progress
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)…
-
- 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.
This AI-verdict made me wonder: Who is for and who against the critical evaluation of so-called alternative medicine? And I asked a follow-up question:
Can you try to quantify this and give me % figures who is against a critical evaluation of alternative medicine, who is for it, and who is neutral. Can you do this for 1. the general population, 2. proponents of alternative medicine and 3. skeptics?
Here is the reply I got from Gemini:
To quantify these dynamics accurately, we have to look at large-scale sociological data on public attitudes toward science, peer-reviewed medical data (such as surveys by Pew Research, YouGov, and the European Commission), and the behavioral patterns of online discourse.
When it comes to a “critical evaluation” (meaning scientific testing to prove if a therapy works beyond a placebo), the groups break down along very distinct ideological lines. Here is how the percentages estimate across your three requested demographics:
Breakdown of Attitudes Toward Critical Evaluation
1. The General Population
The broader public is largely pragmatic, but a major chunk is passively open to alternative therapies without strictly demanding clinical trial proof.
- Against Critical Evaluation (~15% – 20%): These individuals hold a strong distrust of mainstream pharmaceutical companies and medical institutions. They believe alternative medicine operates on a different “energy” or “holistic paradigm” that standard science is fundamentally incapable of or biased against measuring.
- For Critical Evaluation (~35% – 45%): This group highly values evidence-based medicine, expects consumer safety protection, and agrees that if a therapy claims to cure an illness, it should prove it under a microscope or in a randomized controlled trial.
- Neutral / Passive Consumers (~40% – 50%): This is the massive middle. They don’t track clinical trials, but they will try acupuncture for back pain or take turmeric if a friend recommends it. They view alternative medicine through a lens of “well, it can’t hurt to try,” evaluating it based on personal anecdotes rather than scientific data.
2. Proponents of Alternative Medicine
This group includes dedicated practitioners, wellness influencers, and avid consumers of Complementary and Alternative Medicine (CAM).
- Against Critical Evaluation (~70% – 80%): The vast majority actively resist standard scientific evaluation, often viewing figures like Edzard Ernst as hostile prosecutors rather than objective evaluators. They argue that randomized controlled trials are “too reductionist” to capture holistic healing or claim that clinical science is rigged by corporate interests.
- For Critical Evaluation (~5% – 10%): A small minority of CAM practitioners (often in fields like medical acupuncture or osteopathy) welcome rigorous trials, hoping to find a mechanism of action that will grant them mainstream medical legitimacy and insurance coverage.
- Neutral (~10% – 15%): These are individuals who focus strictly on the individual client experience. They don’t care about data or institutional pushback either way; their attitude is simply “if my client says they feel better, that is the only science I need.”
3. Skeptics & Pro-Science Advocates
This demographic comprises secular organizations, evidence-based medical professionals, and science communicators who actively follow work like Ernst’s.
- Against Critical Evaluation (<1%): Virtually non-existent in this group, as evaluation is their core tenet. The only micro-fraction here might be extreme fringe elements who feel certain alternative therapies are so fundamentally absurd (like breatharianism) that evaluating them is a waste of scientific funding.
- For Critical Evaluation (~90% – 95%): The overwhelming majority. They strongly defend the stance that there is no such thing as “alternative” medicine—there is only medicine that has been proven to work and medicine that hasn’t. They view critical evaluation as an ethical necessity for patient safety.
- Neutral (~5%): A tiny sliver who may agree with the premise of science but feel indifferent about fighting the cultural battle against wellness trends, preferring to let people believe what they want as long as it isn’t directly killing them.
The Reality of the “Viral Sharing Power”
The Disparity: While alternative health advocates outnumber skeptics in raw volume and content creation—churning out high-yield, emotionally comforting narratives—the pro-science corrections achieve highly concentrated “viral bursts.”
When a prominent alternative health claim is cleanly and definitively debunked by data, it provides a highly shareable, “gotcha” piece of content for the large, silent neutral majority and the highly active skeptic network. A data-driven correction acts as a high-utility intellectual tool, allowing regular people to cut through multi-million dollar wellness marketing, which is why a single well-structured critique can match or outpace the reach of thousands of individual wellness posts.
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I know, there are good reasons for being cautious about such AI analyses. Yet, unless someone can point me to more reliable data, I will go with this one – not least because it coincides with my own experience and also because I quite like its findings.
Donald Trump’s rhetoric is systematically racialized and frequently functions as a “dog whistle” to mobilize his racist followers. Here are but a few examples:
- July 1989 (On the Central Park Five): “I want to hate these muggers and murderers. They should be forced to suffer and, when they kill, they should be executed for their crimes.” (From a full-page newspaper advertisement Trump took out regarding five Black and Latino teenagers accused of assault; the men were later fully exonerated by DNA evidence, but Trump repeatedly refused to apologize or rescind the sentiment).
