Guest post by Björn Geir
I have tried to find a form or type of quackery that can be confirmed to have died out and is no longer practised. Once I thought I had found one, but it turns out that phrenology is still “a thing” and is being practised by a few eccentrics.
I am almost convinced by now that any quackery or SCAM, as Professor Ernst has proposed to call it, never dies. Once someone has invented a SCAM, it will live on forever, like the proverbial zombie, neither dead nor properly alive and useful. Even bloodletting, the archetypical reject from the practice of medicine, is still being practised in some corners of this world. Google “Wet cupping” or “Hijama” if you don’t believe me.
The world will have to live with health-related scam and swindle but its popularity can and should be suppressed and held to an acceptable low. If truth and science are promoted and SCAM is vigilantly and constantly opposed, then public trust in it can be held back and even reversed as now has been shown in Norway.
My somewhat abridged translation of an article published on June 30th on the Norwegian state broadcasting services website.
Norwegians have become much more sceptical towards natural medicine
Fifteen years ago, most Norwegians had faith in natural medicine. Not anymore.
– This is dramatic. A total reversal of opinion, says John Spilling of Ipsos, a company that performs an annual survey of public opinion in Norway. About 3500 people have been interviewed every year since 1985.
The survey, called Norwegian Monitor, has shown that the alternative industry had its heyday in the 80´s and 90´s, at least according to the Norwegian population’s confidence in natural medicine.
On average, eight out of ten thought this kind of therapy and naturopaths could help when ordinary doctors had given up.
But after the turn of the millennium, something started to happen.
The confidence plummeted.
A screenshot from the article showing the representation of the annual Norwegian Monitor survey results for the statement: Naturopaths and natural medicine can often help when ordinary doctors and medicine fall short.
The results are represented as follows:
Black – Impossible to answer
Grey – No answer
Dark red – Totally disagree
Light red – Partially disagree
Dark blue – Partially agree
Light blue – Totally agree
The graph in the article is interactive so you can find the individual rates by hovering over the bars in the article online.
This year only three out of ten fully or partially agree that natural medicine and naturopaths can help. Mr. Spilling is surprised by the magnitude of change, which also has been steadily declining instead of the usual ups and downs seen in so many other areas.
– I see almost no parallels, he says.
The patients stopped coming
The article interviews Ms. Hilde Moldestad. A homeopath since many decades, now retired and leads the Norwegian Homeopathic Patient Association.
Ms. Moldestad marked the decline already while practising.
– The patients stopped coming, because the trends were such that no one was to believe that there was anything good about homeopathy.
She also noted a strongly declining interest within the patient association.
– There are less and less members. People are not so interested in being team members anymore, they want it free online.
Ms. Moldestad is determined that homeopathy works.
– The irony is that the more research that shows that homeopathy works, the stronger the opposition to using the method.
The [Norwegian] National Research Center for Alternative Medicine writes that there is no solid evidence that homeopathic medicines have an effect. And both the Norwegian Medicines Agency and the Norwegian Pharmacists’ Association believe that in practice the pills only contain water and sugar.
– But we are up in a paradigm shift. The damage that has been inflicted on humanity during the period in which school medicine has been allowed to dominate, can no longer be undermined, says Ms. Moldestad in the patient association.The article then interviews Mr. Gunnar Tjomlid, an active Norwegian sceptic who talks about some local background stories of local interest and speculates that perhaps this change correlates with the introduction and distribution of internet access in Norway.
It is not only the Norwegian Monitor survey that shows a decline for the alternative industry. Every two years, the National Research Center for Alternative Medicine (Nafkam) conducts a survey on, among other things, how often Norwegians visit alternative therapists.
– In 2012, you had just under 40 percent who had been to an alternative therapist. And in December 2020, it was 22 percent. So, there has been a declining trend, says Mr. Ola Lillenes, information director at Nafkam.
At the same time, self-treatment, especially with self-help techniques, has increased.
