Professor Anthony Pelosi just published an intriguing paper. Here is the abstract:
During the 1980s and 1990s, Hans J Eysenck conducted a programme of research into the causes, prevention and treatment of fatal diseases in collaboration with one of his protégés, Ronald Grossarth-Maticek. This led to what must be the most astonishing series of findings ever published in the peer-reviewed scientific literature with effect sizes that have never otherwise been encounterered in biomedical research. This article outlines just some of these reported findings and signposts readers to extremely serious scientific and ethical criticisms that were published almost three decades ago. Confidential internal documents that have become available as a result of litigation against tobacco companies provide additional insights into this work. It is suggested that this research programme has led to one of the worst scientific scandals of all time. A call is made for a long overdue formal inquiry.
The Guardian reported further details on this story sating that the work of one of the most famous and influential British psychologists of all time, Hans Eysenck, is under a cloud following an investigation by King’s College London, which has found 26 of his published papers “unsafe”.
It is argued that there is now suficient evidence to regard psychosocial variables, in
particular personality and stress, as important risk factors for cancer and coronary heart
disease (CHD), equal in importance to smoking, heredity, cholesterol level, blood pressure,
and other physical variables. Furthermore, it is now clear that both types of factors act
synergistically; that is, each by itself is relatively benign, but their effects multiply to produce
high levels of disease…
The claim (which Eysenck published many times over, for instance here) was picked up and promoted by many believers in SCAM. This might have been helped by Eysenck’s bizarre openness to all things paranormal. Today his belief of a link between personality/stress and cancer is deeply engrained in SCAM.
King’s College says the results and conclusions of the papers “were not considered scientifically rigorous” by its committee of inquiry. Prof Sir Robert Lechler, the provost at King’s, has contacted the editors of the 11 journals where the papers appeared, recommending they should be retracted.
Prof Anthony Pelosi, consultant psychiatrist at the Priory Hospital, Glasgow, whose own investigation prompted the inquiry by King’s, said their work “led to what must be the most astonishing series of findings ever published in the peer-reviewed scientific literature, with effect sizes that have never otherwise been encountered in biomedical research”.
Among more than 3,000 people in the studies, Eysenck and his colleague claimed people with a “cancer-prone” personality were 121 times more likely to die of the disease than those without. Cancer-prone personalities were described as generally passive in the face of stress from outside.
Eysenck and Grossarth-Maticek apparently even had a cure for cancer. In one study, they gave 600 “cancer-prone” individuals a leaflet on how to be more “autonomous” and take control of their destiny. It contained such advice as: “Your aim should always be to produce conditions which make it possible for you to lead a happy and contented life.” It appeared to deliver miracles. Over 13 years, the 600 people randomly assigned to bibliotherapy, as it was called, had all-cause mortality of 32%, compared with 82% of 600 people not fortunate enough to receive a leaflet.
“I honestly believe, having read it so carefully and tried to find alternative interpretations, that this is fraudulent work,” said Pelosi, who is concerned Eysenck’s ideas still have a following. “His acolytes always bragged he was the most cited psychologist of all time… In the social sciences citation index, he was number three. Number two was Freud. Number one was Karl Marx. He was hugely prolific, widely cited and very influential… Many fringe medical practitioners hold the same conviction.”
The World Federation of Chiropractic (WFC) claim to have been at the forefront of the global development of chiropractic. Representing the interests of the profession in over 90 countries worldwide, the WFC has advocated, defended and promoted the profession across its 7 world regions. Now, the WFC have formulated 20 principles setting out who they are, what they stand for, and how chiropractic as a global health profession can, in their view, impact on nations so that populations can thrive and reach their full potential. Here are the 20 principles (in italics followed by some brief comments by me in normal print):
1. We envision a world where people of all ages, in all countries, can access the benefits of chiropractic.
That means babies and infants! What about the evidence?
2. We are driven by our mission to advance awareness, utilization and integration of chiropractic internationally.
One could almost suspect that the drive is motivated by misleading the public about the risks and benefits of spinal manipulation for financial gain.
3. We believe that science and research should inform care and policy decisions and support calls for wider access to chiropractic.
If science and research truly did inform care, it would soon be chiropractic-free.
4. We maintain that chiropractic extends beyond the care of patients to the promotion of better health and the wellbeing of our communities.
The best example to show that this statement is a politically correct platitude is the fact that so many chiropractors are (educated to become) convinced that vaccinations are undesirable or harmful.
5. We champion the rights of chiropractors to practice according to their training and expertise.
I am not sure what this means. Could it mean that they must practice according to their training and expertise, even if both fly in the face of the evidence?
6. We promote evidence-based practice: integrating individual clinical expertise, the best available evidence from clinical research, and the values and preferences of patients.
So far, I have seen little to convince me that chiropractors care a hoot about the best available evidence and plenty to fear that they supress it, if it does not enhance their business.
7. We are committed to supporting our member national associations through advocacy and sharing best practices for the benefit of patients and society.
Much more likely for the benefit of chiropractors, I suspect.
8. We acknowledge the role of chiropractic care, including the chiropractic adjustment, to enhance function, improve mobility, relieve pain and optimize wellbeing.