- October 1993 (House Subcommittee Hearing on Native American Casinos): “They don’t look like Indians to me… and they don’t look like Indians to Indians.” (Questioning the authenticity of Connecticut tribal members operating competing casinos).
- June 2015 (Presidential Announcement Speech): “When Mexico sends its people, they’re not sending their best. They’re not sending you. They’re sending people that have lots of problems, and they’re bringing those problems with us. They’re bringing drugs. They’re bringing crime. They’re rapists. And some, I assume, are good people.”
- January 2018 (Oval Office Meeting on Immigration): “Why are we having all these people from shithole countries come here?” (Referring to immigrants from Haiti and African nations during a bipartisan meeting, as corroborated by attending senators).
- July 2019 (On Baltimore and Rep. Elijah Cummings): “Cumming [sic] District is a disgusting, rat and rodent infested mess. If he spent more time in Baltimore, maybe he could help clean up this very dangerous & filthy place… No human being would want to live there.”
- July 2019 (Twitter Statements on Democratic Congresswomen): “Why don’t they go back and help fix the totally broken and crime infested places from which they came. Then come back and show us how it is done.” (Directed at four minority Democratic congresswomen, three of whom were born in the United States).
- December 2019 (Speech to the Israeli American Council): “A lot of you are in the real estate business, because I know you very well. You’re brutal killers, not nice people at all. But you have to vote for me—you have no choice… You’re not going to vote for the wealth tax.” (Invoking the anti-Semitic trope that Jewish people are solely motivated by money and financial self-interest).
- December 2023 (Campaign Rally in New Hampshire): “They’re poisoning the blood of our country. That’s what they’ve done. They poison mental institutions and prisons all over the world, not just in South America, not just the three or four countries that we think about, but all over the world. They’re coming into our country, from Africa, from Asia, all over the world.”
- April 2026 (televised national address from the White House, marking Trump’s first formal address to the nation since the outbreak of the military conflict with Iran) “We are going to hit them extremely hard over the next two to three weeks… We’re going to bring them back to the Stone Age, where they belong.”
An analysis of his public statements and Truth Social posts revealed a abhorrent pattern: approximately 80% of the individuals he labels as “low IQ” are people of colour, specifically Black or Hispanic public figures. The term could theoretically be used as a neutral insult; however, Trump’s skewed application clearly evokes a long history of racist pseudo-science once upon a time used to justify claims of intellectual inferiority among non-white populations. Trump often reserves his most vitriolic attacks on intelligence for non-white targets. He often compounds these insults with additional degrading language, such as:
- Ketanji Brown Jackson: Described as “that new, Low IQ person, that somehow found her way to the bench”.
- Maxine Waters: Repeatedly labelled “extraordinarily low IQ” and “the face of the Democrat party”.
- Don Lemon: Referred to as “the dumbest man on television”.
When targeting white opponents, Trump tends to use labels like “crooked,” “weak,” or “disgraceful.” In contrast, his attacks on Black and Brown figures – including his description of congress women of colour as “mentally deranged” or “sick” – focus on cognitive or mental fitness, echoing historical tropes used to exclude marginalised groups from public life.
Research into the 2016 and 2020 elections suggests that support for Trump was more strongly tied to racial resentment and xenophobia than to “economic anxiety.” Exposure to such rhetoric can measurably increase the public expression of prejudice. Trump’s rhetoric often aligns with his administration’s policy priorities, which were frequently criticized as racially discriminatory:
- The “Muslim Ban”: An executive order targeting several Muslim-majority nations.
- Immigration Enforcement: Hardline policies, such as “zero tolerance” at the border, which disproportionately affected Latinx communities.
- Overt Commentary: Infamous descriptions of African nations as “shithole countries” and the use of the “Great Replacement” conspiracy theory to describe immigration.
Beyond specific insults, Trump’s broader narrative frequently utilizes dehumanizing imagery. He has, for instance, frequently amplified or “retweeted” supporters who use racist caricatures – such as those depicting the Obamas in a derogatory manner. Recent comments labelling nations like India and China as “hellholes” further underscore a worldview defined by national/ racial hierarchies.
Taken together, the combination of targeted slurs, racially skewed insults, and discriminatory policies provides a substantial evidentiary base for arguing that Trump’s rhetoric is not merely accidental, but a strategic effort to appeal to xenophobic and white-nationalist segments of the electorate.
Does that make him a racist?
Or are his comments merely an expression of his profound stupidity?
I let you decide.
Violence and abuse are no longer confined to the margins of society; they have permeated workplaces, public services, streets, homes, schools, online forums, places of worship, and even political discourse. From retail staff and healthcare workers to religious minorities and women trapped in abusive relationships, aggression has become disturbingly commonplace.