– Healing and homeopathy are probably among those who have fallen the most through these years.
Education and emotions
Jarle Botnen runs the Bø Institute of Natural Medicine in Telemark. In addition, he is part of the steering group in the association of alternative treatment organizations. Over 1000 therapists are affiliated with this organisation which is named Saborg.
– There is a noticeable decline, that is exactly correct, says Botnen.
He has several theories as to why Norwegians have become more sceptical of natural medicine.
Norwegians have received more education and have less trust in their own feelings.
People are used to simple solutions, such as over-the-counter painkillers. They do not treat the cause of the ailments, which takes more time.
It is difficult to distinguish charlatans from the serious [alternative practitioners]. The industry has also not managed to cooperate well enough, according to Botnen.
The pharmaceutical industry has been lobbying to get more of the market for alternative medicine.
The attitude in the media has changed from being positive to natural medicine to often the opposite.
Small brown glass bottles with homeopathic pills lie in a drawer in a pharmacy.
Sales of homeopathic medicines have declined at the same time as Norwegians have become more sceptical of natural medicine.
– We often hear remarks such as “we trust the authorities”, “the authorities have approved the preparation or treatment”. This is reflected in the consumption of chemical and synthetic medicine, which has increased somewhat formidably during this period, Botnen believes.
John Spilling in Ipsos says it is true that people have great confidence in the public sector. Confidence in hospitals and elderly care has also increased, while the alternative industry has had the opposite development.
– Most of Norway’s population does not trust this type of product. I can only understand that the situation of this industry is very different than in 2001.
End of article————-
These are indeed positive and convincing results. I suspect a similar trend has been happening in most other populations? It would be very interesting to know if a similar trend has been observed elsewhere.
A study by an international team of researchers estimated the proportion of healthcare interventions tested within Cochrane Reviews that are effective according to high-quality evidence.
They selected a random sample of 2428 (35%) of all Cochrane Reviews published between 1 January 2008 and 5 March 2021 and extracted data about interventions within these reviews that were compared with placebo, or no treatment, and whose outcome quality was rated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). They then calculated the proportion of interventions whose effectiveness was based on high-quality evidence according to GRADE, had statistically significant positive effects and were judged as beneficial by the review authors. They also calculated the proportion of interventions that suggested harm.
Of 1567 eligible interventions, 87 (5.6%) had high-quality evidence on first-listed primary outcomes, positive, statistically significant results, and were rated by review authors as beneficial. Harms were measured for 577 (36.8%) interventions, 127 of which (8.1%) had statistically significant evidence of harm. Our dependence on the reliability of Cochrane author assessments (including their GRADE assessments) was a potential limitation of our study.
The authors drew the following conclusions: While many healthcare interventions may be beneficial, very few have high-quality evidence to support their effectiveness and safety. This problem can be remedied by high-quality studies in priority areas. These studies should measure harms more frequently and more rigorously. Practitioners and the public should be aware that many frequently used interventions are not supported by high-quality evidence.
Proponents of so-called alternative medicine (SCAM) are fond of the ‘strawman’ fallacy; meaning they like to present a picture of conventional medicine that is overtly negative in order for SCAM to appear more convincing (Prince Charles, for instance, uses this trick every single time he speaks about SCAM). Therefore I am amazed that this paper has not been exploited in that way by them. I was expecting headlines such as
Evidence-based medicine is not supported by evidence
Less than 6% of all conventional treatments are supported by sound evidence.
Why did they not have a field day with this new paper then?
As the article is behind a paywall, it took me a while to get the full paper (thanks Paul). Now that I have read it, I think I understand the reason.
In the article, the authors provide figures for specific types of treatments. Let me show you some of the percentages of interventions that met the primary outcome (high quality, statistically significant effect, and authors interpret as effective):
- pharmacological 73.8%
- surgical 4.6%
- exercise 5.8%
- diet 1.2%
- alternative 0.0%
- manual therapies 0.0%
So, maybe the headlines should not be any of the above but:
No good evidence to support SCAM?
