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

risk

An article has just been published announcing the reform of the German Heilpraktiker, the profession of alternative practitioners that has been discussed repeatedly on this blog and criticised recently by the ‘Muensteraner Kreis’. As the new article is in German, I will try to summarise the essence of it here:

The health ministers of all German counties have decided yesterday that they will start reforming the profession of the Heilpraktiker that has attracted much criticism in recent months. The current laws are no longer fit for purpose. There is neither a mandatory agreement for the education of the Heilpraktiker, nor a uniform regulation of the profession.

The senator for health from Hamburg stated: “We feel that the Heilpraktiker should not be allowed to do certain thing, but be permitted to do plenty of activities that remain legal.” At present, the Heilpraktiker is allowed to treat fractures, malignancies, give injections, and even manufacture certain medicines. “We believe there is a need for regulation to protect patients.”

Now a working group will be formed to investigate and produce a report within a year. Remarkably, the German health secretary avoided commenting. In a statement, it was said that patients must be empowered to make decisions on the basis of quality-assured information.

The full German text is below.

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Nach mehreren deutschlandweit Aufsehen erregenden Todesfällen beispielsweise von Krebspatienten, die kurz nach der Therapie durch einen Heilpraktiker in Brüggen-Bracht starben, will die Politik sich nun diesen Berufszweig vornehmen. Die Gesundheitsminister aller Bundesländer haben am Donnerstag beschlossen, eine Reform anzugehen. „Das unzureichend regulierte Heilpraktikerwesen mit seiner umfassenden Heilkundebefugnis steht unverändert in der Kritik“, heißt es in einer Erklärung. Das Heilpraktikergesetz könne dem heutigen Anspruch an den Gesundheitsschutz der Patienten nicht mehr gerecht werden. Für Heilpraktiker gebe es weder verbindliche Regeln zur Ausbildung noch eine einheitliche Berufsordnung. Andere Gesundheitsberufe müssten hingegen strenge Qualifikationskriterien erfüllen.

„Wir sehen es als kritisch an, dass einige Tätigkeiten zwar den Heilpraktikern untersagt sind, aber es noch eine Fülle von Tätigkeiten gibt, die zugelassen sind“, sagte die Hamburger Senatorin für Gesundheit, Cornelia Prüfer-Storcks, auf einer Pressekonferenz – sie hatte die Initiative maßgeblich  vorangetrieben.  So dürfen Heilpraktiker Knochenbrüche therapieren, schwere und bösartige Erkrankungen behandeln und Injektionen geben. Selbst die Herstellung von Arzneimitteln für bestimmte Patienten sei Heilpraktikern erlaubt. „Ohne die Prüfmechanismen, die wir normalerweise haben, wenn wir Arzneimittel zulassen und produzieren“, kritisierte Prüfer-Storcks. „Wir glauben, dass es hier Regelungsbedarf gibt aus Sicht des Patientenschutzes.“

„Die Ministerinnen und Minister, Senatorinnen und Senatoren für Gesundheit sehen eine zwingende Reformbedürftigkeit des Heilpraktikerwesens“, heißt es in dem kurzen, MedWatch vorliegenden Beschluss. „Der Bund wird gebeten, eine Bund-Länder-Arbeitsgruppe einzurichten, die eine grundlegende Reform des Heilpraktikerwesens prüft.“ Das Ergebnis der Prüfung solle bis zur Gesundheitsministerkonferenz in einem Jahr vorgelegt werden.

Bundesgesundheitsminister Jens Spahn erklärte auf der Pressekonferenz das Patientenwohl zwar zum entscheidenden Maßstab für die Gesundheitspolitik. „Deshalb finde ich es richtig, dass die Gesundheitsministerkonferenz bei der Patientenorientierung ihren Schwerpunkt setzt“, sagte er. Auf mögliche Reformen des Heilpraktikerberufes ging der Minister bei der Pressekonferenz jedoch nicht ein. Inwiefern sein Haus die von den Landesministern geforderte Reform des Heilpraktikerwesens mit unterstützen wird, bleibt offen. Auf Nachfrage, ob das Ministerium eine Bund-Länder-Arbeitsgruppe unterstützen würde, versteckte sich eine Sprecherin bereits im Mai hinter der Mini-Reform von Gröhe. Mit Blick auf die kurze Zeit seit Inkrafttreten dieser Änderungen sei es angemessen, zunächst zu prüfen, ob und inwieweit diese zum Schutz des Patientenwohles beiträgt, erklärte sie – „ehe weitere gesetzliche Maßnahmen in Betracht gezogen werden sollten“.

