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

regulation

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The over-use of X-ray diagnostics by chiropractors has long been a concern (see for instance here,and here). As there is a paucity of reliable research on this issue, this new review is more than welcome.

It aimed to summarise the current evidence for the use of spinal X-ray in chiropractic practice, with consideration of the related risks and benefits. The authors, chiropractors from Australia and Canada who did a remarkable job in avoiding the term SUBLUXATION throughout the paper, showed that the proportion of patients receiving X-ray as a result of chiropractic consultation ranges from 8 to 84%. I find this range quite staggering and in need of an explanation.

The authors also stated that current evidence supports the use of spinal X-rays only in the diagnosis of trauma and spondyloarthropathy, and in the assessment of progressive spinal structural deformities such as adolescent idiopathic scoliosis. MRI is indicated to diagnose serious pathology such as cancer or infection, and to assess the need for surgical management in radiculopathy and spinal stenosis. Strong evidence demonstrates risks of imaging such as excessive radiation exposure, over-diagnosis, subsequent low-value investigation and treatment procedures, and increased costs. In most cases the potential benefits from routine imaging, including spinal X-rays, do not outweigh the potential harms. The authors state that the use of spinal X-rays should not be routinely performed in chiropractic practice, and should be guided by clinical guidelines and clinician judgement.

The problem, however, is that many chiropractors do not abide by those guidelines. The most recent data I am aware of suggests that  only about half of them are even aware of radiographic guidelines for low back pain. The reasons given for obtaining spinal X-rays by chiropractors are varied and many are not supported by evidence of benefit. These include diagnosis of pathology or trauma; determination of treatment options; detection of contraindications to care; spinal biomechanical analysis; patient reassurance; and medicolegal reasons.

One may well ask why chiropractors over-use X-rays. The authors of the new paper provide the following explanations:

  • lack of education,
  • ownership of X-ray facilities,
  • and preferred chiropractic technique modalities (i. e. treatment techniques which advocate the use of routine spinal X-rays to perform biomechanical analysis, direct appropriate treatment, and perform patient reassessment).

Crucially, the authors state that, based on the evidence, the use of X-ray imaging to diagnose benign spinal findings will not improve patient outcomes or safety. For care of non-specific back or neck pain, studies show no difference in treatment outcome when routine spinal X-rays have been used, compared to management without X-rays.

A common reason suggested by chiropractors for spinal X-ray imaging is to screen for anomalies or serious pathology that may contraindicate treatment that were otherwise unsuspected by the clinical presentation. While some cases of serious pathology, such as cancer and infection, may not initially present with definitive symptoms, X-ray assessment at this early stage of the disease process is also likely to be negative, and is not recommended as a screening tool.

The authors concluded that the use of spinal X-rays in chiropractic has been controversial, with benefits for the use of routine spinal X-rays being proposed by some elements of the profession. However, evidence of these postulated benefits is limited or non-existent. There is strong evidence to demonstrate potential harms associated with spinal X-rays including increased ionising radiation exposure, over-diagnosis, subsequent low-value investigation and treatment procedures, and increased unnecessary costs. Therefore, in the vast majority of cases who present to chiropractors, the potential benefit from spinal X-rays does not outweigh the potential harms. Spinal X-rays should not be performed as a routine part of chiropractic practice, and the decision to perform diagnostic imaging should be informed by evidence based clinical practice guidelines and clinician judgement.

So, if you consult a chiropractor – and I don’t quite see why you should – my advice would be not to agree to an X-ray.

According to the 2014 European Social Survey, Spain is relatively modest when it comes to using alternative therapies. While countries such as Austria, Denmark, Estonia, Finland, France, Germany, Lithuania, Sweden and Switzerland all have 1-year prevalence figures of over 30%, Spain only boasts a meagre 17%. Yet, its opposition to bogus treatments has recently become acute.

In 2016, it was reported that a master’s degree in homeopathic medicine at one of Spain’s top universities has been scrapped. Remarkably, the reason was “lack of scientific basis”. A university spokesman confirmed the course was being discontinued and gave three main reasons: “Firstly, the university’s Faculty of Medicine recommended scrapping the master’s because of the doubt that exists in the scientific community. Secondly, a lot of people within the university – professors and students across different faculties – had shown their opposition to the course. Thirdly, the postgraduate degree in homeopathic medicine is no longer approved by Spain’s Health Ministry.”

