MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

progress

Since about two years, I am regularly trying to warn people of charlatans of all types who mislead the public on COVID-related subjects. In this context, a recent paper in JAMA is noteworthy. Allow me to quote just a few passages from it:

COVID-19 misinformation and disinformation flood the public discourse; physicians are not the only source. But their words and actions “may well be the most egregious of all because they undermine the trust at the center of the patient-physician relationship, and because they are directly responsible for people’s health,” Pawleys Island, South Carolina, family medicine physician Gerald E. Harmon, MD, president of the American Medical Association (AMA), (which publishes JAMA)wrote recently. In November, the AMA House of Delegates adopted a new policy to counteract disinformation by health care professionals.

… Few physicians have been disciplined so far, even though the Federation of State Medical Boards (FSMB), representing the state and territorial boards that license and discipline physicians, and, in some cases, other health care professionals, and the American Board of Medical Specialties (ABMS), consisting of the boards that determine whether physicians can be board-certified, have issued statements cautioning against spreading false COVID-19 claims.

In July 2021, the FSMB warned that spreading COVID-19 misinformation could put a physician’s license at risk. The organization said it was responding “to a dramatic increase in the dissemination of COVID-19 vaccine misinformation and disinformation by physicians and other health care professionals.”

The ABMS released a statement in September 2021. “The spread of misinformation and the misapplication of medical science by physicians and other medical professionals is especially harmful as it threatens the health and well being of our communities and at the same time undermines public trust in the profession and established best practices in care,” the ABMS said.

In an annual survey of its 70 member boards conducted in fall 2021, the FSMB asked about complaints and disciplinary actions related to COVID-19. Of the 58 boards that responded, 67% said they had seen an uptick in complaints about licensees spreading false or misleading COVID-19 misinformation, according to results released in December 2021. But only 12 (21%) of the 58 boards said they’d taken disciplinary action against a physician for that reason…

__________________
There is no question, misinformation by physicians is lamentable, particularly during a health crisis. The fact that only so few of the wrong-doers get caught and punished for it is depressing, in my view. What seems nevertheless encouraging is that the proportion of physicians who misinform their patients about COVID is small.
How does that compare to non-medically trained practitioners of so-called alternative medicine (SCAM)?
  • What percentage of lay-homeopaths misinform their patients?
  • What percentage of chiropractors misinform their patients?
  • What percentage of energy healers misinform their patients?
  • What percentage of naturopaths misinform their patients?
  • What percentage of acupuncturists misinform their patients?
  • etc., etc.

As the total number of SCAM practitioners might, in some parts of the world, easily outnumber doctors, these questions are highly relevant. Yet, I am not aware of any reliable data on these issues. Judging from what I have observed (and written about) during the pandemic, I guess that the percentages are likely to be substantial and way higher than those for doctors. To me, this suggests that we ought to focus much more on SCAM practitioners if, in future health crises, we want to prevent the confusion and harm that misinformation inevitably causes.

Recently, there has been a flurry of research interest in mindfulness – one could almost call it hype! Not that this is reflected in loads of rigorous trials, rather it manifests itself by an unprecedented amount of systematic reviews on mindfulness being published.

I conducted a Medline search on 8/2/2022 for meta-analyses of mindfulness. It resulted in no less than 9 such papers. Here are their conclusions:

  1. This meta-analysis suggests that SOF is a moderately effective evidence-based practice for reducing disruptive behavior.
  2. In conclusion, both mindfulness interventions showed robust evidence on anxiety symptoms in pretest-posttest periods compared to control groups. Few studies and lack of evidence of follow-up periods were the main limitations found.
  3. Memory specificity did not significantly differ from baseline to post-treatment for either MBCT and Control interventions.
  4. Although this review was limited by search strategies and most of the included studies were of low quality, it still provided some tentative support for PSIs for the treatment of TOPFA women.
  5. Meta-regression results showed that some heterogeneity in effect size could be accounted for by intervention dosage, study population, and study design. Our findings quantify MBIs’ potential for improving immune function and thus impacting somatic disorders.
  6. Mindfulness interventions somewhat improved depression in emerging adults. Because primary researchers did not report the adverse effects, mindfulness interventions should be used with caution. Future researchers might study the adverse effects of mindfulness interventions as well as the long-term effects.
  7. The effect of MBIs on pain in cancer patients was demonstrated in our analysis, albeit with small effect sizes. High-quality RCTs are needed to verify the efficacy of MBIs on cancer patients or survivors with pain complaints. Future trials should take into account the specific pain outcome measures (pain intensity or pain interference), the approach of intervention provision (clinic-based or remote MBI, group or individual practice), the duration and frequency of interventions and the comparators (passive or active control arms).
  8. This meta-analysis found that MBIs had beneficial effects on mental health such as psychological distress and wellbeing in nurses.
  9. Because MBIs show promise across some PICOS, future RCTs and meta-analyses should build on identified strengths and limitations of this literature.

This amounts to about two systematic reviews/meta-analyses per week!

And what do these papers tell us?

If you are an advocate of mindfulness, you probably conclude that your pet therapy is supported by reasonably sound evidence. If, however, you think a little more critically, you would probably see that the evidence is far from strong. The effect size is usually small and of doubtful clinical relevance. This is, I think, important because clinical trials of mindfulness cannot easily control for placebo effects (there is no adequate placebo that would allow patients to be blinded). Therefore, the small effects that do emerge in systematic reviews/meta-analyses are most likely the result of a placebo response and not due to mindfulness per se.

