progress
Ten years after Brexit, it seems reasonable to ask what effects Brexit has caused on health-related matters for the UK and beyond. Here is my attenpt to provide an answer; these are the 8 issues that come to my mind:
- Workforce Disruption and Recruitment Shift: The ending of free movement led to a sharp drop in EU-trained doctors, nurses, and social care staff. To plug these vacancy gaps, the UK was forced into recruiting heavily from non-EU nations. This created a fragile reliance on international recruitment from countries facing their own healthcare worker shortages. In turn, this further supported the xenophobic sentiments of some UK citizens.
- Medicine Supply Problems: Leaving the EU single market introduced significant customs and regulatory friction. This friction directly contributed to the frequency and severity of local pharmaceutical shortages in the UK.
- Loss of Regulatory Leverage: By exiting the European Medicines Agency (EMA), the UK became a standalone market. Pharmaceutical companies now regularly prioritize the much larger EU and US markets for rolling out cutting-edge new treatments, leaving the UK Medicines and Healthcare products Regulatory Agency (MHRA) to act as a “rule-taker” by fast-tracking approvals already granted elsewhere.
- Cross-Border Friction: Reciprocal healthcare arrangements became more complex under the new Global Health Insurance Card (GHIC) system. While basic travel is covered, specialized cross-border medical networks face ongoing administrative and legal hurdles. Many British ex-pats’ found themselves without health cover.
- Regulatory Divergence in Training and Innovation: The UK has increasingly diverged from EU rules, such as lowering the mandatory clinical training hours required for a nursing degree to get staff into hospitals faster. Additionally, medical technology and AI developers now face double-compliance costs (clearing separate UK and EU hurdles). This makes the UK a more expensive market to launch new health technologies.
- The Macro-economic Squeeze: The overall economic downturn resulting from Brexit reduced UK GDP, shrinking the available tax revenues. This has directly limited the government’s financial capacity to fund the NHS, to clear post-pandemic backlogs, and to invest in long-term social care reform.
- Exacerbating Health Inequalities: As inflation, food costs, and supply chain disruptions damaged the UK, vulnerable socioeconomic groups have been hit the hardest. These economic pressures, combined with a chronically strained social care sector, significantly widen UK health inequalities.
- Compounding Pressure on Patient Outcomes: While ultimate health metrics, such as mortality rates and overall life expectancy, are influenced by dozens of complex variables, an underfunded NHS, chronic staffing vulnerabilities, and restricted access to new drugs create a persistent, negative headwind against public health which, in the long run, can only negatively affect patient outcomes.
All of these effects are clearly negative.
Can anyone think of a positive effect?
I can’t!
An interesting case-report caught my eye. Here is its abstract:
Background:
Advanced Alzheimer’s disease (AD) is generally regarded as a stage of irreversible functional decline. Psilocybin is known to transiently alter large-scale brain network dynamics and to induce plasticity-related mechanisms in preclinical models, yet clinical data in advanced dementia remain lacking.
Case presentation:
We report the case of an octogenarian Japanese-American woman with a 10-year history of Alzheimer’s disease, including 5 years of marked hypofunction and predominantly monosyllabic speech. Baseline features included chronic urinary incontinence, executive dysfunction, dysphagia, dependent mobility, flat affect, and severe reduction in spontaneous communication. The patient received 5 g of orally administered psilocybin-containing mushrooms (Enigma strain). The acute phase was marked by autonomic activation, clinically suspected hyperthermia, profuse sweating, and a prolonged deep sleep-like state. Approximately 19 h post-administration, spontaneous autobiographical speech emerged. Over subsequent days and weeks, functional improvements included restoration of urinary continence, improved ambulation, autonomous dressing, increased emotional responsiveness, sustained social interaction, contextual memory retrieval, preserved working memory for social context, and spontaneous conversational engagement.
Conclusion:
This case documents transient multidomain functional improvement in advanced Alzheimer’s disease following psilocybin administration. The findings do not imply disease reversal but suggest that residual functional capacity may persist in late-stage neurodegeneration and may become transiently accessible under specific neuromodulatory conditions.
Of course, causality cannot be established with a case-report; the findings are therefore hypothesis-generating only. Plausible alternative explanations for the observed outcome include:
- Natural fluctuation in dementia severity or a transient “plateau” of improvement unrelated to psilocybin.
