals employ rigorous clinical trials for that purpose.
- Lauterbach caved in because of the pressure from the Green Party and insists that his plans are merely postponed.
- The ‘German Medical Assembly’ decided that the use of homoeopathy in diagnostics and therapy does not constitute rational medicine. German doctors continue to be free to practice homeopathy, if they so wish.
- The notion that ‘homeopathic medicine can cure or improve even the most serious conditions’ is so obviously and dangerously wrong that it had to be corrected. This has little to do with the influence of opponents but is due to the influence of the evidence.
I feel that, if proponents of homeopathy want to save their beloved quackery from the face of the earth, they could at least get their facts right and think of some agruments that are a little less ridiculous.
Being a dedicated crook and a liar himself, Donald Trump has long had an inclination to surround himself with crooks and liars. As discussed repeatedly, this preferance naturally extends into the realm of healthcare, Some time ago, he sought the advice of Andrew Wakefield, the man who published the fraudulent research that started the myth about a causal link between MMR-vaccinations and autism.
Early November this year, Trump stated that, if he wins the election, he’ll “make a decision” about whether to outlaw some vaccines based on the recommendation of Robert F. Kennedy Jr., a notorious vaccine critic without any medical training. The president doesn’t have authority to ban vaccines but he can influence public health with appointments to federal agencies that can change recommendations or potentially revoke approvals.
Now that he did win the election, Trump suggested that Robert F. Kennedy Jr., his pick to run Health and Human Services, will investigate supposed links between autism and childhood vaccines, a discredited connection that has eroded trust in the lifesaving inoculations.
“I think somebody has to find out,” Trump said in an exclusive interview with “Meet the Press” moderator Kristen Welker. Welker noted in a back-and-forth that studies have shown childhood vaccines prevent about 4 million deaths worldwide every year, have found no connection between vaccines and autism, and that rises in autism diagnoses are attributable to increased screening and awareness.
Trump, too stupid to know the difference between correlation and causation, replied: “If you go back 25 years ago, you had very little autism. Now you have it.” “Something is going on,” Trump added. “I don’t know if it’s vaccines. Maybe it’s chlorine in the water, right? You know, people are looking at a lot of different things.” It was unclear whether Trump was referring to opposition by Kennedy and others to fluoride being added to drinking water.
Kennedy, the onetime independent presidential candidate who backed Trump after leaving the race, generated a large following through his widespread skepticism of the American health care and food system. A major component of that has been his false claims linking autism to childhood vaccinations. Kennedy is the founder of a prominent anti-vaccine activist group, Children’s Health Defense. The agency Trump has tasked him with running supports and funds research into autism, as well as possible new vaccines.
The debunked link between autism and childhood vaccines, particularly the inoculation against mumps, measles and rubella, was first claimed in 1998 by Andrew Wakefield who was later banned from practicing medicine in the UK. His research was found to be fraudulent and was subsequently retracted. Hundreds of studies have found childhood vaccines to be safe.
Autism diagnoses have risen from about 1 in 150 children in 2000 to 1 in 36 today. This rise has been shown to be due to increased screening and changing definitions of the condition. Strong genetic links exist to autism, and many risk factors occurring before birth or during delivery have been identified.
If Trump does, in fact, ‘outlaw’ certain vaccinations, he would endanger the health of the US as well as the rest of the world. Will he really be that stupid?
It has been reported that the Dresden Higher Regional Court (OLG) examined the extent to which a doctor must inform his patient, if he/she uses so-called alternative medine (SCAM) that deviates from conventional medicine. To be precise, the case was about a detoxification therapy with so-called chelating agents. A patient had received ‘holistic treatment’ for symptoms of exhaustion with sleep disorders, headaches, concentration problems and general restlessness and became worse and worse during the course of the therapy. Eventually, he sued for compensation for pain and suffering and damages.
Initially, the patient had been treated conservatively with iron supplements. After carrying out ‘provocation test’, the doctor diagnosed a heavy metal load, which he treated with ‘elimination therapy’ in the form of an i.v. “detox therapy” (2-3-dimercaptopropane-1-sulfonate (DMPS)). The patient subsequently became increasingly unwell, leading to hospitalisation and treatment for severe thrombocytopenia with moderate liver damage.