A few weeks ago, I had the great pleasure of being invited to a science festival in Bilbao and was impressed by the buoyant sceptic movement in Spain. At the time, two of my books were published in Spanish and received keen interest by the Spanish press.

 

And now, it has been reported that Spain’s Ministry of Health has released a list of only 2,008 homeopathic products whose manufacturers will have to apply for an official government license for if they wish to continue selling them. The homeopathic producers have until April 2019 to prove that their remedies actually work, which may very well completely slash homeopathic products in Spain.

It’s the latest blow for Spain’s homeopathy industry, once worth an estimated €100 million but which has seen a drop in public trust and therefore sales of around 30 percent in the last five years. Spain’s Health Ministry stopped allowing homeopathy treatments from being prescribed as part of people’s social security benefits, along with acupuncture, herbal medicine and body-based practices such as osteopathy, shiatsu or aromatherapy.

“Homeopathy is an alternative therapy that has not shown any scientific evidence that it works” Spanish Minister of Health Maria Luisa Carcedo is quoted as saying in La Vanguardia in response to the homeopathic blacklist. “I’m committed to combatting all forms of pseudoscience.”

Even though illegal and unethical, many remedies used in Traditional Chinese Medicine (TCM) still contain animal parts. This fact has long concerned critics. Not only is there no evidence that these ingredients have any positive health effects, they also endanger the survival of endangered species. In the past, China has paid lip service to conservation and evidence. However, even these half-hearted pronouncements seem to be a thing of the past.

China’s State Council is now replacing its 1993 ban on the trade of tiger bones and rhino horn. Horns of rhinos or bones of tigers that were bred in captivity can hence force be used “for medical research or clinical treatment of critical illnesses” under the new rules. The fact that no critical illness responds to either of these remedies seems to matter little.  Grave concern has therefore been voiced by the World Wildlife Fund (WWF) over China’s announcement.

“It is deeply concerning that China has reversed its 25 year old tiger bone and rhino horn ban, allowing a trade that will have devastating consequences globally”, said Margaret Kinnaird, WWF Wildlife Practice Leader. “Trade in tiger bone and rhino horn was banned in 1993. The resumption of a legal market for these products is an enormous setback to efforts to protect tigers and rhinos in the wild. China’s experience with the domestic ivory trade has clearly shown the difficulties of trying to control parallel legal and illegal markets for ivory. Not only could this lead to the risk of legal trade providing cover to illegal trade, this policy will also stimulate demand that had otherwise declined since the ban was put in place.”

Both tiger bone and rhino horn were removed from the TCM pharmacopeia in 1993, and the World Federation of Chinese Medicine Societies released a statement in 2010 urging members not to use tiger bone or any other parts from endangered species. Even if restricted to antiques and use in hospitals, the WWF argue, this trade would increase confusion by consumers and law enforcers as to which products are and are not legal, and would likely expand the markets for other tiger and rhino products. “With wild tiger and rhino populations at such low levels and facing numerous threats, legalized trade in their parts is simply too great a gamble for China to take. This decision seems to contradict the leadership China has shown recently in tackling the illegal wildlife trade, including the closure of their domestic ivory market, a game changer for elephants warmly welcomed by the global community,” Kinnaird added.

WWF calls on China to set a clear plan and timeline to close existing captive tiger breeding facilities used for commercial purposes. Such tiger farms pose a high risk to wild tiger conservation by complicating enforcement and increasing demand in tiger products.

China’s announcement comes at the precise moment when we learnt from the 2018 edition of the Living Planet Report that, between 1970 and 2014, there was 60% decline, on average, among 16,700 wildlife populations around the world. The Living Planet report, issued every two years to track global biodiversity, is based on the Living Planet Index, put out every two years since 1998 in collaboration with the Zoological Society of London and based on international databases of wildlife populations. The two previous reports, in 2014 and 2016, found wildlife population declines of 50% and 58%, respectively, since 1970.

Samuel Hahnemann invented homeopathy about 200 years ago. His placebos were better than (or not as bad as) the ‘heroic’ medicine of his time which frequently was more dangerous than the disease it aimed to cure. Thus, homeopathy took Germany by storm. When, about 100 years ago, medicine finally became scientific and was able to offer more and more effective treatments, the popularity of homeopathy began to wane. Yet, before its natural demise, during the Third Reich, it received a significant boost from Nazi-greats such as Hess and Himmler. After this nightmare was over, German homeopathy went into another slow decline. But when the New Age movement and the current boom in alternative medicine reached Germany, homeopathy seemed to thrive once again.