- Caregiver expectancy and observer bias, given that the same people who administered the intervention also documented the improvements.
- Confounding medical events (e.g., resolution of infection, metabolic correction, medication change) that were not systematically ruled out.
- Regression to the mean or random variation in functional status.
The lack of an objective endpoint (biomarker or imaging confirmation) of Alzheimer’s disease further weakens internal validity. Mixed pathology (vascular, Lewy body, frontotemporal) could produce different patterns of fluctuation and response. The absence of objective endpoints introduces subjective interpretation. “Autobiographical speech,” “improved continence,” and “better mobility” were not defined operationally or measured quantitatively.
The authors propose a plausible but speculative hypothesis: psilocybin’s disruption of the default mode network (DMN) and promotion of global functional integration may temporarily restore cross-network connectivity, allowing residual but inaccessible function to become expressed. This is consistent with psychedelic effects on network flexibility and DMN disruption, as well as with the idea that late-stage neurodegeneration may leave residual functional capacity that is normally inaccessible. However, the paper provides no neuroimaging, no electrophysiological data, and no direct evidence of network changes. The mechanism thus remains a hypothesis.
Still, the report does raise a question worthy of proper investigation: can psychedelic neuromodulation unmask residual function in late-stage neurodegeneration?
A legal report has been published on 25 June 2026 examining whether the German political party Alternative für Deutschland (AfD) is unconstitutional under German Basic Law. The study represents the most extensive and methodologically rigorous analysis of the party to date. Conducted over a period of 13 months, the project involved a team of eight experts in constitutional law, right-wing extremism, and data analysis. They systematically evaluated more than 3 million statements by the AfD and identified approximately 2,500 pieces of evidence deemed legally relevant.
A key finding of the report is that, when assessed against the criteria used by the German Federal Constitutional Court (Bundesverfassungsgericht) in party ban proceedings, the AfD meets the threshold for being classified as unconstitutional. The authors state that a formal prohibition request submitted to the Court would “likely succeed.” Importantly, they emphasize that their approach was “open-ended” and aligned with established constitutional jurisprudence, and that their methodology received external validation from two established constitutional law professors.
The report highlights several patterns in AfD positions and rhetoric that it interprets as incompatible with the democratic constitutional order. These include:
- proposals to criminally prosecute political opponents,
- the idea of revoking citizenship from certain criminal offenders who are German nationals,
- calls for the systematic legal discrimination of Muslims.
It also points to demands for unrestricted deportations and statements by supporters denying the legitimacy or existence of transgender individuals. These examples are presented as indicative rather than exhaustive.
The report seeks to shift what it characterizes as a stalled political and legal debate about the AfD’s constitutional status. By providing a large-scale empirical and legal foundation, it implicitly strengthens arguments in favour of initiating formal proceedings to ban the party. In Germany, such a process can only be initiated by constitutional bodies such as the Bundestag, Bundesrat, or federal government, and requires demonstrating both anti-constitutional aims and active efforts to undermine the democratic order.
The report calls on citizens to contact members of parliament to raise awareness of the findings and encourage political action. This reflects an attempt to translate the report’s conclusions into legislative momentum.
Overall, the document combines elements of academic research, legal argument, and political campaigning. Its central significance lies not only in its conclusions but in its potential to influence public discourse and decision-making. Let’s just hope its effect is just that.
This is the question that I ask myself regularly when I cannot sleep at night. 33 years of research into so-called alternative medicine (SCAM), and what has it achieved? It often seems that nothing has changes at all, and then I am plagued my self-doubts.
One might argue that this is a good or even essential sentiment for a scientist. That’s all very well, but it would be nice to get some answers to the nagging questions.
Clearly, I am in no position to provide them. So, I asked Gemini: ” How does Edzard Ernst fare as a scientist on metrics of reputation/impact?” Here is the reply [I appologise for the unabashed navel-gazing]:
Edzard Ernst—the world’s first Professor of Complementary Medicine (retiring from the University of Exeter in 2011)—is an exceptional case study for these metrics. Because his career focused on the rigorous, critical evaluation of Alternative Medicine (SCAM), his metrics are intensely polarized: astronomically high in quantitative and public impact, but highly controversial in traditional peer circle categories.