Of course, you have to pretend that chiropractic adjustments (of subluxations) are useful. However, evidence would be better than pretence.
9. We support research that investigates the methods, mechanisms, and outcomes of chiropractic care for the benefit of patients, and the translation of research outcomes into clinical practice.
And if it turns out to be to the detriment of the patient? It seems to me that you seem to know the result of the research before you started it. That does not bode well for its reliability.
10. We believe that chiropractors are important members of a patient’s healthcare team and that interprofessional approaches best facilitate optimum outcomes.
Of course you do believe that. Why don’t you show us some evidence that your belief is true?
11. We believe that chiropractors should be responsible public health advocates to improve the wellbeing of the communities they serve.
Of course you do believe that. But, in fact, many chiropractors are actively undermining the most important public health measure, vaccination.
12. We celebrate individual and professional diversity and equality of opportunity and represent these values throughout our Board and committees.
What you should be celebrating is critical assessment of all chiropractic concepts. This is the only way to make progress and safeguard the interests of the patient.
13. We believe that patients have a fundamental right to ethical, professional care and the protection of enforceable regulation in upholding good conduct and practice.
The truth is that many chiropractors violate medical ethics on a daily basis, for instance, by not obtaining fully informed consent.
14. We serve the global profession by promoting collaboration between and amongst organizations and individuals who support the vision, mission, values and objectives of the WFC.
Yes, those who support your vision, mission, values and objectives are your friends; those who dare criticising them are your enemies. It seems far from you to realise that criticism generates progress, perhaps not for the WFC, but for the patient.
15. We support high standards of chiropractic education that empower graduates to serve their patients and communities as high value, trusted health professionals.
For instance, by educating students to become anti-vaxxers or by teaching them obsolete concepts such as adjustment of subluxation?
16. We believe in nurturing, supporting, mentoring and empowering students and early career chiropractors.
You are surpassing yourself in the formulation of platitudes.
17. We are committed to the delivery of congresses and events that inspire, challenge, educate, inform and grow the profession through respectful discourse and positive professional development.
You are surpassing yourself in the formulation of platitudes.
18. We believe in continuously improving our understanding of the biomechanical, neurophysiological, psychosocial and general health effects of chiropractic care.
Even if there are no health effects?!?
19. We advocate for public statements and claims of effectiveness for chiropractic care that are honest, legal, decent and truthful.
Advocating claims of effectiveness in the absence of proof of effectiveness is neither honest, legal, decent or truthful, in my view.
20. We commit to an EPIC future for chiropractic: evidence-based, people-centered, interprofessional and collaborative.
And what do you propose to do with the increasing mountain of evidence suggesting that your spinal adjustments are not evidence-based as well as harmful to the health and wallets of your patients?
What do I take out of all this? Not a lot!
Perhaps mainly this: the WFC is correct when stating that, in the interests of the profession in over 90 countries worldwide, the WFC has advocated, defended and promoted the profession across its 7 world regions. What is missing here is a small but important addition to the sentence: in the interests of the profession and against the interest of patients, consumers or public health in over 90 countries worldwide, the WFC has advocated, defended and promoted the profession across its 7 world regions.
I have often discussed the fact that many proponents of so-called alternative medicine (SCAM) have in recent years adopted the following argument: even if our SCAM were just a placebo, it would still be useful. After all, placebo effects are real and increasingly backed by sound science. The argument is deeply flawed, yet it convinces many lay people.
A recent article by Fabrizio Benedetti, the leading researcher in the area of placebo, is addressing exactly this issue. I feel that it is sufficiently important to quote it extensively here:
… a number of biochemical pathways, such as endogenous opioids and cannabinoids,5,6 and brain regions, like the prefrontal cortex, have been found to be involved in placebo analgesia. Likewise, dopamine and the basal ganglia circuitry have been found to mediate placebo responses in Parkinson’s disease. Although this is wonderful news for science, this may not be the case for society. The number of nonmedical organizations and healers that rely on this hard science, and actually justify their odd and bizarre procedures, has increased over the past few years. The main claim is that any procedure boosting patients’ expectations, which represent the main mediator of placebo effects, is acceptable because it can activate the same biochemical pathways and neural networks that have been made credible by hard science…
The crucial point here is that when hard science started investigating placebo effects, it unconsciously produced a shift in quackery thinking. In fact, charlatans are becoming more and more aware that their bizarre interventions could work through a placebo effect. Indeed, whereas hard science has so far denied any scientific basis for nonconventional therapies, now the very same hard science certifies that the placebo effect has scientific grounds. Therefore, quacks are no longer interested in showing that their pseudo-interventions work; rather, they justify their use on the basis of the possibility that these bizarre interventions may induce strong placebo effects…
… A first point that should be emphasized is that placebos do not cure, but rather, they may sometimes improve quality of life. There is plenty of confusion on this point, and unfortunately, many claim that they can cure virtually all illnesses with placebos. Hard science tells us that placebos can reduce symptoms such as pain and muscle rigidity in Parkinson’s disease, yet the progression of the disease is not affected; for example, in Parkinson’s disease, neurons keep degenerating even though some symptoms can be reduced for a short time.4 The second point is related to the first. The type of disease is crucial, and we need to make people understand that pain is different from cancer and that anxiety differs from infectious diseases. The psychological component of some illnesses can indeed be modulated by placebos, but placebos cannot stop cancer growth, nor can they kill the bacteria of pneumonia. The third point is related to the difference between real placebo effects and spontaneous remissions. So far, hard science has studied the placebo effect within a time span of hours/days, thereby limiting our knowledge to short-lasting effects. Consequently, long-lasting effects can be often attributed to spontaneous remissions.