In the 1990s evidence-based medicine (EBM) grew into one of the central concepts of medicine. In Germany, however, EBM had a relatively hard time to get established. This might be one of the reasons why homeopathy continued to prosper, despite the arrival of ever clearer evidence that highly diluted homeopathic remedies are pure placebos. While, in the UK, we had an increasingly lively debate about the uselessness of homeopathy, Germany remained the promised land of homeopathy. Sales figures of homeopathics continued to increase steadily and reached a level of about half a billion Euros per annum.

The golden age of German homeopathy had dawned:

  • The media, often sponsored by homeopathic interest groups, kept on promoting homeopathy largely unopposed.
  • The mighty Carstens Stiftung worked tirelessly to promote it.
  • Homeopathy became established in many medical schools.
  • Homeopathy was available and often advertised in almost all pharmacies.
  • The public was convinced that homeopathy worked.
  • The Heilpraktiker adopted homeopathy fully.
  • The medical and other conventional healthcare professions embraced it to a large degree.
  • The adult education institutes (Volkshochschulen) offered courses.
  • Politicians were squarely on the side of homeopathy,
  • Health insurances, paid for it.

Of course, there were also some (and always had been) opposing voiced and organisations, such as the GWUP (the German sceptic organisation), for example. But somehow, they remained relatively low-key. When, every now and then, courageous journalists dared to think of a critical take on homeopathy, they had to search far and wide to find a German-speaking expert who was willing or able to tell them the truth: that homeopathy is neither biologically plausible nor evidence-based and therefore an expensive, potentially harmful waste of money that makes a mockery of EBM. During this period, journalists (far too) often asked me for some critical comments. I hardly ever published my research in German, but they nevertheless would find me via my Medline-listed papers. I often felt like a very lone voice in a German desert.

For the German homeopathic industry, I evidently was more than just a lone voice. Unbeknown to me, they clubbed together and financed a PR-man/journalist (at the tune of Euro 30 000/year) to write as many defamatory articles about me as he could muster. First, I was bewildered by his activity, then I tried to communicate with him (only to get mis-quoted), and eventually I ignored his writings. Yet, a German investigative journalist found Fritzsche’s one-sided activities offensive and started investigating. His research and subsequent article disclosed the fact that he was being paid by the homeopathic industry. Once I learn about this scandal, I wrote to some of the financiers directly and asked for an explanation. As a result, they discontinued their sponsorship. Shortly afterwards, Fritzsche committed suicide.

At heart, I have always been an optimist and strongly believe that in medicine the truth, in this case the evidence, will always prevail, no matter what obstacles others might put in its way. Recent developments seem to suggest that I might be right.

In the last few years, several individuals in Germany have, from entirely different angles, taken a fresh look at the evidence on homeopathy and found it to be desperately wanting. Independent of each other, they published articles and books about their research and insights. Here are 5 examples:

Die Homöopathie-Lüge: So gefährlich ist die Lehre von den weißen KügelchenChristian Weymayr, Nicole Heißmann, 2012

In Sachen Homöopathie: Eine Beweisaufnahme, Norbert Aust, 2013

Homöopathie neu gedacht: Was Patienten wirklich hilft, Natalie Grams, 2015

Der Glaube an die Globuli: Die Verheißungen der HomöopathieNorbert Schmacke, Bernd Hontschik, 2015

Der wahrscheinlich teuerste Zucker der Welt: Was Sie über Homöopathie und Alternativmedizin wissen sollten, Oliver Grunau, 2017

Inevitably, these individuals came into contact with each other and subsequently founded several working-groups to discuss their concerns and coordinate their activities. Thus the INH and the Muensteraner Kreis were born. So, now we have at least three overlapping groups of enthusiastic, multidisciplinary experts who voluntarily work towards informing the German public that paying for homeopathy out of public funds is unethical, nonsensical and not in the interest of progress:

  • the GWUP,
  • the INH
  • and the Muensteraner Kreis.

No wonder then, that the German homeopathic industry and other interested parties got worried. When they realised that (presumably due to the work of these altruistic enthusiasts) the sales figures of homeopathics in Germany had, for the first time since many years, started declining, they panicked.