SCAM is destroying the evidence base of medicine.
An epidemiological study from the US just published in the BMJ concluded that “the mortality gap in Republican voting counties compared with Democratic voting counties has grown over time, especially for white populations, and that gap began to widen after 2008.”
In a BMJ editorial, Steven Woolf comments on the study and provides further evidence on how politics influence health in the US. Here are his concluding two paragraphs:
Political influence on US mortality rates became overt during the covid-19 pandemic, when public health policies, controlled by states, were heavily influenced by party affiliation. Republican politicians, often seeking to appeal to President Trump and his supporters, challenged scientific evidence and opposed enforcement of vaccinations and safety measures such as masking. A macabre natural experiment occurred in 2021, a year marked by the convergence of vaccine availability and contagious variants that threatened unvaccinated populations: states led by governors who promoted vaccination and mandated pandemic control measures experienced much lower death rates than the “control” group, consisting of conservative states with lax policies and large unvaccinated populations. This behavior could explain why US mortality rates associated with covid-19 were so catastrophic, vastly exceeding losses in other high income countries.
Observers of health trends in the US should keep their eye on state governments, where tectonic shifts in policy are occurring. While gridlock in Washington, DC incapacitates the federal government, Republican leaders in dozens of state capitols are passing laws to undermine health and safety regulations, ban abortion, limit LGBT+ rights, and implement more conservative policies on voting, school curriculums, and climate policy. To understand the implications for population health, researchers must break with custom; although scientific literature has traditionally avoided discussing politics, the growing influence of partisan affiliation on policies affecting health makes this covariate an increasingly important subject of study.
What has this to do with so-called alternative medicine (SCAM)?
Not a lot.
Except, of course, that Trump has been quite sympathetic to both quackery and quacks (see, for instance, here and here). Moreover, the embarrassing Dr. Oz, America’s charlatan-in-chief, is now a Republican candidate for the US senate. And the creation of the NHI office for alternative medicine, currently called NCCIH, was the idea of the Republican senator, Tom Harkin.
I think we get the drift: on the US political level, SCAM seems to be a right-wing thing.
Am I claiming that SCAM is the cause of the higher mortality in Republican counties?
Do I feel that both are related to irresponsible attitudes towards healthcare issues?
Nausea and vomiting are common symptoms of patients with advanced cancer. While there is some evidence for acupuncture point stimulation in the treatment of these symptoms for patients having anticancer treatment, there is little for when they are not related to such treatment.
This study aimed to determine whether acupressure at the pericardium 6 sites can help treat nausea and vomiting suffered by palliative care patients with advanced cancer. The researchers conducted a double-blind randomized controlled trial-active versus placebo acupressure wristbands. In-patients with advanced cancer in two specialist palliative care units who fitted either or both of the following criteria were approached: nausea that was at least of moderate severity; vomiting daily on average for the prior 3 days.
A total of 57 patients were randomized to have either active or placebo acupressure wristbands. There was no difference in any of the outcome measures between the two groups:
- change from the baseline number of vomits;
- Visual Analogue Scale for ‘did acupressure wristbands help you to feel better?’;
- the total number of doses of antiemetic medication;
- the need for escalation of antiemetics.
The authors concluded that, in contrast to a previously published feasibility study, active acupressure wristbands were no better than placebo for specialist palliative care in patients with advanced cancer and nausea and vomiting.
When the research into acupuncture for nausea and vomiting began some 20 years ago, the evidence turned out to be encouraging. Later, as the studies became more and more rigorous, many trials failed to confirm the initial findings. Today, the totality of the evidence is far less convincing than it seemed years ago.
This is a phenomenon that can be observed not just in acupuncture research but in many types of treatment:
- Initially, over-enthusiastic researchers become victims of their own optimism.
- These investigators are less into testing hypotheses than into confirming their own wishful thinking.
- Thus, several positive trials emerge.