In addition to these three important points, we should also make patients understand that a diagnosis is required before any sort of therapy. An apparently trivial pain may conceal a danger; thus, it must never be treated unless a diagnosis has been made before, and this can be made only by physicians. Moreover, not only should we discuss and consider the positive effects of placebos and the impact they may have in clinical trials and medical practice, but we should also pay much of our attention to the negative counterpart, that is, the misuse and abuse by quacks, charlatans, shamans, and nonmedical organizations. Thus, we need to inform the whole society that the benefits following a nonconventional healing procedure are attributable to a placebo effect in most of the cases. Last but not least, we need to be more honest on the real efficacy of many pharmacological and nonpharmacological treatments, acknowledging that some of them are useful whereas some others are not: This will boost patients’ trust and confidence in medicine further, which I believe are the best foes of quackery…
…Unfortunately, quackery has today one more weapon on its side, which is paradoxically represented by the hard science–supported placebo mechanisms. This new “scientific quackery” can do a lot of damage; thus, we must be very cautious and vigilant as to how the findings of hard science are exploited. The study of the biology of these vulnerable aspects of mankind may unravel new mechanisms of how our brain works, but it may have a profound negative impact on our society as well. We cannot accept a world where expectations can be enhanced with any means and by anybody. This is a perspective that would surely be worrisome and dangerous. I believe that some reflections are necessary in order to avoid a regression of medicine to past times, in which quackery and shamanism were dominant. Unfortunately, the new knowledge about placebos by hard science is now backfiring on it. What we need to do is to stop for a while and reflect on what we are doing and how we want to move forward. A crucial question to answer is, Does placebo research boost pseudoscience?
I am immensely thankful to Prof Benedetti to make such clear and long-overdue statements. They will be most helpful in refuting the myth that homeopathy, para-normal healing, reflexology, acupuncture, chiropractic, etc., etc. are legitimate and uselful therapies, even if they are not better than a placebo. Using placebo therapies in routine care is not in the best interest of either the patient or progress.
“There is a ton of chiropractor journals. If you want evidence then read some.”
This was the comment by a defender of chiropractic to a recent post of mine. And it’s true, of course: there are quite a few chiro journals, but are they a reliable source of information?
One way of quantifying the reliability of medical journals is to calculate what percentage of its published articles arrive at negative conclusion. In the extreme instance of a journal publishing nothing but positive results, we cannot assume that it is a credible publication. In this case, it would be not a scientific journal at all, but it would be akin to a promotional rag.
Back in 1997, we published our first analysis of journals of so-called alternative medicine (SCAM). It showed that just 1% of the papers published in SCAM journals reported findings that were not positive. In the years that followed, we confirmed this deplorable state of affairs repeatedly, and on this blog I have shown that the relatively new EBCAM journal is similarly dubious.
But these were not journals focussing specifically on chiropractic. Therefore, the question whether chiro journals are any different from the rest of SCAM is as yet unanswered. Enough reason for me to bite the bullet and test this hypothesis. I thus went on Medline and assessed all the articles published in 2018 in two of the leading chiro journals.
- JOURNAL OF CHIROPRACTIC MEDICINE (JCM)
- CHIROPRACTIC AND MANUAL THERAPY (CMT)
I evaluated them according to
- TYPE OF ARTICLE
- DIRECTION OF CONCLUSION
The results of my analysis are as follows:
- The JCM published 39 Medline-listed papers in 2018.
- The CMT published 50 such papers in 2018.
- Together, the 2 journals published:
- 18 surveys,
- 17 case reports,
- 10 reviews,
- 8 diagnostic papers,
- 7 pilot studies,
- 4 protocols,
- 2 RCTs,
- 2 non-randomised trials,
- 2 case-series,
- the rest are miscellaneous types of articles.
4. None of these papers arrived at a conclusion that is negative or contrary to chiropractors’ current belief in chiropractic care. The percentage of publishing negative findings is thus exactly 0%, a figure that is almost identical to the 1% we found for SCAM journals in 1997.
I conclude: these results suggest that the hypothesis of chiro journals publishing reliable information is not based on sound evidence.