My conclusion is therefore not nearly as positive as that of fans of mindfulness: the collective evidence suggests to me that the success of mindfulness relies mostly or even entirely on the placebo effect. And this means that even dozens of further systematic reviews are not going to advance our knowledge significantly. What is needed, I think, is a few truly rigorous studies aimed at determining whether the effects of mindfulness are specific or non-specific in nature. My prediction is that, once we have this evidence, the current hype around mindfulness will calm down.

The ‘Society of Physicians and Scientists for Health, Freedom and Democracy’  (Gesellschaft der Mediziner und Wissenschaftler für Gesundheit, Freiheit und Demokratie e.V. MWGFD) recently held a press coference where they presented its 10-point plan for a Corona phase-out concept. Here are their 10 demands (my translation):

  1. Immediate cessation of COVID vaccinations and in particular compulsory COVID vaccination.
  2. End all non-evidence-based non-pharmaceutical measures (NPI’s), such as lockdowns, school closures, mandatory masks in public spaces, isolation, quarantine, contact tracing, stand-off rules, as well as RT-PCR and rapid antigen testing of people without symptoms of disease, and immediately open sports venues, restaurants, churches and cultural institutions to all without access conditions
  3. Pandemic management must be sensibly controlled on the basis of science and evidence, including correct testing of the genuinely ill and correct recording of the epidemic situation. Since this has been neglected for two years, we demand the resignation of the previous advisory experts.
  4. Drawing up easily applicable concepts for the prevention and early treatment of COVID-19 and also for the inpatient and, if necessary, intensive medical treatment of severe courses.
  5. The dominance of one single logic, namely the virological logic, must be ended. Other aspects, such as economic, social, psychological, educational and holistic medical considerations must be included.
  6. Reassuring the population about sufficient medical care for all
  7. The media should provide wide-ranging comprehensive information, according to the ethical guidelines for journalists formulated in the Press Code, without creating fear and panic.
  8. Provide programmes to treat the physical and psychological trauma caused by the operations, especially for children and adolescents
  9. Ending the care crisis through appropriate measures
  10. Separation of powers, justice and freedom

Who would put their name to such complete idiocy?

You may well ask!

The members of the MWGFD are:

  • Prof. Dr. med. Sucharit Bhakdi, Facharzt für Mikrobiologie und Infektionsepidemiologie, ehem. Direktor des Instituts für Medizinische Mikrobiologie und Hygiene der Johannes Gutenberg-Universität Mainz
  • Dr. med. Thomas Binder, Kardiologe, Vorstand Aletheia – Medizin und Wissenschaft für Verhältnismässigkeit, Wettingen, Schweiz
  • Prof. Dr. med. Arne Burkhardt, Facharzt für Pathologie, Reutlingen
  • Prof. Dr.-Ing. Aris Christidis, ehem. Technische Hochschule Mittelhessen, Giessen Fachbereich Mathematik, Naturwissenschaften und Informatik
  • Andreas Diemer, Arzt für Allgemeinmedizin und Naturheilverfahren, Diplom- Physiker, Musiker, Leiter der Akademie Lebenskunst und Gesundheit, Gernsbach
  • Dr. med. univ. Dr. phil. Christian Fiala, Facharzt für Frauenheilkunde und Geburtshilfe, Arzt für Allgemeinmedizin, Tropenmedizin, Wien
  • Dr. med. Heinrich Fiechtner, Hämatologe und Internistischer Onkologe, Stuttgart
  • Daniela Folkinger, Psychologische Beraterin, Lehrerin, Thurmansbang
  • Dr. med. Margareta Griesz-Brisson, Neurologin, London und Müllheim, BW
  • Prof. Dr. med. Dr. phil. Martin Haditsch, Facharzt für Mikrobiologie, Virologie und Infektionsepidemiologie, Hannover
  • Dr. Dr. Renate Holzeisen, Rechtsanwältin, Bozen
  • Prof. Dr. rer. hum. biol. Ulrike Kämmerer, Humanbiologin, Universitätsklinikum Würzburg
  • Prof. Dr. Christian Kreiß, Volkswirtschaftler, Hochschule Aalen
  • Prof. Dr. Christof Kuhbandner, Pädagogische Psychologie, Universität Regensburg
  • Prof. Dr. med. Walter Lang, Pathologe, Hannover
  • Werner Möller, Intensivpfleger und Atmungstherapeut, Stuttgart, Gründer der Initiative „Pflege für Aufklärung“
  • Prof. Dr. Werner Müller, Rechnungswesen, Controlling, Steuern, Fachbereich Wirtschaft der Hochschule Mainz
  • Cornelia Reichl, Heilpraktikerin, Passau
  • Prof. Dr. rer. nat. Karina Reiß, Mikrobiologie, Quincke-Forschungszentrum der Christian-Albrechts-Universität zu Kiel
  • Dr. med. Konstantina Rösch, Allgemeinärztin, Graz
  • Prof. Dr. phil. Franz Ruppert, Psychotraumatologie, psychologische Psychotherapie, Psychologie, Katholische Stiftungshochschule München
  • Heiko Schöning, Arzt, Hamburg
  • Univ.-Prof. Dr. med. Dr. rer. nat. M. Sc. Christian Schubert, Klinik für Medizinische Psychologie, Medizinische Universität Innsbruck.
  • Prof. Dr. Martin Schwab, Lehrstuhl für Bürgerliches Recht, Verfahrens- und Unternehmensrecht, Universität Bielefeld
  • Univ.-Prof. Dr. med. Andreas Sönnichsen, Abteilung für Allgemeinmedizin und Familienmedizin, Medizinische Universität Wien, bis Januar 2021 Vorsitzender des Deutschen Netzwerks Evidenzbasierte Medizin,
  • Priv. Doz. Dr. med. Josef Thoma, HNO-Arzt, Berlin.
  • Prof. Dr. Hans-Werner Vohr, Immunologie und Immuntoxikologie, Universität Düsseldorf.
  • Prof. Dr. Dr. Daniel von Wachter, Professor für Philosophie an der Internationalen Akademie für Philosophie im Fürstentum Liechtenstein
  • Prof. Dr. Harald Walach, klinischer Psychologe, Gesundheits-wissenschaftler, Leiter des Change Health Science Instituts, Berlin
  • Dr. med. Ronald Weikl, Facharzt für Frauenheilkunde und Geburtshilfe, Praktischer Arzt, Naturheilverfahren, Passau
  • Ernst Wolff, Autor, Finanzexperte und freier Journalist, Berlin