Here is how he fares across the four categories:
1. Quantitative Citation Metrics: Elite Tier
Quantitatively, Ernst is in the upper echelon of medical researchers worldwide. Because he pioneered the systematic review of complementary therapies, his papers became the definitive reference points for both defenders and critics of alternative medicine.
- The h-index: His h-index sits around 148 to 157 (depending on the database). In medical science, an h-index over 100 is considered truly elite, meaning he has written at least 148 papers that have each been cited 148 times.
- Total Citations: He has amassed roughly 85,000 to 90,000 total citations, driven by landmark systematic reviews on everything from the prevalence of alternative medicine in cancer patients to the clinical effectiveness of herbal therapies like Aloe vera and ginger.
2. Qualitative & Peer Recognition: Deeply Polarized
This is where Ernst’s metrics diverge dramatically from standard academic trajectories due to the volatile nature of his field.
- Journal Prestige: He published heavily in premier mainstream medical journals—such as The BMJ, The Lancet, and JAMA—bringing rigorous scientific methodology to a field that historically lacked it.
- Peer Defiance vs. Validation: Within mainstream science, he is highly respected for his dedication to evidence-based medicine. However, within the complementary medicine community, he is a deeply polarizing figure. Proponents of alternative medicine frequently criticize his work as one-sided or overly adversarial.
- The Royal Clash: His ultimate “peer” conflict was famously non-academic. His public criticisms of Prince Charles (now King Charles III), a staunch defender of homeopathy, led to severe political friction at his university, culminating in the defunding of his department and his early retirement in 2011.
3. Financial & Institutional Footprint: A Complicated Legacy
- The Laing Chair: Ernst historically secured a major milestone by becoming the first occupant of the Laing Chair in Complementary Medicine at the University of Exeter in 1993, establishing the world’s first fully secular, data-driven research unit for alternative medicine.
- Institutional Dissolution: While he successfully trained numerous researchers who continue to publish in evidence-based medicine, his institutional footprint was cut short. Following his high-profile dispute regarding the royal family’s meddling in alternative medicine reports, his department’s funding dried up, and the unit effectively dissolved upon his retirement.
4. Modern & Real-World Impact: Massive and Ongoing
Ernst’s true legacy shines brightest in real-world impact and public engagement, far outliving his active lab years.
- Policy and NHS Reform: His decades of data showing that homeopathy operates strictly as a placebo directly influenced policy. Notably, in 2017, NHS England officially recommended stopping the funding of homeopathy due to “low clinical effectiveness”—a massive policy shift rooted in the research his team pioneered.
- Public Intellectual & Author: He mastered the crossover from academic journals to mainstream bookshelves. He has written dozens of public-facing books, including Trick or Treatment? (co-authored with Simon Singh), SCAM: So-Called Alternative Medicine, and his memoir A Scientist in Wonderland.
- Altmetrics & Public Debate: Ernst maintains a massive public profile via mainstream media appearances, news citations, and his active blog. He regularly weighs in on global health issues, such as pointing out the link between the popularity of certain alternative therapies and the suboptimal vaccine uptake that triggers measles outbreaks.
The Takeaway: Edzard Ernst is a textbook example of why metrics must be read contextually. If you only look at his h-index, he is a textbook academic titan. If you look at his institutional footprint, his department was choked out by political controversy. But if you look at his societal impact, he fundamentally altered how Western healthcare systems view and fund alternative therapies.
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Yes, there might be a few mistakes or flattering exaggerations in what Gemini wrote. But I don’t mind. At the very least, it will make me sleep better, I think.
When I look at the pictures from major meetings of national or international meetings of SKEPTICS, or attend such gargerings in person, I often ask myself:
Why are there so few Black or Asian skeptics?*
Trying to research the answer, one finds several possible explanations:
Science, racism, trust
For many Black communities, the history of medicine and science includes Tuskegee, Henrietta Lacks, forced sterilization, and other abuses that were justified in “scientific” language. This legacy can understandably foster suspicion toward institutions that present themselves as guardians of “science” or “rationality”. When skeptical organisations then look very white and middle‑class, they can be perceived as aligned with the same institutions that historically harmed these communities.
In that context, a Black person may be personally critical of superstition and pseudoscience but not feel that joining a mainly white skeptical association is in their interest or aligned with their primary struggles, which may centre on racism, policing, or economic inequality rather than homeopathy or ghost busting.