In a paper discussed in a previous blog, Ioannidis et al published a comprehensive database of a large number of scientists across science. They used Scopus data to compile a database of the 100,000 most-cited authors across all scientific fields based on their ranking of a composite indicator that considers six citation metrics (total citations; Hirsch h-index; coauthorship-adjusted Schreiber hm-index; number of citations to papers as single author; number of citations to papers as single or first author; and number of citations to papers as single, first, or last author). The authors also added this caution:
Citation analyses for individuals are used for various single-person or comparative assessments in the complex reward and incentive system of science. Misuse of citation metrics in hiring, promotion or tenure decision, or other situations involving rewards (e.g., funding or awards) takes many forms, including but not limited to the use of metrics that are not very informative for scientists and their work (e.g., journal impact factors); focus on single citation metrics (e.g., h-index); and use of calculations that are not standardized, use different frames, and do not account for field. The availability of the data sets that we provide should help mitigate many of these problems. The database can also be used to perform evaluations of groups of individuals, e.g., at the level of scientific fields, institutions, countries, or memberships in diversely defined groups that may be of interest to users.
It seems thus obvious and relevant to employ the new metrics for defining the most ‘influential’ (most frequently cited) researchers in so-called alternative medicine (SCAM). Doing this creates not one but two non-overlapping tables (because ‘complementary&alternative medicine’ is listed both as a primary and a secondary field (not sure about the difference)). Below, I have copied a small part of these tables; the first three columns are self-explanatory; the 4th relates to the number of published articles, the 4th to the year of the author’s first publication, the 5th to the last, the 6th column is the rank amongst 100 000 scientists of all fields who have published more than a couple of papers.
|Ernst, E.||University of Exeter||gbr||2253||1975||2018||104|
|Davidson, Jonathan R. T.||Duke University||usa||426||1972||2017||1394|
|Kaptchuk, Ted J.||Harvard University||usa||245||1993||2018||6545|
|Eisenberg, David M.||Harvard University||usa||127||1991||2018||8641|
|Linde, Klaus||Technische Universitat Munchen||deu||276||1993||2018||19488|
|Schwartz, Gary E.||University of Arizona||usa||264||1967||2018||21893|
|Eloff, J.N.||University of Pretoria||zaf||204||1997||2018||23830|
|Birch, Stephen||McMaster University||can||244||1985||2018||31925|
|Wilson, Kenneth H.||Duke University||usa||76||1976||2017||40760|
|Kemper, Kathi J.||Ohio State University||usa||181||1988||2017||45193|
|Oken, Barry S.||Oregon Health and Science University||usa||121||1974||2018||51325|
|Postuma, Ronald B.||McGill University||can||159||1998||2018||61018|
|Patwardhan, Bhushan||University of Pune||ind||144||1989||2018||64465|
|Krucoff, Mitchell W.||Duke University||usa||261||1986||2016||66028|
|Baliga, Manjeshwar Shrinath||142||2002||2018||83030|
|Mischoulon, David||Harvard University||usa||194||1992||2018||91705|
|Büssing, Arndt||University of Witten/Herdecke||deu||207||1980||2018||95907|
|Langevin, Helene M.||Harvard University||usa||67||1999||2018||98290|
|Kuete, Victor||University of Dschang||cmr||239||2005||2018||128347|
|White, Adrian||University of Plymouth||gbr||294||1990||2016||16714|
|Astin, John A.||California Pacific Medical Center||usa||50||1994||2014||21379|
|Kelly, Gregory S.||37||1985||2011||31037|
|Walach, Harald||University of Medical Sciences Poznan||pol||246||1996||2018||31716|
|Berman, Brian M.||University of Maryland School of Medicine||usa||211||1986||2018||34022|
|Lewith, George||University of Southampton||gbr||380||1980||2018||34830|
|Kidd, Parris M.||University of California at Berkeley||usa||38||1976||2011||36571|
|Jonas, Wayne B.||187||1992||2018||42445|
|MacPherson, Hugh||University of York||gbr||143||1996||2018||49923|
|Bell, Iris R.||University of Arizona||usa||142||1984||2015||51016|
|Ritenbaugh, Cheryl||University of Arizona||usa||172||1981||2018||63248|
|Boon, Heather||University of Toronto||can||188||1988||2017||69066|
|Aickin, Mikel||University of Arizona||usa||149||1996||2014||72040|
|Lee, Myeong Soo||430||1996||2018||72358|
|Lao, Lixing||University of Hong Kong||hkg||247||1990||2018||74896|
|Witt, Claudia M.||Charite – Universitatsmedizin Berlin||deu||238||2001||2018||78849|
|Sherman, Karen J.||136||1984||2017||82542|
|Verhoef, Marja J.||University of Calgary||can||190||1989||2016||84314|
|Smith, Caroline A.||University of Western Sydney||aus||135||1979||2018||94130|
|Miller, Alan L.||30||1980||2016||94421|
|Paterson, Charlotte||University of Bristol||gbr||71||1995||2017||95130|
|Milgrom, Lionel R.||London Metropolitan University||gbr||107||1979||2017||112943|
|Adams, Jon||University of Technology NSW||aus||294||1999||2018||128486|
|Litscher, Gerhard||Medical University of Graz||aut||245||1986||2018||133122|
|Chen, Calvin Yu-Chian||China Medical University Taichung||chn||130||2007||2016||164522|
No other researchers are listed in the ‘Complementary&Alternative Medicine’ categories and made it into the list of the 100 000 most-cited scientists.