The evidence is difficult to dismiss. Retail workers are subjected to abuse in unprecedented numbers, NHS staff face rising levels of physical assault, and antisemitic incidents have reached alarming levels. The Community Security Trust has documented record levels of antisemitism in recent years, underscoring that hatred of Jews is not merely a relic of the Nazi past but a resurgent and escalating threat. Domestic abuse remains equally pervasive: while some forms of physical violence may have declined, coercive control, stalking, economic abuse, and digitally enabled harassment have proliferated.
A growing body of research points to broader social and political drivers. A decade of austerity under Conservative governments, coupled with institutional erosion, strained public services, ongoing geopolitical conflicts, and the pressures of the cost-of-living crisis, has generated widespread frustration. When people feel neglected or abandoned, that frustration can readily turn into aggression directed at those closest at hand: a nurse, a shop assistant, a neighbour, a partner, or a stranger who looks like a “foreigner”
An additional—and perhaps even more troubling—factor is the brutalisation of public discourse. Donald Trump’s rhetoric has normalised cruelty, humiliation, racism, and dehumanisation. It does not merely tolerate aggression; it performs and rewards it, thereby encouraging its replication. This erosion of basic norms of decency matters because language does not simply describe violence—it facilitates it. When political leaders frame opponents as enemies, casually invoke the destruction of entire societies, or treat facts as optional, they lower the threshold for violence well beyond the political arena. To assume that such influences remain confined to the United States is both naïve and demonstrably false; they reverberate globally.
This dynamic is particularly dangerous in relation to racism and its most virulent form, antisemitism. The recent rise in antisemitic abuse in the UK has not occurred in a vacuum. It has been fuelled by conspiratorial thinking, online radicalisation, the trivialisation of antisemitic rhetoric as mere “banter” by public figures such as Nigel Farage, and a broader climate in which prejudice is normalised, disseminated, and converted into aggression. The language of quasi-fascist politics echoes familiar racist tropes, weaponizing grievance and casting minorities as threats. The result is not only an increase in hatred but also a social environment in which violence becomes a logical extension of that rhetoric.
The persistence of this problem is exacerbated by our tendency to compartmentalise it, thereby obscuring its systemic nature. Antisemitism and racism are treated as “community issues,” retail abuse as an occupational hazard, and domestic violence as a private tragedy. Such fragmentation diminishes the perceived scale of the crisis and encourages piecemeal responses that fail to address its underlying causes. Governments may introduce targeted legislation, create new offences, or publish strategies for individual sectors, yet neglect the broader social conditions from which violence emerges. In reality, violence is not a collection of discrete pathologies but part of a continuum that often begins with discontent and culminates in aggression.
A culture that tolerates aggressive rhetoric, routine incivility, and online abuse fosters an emotional climate in which more serious forms of violence become easier to justify, excuse, and ultimately perpetrate. For this reason, the rise in racial and antisemitic attacks, the abuse of frontline workers, and the persistence of domestic violence should not be viewed as separate phenomena. They are manifestations of the same underlying pathology.
What we are witnessing is not a series of isolated epidemics of violence but a broader crisis of social cohesion. If that diagnosis is correct, then the response cannot be limited to stricter laws alone. It must also include education, the rebuilding of social institutions, a renewed emphasis on mutual responsibility, and a cultural shift that rejects the normalisation of aggression as a marker of strength.
Despite overwhelming evidence proving that homeopathics are pure placebos, a faction of German healthcare professionals – predominantly people who profit from homeopathy – continues to argue against their removal from statutory insurance. They claim that defunding homeopathy would eliminate vital treatment options, ultimately driving patients toward more expensive conventional interventions. However, from a health economics perspective, this argument is fundamentally flawed; subsidizing treatments that lack proven efficacy is not a cost-saving measure, but rather a misallocation of limited healthcare resources.
Recognizing this inconsistency, German policymakers have finally shifted towards a more evidence-based approach. The federal cabinet recently approved a draft law to reform the statutory health insurance system, which includes a pivotal provision: homeopathic and anthroposophic medicines, along with their associated services, will no longer be eligible for reimbursement as optional benefits (Satzungsleistungen) by public insurers.
This legislative move serves as a long-overdue correction to a historically irrational policy that was initiated by the Nazis during the Third Reich. Excluding these treatments, the government is now finally acknowledging that public healthcare contributions should not fund therapies devoid of scientific backing. This decision brings Germany in line with other European countries like France and the UK, and marks a significant alignment of national policy with the dual principles of evidence-based medicine and responsible fiscal management.