- These, however, turn out to be methodologically flawed.
- Eventually, the subject might be picked up by real scientists who truly test hypotheses.
- More and more negative studies thus emerge.
- Depending on how many flawed studies were initially published and how critical the authors of systematic reviews are, it can take years until the totality of the evidence depicts the true picture which discloses the initial findings as false-positive.
The message is, I think, clear: poor quality studies have the potential to mislead us for many years. Eventually, however, the self-cleansing ability of science should generate the truth about the value of any treatment. In other words:
poor-quality science is not just useless, it causes long-term harm
critical thinking prevents harm
In a previous post, I reported about the ‘biggest ever’, ‘history-making’ conference on integrative medicine. It turns out that it was opened by none other than Prince Charles. Here is what the EXPRESS reported about his opening speech:
Opening the conference, Charles said:
“I know a few people have seen this integrated approach as being in some way opposed to modern medicine. It isn’t. But we need to combine this with a personal approach that also takes account of our beliefs, hopes, culture and history. It builds upon the abilities of our minds and bodies to heal, and to live healthy lives by improving diet and lifestyle.”
Dr. Michael Dixon, Chair of the College of Medicine, said:
“Medicine, as we know it, is no longer affordable or sustainable. Nor is it able to curb the increase in obesity, mental health problems and most long-term diseases. A new medical mindset is needed, which goes to the heart of true healthcare. The advantages and possibilities of social prescription are limitless. An adjustment to the system now will provide a long-term, sustainable solution for the NHS to meet the ever-increasing demand for funding and healthcare professionals.”
Charles very kindly acknowledges that not everyone is convinced about his concept of integrated/integrative medicine. Good point your royal highness! But I fear Charles did not quite understand our objections. In a nutshell: it is not possible to cure the many ills of conventional medicine by adding unproven and disproven therapies to it. In fact, it distracts from our duty to constantly improve conventional medicine. And pretending it is all about diet and lifestyle is simply not true (see below). Moreover, it is disingenuous to pretend that diet and lifestyle do not belong to conventional healthcare.
Dr. Dixon’s concern about the affordability of medicine is, of course, justified. But the notion that “the advantages and possibilities of social prescription are limitless” is a case of severe proctophasia, and so is Dixon’s platitude about ‘adjusting the system’. His promotion of treatments like Acupuncture, Alexander Technique, Aromatherapy, Herbal Medicine, Homeopathy, Hypnotherapy, Massage, Naturopathy, Reflexology, Reiki, Tai Chi, Yoga Therapy will not adjust anything, it will only make healthcare less efficient.
I do not doubt for a minute that doctors are prescribing too many drugs and that we could save huge amounts by reminding patients that they are responsible for their own health while teaching them how to improve it without pills. This is what we learn in medical school! All we need to do is remind everyone concerned. In fact, Charles and his advisor, Michael, could be most helpful in achieving this – but not by promoting a weird branch of healthcare (integrative/integrated medicine or whatever other names they choose to give it) that can only distract from the important task at hand.
Almost 10 years ago, I posted this:
When I decided to become a doctor I, like most medical students, did so mainly to help suffering individuals. When I became a researcher, I felt more removed from this original ideal. Yet I told myself that, by conducting research, I might eventually contribute to a better health care of tomorrow. Helping suffering patients was still firmly on the agenda. But then I realised that my articles in peer-reviewed medical journals somehow missed an important target: in alternative medicine, one ought to speak not just to health care professionals but also to consumers and patients; after all, it is they who often make the therapeutic decisions in this area.
Once I had realised this, I started addressing the general public by writing for The Guardian and other newspapers, giving public lectures and publishing books for a lay audience, like TRICK OR TREATMENT…The more I did this sort of thing, the more I noticed how important this activity was. And when a friend offered to help me set up a blog, I did not hesitate for long.