In einem Grundsatzbeschluss sprach sich die Gesundheitsministerkonferenz außerdem für „Patientenorientierung als Element einer zukunftsweisenden Gesundheitspolitik“ aus. „Das heißt, dass der Patient natürlich das Heft in der Hand haben muss, dass er versteht, was mit ihm gemacht wird, warum es mit ihm gemacht wird, mit welchen Chancen die Behandlung verbunden ist“, sagte NRW-Gesundheitsminister Karl Laumann. Auch in der Ausbildung des Gesundheitspersonals sollten diese Aspekte einen großen Stellenwert bekommen, betonte Laumann – und erwähnte zwar Ärzte als Berufsgruppe explizit, nicht aber Heilpraktiker. Der frühere Bundespatientenbeauftragte forderte außerdem mehr Transparenz ein. In Teilen des Gesundheitssystems gebe es wegen mangelnder Transparenz „eine gewisse Misstrauenskultur“, sagte er.

Die Minister wollen laut dem Beschluss die Patientensouveränität und der Orientierung im Gesundheitswesen verbessern, die Gesundheitskompetenz und gesundheitliche Eigenverantwortung beispielsweise durch die Einrichtung eines nationalen Gesundheitsportals deutlich stärken und Kommunikation und Wissenstransfer zwischen Patienten und allen Beteiligten im Gesundheitswesen fördern. „Patienten sollen so in die Lage versetzt werden, ihre Interessen besser zu vertreten und ihre Entscheidungen auf der Basis qualitätsgesicherter Informationen zu treffen“, heißt es.

Kommunikationskompetenz und wertschätzende Beziehungsgestaltung sei im Gesundheitswesen von wesentlicher Bedeutung für die Partizipation, Qualität, Sicherheit und den Erfolg der gesundheitlichen Prävention und der medizinischen Behandlung, betonen die Minister. Allgemeinverständliche „Patientenbriefe“ sollen als erster Schritt die Informiertheit von Patienten nach Krankenhausbehandlungen erhöhen. Außerdem soll das Bundesgesundheitsminister eine Pflicht schaffen, dass niedergelassene Ärzte ihren Patienten neutrale und evidenzbasierte schriftliche Informationen zu Zusatzangeboten – sogenannten „Individuellen Gesundheitsleistungen“ – zur Verfügung stellen müssen.

Bei Behandlungsfehlern sollen nach Ansicht der Landesminister auf Bundesebene weitere Erleichterungen umgesetzt werden: Die Beweislast und das Beweismaß soll zu Gunsten von Patienten überarbeitet werden. Außerdem sollten Krankenkassen gesetzlich verpflichtet werden, Patienten beim Nachweis eines Behandlungsfehlers besser zu unterstützen.

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I have been banging on about the German Heilpraktiker, its infamous history and its utter inadequacy since many years. This is what I published in 1996, for instance:

Complementary medicine is increasing in popularity. In most countries its practice is in the hands of non-medically trained practitioners, professions which are often not properly regulated. When discussing solutions to this problem the German “Heilpraktiker” is often mentioned. The history and present situation of this profession are briefly outlined. The reasons why the “Heilpraktiker concept” is not an optimal solution are discussed. It is concluded that the best way forward consists of regulation and filling the considerable gaps in knowledge relating to complementary medicine.

It goes without saying that, after so many tears of warning about the risks involved in allowing poorly trained practitioners, who are all too often unable to see the limits of their competency (and after many unnecessary fatalities), I am delighted that progress seems finally to be on the horizon.

An announcement by the UK Society of Homeopaths caught my attention. Here it is in its full and unabbreviated beauty:

START OF ANNOUNCEMENT

Homeopaths are being urged to contribute to an inquiry exploring ways to tackle a looming public health crisis threatened by ‘superbugs’ – bacteria resistant to antibiotics and other antimicrobial drugs.

The Commons Select Committee on Health and Social Care is inviting evidence for its investigation into the progress made by the government so far in responding to the challenge.

The two angles it is exploring are:

  • What results have been delivered by the current UK strategy on antimicrobial resistance (AMR), launched in 2013?
  • Key actions and priorities for the government’s next AMR strategy, due to be published at the end of 2018.

The Society of Homeopaths is putting together a submission and is asking members to submit their own evidence to the inquiry of using homeopathic alternatives to antimicrobials.