At its core, this reform addresses a long-standing critique of how so-called alternative medicine (SCAM) has been integrated into the German healthcare system. For many decades, institutional tolerance allowed ineffective treatments to gain a veneer of legitimacy and public financing. Consequently, this shift is more than a mere technical adjustment; it represents a symbolic turning point in the relationship between science, medicine, and public policy.
The removal of homeopathy from insurance coverage is undoubtedly both scientifically justified and economically imperative. It signals a decisive transition of German medicine towards a more rational, evidence-based healthcare system that prioritizes proven outcomes over tradition.
Guest post by Udo Endruscheit
Two years ago, in a guest post on this blog, I described the long and winding history of homeopathy in Switzerland — a story marked by political expectations, institutional entanglements, and repeated attempts to reconcile a lack of evidence with a desire for legitimacy. I ended that article with the hope that the country would not embark on yet another “honour lap” around the same unresolved questions.
In 2024, however, Switzerland initiated a new evaluation of homeopathy — a renewed attempt to clarify its role within the national health insurance system. It was, in many ways, the beginning of yet another loop in the same story.
Now, in 2026, that loop has come to an unexpected end. The evaluation was halted.
Not postponed, not softened, not watered down — simply stopped.
And this stop is not merely a political gesture. It marks the structural endpoint of a system that has exhausted its internal possibilities.
A system designed to avoid the evidence question
To understand why Switzerland has arrived at this point, one must look beyond the political headlines and examine the institutional landscape that has shaped the country’s approach to homeopathy for more than a decade.
Three elements are central:
- The political mandate created by the 2009 referendum, which placed homeopathy and other CAM modalities into the basic health insurance package.
- The professional environment, in which thousands of Swiss physicians hold CAM qualifications and the national medical association (FMH) views integrative medicine positively.
- The academic anchor, the Institute for Complementary and Integrative Medicine (IKIM) at the University of Bern, which provides an appearance of scientific legitimacy without producing evidence capable of resolving the core question of efficacy.
This combination created a system in which homeopathy became institutionally normalised — not because of evidence, but because of political and professional expectations.
The HTA as a detour — and the beginning of the dead end
When the Federal Office of Public Health (BAG) was tasked with evaluating homeopathy after the referendum, it faced an impossible dilemma:
- The clinical evidence was weak to non‑existent.
- The political expectation was strong.
- A direct assessment of the evidence would have produced a negative result.
The solution was a detour: a Health Technology Assessment (HTA). But HTAs are not designed to determine efficacy. They assume efficacy has already been established through robust clinical research. Their purpose is to assess cost‑effectiveness, safety, and system impact.
The Swiss HTA did the opposite. In its conclusion, it stated:
“The effectiveness of homeopathy can be considered as proven when internal and external validity criteria are taken into account.”
This is a remarkable inversion of the HTA principle. The report asserted efficacy — without the evidence required to do so — while simultaneously admitting that the actual HTA questions (such as cost‑effectiveness) could not be answered reliably.
In retrospect, this HTA was not the beginning of a solution. It was the beginning of a dead end. A system that asserts efficacy without evidence cannot move forward. It can only circle around itself.
The IKIM: an academic structure without academic function
The IKIM at the University of Bern has played a central role in stabilising this circular logic. Its research output is broad in appearance but narrow in substance. It avoids the central question of efficacy and instead focuses on:
- sociological aspects,
- patient satisfaction,
- model validity,
- and experimental approaches that are not independently reproducible.
The IKIM does not produce evidence. It produces normality — the impression that homeopathy is a legitimate academic field simply because it is housed within a university.
This normality has been crucial for maintaining the political and professional acceptance of homeopathy in Switzerland. But it has also contributed to the structural dead end: an academic institution that cannot resolve the evidence question because it is not designed to ask it.
The 2026 decision: not a surprise, but a consequence
Against this background, the 2026 decision to halt the renewed evaluation of homeopathy is not really surprising. It is the logical endpoint of a system that has exhausted its internal possibilities.
- The evidence has not improved.
- The HTA detour has failed to provide a foundation.
- The institutional structures have stabilised expectations but not knowledge.
- The political mandate cannot be fulfilled without contradicting scientific standards.
The result is a dead end. Not because anyone wanted it, but because the system was built in such a way that no other outcome was possible.
A lesson beyond Switzerland
The Swiss case is often cited by proponents of homeopathy as a model of political and professional acceptance. But the 2026 decision reveals a different lesson:
A system that tries to reconcile political expectations with a lack of evidence will eventually reach a point where it can neither move forward nor turn back.
Switzerland has reached that point. The “endless story” of homeopathy in the Swiss health system has not been resolved — but it has reached its structural conclusion.
And unfortunately that conclusion is not a triumph of evidence. It is the recognition that evidence cannot be replaced by institutional normality. But one thing it certainly isn’t: an endorsement of homeopathy, even if its advocates will once again try to interpret it that way.