Their reaction was, as far as I can see, similar to their previous response to criticism: they started a media campaign in an attempt to sway public opinion. And just like before, they have taken to employing PR-people who currently spend their time defaming all individuals voicing criticism of homeopathy in Germany. Their prime targets are those experts who are most exposed to activities of responsibly informing the public about homeopathy via lectures, publications social media, etc. All of us currently receive floods of attack, insults and libellous defamations. As before (innovation does not seem to be a hallmark of homeopathy), these attacks relate to claims that:

  • we are incompetent,
  • we do not care about the welfare of patients,
  • we are habitual liars,
  • we are on the payroll of the pharmaceutical industry,
  • we aim at limiting patient choice,
  • we do what we do because we crave the limelight.

So, what is going to happen?

I cannot read tea leaves but am nevertheless sure of a few things:

  • The German homeopathy lobby will not easily give up; after all, they have half a billion Euros per year to lose.
  • They will not argue on the basis of science or evidence, because they know that neither are in their favour.
  • They will fight dirty and try to defame everyone who stands in their way.
  • They will use their political influence and their considerable financial power.

AND YET THEY WILL LOSE!

Not because we are so well organised or have great resources – in fact, as far as I can see, we have none – but because, in medicine, the evidence is invincible and will eventually prevail. Progress might be delayed, but it cannot be halted by those who cling to an obsolete dogma.

The UK Royal Pharmaceutical Society have published a quick reference guide on homeopathy. In it, they make the following 5 ‘key points’:

  • The Royal Pharmaceutical Society (RPS) does not endorse homeopathy as a form of treatment because there is no scientific basis for homeopathy nor any evidence to support the clinical efficacy of homeopathic products beyond a placebo effect.
  • The RPS does not support the prescribing of homeopathic products on the NHS.
  • Pharmacists should ensure, wherever possible, that patients do not stop taking their prescribed conventional medication, if they are taking or are considering taking a homeopathic product.
  • Pharmacists must be aware that patients requesting homeopathic products may have serious underlying undiagnosed medical conditions which may require referral to another healthcare professional.
  • Pharmacists must advise patients considering a homeopathic product about their lack of efficacy beyond that of a placebo.

This publication is a few months old, but I only saw it recently. It could not be clearer and it is much more to the point than the General Pharmaceutical Council’s ‘Standards for Pharmacy Professionals‘ which state:

People receive safe and effective care when pharmacy professionals reflect on the application of their knowledge and skills and keep them up-to-date, including using evidence in their decision making. A pharmacy professional’s knowledge and skills must develop over the course of their career to reflect the changing nature of healthcare, the population they provide care to and the roles they carry out. There are a number of ways to meet this standard and below are examples of the attitudes and behaviours expected.

People receive safe and effective care when pharmacy professionals:

  • recognise and work within the limits of their knowledge and skills, and refer to others when needed
  • use their skills and knowledge, including up-to-date evidence, to deliver care and improve the quality of care they provide
  • carry out a range of continuing professional development (CPD) activities relevant to their practice
  • record their development activities to demonstrate that their knowledge and skills are up to date
  • use a variety of methods to regularly monitor and reflect on their practice, skills and knowledge

The two statements together should suffice to finally get some sense into UK pharmacies when it comes to the sale of homeopathic remedies. What is needed now, I think, is an (under-cover?) investigation to see how many UK community pharmacists abide by this guidance.

If anyone has the means to conduct it, I would be delighted to advise them on the best methodology.

On 4 September 2018, during the FIP (78th FIP World Congress of Pharmacy and Pharmaceutical Sciences), a meeting took place intended to give an opportunity to practising pharmacists to voice their opinions on the question whether pharmacies should stop selling homeopathic products. Attendees were provided with voting materials to allow them to express their views in a spontaneous and powerful manner, and for FIP to ascertain genuine opinions about this important matter. The debate and subsequent voting is likely to influence FIP policymaking and statement formulation. Here is the outline of the meeting:

The Great Debate – The motion “Pharmacists should not sell or dispense homeopathic products”