To make this easier to read, I have ordered all SCAM researchers according to their rank in one single list and, where known to me, added the respective focus in SCAM research (ma = most areas of SCAM):
- ERNST EDZARD (ma)
- DONALDSON JONATHAN
- KAPTCHUK TED (acupuncture)
- EISENBERG DAVID (TCM)
- WHITE ADRIAN (acupuncture)
- LUNDEBERG THOMAS (acupuncture)
- LINDE KLAUS (homeopathy)
- ASTIN JOHN (mind/body)
- SCHWARTZ GARRY (healing)
- ELOFF JN
- KELLY GREGORY
- WALLACH HARALD (homeopathy)
- BIRCH STEVEN (acupuncture)
- BERMAN BRIAN (acupuncture)
- LEWITH GEORGE (acupuncture)
- KIDD PARRIS
- WILSON KENNETH
- JONAS WAYNE (homeopathy)
- KEMPER KATHIE (ma)
- MACPHERSON HUGH (acupuncture)
- BELL IRIS (homeopathy)
- OKEN BARRY (dietary supplements)
- PITTLER MAX (ma)
- PATRICK LYN
- RITENBAUGH CHERYL (ma)
- POSTUMA RONALD
- PATWARDHAN BHUSHAN
- KRUCOFF MICHELL
- BOON HEATHER
- AICKIN MIKEL (ma)
- LEE MYEONG SOO (TCM)
- LAO LIXING (acupuncture)
- WITT CLAUDIA (ma)
- CHIESA ALBERTO
- SHERMAN KAREN (acupuncture)
- BALIGA MANJESHWAR
- VERHOEF MARIA (ma)
- MISCHOULON DAVID
- SMITH CAROLINE (acupuncture)
- MILLER ALAN
- PATERSON CHARLOTTE (ma)
- BUESSING ARNDT (anthroposophical medicine)
- LANGEVIN HELENE (ma)
- CREATH KATHERINE
- MILGROM LIONEL (homeopathy)
- KUETE VICTOR
- ADAMS JON (ma)
- LITSCHER GERHARD
- CHEN CALVIN
The list is interesting in several regards. Principally, it offers individual SCAM researchers for the first time the opportunity to check their international standing relative to their colleagues. But, as the original analysis in Ioannidis’s paper contains much more data than depicted above, there is much further information to be gleaned from it.
For instance, I looked at the rate of self-citation (not least because I have sometimes been accused of overdoing this myself). It turns out that, with 7%, I am relative modest and well below average in that regard. Most of my colleagues are well above that figure. Researchers who have exceptionally high self-citation rates include Buessing (30%), Kuete (43%), Adams (36%), Litscher (45%), and Chen (53%).
The list also opens the possibility to see which countries dominate SCAM research. The dominance of the US seems fairly obvious and would have been expected due to the size of this country and the funds the US put into SCAM research. Considering the lack of funds in the UK, my country ranks surprisingly high, I find. No other country is well-represented in this list. In particular Germany does not appear often (even if we would classify Wallach as German); considering the large amounts of money Germany has invested in SCAM research, this is remarkable and perhaps even a bit shameful, in my view.
Looking at the areas of research, acupuncture and homeopathy seem to stand out. Remarkably, many of the major SCAMs are not or not well represented at all. This is in particular true for herbal medicine, chiropractic and osteopathy.
The list also confirms my former team as the leaders in SCAM research. (Yes, I know: in the country of the blind, the one-eyed man is king.) Pittler, White and Lee were, of course, all former co-workers of mine.
Perhaps the most intriguing finding, I think, relates to the many SCAM researchers who did not make it into the list. Here are a few notable absentees:
- Behnke J – GERMANY (homeopathy)
- Bensoussan A – AUSTRALIA (acupuncture)
- Brinkhaus B – GERMANY (acupuncture)
- Bronfort G – US (chiropractic)
- Chopra D – US (mind/body)
- Cummings M – UK (acupuncture)
- Dixon M – UK (ma)
- Dobos G – GERMANY (ma)
- Fisher P – UK (homeopathy)
- Fonnebo V – NORWAY (ma)
- Frass M – AUSTRIA (homeopathy)
- Goertz C – US (chiropractic)
- Hawk C -US (chiropractic)
- Horneber M – GERMANY (ma)
- Jacobs J – US (homeopathy)
- Jobst K – UK (homeopathy)
- Kraft K – GERMANY (naturopathy)
- Lawrence D – US (chiropractic)
- Long CR – US (chiropractic)
- Meeker WC – US (chiropractic)
- Mathie R – UK (homeopathy)
- Melchart – GERMANY (ma)
- Michalsen A – GERMANY (ma)
- Mills S – UK (herbal medicine)
- Peters D – UK (ma)
- Reilly D -US (homeopathy)
- Reily D – UK (homeopathy)
- Robinson N – UK (ma)
- Streitberger K – GERMANY (acupuncture)
- Tuchin PJ – US (chiropractic)
- Uehleke – GERMANY (naturopathy)
- Ullman D – US (homeopathy)
- Weil A – US (ma)
I leave it to you to interpret this list and invite you to add more SCAM researchers to it.