As we see, the ‘Society of Physicians and Scientists for Health, Freedom and Democracy’ does not just contain physicians and scientists but also – contrary to its name – simple non-academic loons. And, of course, an important member – the main reason for today blogging about it – it includes SCAM practitioners and – most importantly – Prof Harald Walach who has featured so regularly on this blog.

There has been much discussion recently about the best way to persuade anti-vaxxers to change their minds. As they seem completely resistant to the scientific consensus, this has so far not been an easy task. Many experts tell us that we foremost must not ridicule them. I think the ’10 demands’ show that this is also not necessary because they are so very efficient in doing that themselves.

January 27 is ‘Holocaust Memorial Day’, the day to remember the victims of the Third Reich. So, please allow me to reproduce today a (slightly altered and shortened) paper that I published back in 1996 on the role of the German medical profession in the killing of millions:

 

On January 27, 1945, the concentration camp in Auschwitz was liberated by the Red Army. By May of the same year about 20 more such camps were discovered. Even today, it is hard to understand how so many terrible atrocities could have happened in a cultured country, and, more specifically, under the eyes of a medical profession that belonged to the world’s finest. Here I will try to explain how many of the worst infamies happened with the active help of Germany’s medical profession.

The pseudoscience of “race hygiene” had strong roots. In the second half of the 19th century, “Social Darwinism” had become increasingly popular throughout Europe. This theory assumed that, just as animal species fight for the survival of the fittest, whole nations struggle in a similar fashion. In this process of natural selection, the fittest nation would be the one that is genetically more pure than its neighbors.

Social Darwinism originated from France (Duke Gobinau), England (Francis Galton), and Germany alike. Its German proponents, however, were to expand it significantly: Alfred Ploetz coined the term “race hygiene” (Rassenhygiene) , Ernst Haeckel first considered selection by killing “weaklings,“’ and the physician Fritz Lenz finally formulated his theory of race inequality. Lenz’s works were read by Hitler during his prison sentence in Landsberg (1924 to 1925). They had a great influence on his race politics of the years to come.’ The ingredient of antisemitism had continually been added to “Social Darwinism” and the diabolic result turned out to be race hygiene.

As the word implies, it was essentially a medical issue. Throughout his credo Mein Kampf, Hitler refers to the Jewish race as a bacillus, a parasite, a disease. The propaganda of the Third Reich adopted these medical analogies. The “biological body of the German people” (Volkskoerper) was threatened. The healer was Hitler, who promised to eradicate this assault to the nation’s health once and for all. The Jewish question had been rendered a medical problem, the therapy of which was to be realized in places like Auschwitz and Dachau.

The medical profession promoted the belief that to cure individuals was one thing, but to heal the nation was incomparably more important. Owing to the popularity of Social Darwinism, a long history of antisemitism, and a powerful Nazi propaganda, the majority of the medical profession adopted the ideas of race hygiene. These were subsequently further perverted with applied racism.

Race hygiene had been initially developed by and was later entrusted to the German medical profession. There was shamefully little resistance from organized medicine, and many have wondered why. One answer is that critical peers who could have constituted opposition within the profession had been quickly eliminated. At the Medical Faculty of Vienna, for instance, some 80% of the faculty were dismissed within weeks of the German take-over. The most frequent reason for the dismissal of doctors at all levels was being of Jewish origin. Vacant posts were filled with new staff known not for their medical expertise but for political trustworthiness. Opposition from peers was thus minimal.