The expert opinion obtained in the first-instance of the ensuing legal proceedings considered the cause of the patient’s complaints to be the administration of an inadmissibly excessive amount of alpha-lipoic acid during ‘detoxification therapy’. It became clear that the doctor had not properly informed the patient about this therapy and its risks.
The court considered that the basic information required under German law had not been provided. This basic information gives the patient a general idea of the severity of the procedure and the impact of the associated burdens on their lifestyle. The obligation to provide information also applies to practitioners who use SCAM. A doctor who offers SCAM must therefore clearly inform the patient that they are deviating from a conventional approach. He/she must also explain why he/she is doing this and what advantages and disadvantages the patient can expect as a result.
Detoxification therapy is indisputably such a SCAM, the costs of which are not covered by the health insurance companies. The patient must therefore not only be informed of the risks and the danger of failure of the procedure, but must also be informed that the planned therapy is not standard medical practice and that the effectiveness of the therapy is unproven.
The patient must be able to weigh up whether they want to take the risks of treatment with regard to the prospects of success in view of their state of health before the procedure. Such information was not provided in the present case. For this reason, the Regional Court awarded damages for pain and suffering amounting to EUR 15,000 for the damage to health suffered.
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On this blog, we have often discussed the problems of informed consent. Informed consent, I have previously stated, must usually include full information on:
- the diagnosis
- its natural history
- the most effective treatment options available
- the proposed therapy
- its effectiveness
- its risks
- its cost
- a rough treatment plan
Only when this information has been transmitted to and understood by the patient can informed consent be considered complete. I do understand why many SCAM practitioners do not like informed consent – it could stop many from practising: they are frequently unable to provide the required information. Yet, ALL clinicians have a moral, ethical and legal duty to obtain informed consent BEFORE starting a therapy. It is reassuring that the German court agrees.
The BMJ just published an article entitled “Disinformation enabled Donald Trump’s second term and is a crisis for democracies everywhere“. Please allow me to show you a few excerpts from this paper:
Donald Trump did not win the 2020 election, but asserting that he did became a prerequisite for Republicans standing for nomination to Congress or the Senate to win their primaries. An entire party became a vehicle for disinformation. Trump did win the 2024 presidential election, and key to that victory was building on the success of that lie. If you control enough of the information ecosystem, truth no longer matters…
… Readers of The BMJ will recall the huge amounts of misinformation (wrong or misleading content that is unknowingly shared) and disinformation (false content that is deliberately spread) during the covid-19 pandemic, some generated or amplified by politicians. This reduced vaccine uptake, promoted ineffective treatments, and encouraged attacks on health workers. In the past, factually incorrect statements might have had only local consequences, but a lie can now circle the world in seconds. Yet the speed in which disinformation can spread is only part of the problem…
… Part of Musk’s reason for buying Twitter was to influence the social discourse. And influence he did—by using his enormous platform (203 million followers) to endorse Trump, spread disinformation about voter fraud and deep fakes of Kamala Harris, and amplify conspiracy theories about everything from vaccines to race replacement theory to misogyny. Musk’s platform is effective: his endorsement of Trump coincided with Republican leaning posts being algorithmically favoured over Democrat leaning posts. A more mundane example: after Musk published three non-evidence based posts on X that favoured one medication over another, sales of the former rose by 18% while the other fell by 11%. …
The warning signs are clear for democracies around the world. Firstly, governments must regulate social media companies more rigorously. Brazil’s victorious dispute with X shows what is possible, and a major battle between the European Commission and Musk is under way. Beyond that, we must grapple with how to hold the world’s richest people to account when they directly interfere with national and international politics.
Secondly, public health agencies must create robust surveillance systems for infodemics just as they have for epidemics. They must monitor the emergence of disinformation and counter it or, ideally, anticipate and counter (pre-bunk) it among vulnerable audiences (and build population resilience). Independent organisations that are countering disinformation are already being deliberately targeted (https://counterhate.com/). And we must accelerate research on “inoculating” people against the algorithms and content that attempt to radicalise them.