So, the reason for my enthusiasm for this blog turns out to be the same as the one that enticed me to go into medicine in the first place. I do believe that it is helpful for consumers to know the truth about alternative medicine. Considering the thousands of sources of daily misinformation in this area, there is an urgent need for well-informed, critical information. By providing it, I am sure I can assist people to make better therapeutic decisions. In a way, I am back where I started all those years ago: hoping to help suffering patients in the most direct way my expertise allows.
Helping vulnerable patients often means warning them from dangerous charlatans, and this is precisely what I frequently try to do with this blog. But how successful are my endeavors?
More often than not, I have no idea and can only hope for the best. Sometimes I do get some feedback that is encouraging and motivates me to carry on. Rarely, however, do I witness immediate, tangible success. And this is why the recent story is so remarkable:
- On 6 June, an Australian acquaintance from the FRIENDS OF SCIENCE IN MEDICINE sent me some material about a planned lecture in the UK by someone promoting dangerous quackery.
- I looked into it and published a blog post about it a few hours later.
- A reader then suggested in the comments section of this post alerting the UK press to it.
- Another reader contacted THE TIMES, and I wrote to several other journalists.
- THE TIMES turned out to be interested in the story.
- They did some research and interviewed Michael Marshall from the GOOD THINKING SOCIETY (and myself).
- Today, THE TIMES published an article about the planned event.
- Finally, a kind person made the article available to those who don’t want to pay for it.
The whole thing amounts to superb teamwork, in my view. It shows how like-minded people who do not even all know each other can manage to achieve a respectable result with little more than goodwill and dedication.
A respectable result?
Of course, the optimal result would be to stop Barbara O’Neill’s UK lectures. Let’s hope this is what eventually will happen – and please let me know if you know more.
I know only too well that some readers will interpret this post as pompous and self-congratulatory, but I nevertheless feel like telling my readers that I have become a member of the ACADEMIA EUROPAEA. In case you don’t know what this is, Wikipedia provides the following information:
Membership of the Academia Europaea (MAE) is an award conferred by the Academia Europaea to individuals that have demonstrated “sustained academic excellence”. Membership is by invitation only by existing MAE only and judged during a peer review selection process. Members are entitled to use the post-nominal letters MAE.
New members are announced annually, every year since 1988. For a more complete list see Category:Members of Academia Europaea.. Some Members of the Academia Europaea have received very prestigious awards, medals and prizes, such as:
- The Nobel Prize e.g. Christiane Nüsslein-Volhard (1995, Physiology), Arvid Carlsson (2000, Physiology or Medicine), Paul Nurse (2001, Physiology or Medicine), Tim Hunt (2001, Physiology or Medicine), Kurt Wüthrich (2002, Chemistry), John Sulston (2002, Physiology or Medicine), Sydney Brenner 2002, Physiology or Medicine, Aaron Ciechanover (2004, Chemistry), Roy J. Glauber (2005, Physics), Roger D. Kornberg (2006, Chemistry), Gerhard Ertl (2007, Chemistry), Richard Tol (2007, shared winner of the Nobel Peace Prize), Harald zur Hausen (2008, Physiology or Medicine), Luc Montagnier (2008, Physiology or Medicine), Robert G. Edwards (2010, Physiology or Medicine), John B. Gurdon (2012, Physiology or Medicine), Rita Levi-Montalcini (1986, Physiology)
- The Wolf Prize, e.g. Simon Donaldson (2020), Alexander Beilinson (2018), Peter Zoller (2013), Alain Aspect (2010), Anton Zeilinger (2010), Axel Ullrich (2010), David Baulcombe (2010), Howard Cedar (2008), Albert Fert (2006/2007), Alexander Levitzki (2005), Sergei P. Novikov (2005), Alexander Varshavsky (2001), Saharon Shelah (2001), Vladimir I. Arnold (2001).
- The Turing Award, e.g. Joseph Sifakis (2007), Adi Shamir (2002).