Forced sterilization was introduced in order to secure the freedom of the German nation from the threat of contamination by inferior (Jewish) blood. It was legalized through the “law for the prevention of genetically diseased offspring” (Gesetz zur Verhinderung erbkranken Nachwuchs) as early as July 1933, only 5 months after the Nazis came to power. The swift move was possible because of preparatory work performed during the Weimar Republic, much of which was contributed by the medical profession. The law provided that handicapped individuals were to be identified, examined by a jury of experts who had to write a report, and subsequently sterilized. For this purpose, some 200 Genetic Health Courts were instituted. These were empowered to order involuntary sterilization. An estimated 400,000 individuals became victims of these courts.

At this stage, physicians had assumed an executive position within the Nazi state as “delegated judges” and “guardians over the law.“’ When these medical experts’ reports were evaluated after the war, the overwhelming majority were found to be of unacceptable quality and almost all had recommended sterilization. Yet in the minds of leading proponents of race hygiene, the law did not go far enough but created human “ballast” and an economic burden that had to be eliminated by other means. Therefore, the concept of euthanasia was transformed from voluntary assisted death to involuntary, medically supervised killing.

The Nazi euthanasia program started in various specialized medicine departments in 1939. It was a delicate issue even by Nazi standards. Therefore, an attempt was made to keep it a secret. In theory, the program was aimed at eradicating children suffering from “idiocy, Down’s syndrome, hydrocephalus and other abnormalities.” In practice, however, it was sufficient for physicians to fill in the diagnosis “Jew” to effectively issue a death sentence.”

At the end of 1939, the program was extended to adults “unworthy of living.” It is estimated that more than 70,000 predominantly psychiatric patients fell victim to the program. Psychiatrists became concerned about whether there would be enough patients left to keep their specialty alive.” “Action T4” was the Berlin headquarters of the euthanasia program. It was run by approximately 50 volunteer physicians.

Questionnaires were sent to psychiatric and other hospitals urging the physicians in charge to name candidates for euthanasia. In some cases, the inducement was a financial reward. The victims were then transported to specialized centers where they were gassed or poisoned. Action T4 was therefore responsible for supervised murder. Its true significance, however, lies even beyond this horror.

Hitler himself formally discontinued the program on August 24, 1941, following increasing opposition from both the general population and the clergy. But action T4 turned out to be nothing less than a “pilot project” for the extinction of millions in the concentration camps. The T4 units had thus developed the technology for killing on an “industrial scale.” It was only with this technical know-how that the total extinction of all Jews of the expanding Reich could be anticipated. Most importantly, however, this truly monstrous task required medical know-how and reliability. Almost without exception, those physicians who had worked for T4 went on to take charge of what the Nazis called the Final Solution.

While action T4 had killed thousands, its offspring would eliminate millions under the trained guidance of doctors. The role the medical profession played in the atrocities of the Third Reich was therefore critical and essential. German physicians had been involved at all levels and stages. They had developed and accepted the pseudo-science of race hygiene. They were instrumental in developing it further into applied racism. They had evolved the know-how of mass extinction. Finally, they also performed outrageously cruel and criminal experiments under the guise of scientific inquiry.

The aim of generating pure Aryans had taken precedence over the most fundamental ethical issues in medicine. German doctors had betrayed all the ideals medicine had previously embraced and had become involved in criminal activities to an extent and degree that is unprecedented in the entire history of medicine.

Ironically German science suffered the most: 16 of the Jewish refugees were later awarded Nobel prizes. Many of the brightest Jewish figures, formerly involved in German medicine, made invaluable contributions to the healthcare of the United Kingdom, the United States, and other countries.

The memory of what happened during this period should fortify us against similar, future violations. Forced sterilization, and even ethnic cleansing, did not disappear from the world when 7 of the accused Germans were sentenced to death in the Nuremberg Doctor’s Tribunal. Such violations of humanity are a tragic reality even today. Understanding the greatest blot on the record of medicine could and should be a preventive measure. More importantly, perhaps, this story needs to be told and retold to honor those who became its victims.

(References can be found in the original paper)

 

 

PS

Personally, I do not need a ‘memorial day’ for remembering. I believe we must never forget.

Currently, 15.2 percent of German adults have not even had their first COVID vaccination. A long-term study has recently investigated why some Germans do behave in this way.

Researchers from the University of Erfurt surveyed around 1,200 unvaccinated and 2,000 vaccinated people in Germany. Here is a summary of the findings:

  • 74% of the unvaccinated definitely do not want to be vaccinated against Corona
  • 6% are willing to get vaccinated
  • 37 percent of those who have not been vaccinated against Corona do not want to be vaccinated against anything
  • thus, about two-thirds of them are not principled vaccination refusers.

The researchers also asked the unvaccinated Germans about their reasons for deciding against vaccination:

  • 56% of the unvaccinated are afraid of vaccination
  • 64% of these people cite fear of vaccination consequences and side effects as their reason
  • 8% are even afraid of dying from the vaccination
  • 38% of the unvaccinated agree with the statement, “I am proud not to have been vaccinated against Covid-19”, while 60% of the vaccinated agree with the sentence “I am proud to be vaccinated against Covid-19.” Unvaccinated people also have much less trust in the federal government and the Robert Koch Institute than vaccinated people.
  • 86% of the unvaccinated Germans find the current debate unfair, arrogant, and moralizing.

Based on these findings, the researchers recommend that measures to combat the pandemic should focus above all on maintaining the trust of the majority of those who have been vaccinated. The researchers also advise that attention should be paid to respectful and factual communications, especially by VIPs.