Finally, politicians and the public health community must not be afraid of calling out disinformation, and we must all support and applaud them in doing so. And moving beyond responding to false rhetoric, we must also get on the front foot and create compelling counter narratives of a better politics that can support a kinder, more inclusive, and socially just world.
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I’d like to thank the authors (Martin McKee, professor of European public health, Christina Pagel, professor of operational research, and Kent Buse, co-founder of ‘Global Health) for their courage to speak out and stand up for the truth. I am in full agreement with them and encourage all my readers to study their excellent paper in full.
We all tend to believe that natural means harmless. Sadly this notion is far from true. The Korea Adverse Event Reporting System (KAERS) compiles spontaneously reported adverse event data for medicinal products including herbal medicines. This study analyzed adverse event data specifically related to herbal medicine products from the KAERS database.
Individual case safety reports (ICSRs) encompassing 84 types of herbal medicine products, identified by item codes from 2012 to 2021, were extracted from the KAERS database. Descriptive statistics were employed to analyze the characteristics of the extracted reports, and adverse event information was systematically categorized and analyzed based on the MedDRA System Organ Class and preferred term classification.
In total, 1,054 ICSRs were extracted, with some documenting multiple adverse events in a single ICSR, resulting in 1,629 extracted adverse events. When categorized by the MedDRA System Organ Class, gastrointestinal disorders were the most prevalent (28.7%), followed by skin and subcutaneous tissue disorders (20.1%). Based on the preferred terms, the most frequently reported adverse events were:
- diarrhea (5.8%),
- urticaria (5.3%),
- pruritus (4.7%),
- rash (4.4%),
- abdominal discomfort (4.2%).
The most frequently reported herbal medicines were:
- Bangpungtongseong-san (297 cases),
- Kyeongok-go (144 cases),
- Eunkyo-san (108 cases).
The authors conclused that spontaneously reported adverse events associated with herbal medicine products were systematically documented using the KAERS database. This study, which focused on voluntarily reported adverse reactions, underscores the need for additional research to estimate the incidence rate of adverse events and assess causality.
The authors also noted that serious adverse events, including death, life-threatening conditions, initial or prolonged hospitalization, and other importantmedical events, were individually evaluated for each reported adverse event. Out of the 1,054 ICSRs, 48 (4.6%) included one or more serious adverse events (four ICSRs were identified with duplicate labels spanning two serious adverse event categories). Further, among the 1,629 adverse events, 99 (6.1%) were identified as serious adverse events. Two cases of death were reported, with causality categorized as unknown or unlikely. Regarding life-threatening conditions, three cases of dyspnea, nausea, and dizziness have been reported, all of which resulted in recovery. Thirty-one cases of initial or prolonged hospitalization have been reported. Among the adverse events associated with hospitalization (51 events in total, considering the multiple events reported in one ICSR with hospitalization), the most frequent were:
- increased aspartate amino transferase and alanineaminotransferase levels (7 case seach),
- dyspnea (3 cases),
- liver function test abnormality (2 cases),
- nausea (2 cases),
- rash (2 cases).
Sixteen cases of other important medical events were reported, and among 43 related events, dyspnea (5 cases), angioedema (4 cases), urticaria (4 cases), anaphylactic reaction (3 cases), chest discomfort (2 cases), and dizziness (2 cases) were reported.
Yes, the ‘natural equals harmless’ fallacy is very widespread. It certainly is an excellent advertising gimmick. However, as this study demonstrates very clearly, it is as fallacious as it is dangerous.
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?
I was alerted to an article that makes several interesting points about the current popularity of so-called alternative medicine. Here is a section of it:
The rise of alternative medicine invites the question, what is conventional medicine doing, or not doing, that leads to all this alternative medicine? Here are some hypotheses that I invite you to comment on.