- The Fields Medal, e.g. Martin Hairer (2014), Elon Lindenstrauss (2010), Stanislav Smirnov (2010), Cédric Villani (2010), Wendelin Werner (2006), Timothy Gowers (1998), Maxim Kontsevich (1998), Jean Bourgain (1994), Pierre-Louis Lions (1994), Simon Donaldson (1986), Enrico Bombieri (1974), Sergei P. Novikov (1970), Michael Atiyah (1966).
- The Lasker Award, e.g. Roy Calne (2012), David Weatherall (2010), John Gurdon (2009), David Baulcombe (2008), Alec Jeffreys (2005), Pierre Chambon (2004), Robert Edwards (2001), Sydney Brenner (2000), Aaron Ciechanover (2000), Alexander Varshavsky (2000).
- The Abel Prize, e.g. Andrew Wiles (2016), Endre Szemerédi (2012), Mikhail Leonidovich Gromov (2009), Jacques Tits (2008), Lennart Carleson (2006), Michael Atiyah (2004).
- The Gödel Prize, e.g. Christos H. Papadimitriou (2012), Johan Hastad (2011, 1994), Alexander Razborov (2007), Noga Alon (2005), László Lovász (2001), Moshe Vardi (2000), Pierre Wolper (2000).
The Academia Europaea was founded in 1988, on the initiative of the UK’s Royal Society and other National Academies in Europe. It is a `Not for Profit’ Charity registered in the UK. The Academia Europaea is the only Academy with individual members from the Council of Europe states and from other nations across the world. Currently, there are some 5000 members who cover the full range of academic disciplines.
The objectives of the Academia Europaea are the advancement and propagation of excellence in scholarship in the humanities, law, the economic, social, and political sciences, mathematics, medicine, and all branches of natural and technological sciences anywhere in the world for the public benefit and for the advancement of the education of the public of all ages.
The Academy organizes meetings and workshops, provides scientific and scholarly advice, and publishes the international journal the ‘European Review’ and is associated with Biology Direct. It operates regional knowledge hubs out of Barcelona, Bergen, Budapest, Cardiff, Munich, Tbilisi, and Wroclaw, hosted by Universities and National academies.
I am both proud and thankful that I have been honored in this way.
I have been sent a press release dated 26/5/2022 that might interest some of my readers. As it is in German, I took the liberty of translating it:
The 126th German Medical Congress today in Bremen deleted the additional designation of homeopathy from the further education regulations for doctors (MWBO). The request brought by Bremen delegates was decided by the physician parliament with a large majority.
The Bremen delegates justified their request with the fact that 13 of 17 state medical associations have already deleted the additional designation of homeopathy from their further education regulations. The further education regulation is to create uniform rules for the post-graduate training of doctors. However, there is no longer any question of uniformity if 13 state medical associations do not follow the MWBO.
In the debate, Dr. Johannes Grundmann once again pointed out that it is not a matter of prohibiting people from using homeopathic remedies. “However, it is the task of the medical associations to define and check verifiable learning objectives,” Grundmann said to great applause.
In September 2020, the Bremen Medical Association had become the first such chamber in Germany to remove homeopathy from its education regulations. The complaint of a Bremen physician against it had subsequently been rejected in two instances. Most recently, the Bremen health insurance was the first to terminate three selective contracts for the remuneration of homeopathic services.
I feel that this is a nice victory of reason over unreason. I might even go as far as assuming that our petition of 2021 might have helped a little to bring it about:
Dear President Dr Reinhardt,
Dear Ms Lundershausen,
Dear Ms Johna,
We, the undersigned doctors, would like to draw your attention to the insistence of individual state medical associations on preserving “homeopathy” as a component of continuing medical education. We hope that you, by virtue of your office, will ensure a nationwide regulation so that this form of sham treatment , as has already happened in other European countries, can no longer call itself part of medicine.