According to the inquiry background papers, antimicrobial resistance – in which bacteria have evolved into ‘superbugs’,  resistant to drugs devised to kill them – is a “significant and increasing threat” to public health in the UK and globally. EU data indicates that it is responsible for 700,000 deaths a year worldwide and at least 50,000 in the US and Europe.

The death toll could reach 10m people a year by 2050 if the rise in resistance is not headed off, it is estimated.

Society Chief Executive Mark Taylor said: “Our members know a great deal about the alternatives to antibiotics through their own practice and knowledge. This is a timely inquiry from the Health and Social Care Committee to assess the success of the existing strategy and an opportunity to make the case again for fresh thinking on this pressing public health challenge.”

END OF ANNOUNCEMENT

Yes, of course!

We have a crisis of antibiotic resistance.

Who is going to offer the solution?

THE HOMEOPATHS!!!

How?

They are going to treat us all with homeopathic remedies when the superbugs strike.

And the result?

No more crisis.

How come?

Because they have turned it into a catastrophe!!!

Traditional vaginal practices usually relate to personal hygiene, genital health or sexuality. Hygiene practices involve external washing and intravaginal cleansing or douching and ingestion of substances. Health practices include intravaginal cleansing, traditional cutting, insertion of herbal preparations, and application of substances to soothe irritated vaginal tissue.

One such traditional practice is ‘vaginal steaming’.

Recently vaginal steaming has become a fad promoted by SCAM-promoters (such as the vagina-obsessed Gwyneth Paltrow) with the claim that it leads to a range of health benefits. According to one website, for instance, vaginal steaming, Yoni Eggs, yoni or v-steam, as it is casually known, acts as an internal cleanser of the membranes of the vaginal tissues and uterus. This is considered especially important for stagnant fertility conditions and/or incomplete emptying of menses each cycle. This women’s treatment gently but effectively cleanses, tones and revitalizes a woman’s center, providing a myriad benefits from reduced menstrual cramps to increased fertility and more. Support your natural feminine cycle, help your body to heal, relax, and detoxify both physically and emotionally with a yoni steam.

The method is recommended for a wide range of conditions and is said to achieve all of the following and much, much more:

  • Significant reduction of pain, bloating and exhaustion associated with menstruation.
  • Significant reduction of PMS.
  • Decrease of menstrual flow as well as reduction of dark purple or brown blood at the onset or end of menses.
  • Regulation of irregular or absent menstrual cycles.
  • Increased fertility.
  • Faster healing and toning of the reproductive system following childbirth.
  • Assisting in healing uterine fibroids, ovarian cysts, uterine weakness, uterine prolapse & endometriosis.
  • Breaking down of reproductive adhesion/scar tissue. Assisting with the repair of a vaginal tear, episiotomy, or C-section scar.
  • Assisting with the healing of haemorrhoids.
  • Treating chronic vaginal/yeast infections and maintaining healthy vaginal odour.
  • Relief of menopausal symptoms such as vaginal dryness or pain during sex.
  • Detoxification of the womb/removal of toxins from the body. Release of stored emotions.
  • Reconnection with our female bodies and tapping into the sexual energy that is our creative potential.

Frequently, entrepreneurs recommend adding herbal or other ingredients. Herbs often used include:

  • mugwort
  • wormwood
  • chamomile
  • calendula
  • basil
  • oregano
None of these claims are supported by anything we would recognise as evidence, and it would be easy to make fun at the quacks who make them (and the women who fall for them) – unless, of course, there was real and significant harm involved. I fear, the potential for harm is undeniable:
  • vaginal steaming arms your bank account;
  • it disrupts the normal pH balance of the vagina;
  • in turn, this increases the risk of fungal and bacterial infections;
  • vaginal steaming can cause burns;
  • with added herbs, it can cause allergies.

New Zealand psychologists analysed online accounts of vaginal steaming to determine the sociocultural assumptions and logics within such discourse, including ideas about women, women’s bodies and women’s engagement with such ‘modificatory’ practices. Ninety items were carefully selected from the main types of website discussing vaginal steaming: news/magazines; health/lifestyle; spa/service providers; and personal blogs. Within an overarching theme of ‘the self-improving woman’ the researchers identified four themes: (1) the naturally deteriorating, dirty female body; (2) contemporary life as harmful; (3) physical optimisation and the enhancement of health; and (4) vaginal steaming for life optimisation. The authors concluded that online accounts of vaginal steaming appear both to fit within historico-contemporary constructions of women’s bodies as deficient and disgusting, and contemporary neoliberal and healthist discourse around the constantly improving subject.