12:30 – 12:34 Introduction by the chairs

  1. 12:34 – 12:57 For the motion
    Geoff Tucker (University of Sheffield, UK)
  2. 12:57 – 13:20 Against the motion
    Christine Glover (Glover’s Integrated Healthcare, UK)
  3. 13:20 – 13:25 Ethical considerations related to homeopathy
    Betty Chaar (The University of Sydney, Australia)
  4. 13:25 – 13:35 Responses and summary
    Facilitator: Andy Gray (University of KwaZulu Natal, South Africa)

    1. Against the motion
      Christine Glover (Glover’s Integrated Healthcare, UK)
    2. For the motion
      Geoff Tucker (University of Sheffield, UK)
  1. 13:35 -14:00 Open forum – Questions from the audience with speakers and chairs as panel/ Vote and concluding comments

The German ‘Pharmazeutische Zeitung‘ just published a report about the outcome of the meeting:

“Bei der Abstimmung im Anschluss sprachen sich fast zwei Drittel der im Auditorium anwesenden Pharmazeuten gegen eine Distribution von homöopathischen Produkten durch Apotheken aus. Mehr als ein Drittel stimmte für den Erhalt der Produkte in den Apotheken. Das Ergebnis habe keine bindende Wirkung für den Entscheidungsprozess des FIP, machte der Moderator der Sitzung, Andy Gray von der Universität KwaZulu Natal in Südafrika, deutlich. Es gebe aber einen Hinweis, in welche Richtung sich die Organisation orientieren sollte. (ch).”

In plain English: two thirds voted for the motion and against homeopathic products remaining on sale in pharmacies. The vote has, however, no binding effect on FIP policy. It is nevertheless likely to determine the direction in which FIP will decide.

I think this is long-overdue (I have been trying to persuade pharmacists to do something like this since ~15 years). I now applaud the FIP for raising the issue. Bravo!

What next?

The vote needs to be translated into policy.

Other healthcare professionals – not least doctors – must follow suit.

If you thought that Chinese herbal medicine is just for oral use, you were wrong. This article explains it all in some detail: Injections of traditional Chinese herbal medicines are also referred to as TCM injections. This approach has evolved during the last 70 years as a treatment modality that, according to the authors, parallels injections of pharmaceutical products.

The researchers from China try to provide a descriptive analysis of various aspects of TCM injections. They used the the following data sources: (1) information retrieved from website of drug registration system of China, and (2) regulatory documents, annual reports and ADR Information Bulletins issued by drug regulatory authority.

As of December 31, 2017, 134 generic names for TCM injections from 224 manufacturers were approved for sale. Only 5 of the 134 TCM injections are documented in the present version of Ch.P (2015). Most TCM injections are documented in drug standards other than Ch.P. The formulation, ingredients and routes of administration of TCM injections are more complex than conventional chemical injections. Ten TCM injections are covered by national lists of essential medicine and 58 are covered by China’s basic insurance program of 2017. Adverse drug reactions (ADR) reports related to TCM injections account for  over 50% of all ADR reports related to TCMs, and the percentages have been rising annually.

The authors concluded that making traditional medicine injectable might be a promising way to develop traditional medicines. However, many practical challenges need to be overcome by further development before a brighter future for injectable traditional medicines can reasonably be expected.

I have to admit that TCM injections frighten the hell out of me. I feel that before we inject any type of substance into patients, we ought to know as a bare minimum:

  • for what conditions, if any, they have been proven to be efficacious,
  • what adverse effects each active ingredient can cause,
  • with what other drugs they might interact,
  • how reliable the quality control for these injections is.

I somehow doubt that these issues have been fully addressed in China. Therefore, I can only hope the Chinese manufacturers are not planning to export their dubious TCM injections.

The ‘Healing Revolution’ began, according to BIO KING’s website, more than 25 years ago with the establishment of King Bio. Its founder, Dr. Frank King, was inspired to find the root causes of illness and empower the whole person. He cultivated an interest in developing pure water-based homeopathic medicines – a type of natural product that was not, to his knowledge, being produced anywhere else. Committed to researching and developing this new homeopathic medicine, Dr. King moved to Asheville, North Carolina, and opened King Bio in 1989. For more than 25 years, King Bio’s mission has remained true to the empowerment of whole person health, most recently including breakthroughs in whole food dietary supplements. Dr. King’s vision for the company has always centered around three core guiding principles: health, wholeness, and innovation.