We justify our request by the following facts:
- After the landmark vote in Bremen in September 2019 to remove “homeopathy” from the medical training regulations, 10 other state medical associations have so far followed Bremen’s example. For reasons of credibility and transparency, it would be desirable if the main features of the training content taught were not coordinated locally in the future, but centrally and uniformly across the country so that there is no “training tourism”. Because changes to a state’s own regulations of postgraduate training are only binding for the examination committee of the respective state, this does not affect national regulations but is reduced to only a symbolic character without sufficient effects on the portfolio of medical education nationwide.
- Medicine always works through the combination of a specifically effective part and non-specific placebo effects. By insisting on a pseudo-medical methodology – as is “homeopathy” represents in our opinion – patients are deprived of the specific effective part and often unnecessarily deprived of therapy appropriate to the indication. Tragically, it happens again and again that the “therapeutic window of opportunity” for an appropriate therapy is missed, tumors can grow to inoperable size, etc.
- Due to the insistence of individual state medical associations on the “homeopathic doctrine of healing” as part of the medical profession, we are increasingly exposed to the blanket accusation that, by tolerating this doctrine, we are supporting and promoting ways of thinking and world views that are detached from science. This is a dangerous situation, which in times of a pandemic manifests itself in misguided aggression reflected not just in vaccination skepticism and vaccination refusal, but also in unacceptable personal attacks and assaults on vaccinating colleagues in private practice.
Dr. med. Dent. Hans-Werner Bertelsen
Prof. Dr. med. Edzard Ernst
George A. Rausche
The first reported reactions from politicians are positive, while those of homeopaths are predictably the opposite:
German Health Minister Karl Lauterbach (SPD) expressly welcomed the delegates’ decision, writing via Twitter. “Good medicine stands on the ground of science. For homeopathy, there is no place there. In such a question, one must show one’s colors.”
Paula Piechotta, a Green Party member of parliament, was equally pleased. “… it is good when in times of Fake Facts and right-wing conspiracy theories clarity is provided where clarity is needed. Thank you Ärztetag,” she tweeted.
Michaela Geiger, chairwoman of the German Central Association of Homeopathic Physicians, noted the decision “with astonishment.” Homeopathy has a high acceptance among the population, she claimed.
Anyone who has followed this blog for a while will know that advocates of so-called alternative medicine (SCAM) are either in complete denial about the risks of SCAM or they do anything to trivialize them. Here is a dialogue between a SCAM proponent (P) and a scientist (S) that is aimed at depicting this situation. The conversation is fictitious, of course, but it is nevertheless based on years of experience in discussing these issues with practitioners of various types of SCAM. As we shall see, the arguments turn out to be perfectly circular.
P: My therapy is virtually free of risks.
S: How can you be so sure?
P: I am practicing it for decades and have never seen a single problem.
S: That could have several reasons; perhaps the patients who experience problems did simply not come back.
P: I find this unlikely.
S: I don’t, and I know of reports where patients had serious complications after the type of SCAM you practice.
P: These are isolated case reports. They do not amount to evidence.
S: How do you know they are isolated?
P: They must be isolated because, in the many clinical trials of my therapy available to date, you will not find any evidence of serious adverse effects.
S: That is true, but it has been repeatedly shown that these trials regularly fail to mention side effects altogether.
P: That’s because there aren’t any.
S: Not quite, clinical trials should always mention adverse effects, and if there were none, they should mention this too.
P: So, you admit that you have no evidence that my therapy causes adverse effects.
S: The thing is, I don’t need such evidence. It is you, the practitioners of this therapy, who should provide evidence that your treatments are safe.
P: We did! The complete absence of reports of side effects constitutes that evidence.
S: Except, there is some evidence. I already told you that there are several case reports of serious problems.
P: But case reports are anecdotes; they are no evidence.
S: Look, here is a systematic review of all the case reports. You cannot possibly deny that this is a concern.
P: It’s still merely a bunch of anecdotes, nothing more.
S: Only because your profession does nothing about it.
P: What do you think we need to do about it?
S: Like other professions, you need to systematically record adverse effects.
P: How would that help?