Personally, I find the notion that 56% of the unvaccinated are afraid of vaccination the most interesting finding here. It means we need to communicate the safety aspect much better than we have managed so far. As there is good reason to believe that many of the unvaccinated people are proponents of so-called alternative medicine (SCAM) – see for instance here and here – a reasonable strategy should probably include making sure that SCAM practitioners inform their patients correctly and responsibly.

How can this be done?

I am not sure that I know the answer. But I know that there are psychologists who specialize in this sort of thing. It would, I think, be wise to create a multidisciplinary team to tackle the problem. Any solutions that could come out of such an exercise would come too late for the current Omicron wave. But there will be more to come, and we should be better prepared, I feel.

 

Yesterday, my new book arrived on my doorstep.

WHAT JOY!

Its full title is CHARLES, THE ALTERNATIVE PRINCE. AN UNAUTHORISED BIOGRAPHY. I guess that it also clarifies its contents. In case you want to know more, here is the full list of topics:

Foreword by Nick Ross v  Charles, The Alternative Prince: An Unauthorised Biography
1. Why this Book? 1
2. Why this Author? 5
3. Words and Meanings 10
4. How Did It All Start? 13
5. Laurens van der Post 17
6. The British Medical Association 25
7. Talking Health 31
8. Osteopathy 37
9. Chiropractic 43
10. The Foundation of Integrated Health 50
11. Open Letter to The Times 56
12. The Model Hospital 62
13. Integrated Medicine 66
14. The Gerson Therapy 73
15. Herbal Medicine 77
16. The Smallwood Report 82
17. World Health Organisation 90
18. Traditional Chinese Medicine 96
19. The ‘GetWellUK’ Study 100
20. Bravewell 106
21. Duchy Originals Detox Tincture 110
22. Charles’ Letters to Health Politicians 115
23. The College of Medicine and Integrated Health 120
24. The Enemy of Enlightenment 126
25. Harmony 132
26. Antibiotic Overuse 142
27. Ayurvedic Medicine 147
28. Social Prescribing 154
29. Homeopathy 160
30. Final Thoughts 169
Glossary 180
End Notes 187
Index 202

In case you want to know more, here is chapter 1 of my book:

Over the past two decades, I have supported efforts to focus healthcare on the particular needs of the individual patient, employing the best and most appropriate forms of treatment from both orthodox and complementary medicine in a more integrated way.[1]

The Prince of Wales 1997

This is a charmingly British understatement, indeed! Charles has been the most persistent champion of alternative medicine in the UK and perhaps even in the world. Since the early 1980s, he has done everything in his power

  • to boost the image of alternative medicine,
  • to improve the status of alternative practitioners,
  • to make alternative therapies more available to the general public,
  • to lobby that it should be paid for by the National Health Service (NHS),
  • to ensure the press reported favourably about the subject,
  • to influence politicians to provide more support for alternative medicine.

He has fought for these aims on a personal, emotional, political, and societal level. He has used his time, his intuition, his influence, and occasionally his money to achieve his goals. In 2010, he even wrote a book, ‘Harmony’, in which he explains his ideas in some detail[2] (discussed in chapter 25, arguably the central chapter of this biography). Charles has thus become the undisputed champion of the realm of alternative medicine. For that he is admired by alternative practitioners across the globe.

Yet, his relentless efforts are not appreciated by everyone (another British understatement!). There are those who view his interventions as counter-productive distractions from the important and never-ending task to improve modern healthcare. There are those who warn that integrating treatments of dubious validity into our medical routine will render healthcare less efficient. There are those who claim that the Prince’s preoccupation with matters that he is not qualified to fully comprehend is a disservice to public health. And there are those who insist that the role of the heir to the throne does not include interfering with health politics.

  • So, are Charles’ ideas new and exciting?
  • Or are they obsolete and irrational?
  • Has Charles become the saviour of UK healthcare?
  • Or has he hindered progress?
  • Is he a role model for medical innovators?
  • Or the laughing stock of the experts?
  • Is he a successful reformer of healthcare?
  • Or are his concepts doomed to failure?

Charles appears to evade critical questions of this nature. Relying on his intuition, he unwaveringly pursues and promotes his personal beliefs, regardless of the evidence (Box 1). He believes strongly in his mission and is, as most observers agree, full of good intentions. If he even notices any criticism, it is merely to reaffirm his resolve and redouble his efforts. He is reported to work tirelessly, and one could easily get the impression that he is obsessed with his idea of integrating alternative medicine into conventional healthcare.

I have observed Charles’ efforts around alternative medicine for the last 30 years. Occasionally, I was involved in some of them. For 19 years, I have headed the world’s most productive team of researchers in alternative medicine. This background puts me in a unique position to write this account of Charles’ ‘love affair’ with alternative medicine. It is not just a simple outline of Charles’ views and actions but also a critical analysis of the evidence that does or does not support them. In writing it, I pursue several aims:

    1. I want to summarise this part of medical history, as it amounts to an important contribution to the recent development of alternative medicine in the UK and beyond.
    2. I hope to explain how Charles and other enthusiasts of alternative medicine think, what motivates them and what logic they follow.
    3. I will contrast Charles’ beliefs with the published evidence as it pertains to each of the alternative modalities (treatments and diagnostic methods) he supports.
    4. I want to stimulate my readers’ ability to think critically about health in general and alternative medicine in particular.