(thanks to Paul Posadski for helping with the tables)
The journal NATURE has just published an excellent article by Andrew D. Oxman and an alliance of 24 leading scientists outlining the importance and key concepts of critical thinking in healthcare and beyond. The authors state that the Key Concepts for Informed Choices is not a checklist. It is a starting point. Although we have organized the ideas into three groups (claims, comparisons and choices), they can be used to develop learning resources that include any combination of these, presented in any order. We hope that the concepts will prove useful to people who help others to think critically about what evidence to trust and what to do, including those who teach critical thinking and those responsible for communicating research findings.
Here I take the liberty of citing a short excerpt from this paper:
Claims about effects should be supported by evidence from fair comparisons. Other claims are not necessarily wrong, but there is an insufficient basis for believing them.
Claims should not assume that interventions are safe, effective or certain.
- Interventions can cause harm as well as benefits.
- Large, dramatic effects are rare.
- We can rarely, if ever, be certain about the effects of interventions.
Seemingly logical assumptions are not a sufficient basis for claims.
- Beliefs alone about how interventions work are not reliable predictors of the presence or size of effects.
- An outcome may be associated with an intervention but not caused by it.
- More data are not necessarily better data.
- The results of one study considered in isolation can be misleading.
- Widely used interventions or those that have been used for decades are not necessarily beneficial or safe.
- Interventions that are new or technologically impressive might not be better than available alternatives.
- Increasing the amount of an intervention does not necessarily increase its benefits and might cause harm.
Trust in a source alone is not a sufficient basis for believing a claim.
- Competing interests can result in misleading claims.
- Personal experiences or anecdotes alone are an unreliable basis for most claims.
- Opinions of experts, authorities, celebrities or other respected individuals are not solely a reliable basis for claims.
- Peer review and publication by a journal do not guarantee that comparisons have been fair.
Studies should make fair comparisons, designed to minimize the risk of systematic errors (biases) and random errors (the play of chance).
Comparisons of interventions should be fair.
- Comparison groups and conditions should be as similar as possible.
- Indirect comparisons of interventions across different studies can be misleading.
- The people, groups or conditions being compared should be treated similarly, apart from the interventions being studied.
- Outcomes should be assessed in the same way in the groups or conditions being compared.
- Outcomes should be assessed using methods that have been shown to be reliable.
- It is important to assess outcomes in all (or nearly all) the people or subjects in a study.
- When random allocation is used, people’s or subjects’ outcomes should be counted in the group to which they were allocated.
Syntheses of studies should be reliable.
- Reviews of studies comparing interventions should use systematic methods.
- Failure to consider unpublished results of fair comparisons can bias estimates of effects.
- Comparisons of interventions might be sensitive to underlying assumptions.
Descriptions should reflect the size of effects and the risk of being misled by chance.
- Verbal descriptions of the size of effects alone can be misleading.
- Small studies might be misleading.
- Confidence intervals should be reported for estimates of effects.
- Deeming results to be ‘statistically significant’ or ‘non-significant’ can be misleading.
- Lack of evidence for a difference is not the same as evidence of no difference.
What to do depends on judgements about the problem, the relevance (applicability or transferability) of evidence available and the balance of expected benefits, harm and costs.
Problems, goals and options should be defined.
- The problem should be diagnosed or described correctly.
- The goals and options should be acceptable and feasible.
Available evidence should be relevant.
- Attention should focus on important, not surrogate, outcomes of interventions.
- There should not be important differences between the people in studies and those to whom the study results will be applied.
- The interventions compared should be similar to those of interest.
- The circumstances in which the interventions were compared should be similar to those of interest.
Expected pros should outweigh cons.
- Weigh the benefits and savings against the harm and costs of acting or not.
- Consider how these are valued, their certainty and how they are distributed.
- Important uncertainties about the effects of interventions should be reduced by further fair comparisons.
END OF QUOTE
I have nothing to add to this, except perhaps to point out how very relevant all of this, of course, is for SCAM and to warmly recommend you study the full text of this brilliant paper.
John Dormandy was a consultant vascular surgeon, researcher, and medical educator best known for innovative work on the diagnosis and management of peripheral arterial disease. He had a leading role in developing, and garnering international support for, uniform guidelines that had a major impact on vascular care among specialists.
The Trans-Atlantic Inter-Society Consensus on Management of Peripheral Arterial Disease (TASC) was published in 2000.1 Dormandy, a former president of clinical medicine at the Royal Society of Medicine, was the genial force behind it, steering cooperation between medical and surgical society experts in Europe and North America.
“TASC became the standard for describing the severity of the problem that patients had and then defining what options there were to try and treat them,” says Alison Halliday, professor of vascular surgery at Oxford University who worked with Dormandy at St George’s Hospital, London. “It was the first time anybody had tried to get this general view on the complex picture of lower limb artery disease,” she says.
After stumbling across this totally unexpected obituary in the BMJ, I was deeply saddened. John was a close friend and mentor; I admired and loved him. He has influenced my life more than anyone else.