1. Time. Over the short span of my career, visits to conventional medicine providers have gotten shorter. A physician with an established practice can make a 20 minute visit work for most patients but for a less experienced doctor, or one seeing new patients with whom they don’t have an established relationship, or even a seasoned practitioner with an established practice who is just having a bad day, 20 minutes is not enough. This leaves patients wanting the greater time and attention that alternative medicine providers usually spend with patients.
2. Better use of placebos. I use the term placebo with absolutely no negative connotations. As I wrote above, and as I have written in this space, the use of the placebo effect, usually in the form of a therapeutic relationship, is a critical part of conventional and alternative medicine. Because conventional medicine does not depend on the placebo effect – your electrophysiology cardiologist can be an uncaring jerk and still effectively ablate your atrial fibrillation – we have gotten lazy in its use.2 Therefore, for the problems for which we have no real solutions, alternative medicine practitioners often do a better job.
3. People value what they pay for. In the US, and in most developed counties, people do not pay directly for their conventional care. On the other hand, it is the rare insurance policy that pays for acupuncture, chiropractic manipulation, or a consultation with a naturopath. Cognitive dissonance occurs when people are faced with the possibility that what they spent their hard-earned dollars on didn’t work. We resolve the dissonance by convincing ourselves that the treatments we paid for did work.
4. The downside of evidence-based medicine. It hurts me to propose this. Practicing evidence-based medicine entails integrating clinical experience and expertise (science knowledge) with the best available evidence from systematic research. […] conventional doctors often use practices not supported by robust studies. Chapter 2 in Ending Medical Reversal tells us how bad we are at knowing something works just based on our practice experience.3 That leaves science. We are in an age where education and an understanding of science can be a liability. Anybody who knows how to use social media can convince millions that something, anything, is supported by “their science.” Many people regard a treatment based on “rebalancing your life force” or “natural immunomodulators” to be as likely to be effective as ones based on actual biochemistry, immunology, and pathophysiology.
Has the articulation of evidence-based medicine opened the door to alternative medicine practitioners? If we all practice (some occasionally, some always) without data, if we can all quote “clinical experience”, if we all claim that “science” supports our treatment, what does conventional medicine offer that alternative medicine cannot?
In my ideal world, conventional and alternative practitioners would work together. Conventional doctors would diagnose, treat, and prognosticate as best as they can. They would nurture helpful therapeutic alliances with patients. They would also recognize that there are many symptoms that we cannot adequately treat and syndromes that we do not yet understand. Patients with these symptoms and syndromes would be referred to alternative medicine providers. These providers would see if what they have to offer can help. They would also refer back to traditional doctors if the situation changed, progressed, or if findings concerned them.
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2 It is not uncommon that I have to encourage trainees to “sell” their recommendations. This is important not only to get the patient to try the meds but because, in the short term at least, belief that a treatment will work might be the most important aspect of its pharmacology.
3 I still haven’t gotten over the commenter who, after I wrote that one of the things that makes me think masks are effective for COVID is that I worked, unvaccinated but masked for 9 months without getting COVID, asked me if I also put tinfoil inside my white coat.
END OF QUOTE
I disagree with several points the author makes here. Nevertheless, his overall notion -namely that conventional medicine is partly the cause for the popularity of so-called alternative medicine – is correct, in my view. I have often stated that modern medicine often lacks time, compassion, empathy and understanding. Yet patients frequently crave these qualities. Many practitioners are particularly good at providing them, and it is little wonder that patients then seek their help.
The bottom line is that many conventional medics might need to re-learn the necessary skills; and for doing so, they could do worse than to look at the ‘bed-side manners’ (as we used to call this aspect of patient care) of practitioners of so-called alternative medicine.
Available data suggest that general practitioners (GPs) in Germany use so-called alternative medicine (SCAM) modalities more frequently than GPs in many other countries. German researchers investigated the country differences perceived by GPs who have worked in Germany and in one of four other European countries with regard to the role of SCAM in primary care.