On their website, BIO KING also explains: Homeopathy … is energy medicine. Rather than going through digestion, homeopathic remedies deliver their messages almost instantly along the body’s nerve pathways. Like acupuncture, it works bioenergetically (“bio” means “life,” so “bioenergetic” means “life energy”). If the biochemical aspects of the body are like the building blocks of a home, bioenergy is like the invisible electricity that powers it. (A deceased person may have the same biochemical constituents as a living person, but the bioenergy is missing.)

BIO KING is on a mission! To be precise, the mission, as stated on the website, is this:

  • To provide safe, all-natural medicines without harmful side effects.
  • To offer affordable natural medicines that help people overcome common health challenges.
  • To achieve the trust and respect of our customers and uphold the best product quality.
  • To empower people with the most effective ways to achieve abundant health.

Safe medicines?

Without side-effects?

Trust and respect?

Best product quality?

Dr King has been reported to be voluntarily recalling 32 different infant and kids medicines after they tested positive for a microbial contamination. Use of these products could, it is feared, cause life-threatening infections.

Quite a ‘Healing Revolution’!

On this blog, I have ad nauseam discussed the fact that many SCAM-practitioners are advising their patients against vaccinations, e. g.:

The reason why I mention this subject yet again is the alarming news reported in numerous places (for instance in this article) that measles outbreaks are now being reported from most parts of the world.

The number of cases in Europe is at a record high of more than 41,000, the World Health Organization (WHO) warned. Halfway through the year, 2018 is already the worst year on record for measles in Europe in a decade. So far, at least 37 patients have died of the infection in 2018.

“Following the decade’s lowest number of cases in 2016, we are seeing a dramatic increase in infections and extended outbreaks,” Dr. Zsuzsanna Jakab, WHO Regional Director for Europe, said in a statement. “Seven countries in the region have seen over 1,000 infections in children and adults this year (France, Georgia, Greece, Italy, the Russian Federation, Serbia and Ukraine).”

In the U.S., where measles were thought to be eradicated, the Centers for Disease Control and Prevention has reported 107 measles cases as of the middle of July this year. “This partial setback demonstrates that every person who is not immune remains vulnerable no matter where they live, and every country must keep pushing to increase coverage and close immunity gaps,” WHO’s Dr. Nedret Emiroglu said.  95 percent of the population must have received at least two doses of measles vaccine to achive herd immunity and prevent outbreaks. Some parts of Europe have reached that target, while others are even below 70 percent.

And why are many parts below the 95% threshold?

Ask your local SCAM-provider, I suggest.

 

About 7 months ago, I contacted a German journalist who I knew and trusted to tell her about the incredible quackery-promotion performed by Germany’s institutes of adult education, the ‘Volkshochschulen‘ (VHSs). After I had been invited to give a few lectures for the VHSs, I had conducted some preliminary research and realised that, nationwide, they run hundreds of courses promoting the worst types of quackery.

My journalist friend, Veronika Hackenbroch, who works for DER SPIEGEL liked the idea of conducting an in-depth investigation into the matter. What it revealed became the centre-piece of a theme issue published today. Here is its title page:

In a nutshell, the key finding is that every 5th course offered by the VHSs in the area of healthcare is steeped in woo. Considering that their funding comes mainly from the public purse, this is intolerable. When asked why they offer so much quackery, some heads of local VHSs said that they are not competent to evaluate the science; they simply assume that, if doctors in Germany use these treatments – specifically homeopathy – and if the public wants to learn about them, they have to offer them.

When I first heard this argument, it made me speechless. It has some undeniable logic behind it. The heads of VHSs are not medical experts. Thus, they cannot do their own research or evaluations. To just follow what the doctors must therefore seem reasonable to them.

So, where is the crux of the problem?

I think, it lies in the vicious circle that inevitable unfolds such a situation:

  • some people like homeopathy (or other bogus treatments),
  • therefore, they ask their doctors to provide it,
  • therefore, some doctors offer it,
  • therefore, the VHSs feel they can promote if,
  • therefore, people like homeopathy (or other bogus treatments).

This circle has no beginning and no end; it just turns and turns. And it is difficult to stop, not least because it is driven by the relentless promotion of interested parties, such as the manufacturers of woo. Yet, if we want to make progress and are serious about improving healthcare, we have to try stopping it!

But how?

Through providing information and fighting misinformation (of course, some rules and regulations would help as well).

That’s exactly what we tried to do – thank you Veronika Hackenbroch!

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