My book will thus provide an opportunity to weigh the arguments for and against alternative medicine. In that way, it might even provide Charles with a substitute for a discussion about his thoughts on alternative medicine which, during almost half a century, he so studiously managed to avoid.

In pursuing these aims there are also issues that I hope to avoid. From the start, I should declare an interest. Charles and I once shared a similar enthusiasm for alternative medicine. But, as new evidence emerged, I changed my mind and he did not. This led to much-publicised tensions and conflicts. Yet it would be too easy to dismiss this book as an act of vengeance. It isn’t. I have tried hard to be objective and dispassionate, setting out Charles’ claims as fairly as I can and comparing them with the most reliable evidence. As much as possible:

    1. I do not want my personal discords with Charles to get in the way of objectivity.
    2. I do not want to be unfairly dismissive of Charles and his ambitions.
    3. I do not want to be disrespectful about anyone’s deeply felt convictions.
    4. I do not aim to weaken the standing of our royal family.

My book follows Charles’ activities in roughly chronological order. Each time we encounter a new type of alternative medicine, I will try to contrast Charles’ perceptions with the scientific evidence that was available at the time. Most chapters of this book are thus divided into four parts

    1. A short introduction
    2. Charles’ views
    3. An outline of the evidence
    4. A comment about the consequences

While writing this book, one question occurred to me regularly: Why has nobody so far written a detailed history of Charles’s passion for alternative medicine? Surely, the account of Charles ‘love affair’ with alternative medicine is fascinating, diverse, revealing, and important!

I hope you agree.

BOX 1

The nature of evidence in medicine and science

  • Evidence is the body of facts, often created through experiments under controlled conditions, that lead to a given conclusion.
  • Evidence must be neutral and give equal weight to data that fail to conform to our expectations.
  • Evidence is normally used towards rejecting or supporting a hypothesis.
  • In alternative medicine, the most relevant hypotheses often relate to the efficacy of a therapy.
  • Such hypotheses are best tested with controlled clinical trials where a group of patients is divided into two subgroups and only one is given the therapy to be tested; subsequently the results of both groups are compared.
  • Experience does not amount to evidence and is a poor indicator of efficacy; it can be influenced by several phenomena, e.g. placebo effects, natural history of the condition, regression towards the mean.
  • If the results of clinical studies are contradictory, the best available evidence is usually a systematic review of the totality of rigorous trials.
  • Systematic reviews are methods to minimise random and selection biases. The most reliable systematic reviews are, according to a broad consensus, those from the Cochrane Collaboration.

[1] https://www.princeofwales.gov.uk/speech/article-hrh-prince-wales-titled-science-and-homeopathy-must-work-harmony-daily-telegraph

[2] https://www.amazon.co.uk/Harmony-New-Way-Looking-World/dp/0007348037

In case you want to know even more – and I hope you do – please get yourself a copy.

On this blog and elsewhere, I have heard many strange arguments against COVID-19 vaccinations. I get the impression that most proponents of so-called alternative medicine (SCAM) hold or sympathize with such notions. Here is a list of those arguments that have come up most frequently together with my (very short) comments:

COVID is not dangerous

It’s just a flu and nothing to be really afraid of, they say. Therefore, no good reason exists for getting vaccinated. This, I think, is easily countered by pointing out that to date about 5.5 million people have died of COVID-19. In addition, I fear that the issues of ‘long-COVID’ is omitted in such discussions

It’s only the oldies who die

As an oldie myself, I find this argument quite distasteful. More importantly, it is simply not correct.

Vaccines don’t work

True they do not protect us 100% from the infection. But they very dramatically reduce the likelihood of severe illness or death from COVID-19.

Vaccines are unsafe

We have now administered almost 10 billion vaccinations worldwide. Thus we know a lot about the risks. In absolute terms, there is a vast amount of cases, and it would be very odd otherwise; just think of the rate of nocebo effects that must be expected. However, the risks are mostly minor, and serious ones are very rare. Some anti-vaxxers predicted that, by last September, the vaccinated population would be dead. This did not happen, did it? The fact is that the benefits of these vaccinations hugely outweigh the risks.

Vaccines are a vicious tracking system

Some claim that ‘they‘ use vaccines to be able to trace the vaccinated people. Who are ‘they‘, and why would anyone want to trace me when my credit card, mobile phone, etc. already could do that?

Vaccines are used for population control

They‘ want to reduce the world population through deadly vaccines to ~5 billion, some anti-vaxxers say. Again, who are ‘they‘ and would ‘they‘ want to do that? Presumably ‘they‘ need us to pay taxes and buy their goods and services.

There has not been enough research

If those who make this argument would bother to go on Medline and look for COVID-related research, they might see how ill-informed this argument is. Since 2021, more than 200 000 papers on the subject have emerged.

I trust my immune system

This is just daft. I am triple-vaccinated and also hope that I can trust my immune system – this is why I got vaccinated in the first place. Vaccinations rely on the immune system to work.

It’s all about making money

Yes, the pharma industry aims to make money; this is a sad reality. But does that really mean that their products are useless? I don’t see the logic here.