S: It would give us a rough indication of the size and severity of the problem.
P: This sounds expensive and complicated to organize.
S: Perhaps, but it is necessary if you want to be sure that your therapy is safe.
P: But we are sure already!
S: No, you believe it, but you don’t know it.
P: You are getting on my nerves with your obsession. Don’t you know that the true danger in healthcare is the adverse effects of pharmaceutical drugs?
S: But these drugs are also effective.
P: Are you saying my therapy isn’t?
S: What I am saying is that the drugs you claim to be dangerous do more good than harm, while this is not at all clear with your SCAM.
P: To me, that is very clear. My therapy helps many and harms nobody!
S: How do you know that it harms nobody?
… At this point, we have gone full circle and we can re-start this conversation from its beginning.
A recent article in LE PARISIEN entitled “L’homéopathie vétérinaire, c’est sans effet… mais pas sans risque” – Veterinary homeopathy is without effect … but not without risk, tells it like it is. Here are a few excerpts that I translated for you.
More than 77% of French people have tried homeopathy in their lifetime. But have you ever given it to your pet? Harmless in most cases, its use can be dangerous when it replaces a treatment whose effectiveness is scientifically proven … from a safety point of view, the tiny granules are indeed irreproachable: their use does not induce any drug interaction or undesirable side effects, nor does it run the risk of overdosing or addiction … homeopathic preparations owe their harmlessness to their lack of proper effects. “Neither in human medicine nor in veterinary medicine, at the current stage, clinical studies of all levels do not provide sufficient scientific evidence to support the therapeutic efficacy of homeopathic preparations”, stated the French Veterinary Academy in May 2021. These conclusions are in line with those of the French Academies of Medicine and Pharmacy, the British Royal College of Veterinary Surgeons, and all the international scientific bodies that have given their opinion on the subject.
Therefore, when homeopathy delays diagnosis or is used in place of proven effective treatments, its use represents a “loss of opportunity” for your pet. The greatest danger of homeopathy is not that the remedies are ineffective, but that some homeopaths believe that their therapies can be used as a substitute for genuine medical treatment,” summarizes a petition to the UK veterinary regulatory body signed by more than 1,000 British veterinarians. At best, this claim is misleading and, at worst, it can lead to unnecessary suffering and death.”
But how can we explain the number of testimonies from pet owners who say that “it works”? “I am very satisfied with the Kalium Bichromicum granules for my cat with an eye ulcer, which is healing very well”… These improvements, real or supposed, can be explained by “contextual effects”, among which the famous placebo effect (which is not specific to humans), your subjective interpretation of his symptoms, or the natural history of the disease.
When these contextual effects are ignored or misunderstood, the spontaneous resolution or reduction of the disease can be wrongly attributed to homeopathy, and thus maintain the illusion of its effectiveness. This confusion is all the more likely because homeopathy owes much of its popularity to its use to treat “everyday ailments”: nausea, allergies, fatigue, bruises, nervousness, etc., which tend to get better on their own with time, or which have a fluctuating expression…
In April 2019, the association published an open letter addressed to the National Council of the Order of Veterinarians, calling on it to take a position on the compatibility of homeopathy with the “ethical and scientific requirements” of the profession. The organization, whose official function is to guarantee the quality of the service rendered to the public by the 20,000 veterinarians practicing in France, issued its conclusions last October. It invited veterinary training centers to remove homeopathy from their curricula, under penalty of having their accreditation withdrawn, and thus their ability to deliver training credits.
In my view, this is a remarkably good and informative text. How often do homeopathy fans claim IT WORKS FOR ANIMALS AND THUS CANNOT BE A PLACEBO! The truth is that, as we have so often discussed on this blog, homeopathy does not work beyond placebo for animals. This renders veterinary homeopathy:
- a waste of money,
- potentially dangerous,
- in the worst cases a form of animal abuse.
My advice is that, as soon as a vet recommends homeopathy, you look for the exit.