Our paths first crossed in 1979 when I applied for a post in his lab at St George’s Hospital, London. Even though I had never really envisaged a career in research, I wanted this job badly. At the time, I had been working as a SHO in a psychiatric hospital and was most unhappy. All I wished at that stage was to get out of psychiatry.
John offered me the position (mainly because of my MD thesis in blood clotting, I think) which was to run his haemorheology (the study of the flow properties of blood) lab. At the time, St Georges consisted of a research tract, a library, a squash court and a mega-building site for the main hospital.
John’s supervision was more than relaxed. As he was a busy surgeon then operating at a different site, I saw him only about once per fortnight, usually for less than 5 minutes. John gave me plenty of time to read (and to play squash!). As he was one of the world leader in haemorheology research, the lab was always full with foreign visitors who wanted to learn our methodologies. We all learnt from each other and had a great time!
After about two years, I had become a budding scientist. John’s mentoring had been minimal but nevertheless most effective. After I left to go back to Germany and finish my clinical training, we stayed in contact. In Munich, I managed to build up my own lab and continued to do haemorheology research. We thus met regularly, published papers and a book together, organised conferences, etc. It was during this time that my former boss became my friend.
Later, he also visited us in Vienna several times, and when I told him that I wanted to come back to England to do research in alternative medicine, he was puzzled but remained supportive (even wrote one of the two references that got me the Exeter job). I think he initially felt this might be a waste of a talent, but he soon changed his mind when he saw what I was up to.
John was one of the most original thinkers I have ever met. His intellect was as sharp as a razor and as fast as lightening. His research activities (>220 Medline listed papers) focussed on haemorheology, vascular surgery and multi-national mega-trials. And, of course, he had a wicket sense of humour. When he had become the clinical director of St George’s, he had to implement a strict no-smoking policy throughout the hospital. Being an enthusiastic cigar smoker, this presented somewhat of a problem for him. The solution was simple: at the entrance of his office John put a sign ‘You are now leaving the premises of St George’s Hospital’.
I saw John last in February this year. My wife and I had invited him for dinner, and when I phoned him to confirm the booking he said: ‘We only need a table for three; Klari (his wife) won’t join us, she died just before Christmas.’ I know how he must have suffered but, in typical Dormandy style, he tried to dissimulate and make light of his bereavement. During dinner he told me about the book he had just published: ‘Not a bestseller, in fact, it’s probably the most boring book you can find’. He then explained the concept of his next book, a history of medicine seen through the medical histories of famous people, and asked, ‘What’s your next one?’, ‘It’s called ‘Don’t believe what you think’, ‘Marvellous title!’, he exclaimed.
We parted that evening saying ‘see you soon’.
I will miss my friend vey badly.
The Society of Homeopaths (SoH) is the professional organisation of UK lay homeopaths (those with no medical training). The SoH has recently published a membership survey. Here are some of its findings:
- 89% of all respondents are female,
- 70% are between the ages of 35 and 64.
- 91% of respondents are currently in practice.
- 87% are RSHoms.
- The majority has been in practice for an average of 11 – 15 years.
- 64% identified their main place of work as their home.
- 51% work within a multidisciplinary clinic.
- 43% work in a beauty clinic.
- 85% oﬀer either telephone or video call consultations.
- Just under 50% see 5 or fewer patients each week.
- 38% are satisfied with the number of patients they are seeing.
- 80% felt conﬁdent or very conﬁdent about their future.
- 65% feel supported by the SoH.
Because this truly homeopathic survey is based on exactly 132 responses which equates to 14% of all SoH members.
If, however, we were able to conclude anything at all, it would be that the amateur researchers at the SoH cause Hahnemann to turn in his grave. Offering telephone/video consultations and working in a beauty salon would probably have annoyed the old man. But what would have definitely made him jump with fury in his Paris grave is a stupid survey like this one.
An article in the Sydney Morning Herald might be interesting to some readers. It informs us that, after more than 25 years of running, the University of Technology Sydney (UTS) intends to stop offering its degree in Traditional Chinese Medicine (TCM). A review of the Chinese Medicine Department found it should be wound up at the end of 2021 because
- it was no longer financially viable,
- did not produce enough research,
- and did not fit with the “strategic direction” of the science faculty.
The UTS’s Chinese medicine clinic, which offers acupuncture and herbal treatments, would also close. Students who don’t finish by the end of 2021 will either move to another health course, or transfer to another university (Chinese medicine is also offered by the University of Western Sydney, RMIT in Melbourne, and several private colleges).
TCM “is a historical tradition that pre-dated the scientific era,” said the president of Friends of Science, Associate Professor Ken Harvey. “There’s nothing wrong with looking at that using modern scientific techniques. The problem is people don’t, they tend to teach it like it’s an established fact. If I was a scientifically-orientated vice chancellor I would worry about having a course in my university that didn’t have much of a research profile in traditional Chinese medicine.”
But a spokesman for the University of Technology Sydney said the debate over the scientific validity of Chinese medicine had nothing to do with the decision, and was “in no way a reflection of an institutional bias against complementary health care”. Personally, I find this statement surprising. Should the scientific validity of a subject not be a prime concern of any university?