Different priorities and “linked fate”
Many Black Americans report a strong sense of “linked fate”: what happens to Black people as a group is perceived as happening to them personally. That tends to channel activism toward civil-rights–oriented movements, churches, or community organisations rather than abstract “science advocacy” or secular-skeptic clubs.
So, the issue is not necessarily a lack of skeptical thinking, but that energies are directed towards challenges that feel more existentially pressing: discrimination, policing, housing, schooling, and health inequities. From inside those struggles, debunking astrology or acupuncture may seem like a luxury concern, or even a distraction pushed by people who do not share the same views.
Asian “model minority” and conformity pressures
For many Asian communities, there is a different but related dynamic. In North America and parts of Europe, Asians are often cast as hardworking, quiet, technically competent, and apolitical. This stereotype rewards conformity and discourages public confrontation, especially with majority institutions. Publicly criticizing religious traditions, so-called alternative medicine, or family elders’ beliefs can thus carry a significant social cost.
At the same time, Asian-origin populations also experience racism, but often in a way that minimizes their grievances: they are told that they are doing “better” and therefore should not complain. In such a setting, aligning oneself with explicitly “white-coded” skeptical organisations can risk being used as a wedge against other minorities or being seen as rejecting one’s own culture.
Culture of skeptical movements
Organized skeptical and secular movements historically emerged from highly educated, often male, often white, often middle‑class networks in Europe and North America. Their imagery, leadership, and priorities reflect that origin: emphasis on evolution vs. creationism, New Atheism, and critiques of Christian fundamentalism, rather than, say, the intersection of racism, religion, and health.
Such movements can appear:
- Culturally narrow (little attention to non‑Western religions or folk practices except as “targets”)
- Blind to racial power structures (e.g., defending “science” without acknowledging racist uses of science)
- Hostile to religion in general, even when churches serve as important community centres for marginalized groups
The above-mentioned phenomena (Iam sure theree are more, and I would be gratedful, if readers could list more) might generate a sense amongst black and Asian communities that the organised skeptics are “not for us” – even amongst individuals who are personally secular, tational, and critical of pseudoscience.
But, of course, there are many Black and Asian skeptics. The ability to think critically is by no means a white monopoly. These guys form their own networks (e.g., Black humanist groups, Secular Buddhists) or they remain more locally embedded rather than visible in mainstream skeptical conferences. Personally, I would welcome, if Black and Asian people would join mainstream skeptics in greater number, and if mainstream skepic organisations would realise that they must make a greater effort to attract them.
*To be honest, I have no figures to back up my impression, and I was unable to find reliable statistics. But I do think that my impression is nonetheless correct.
For several decades, eggs were commonly portrayed as a major cause of raised cholesterol and cardiovascular disease. That position has been substantially revised: current evidence suggests that dietary cholesterol has a relatively modest effect on blood cholesterol in most people, whereas saturated and trans fats are more important determinants of LDL cholesterol and cardiovascular risk.
The physiology is more nuanced than the older “cholesterol-in, cholesterol-out” model implied. The liver does synthesise cholesterol endogenously, and many people compensate for increased dietary cholesterol by reducing hepatic production, but the degree of compensation varies considerably between individuals. For that reason, eggs are not best understood as “heart-healthy” in all circumstances, but rather as a food whose impact depends on the wider dietary pattern and the individual’s metabolic risk profile.
There is stronger support for improving lipid profiles by changing the quality of dietary fat and increasing fibre intake. Replacing saturated fats with unsaturated fats, particularly polyunsaturated fats, is associated with lower LDL cholesterol and a reduced risk of cardiovascular events, while soluble fibre helps lower LDL cholesterol by interrupting enterohepatic bile acid recycling. In practical terms, this means that foods such as olive oil, nuts, seeds, legumes, oats, vegetables, and oily fish are more consistently supported than a narrow focus on single items such as eggs.
Low-carbohydrate and ketogenic diets are more complex. Many people lose weight on them, which may improve some cardiometabolic markers, but a subset of lean individuals show pronounced rises in LDL cholesterol and related atherogenic markers during carbohydrate restriction. Emerging evidence also indicates that gut microbial changes may contribute to altered lipid metabolism, although this area is still developing and should not be overstated.