People should have the choice

I am all for it! But if someone’s poor choice endangers my life, I do object. For instance, I expect other people not to smoke in public places, stop at red traffic lights and drive on the correct side of the street.

Most COVID patients in hospitals have been vaccinated

If a large percentage of the population has been vaccinated and the vaccine conveys not 100% protection, it would be most surprising, if it were otherwise.

I have a friend who…

All sorts of anecdotes are in circulation. The thing to remember here is that the plural of anecdote is anecdotes and not evidence.

SCAM works just as well

Of course, that argument had to be expected from SCAM proponents. The best response here is this: SHOW ME THE EVIDENCE! In response SCAM fans have so far only been able to produce ‘studies’ that are unconvincing or outright laughable.

In conclusion, the arguments put forward by anti-vaxxers or vaccination-hesitant people are rubbish. It is time they inform themselves better and consider information that originates from outside their bubble. It is time they realize that their attitude is endangering others.

 

Cupping is a so-called alternative medicine (SCAM) that has been around for millennia in many cultures. We have discussed it repeatedly on this blog (see, for instance, here, here, and here). This new study tested the effects of dry cupping on pain intensity, physical function, functional mobility, trunk range of motion, perceived overall effect, quality of life, psychological symptoms, and medication use in individuals with chronic non-specific low back pain.

Ninety participants with chronic non-specific low back pain were randomized. The experimental group (n = 45) received dry cupping therapy, with cups bilaterally positioned parallel to the L1 to L5 vertebrae. The control group (n = 45) received sham cupping therapy. The interventions were applied once a week for 8 weeks.

Participants were assessed before and after the first treatment session, and after 4 and 8 weeks of intervention. The primary outcome was pain intensity, measured with the numerical pain scale at rest, during fast walking, and during trunk flexion. Secondary outcomes were physical function, functional mobility, trunk range of motion, perceived overall effect, quality of life, psychological symptoms, and medication use.

On a 0-to-10 scale, the between-group difference in pain severity at rest was negligible: MD 0.0 (95% CI -0.9 to 1.0) immediately after the first treatment, 0.4 (95% CI -0.5 to 1.5) at 4 weeks and 0.6 (95% CI -0.4 to 1.6) at 8 weeks. Similar negligible effects were observed on pain severity during fast walking or trunk flexion. Negligible effects were also found on physical function, functional mobility, and perceived overall effect, where mean estimates and their confidence intervals all excluded worthwhile effects. No worthwhile benefits could be confirmed for any of the remaining secondary outcomes.

The authors concluded that dry cupping therapy was not superior to sham cupping for improving pain, physical function, mobility, quality of life, psychological symptoms or medication use in people with non-specific chronic low back pain.

These results will not surprise many of us; they certainly don’t baffle me. What I found interesting in this paper was the concept of sham cupping therapy. How did they do it? Here is their explanation:

For the experimental group, a manual suction pump and four acrylic cups size one (internal diameter = 4.5 cm) were used for the interventions. The cups were applied to the lower back, parallel to L1 to L5 vertebrae, with a 3-cm distance between them, bilaterally. The dry cupping application consisted of a negative pressure of 300 millibars (two suctions in the manual suction pump) sustained for 10 minutes once a week for 8 weeks.

In the control group, the exact same procedures were used except that the cups were prepared with small holes < 2 mm in diameter to release the negative pressure in approximately 3 seconds. Double-sided adhesive tape was applied to the border of the cups in order to keep them in contact with the participants’ skin.

So, sham-controlled trials of cupping are doable. Future trialists might now consider the inclusion of testing the success of patient-blinding when conducting trials of cupping therapy.

For my last post of the year 2021, I take the liberty to borrow parts of a BMJ editorial entitled A NEW YEAR’S RESOLUTION OF HEALTH WORKERS:

The prospect of a return to normality seems within reach. But what will that normality look like? We believe that health workers, who have been at the frontline of the pandemic, must offer a vision of a healthier future. We must not let the terrible events of this year recast the pre-pandemic world in a glowing light. The normality we departed from at the onset of the pandemic was unjust, unsustainable, and shaped the evolution of, and responses to, the pandemic with devastating consequences, particularly for the most deprived and vulnerable.

The start of a new year offers an opportunity to question old ways of working and to ask how we can create a better future for everyone. It is a cliché to say that you should never waste a crisis. Just as in wartime and in the global financial crisis, many have profited greatly from the pandemic, whether as providers of online services or by taking advantage of the rush to procure essential goods such as personal protective equipment.

But many were far less fortunate, living in circumstances that rendered them vulnerable to an infection that spread especially rapidly through communities where successive generations had been living ever more precarious lives. As the recovery begins, the powerful groups who benefited from the social and economic systems that created those conditions will, once again, seek to shape the world to their advantage. Health workers cannot remain silent. They must offer a compelling vision of how we should reconfigure the world so that it produces and sustains health for all, resilient in the face of future threats…

A country navigating the pandemic is like a ship navigating treacherous and unpredictable waters in a storm. If the ship, its crew, and its passengers are to come through the experience unscathed it needs three things. First, it needs an experienced captain who understands the ship and commands the trust of the crew. Unfortunately, in some of the countries worst affected, captains were either away from the bridge, denied there was a storm, or had lost the trust of those on whom they depended.