In this context, may I suggest that the UTS might also have a critical look at their ‘AUSTRALIAN RESEARCH CENTRE IN COMPLEMENTARY AND INTEGRATIVE MEDICINE‘. They call themselves ‘the first centre worldwide dedicated to public health and health services research on complementary and integrative medicine’. Judging from the centre director’s publications, this means publishing one useless survey after another.
I have to admit, I do not often read the ‘Aargauer Zeitung’. But perhaps I should? Certainly this article from yesterday’s issue is most interesting.
It reported that the University of Basel will soon have a new chair. Apparently, the move has created a fiercely controversial debate within the university. But the decision to go ahead with the plan has been made, and Carsten Gründemann has been formally invited to become the new professor for «translationale Komplementärmedizin». (I am sure in Basel they know what «translationale Komplementärmedizin» is, however, I don’t.)
As it turns out, the term seems entirely irrelevant, because the chair will be in anthroposophical medicine. In case you are not familiar with this SCAM, here is a short explanation copied from my new book:
Anthroposophic medicine is a form of healthcare developed in the 1920s by Rudolf Steiner (1861–1925) in collaboration with the physician Ita Wegman (1876–1943). It is based on Steiner’s mystical ideas of anthroposophy. Steiner had developed his ‘philosophy’ of anthroposophy from personal experiences, occult notions and mystical concepts. Ita Wegman studied medicine after having met Steiner in 1902. She pioneered an ‘alternative cancer treatment’ with a fermented mistletoe extract, according to Steiner’s ideas. Together, Wegman and Steiner wrote Steiner’s last book entitled ‘Extending Practical Medicine’ which was meant as a theoretical basis for their anthroposophical medicine. Wegman was also a co-founder of the pharmaceutical firm ‘Weleda’ which became the biggest producer of anthroposophical remedies. Proponents of anthroposophic medicine make several irrational assumptions, for instance, they claim that our past lives influence our present health, or that the course of an illness is determined by our ‘karmic’ destiny. Practitioners of anthroposophic medicine are usually medically trained; they employ a variety of treatments including massage, exercise, counselling, and a range of remedies (more than 1 300 different anthroposophic medicinal products are currently on the market). Most of the remedies are, like homeopathic remedies, highly diluted but they are not normally prescribed according to the ‘like cures like’ principle and are therefore distinct from homeopathy.
The report mentions that the creation of the new chair caused wide-spread anger amongst the science-based faculties at Basel. The head of Pharmacy, Christoph Meier, is quoted stating: «Indem die Professur in den Forschungsbetrieb eingebunden wird, bieten wir keine Hand zur Scharlatanerie.» [As the professorship will be tied into research, we offer no opportunity for quackery.]
Carsten Gründemann studied Biochemistry/Biology at the University of Tübingen and Freiburg (Germany) and received his Ph.D. in Experimental Immunology from the University of Tübingen (Germany). He was awarded the Karl und Veronica Carstens (KVC) Science Award 2018 for his research in the field of complementary medicine for multiple sclerosis (MS). He is currently based at the Center for Complementary Medicine, Institute for Environmental Health Sciences, University Medical Center Freiburg. Much of his past research seems to focus on anthroposophical medicines, including those produced by Weleda, the world’s largest manufacturer of anthroposophical preparations. Here is one of his 32 Medline-listed abstracts:
Preparations from anthroposophical medicine (AM) are clinically used to treat inflammatory disorders. We wanted to investigate effects of a selection of AM medications for parenteral use in cell-based systems in vitro.
Colchicum officinale tuber D3, Mandragora D3, Rosmarinus officinale 5% and Bryophyllum 5% were selected for the experiments. Induction of apoptosis and necrosis (human lymphocytes and dendritic cells [DCs]) and proliferation of lymphocytes as well as maturation (expression of CD14, CD83 and CD86) and cytokine secretion (IL-10, IL12p70) of DCs were analyzed. Furthermore, proliferation of allogeneic human T lymphocytes was investigated in vitro in coculture experiments using mature DCs in comparison to controls.
The respective preparations did not induce apoptosis or necrosis in lymphocytes or DCs. Lymphocyte proliferation was dose-dependently reduced by Colchicum officinale tuber D3 while the viability was unchanged. Rosmarinus officinale 5%, but not the other preparations, dose-dependently inhibited the maturation of immature DCs, reduced secretion of IL-10 and IL-12p70 and slightly inhibited proliferation of allogeneic CD4(+) T-lymphocytes in coculture experiments with DCs.
The selected preparations from AM for parenteral use are nontoxic to lymphocytes and DCs. Rosmarinus officinale 5% has immunosuppressive properties on key functions of the immune system which propose further investigation.
The new chair is contractually bound to adhere to the ‘anthroposophical model’ (which probably is a synonym for ‘Steiner cult’). It will be financed to the tune of 3 million Swiss Franks, money that comes from the ‘Software AG Stiftung‘, Weleda, Beatrice Oeri, and other anthroposophical institutions.