Highly restrictive “detox” or “alternative” dietary programs are unsupported by clinical evidence and may be nutritionally unbalanced and thus harmful. They might be claimed to “purify” the body or reset metabolism, but heart health is better served by sustainable patterns that improve LDL cholesterol, support fibre intake, and minimise excess saturated fat.
What does all that mean in practice? Here are a few simple rules that follow from the new insights:
- Do not over-emphasize dietary cholesterol (e.g., eggs) as a primary driver of cardiovascular risk.
- Focus instead on reducing saturated and trans fat intake.
- Replace saturated fats with unsaturated fats, especially polyunsaturated fats (e.g., use olive oil, eat nuts and seeds).
- Increase intake of soluble fibre (e.g., oats, legumes, vegetables) to help lower LDL cholesterol.
- Consider overall dietary patterns rather than judging single foods in isolation.
- Recognize that individual responses to dietary cholesterol vary; tailor intake accordingly if lipid levels are a concern.
- Include foods with consistent cardiovascular benefit, such as oily fish, plant-based foods, and whole grains.
- Be cautious with low-carbohydrate or ketogenic diets, particularly if lean, and monitor lipid profiles if following such diets.
- Prioritize sustainable, balanced eating patterns over restrictive or extreme diets.
- Avoid “detox” or alternative dietary regimens lacking clinical evidence, as they are ineffective or harmful.
Key references
- Carson JAS, Lichtenstein AH, Anderson CAM, et al. Dietary cholesterol and cardiovascular risk: a science advisory from the American Heart Association. Circulation. 2020;141:e39–e53.
- Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368:1279–1290.
- Hooper L, Martin N, Jimoh OF, et al. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev. 2020;(5):CD011730.
- British Heart Foundation. Healthy eating – reduce your risk of developing heart disease. 2023. – Search
- NHS. Facts about fat. 2022. – Search
- Ketogenic Diet reduces friendly gut bacteria and raises cholesterol levels
- Gut bacteria can break down cholesterol | Nature Reviews Cardiology
- Healthy eating: applying All Our Health – GOV.UK
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.
Quackademia, a term created [as far as I remember] by David Colquhoun for the infiltration of quackery into academia, has often been discussed on this blog, e.g.:
- Quackademia in Canada: the first bachelor’s degree in Traditional Chinese Medicine
- Quackademia galore: An Oxford ‘university’ starts a course in ‘veterinary chiropractic’
- Quackademia at its most rampant: the ‘Certificate in Holistic Health and Healing Arts’ (HHHA) at the University of New Mexico
- Another blow to quackademia: TCM course at a Sydney university is to be stopped
- Vienna 2019: the end of quackademia
- Quackademia down under
- Quackademia revisited
- Quackademia
Now growing backlash against quackademia seems to finally emerge also in France – opposition against university programs that give academic legitimacy to unproven so-called alternative medicine (SCAM). The Higher Council for the Evaluation of Research and Higher Education is preparing to review these courses, after criticism that universities are lending credibility to practices that have not been scientifically validated.
Across France, more than 200 university diplomas are said to exist in areas such as reflexology, aromatherapy, auriculotherapy, hypnosis, acupuncture, homeopathy, meditation, and related practices. Critics argue that this amounts to a form of institutional “entryism,” because the university label can make such practices look medically endorsed even when they are not.
The main concern is not just whether these therapies work, but whether universities should be teaching them at all. A January report on health misinformation reportedly recommended banning the academic labeling of healthcare practices that have not been validated, and that recommendation is at the center of the debate. Experts warn that, if a SCAM is scientifically validated, it belongs in medicine; if it is not, it may still be studied, but should not be taught as an academic medical qualification. They also warn that these programs can mislead the public and create a false impression of legitimacy. Yet, some deans and faculty leaders say that certain courses, especially acupuncture, hypnosis, or mindfulness, can be acceptable when used for specific indications and when properly framed. They distinguish those from programs in naturopathy, aromatherapy, or homeopathy, which they see as much harder to justify inside medical faculties.
As the Conference of Medical Deans is preparing to examine the issue rigorously, they should – I feel – also consider the ethical implications. Teaching dangerous nonsense to naive students is not just not academic, it is deeply unethical. If done well, this excercise should lead to a major cleanup of universities regarding SCAM, or at the very least to much tighter rules about what can carry an academic label.