A qualitative study was conducted using semi-structured interviews with 12 GPs who had worked both in Germany and Italy, the Netherlands, Norway or the United Kingdom (UK; n = 3 for each of the four countries). Participants were asked how they perceived and experienced country differences regarding health system, relevance of SCAM modalities, the role of evidence-based medicine (EBM) and science, and how they handle so-called indeterminate situations. For the analysis, we followed a thematic analysis approach according to Braun and Clarke with focus on themes that cover SCAM.
Participants unanimously reported that they perceived SCAM to be more relevant in general practice in Germany compared to the other countries. The researchers identified four overarching themes in relation to the perceived reasons for these differences.
- Physicians with experiences in countries with a strong EBM and science orientation (Netherlands, Norway and the UK) considered the deeply ingrained view in national healthcare systems and GP communities that SCAM modalities are not evidence-based as the main reason for the lower use of SCAM by GPs.
- Extensive training of communication skills was cited as a reason that reduced the need for SCAM in the Netherlands, Norway and the UK.
- Differences in patient expectations and demands were perceived as a factor contributing to greater utilisation of SCAM by German GPs compared to the other countries.
- Country-specific reimbursement mechanisms were considered as a factor influencing the role of SCAM in general practice.
The authors concluded that their study results point to major differences between countries with regard to the role of SCAM in GP care. Differences in basic attitudes in the discipline of general practice, patient expectations and system conditions appear to play an important role here.
The authors comment that a remarkable finding is the very consistent narrative with regard to the Netherlands, Norway and the United Kingdom that a stronger scientific and EBM orientation is seen as the main reason for the lower utilisation of SCAM by GPs compared to Germany. I agree that this is an important and, as far as I can see, new aspect. It concurrs with my personal impression that many German doctors feel that EBM is some sort of ‘KOCHBUCH MEDIZIN’ [cookbook medicine] that limits their freedom of prescribing based on intuition and experience. This, I have always felt, is a profound misunderstanding of what EBM is about.
Some people seem to be impressed by the amount of publications that is currently being published on so-called alternative medicine (SCAM). Last year, for example, Mediline listed around 1 500 articles on the subject.
Is that really impressive?
No!
- Firstly, compared to other subjects, the number is small. If you look in Medline for ‘pharmacological treatments’, for instance, the number is 10 times larger.
- Scecondly, and more importantly, most of the SCAM articles are complete rubbish.
Let me give you just one example of a paper I came across the other day. It is typical in that there are hundreds of very similar articles every week. Its title is “Assessing Perceived Healthcare Access and Attitudes Towards Complementary and Alternative Medicine Amongst Parents in Cebu City”
(Cebu City is in the Philippines.)
Let’s for a moment assume that the information in the paper is of interest to a wider audience. In this case, such information should also be interestiong form the hundreds of other cities in the region. And if that is so, why focus on the Philippines? There are hundreds of thousands of cities around the world that would matter at least as much as Cebu City.
And why survey just parents? Why not childless adults, or children, or older people?
And why just healthy individuals? Surely, this information would be even more relevant, if it related to ill people!
As there are thousands of different illnesses, we would need thousands of different papers reporting the relevant information.
I am sure you see where I am going. If the hundreds of papers like Assessing Perceived Healthcare Access and Attitudes Towards Complementary and Alternative Medicine Amongst Parents in Cebu City are interesting to sufficient amounts of people to merit publication, we need millions of similar papers to cover the subject properly. What is more, as the situation about perceived healthcare access changes rapidly depending on a whole host of factors, we really would require yearly updates. That would mean millions of papers each year for the sole reason of monitoring the perceived healthcare access of various group of people in various locations. This means we need millions of researchers spending millions of hours and millions of dollars conducting millions of surveys.
Alternatively, we could take a step back and ask whether my above-made assumption (that the named paper is interesting) was correct. It does not require much contemplation to conclude it was, in fact, incorrect: the paper is neither interesting nor relevant to anybody.
And, once you look at the myriad of useless papers that are being published in SCAM, you arrive at the conclusion that the effort and funds needed for conducting these nonsensical pseudoscientific studies must urgently be re-directed towards answering some of the many more meaningful research questions. To me, this is nothing less than an ethical imperative.
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END OF RANT