Second, it needs a crew that is adequate for the size of the ship, that is well trained, and that is working as a team to achieve the same goal. Yet in too many countries, skeleton crews were working in health systems that were highly fragmented. Dissenting voices who raise the alarm about the integrity of the ship, the working of the team, or its leadership must not be silenced or lives can be lost. It also needs passengers who are as seaworthy as possible so that they can withstand the storm. One of the sentinel challenges of covid-19 was finding large segments of the population weighted by a disproportionate burden of preventable disease that predisposed them to severe covid-19 once infected.

Third, we need a ship that is securely constructed. Yet in many of the countries that have fared worst, we have been working in vessels that are full of holes. Social safety nets have been ripped asunder, allowing too many people to fall through the holes. We have made many demands on our people—to stay at home, to face loss of income—and we have added greater uncertainty to what were already difficult situations, particularly for certain racially and economically marginalised groups. The disproportionate exposure to covid-19 of many in these groups—a consequence of precarious jobs and social circumstances that denied them the luxury of social distancing—drove, in large part, the high burden of covid-19 among minority and marginalised groups worldwide.

As we look to the prospect of a covid-19 secure future, with effective vaccines, new treatments, and continued countermeasures as necessary, we must ask how we can strengthen the foundations of our societies, coming together to repair the torn safety nets. We must never be afraid to challenge our political leaders when they are going in the wrong direction, and we must insist that they really are guided by the science, and not just those bits that support their beliefs. And we must ensure that our fellow citizens are as healthy as possible so they can withstand the inevitable storms that lie ahead. We must insist that our health systems and other public systems are adequately staffed, with the tools needed to do the job, with teams that are working together, pulling in the same direction. If we do all this, then we, and the populations we serve, can be confident that we can weather any future storms.

___________________________

The editorial was written by 4 authors:

  1. Martin McKee, professor of European public health
  2. May C I van Schalkwyk, NIHR doctoral research fellow
  3. Nason Maani, assistant professor in public health evaluation
  4. Sandro Galea, dean

I think it is most sensible and thought-provoking and I suspect many of us agree with its sentiments. If it did not make you think, perhaps this information will do so:

The editorial was published one year ago in the Christmas issue of the BMJ

2020!

Yes, 2021 has disappointed many of our hopes and turned out to be a difficult year.

I wish us all that 2022 will be better, much better.

THE GUARDIAN published an interesting article about vaccination hesitancy yesterday. Here is a short passage from it:

One major missing piece of the puzzle, currently under consideration, is a strategy that gets to the bottom of why 5 million people remained unvaccinated, especially those in communities with an ingrained distrust of authority.

No 10 even turned to an artificial intelligence (AI) company earlier in the year to determine the causes of vaccine hesitancy, but Whitehall sources acknowledge there is still a lack of understanding about how many of the unvaccinated remain so because of entrenched anti-vax ideology, misconceptions that could be turned around, a lack of time or transport to get to vaccine centres, or just apathy.

Yesterday, it was also reported in DER STANDARD that the Austrian Science Minister Martin Polaschek has commissioned a study from Statistics Austria, which for the first time was to look at the vaccination status of the population according to socio-economic characteristics.

The study yielded fascinating findings that might shed some light on the phenomenon of ‘entrenched anti-vax ideology’:

  • Across all age groups, the proportion of vaccinated persons, including recovered persons, is 67%.
  • Slightly less than four percent of the population are only recovered, and about 30% are neither one nor the other.
  • There are no marked differences between men and women.
  • The willingness to vaccinate is strongly related to the level of education.
  • The vaccination rate in the group of 25-64 year-olds with a university degree is about 84% and thus significantly higher than among those who have only basic education (68%).
  • In this age group, it also seems important whether someone has a job (76%) or not (69%).
  • People employed in the information and communication sector (85%) and public administration (83%) are the most likely to be vaccinated.
  • Workers in agriculture and forestry (67%) and construction (65%) are the least likely to accept vaccinations.
  • Health and social services personnel have a vaccination rate of 79%.
  • More than half of the 600,000 schoolchildren had already been vaccinated, and in the upper secondary school it was even 72%.
  • The rate among teachers is also high, at 85%.
  • 86% of the approximately 395,000 students at universities had been vaccinated.
  • As 92% of all medical students were vaccinated.
  • The vaccination rate among Austrian nationals, at about 70%, is clearly higher than that of people without an Austrian passport (52%).
  • The difference between those born in Austria and those not born in Austria is only five percentage points.
  • The willingness to be vaccinated is higher among people from Turkey (73%) than among those born in Austria (68%).
  • Among Germans and Afghans, it is around 72%.
  • People from Romania (43%) and the Russian Federation (45%) have the lowest vaccination rates.
  • The percentage of vaccinated people is highest among those between 75 and 84 years.

Similar findings have, of course, been reported from other countries. However, what seems new to me here is the finding that vaccination rates are strongly correlated to the level of education: the anti-vax brigade tends to be uneducated and ignorant. If confirmed, this suggests that education might be a way to make them accept vaccinations.

PS

Of course, correlation is not causality. But there seems to be a dose-response relationship between education and willingness to vaccinate. This makes a causal effect more likely.

 

Image

THOSE WHO KNOW NOTHING MUST BELIEVE EVERYTHING

 

 

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