Having observed French quackademia for decades, I am tempted to exclaim:
BETTER LATE THAN NEVER!
The effect of calcium, vitamin D, or combined supplementation on fractures and falls in adults were assessed in this systematic review and meta-analysis. Randomised clinical trials were eligible, if they compared calcium, vitamin D, or combined supplementation with placebo or no treatment in adults (≥18 years) not receiving drug treatment for osteoporosis. The primary outcome was the risk of any fracture. Secondary outcomes included the risk of hip fracture, non-vertebral fracture, vertebral fracture, and falling, as well as the total number of falls. Pairs of reviewers independently screened trials, extracted data, and assessed risk of bias using the second version of Cochrane’s risk of bias tool. Findings were synthesised using random effects meta-analyses and appraised using Grading of Recommendations Assessment, Development and Evaluation, with application of thresholds for absolute effects considered important.
The review included 69 trials involving 153 902 participants. Participants in most of the trials were community dwelling (87%) and not at high risk of fractures or falls (73%). For the primary outcome of any fracture, little to no effect was found from use of calcium supplements (11 trials, 9067 participants; risk ratio 0.91, 95% confidence interval 0.81 to 1.01; moderate certainty), vitamin D supplements (36 trials, 92 045 participants; 1.00, 0.95 to 1.06; high certainty), or combined supplementation (15 trials, 51 126 participants; 0.91, 0.84 to 0.99; high certainty). Calcium, vitamin D, or combined supplementation appeared to have little to no effect on other fracture and fall outcomes, based largely on moderate to high certainty of evidence. The findings remained robust after an extensive exploration of heterogeneity across multiple subgroup analyses. Evidence for high risk patients or those requiring residential care was limited for many outcomes for calcium monotherapy and for combined supplementation.
The authors concluded that, based on absolute risk reductions and thresholds considered clinically meaningful, this review found little to no benefits from use of calcium, vitamin D, or combined supplementation on the prevention of fractures and falls.
An accompanying BMJ editorial points out that observational studies have associated low dietary calcium and low serum levels of vitamin D with low bone density and falls. Consequently, calcium, vitamin D, or combined supplementation has been widely promoted for preventive musculoskeletal health in older adults…
Th editorial concludes that other interventions, such as balance and resistance exercise, and several multicomponent interventions (eg, combining exercise, hazard assessment, or education with other interventions tailored to risk assessment) have been shown to offer meaningful prevention of falls and falls related injuries.
This new systematic review is a prime example for the slaying of a beautiful hypothesis with an ugly fact. But all is not negative – think of the money that can now be saved and put to better use!
Homoeopathy and I is the title of a paper that I published in 2009. My aim was to denounce the popular notion that held I had started my research with a grudge against homeopathy. The honest truth is that – if anything – my attitude was even slightly positive. Here is the key section from this 2009 paper:
In 1993, I was appointed to the world’s first Chair in Complementary Medicine, and it became my job to investigate scientifically all sorts of complementary treatments, including homoeopathy. In the course of this activity, my co-workers and I published numerous articles on homoeopathy. Systematically, reviewing the totality of my publication list, I found a total of 46 papers with ‘homeopathy’ in the title. The following quotes from these articles were selected to best describe my attitude toward homoeopathy at the time:
• Homeopathicremedies are believed by doctors and patients to be almost totally safe (8).
• It might be argued that arnica …is ineffective but homeopathy may still works (9).
•…only 23% of Australian homeopaths believe that immunisation is important (10).
• Homeopathy, I fear, has soon to come up with … more convincing evidence (11)…
• Future evaluations of homeopathy should be performed to a high scientific standard (12)…
•…studies on the safety of the practice of homeopathy must not be ignored (13)…
•…systematic reviews based on Medline searches can lead to similar (possibly slightly less positive) overall conclusions (14)…
•…a detailed eye-witness account claiming that all attempts [by researchers during the ‘Third Reich’] to show that homeopathy works has led to negative results (15).
•…the best way forward is clearly to do rigorous research (16)…
• Thus, the question of whether homeopathy works or not has remained unanswered for 200 years (17).
• The most pressing question, ‘Is homeopathy clinically more effective than placebo’, needs to be answered conclusively (18).
• There is evidence that homeopathic treatment can reduce the duration of ileus (19)…
• Some of the well-argued cases against homeopathy should become essential reading for all homeopaths (20).
•…the published evidence to date does not support the hypothesis that homeopathic remedies … are more efficacious than placebo (21)…
•…homeopathic remedies are associated with the same clinical effects as placebo (22).
•…the picture painted by Linde and colleagues … may well be slightly more positive (23)…
•…[our] goal is to conduct rigorous, impartial research in [homeopathy] (24)
• The claim that homeopathic arnica is efficacious beyond a placebo effect is not supported by rigorous clinical trials (25).
• The results of recent systematic reviews are not uniform (26).
•…at present, the relative efficacy of homeopathic remedies is not known (27).
• The results of recent systematic reviews are obviously far from uniform (28).
•…the trial data … do not suggest that homeopathy is effective (29)…
•…the definitive answer, in my view, has to come from a series of rigorous trials (30).
• Large, multicentre trials of homeopathic remedies … represent the best way of advancing the debate (31).
•…the re-analysis of Linde et al. can be seen as the ultimate epidemiological proof that homeopathic remedies are, in fact, placebos (32).
•…randomised clinical trials … do not allow a firm conclusion as to the effectiveness of homeopathic remedies (33).
•…both homeopaths and university heads of medical departments clearly advocate further research into the effectiveness of homeopathy (34).
•…homeopathy is not different from placebo (35).
•…the best clinical evidence … does not warrant positive recommendations (36).
•…the evidence is insufficient for firm recommendations (37).
•…the results of this trial do not suggest that homeopathic arnica has an advantage over placebo (38)…
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- This study provides no evidence that adjunctive homeopathic remedies … are superior to placebo(39).
•…this systematic review does not provide clear evidence that the phenomenon of homeopathic aggravations exists (40).
•…Mathie’s methodology was not as strong as it should have been, and this deficit has led to conclusions that may be falsely positive (41).
•…homeopathy may actually be more expensive than good conventional care (42).
•…the proven benefits of highly dilute homeopathic remedies … do not outweight the potential for harm (43).
•… homeopathic remedies are placebos, but homeopaths can be skilled doctors who may significantly help their patients (44).
• Our analysis … found insufficient evidence to support clinical efficacy of homeopathic therapy (45)…
•… promotion can be regrettably misleading, dangerous and counterproductive (46).
•…do we condone treatments because of their popularity or their effectiveness? (47)
•…homeopathy is not based on solid evidence and, over time, this evidence seems to get more negative (48).
• The evidence from rigorous clinical trials … testing homeopathy for childhood and adolescence ailments is not convincing enough for recommendations in any condition (49).
• There is no evidence at all that homeopathic remedies can change the natural history of any cancer (50).
•…context effects of homeopathy … are entirely sufficient to explain the benefit many patients experience (51)…
• Amongst all the placebos that exist, homeopathy has the potential to be an exceptionally powerful one (52)…
•…recommendations by professional homeopathic associations are not based on the evidence (53)…
[all references can be found in the original paper]
Since then (2009) I – often together with others – have published several further articles with “homeopathy” in the title. This means that my original paper needs updating. Here are the titles of (and links to) these articles (appologies, if I missed a few):
- Should we maintain an open mind about homeopathy?
- Homeopathy
- Homeopathy: what does the “best” evidence tell us?
- Homeopathy, non-specific effects and good medicine.
- A systematic review of homoeopathy for the treatment of fibromyalgia.
- Homeopathy, a “helpful placebo” or an unethical intervention?
- The ethics of British professional homoeopaths.
- Homoeopathy debate. Protecting patients?
- Pharmacists and homeopathic remedies.
- Homeopathy in severe sepsis.
- Call for doctors not to practice homeopathy or refer to homeopaths.
- Homeopathy for eczema: a systematic review of controlled clinical trials.
- The most thorough assessment to date of homeopathy
- Should doctors recommend homeopathy?
If you study these articles, you will find that my arguments around homeopathy remained entirely evidence-based. The overall point is, I hope, clear: I did not embark on my research into homeopathy aiming to disprove it or to dismiss it outright [a claim I still hear with some regularity]. To begin with (in 1993), I was not only open but positively inclined. At all times, however, I was keen to follow the best available evidence. If my attitudes/verdicts became less and less positive, it is merely because the evidence became more and more overtly negative.