For the sake of ‘journalistic balance’, let’s give Gwyneth the last word about the benefits of vaginal steaming. She knows best because she has done it and was quoted uttering these profound and scientific views: “The first time I tried v-steaming, I was like, ‘This is insane’. My friend Ben brought me and I was like, ‘You are out of your f**king mind. What is this? But then by the end of it I was like, ‘This is so great.’ Then I start to do research, and it’s been in Korean medicine for thousands of years and there are real healing properties. If I find benefit to it and it’s getting a lot of page views, it’s a win-win.”

And who would or could argue with that?

I have often pointed out that, in contrast to ‘rational phytotherapy’, traditional herbalism of various types (e. g. Western, Chinese, Kampo, etc.) – characterised by the prescription of an individualised mixture of herbs by a herbalist – is likely to do more harm than good. This recent paper provides new and interesting information about the phenomenon.

Specifically, it explores the prevalence with which Australian Western herbalists treat menstrual problems and their related treatment, experiences, perceptions, and inter-referral practices with other health practitioners. Members of the Practitioner Research and Collaboration Initiative practice-based research network identifying as Western Herbalists (WHs) completed a specifically developed, online questionnaire.

Western Herbalists regularly treat menstrual problems, perceiving high, though differential, levels of effectiveness. For menstrual problems, WHs predominantly prescribe individualised formulas including core herbs, such as Vitex agnus-castus (VAC), and problem-specific herbs. Estimated clients’ weekly cost (median = $25.00) and treatment duration (median = 4-6 months) covering this Western herbal medicine treatment appears relatively low. Urban-based women are more likely than those rurally based to have used conventional treatment for their menstrual problems before consulting WHs. Only 19% of WHs indicated direct contact by conventional medical practitioners regarding treatment of clients’ menstrual problems despite 42% indicating clients’ conventional practitioners recommended consultation with WH.

The authors concluded that Western herbal medicine may be a substantially prevalent, cost-effective treatment option amongst women with menstrual problems. A detailed examination of the behaviour of women with menstrual problems who seek and use Western herbal medicine warrants attention to ensure this healthcare option is safe, effective, and appropriately co-ordinated within women’s wider healthcare use.

Apart from the fact, that I don’t see how the researchers could possibly draw conclusions about the cost-effectiveness of Western herbalism, I feel that this survey requires further comments.

There is no reason to assume that individualised herbalism is effective and plenty of reason to fear that it might cause harm (the larger the amount of herbal ingredients in one prescription, the higher the chances for toxicity and interactions). The only systematic review on the subject concluded that there is a sparsity of evidence regarding the effectiveness of individualised herbal medicine and no convincing evidence to support the use of individualised herbal medicine in any indication.

Moreover, VAC (the ‘core herb’ for menstrual problems) is hardly a herb that is solidly supported by evidence either. A systematic review concluded that, although meta-analysis shows a large pooled effect of VAC in placebo-controlled trials, the high risk of bias, high heterogeneity, and risk of publication bias of the included studies preclude a definitive conclusion. The pooled treatment effects should be viewed as merely explorative and, at best, overestimating the real treatment effect of VAC for premenstrual syndrome symptoms. There is a clear need for high-quality trials of appropriate size examining the effect of standardized extracts of VAC in comparison to placebo, selective serotonin reuptake inhibitors, and oral contraceptives to establish relative efficacy.

And finally, VAC is by no means free of adverse effects; our review concluded that frequent adverse events include nausea, headache, gastrointestinal disturbances, menstrual disorders, acne, pruritus and erythematous rash. No drug interactions were reported. Use of VAC should be avoided during pregnancy or lactation. Theoretically, VAC might also interfere with dopaminergic antagonists.

So, to me, this survey suggests that the practice of Western herbalists is:

  1. not evidence-based;
  2. potentially harmful;
  3. and costly.

In a nutshell: IT IS BEST AVOIDED.

I have been alerted to this website; it is truly remarkable! Here is but one example, the section with advice on ‘reducing the risk of vaccine damage’:

START OF QUOTE

1. Give vitamin A before the measles vaccine (MMR).Vitamin A has been shown to reduce death in measles sufferers by 50% so will support the body in its dealing with the measles vaccine. The WHO is now giving out Vitamin A pills along with the vaccine! Consider high doses (5,000 IU or more) the day before, on the day and the day after vaccination.

2. Give increased vitamin C before and after all vaccines. Vitamin C is known to help eliminate heavy metals. Consider high doses (3,000-5,000 mg per day) the day before, day of, and day after.

3. Consider detox programs after vaccination. These include homeopathy (before and after each vaccination), supplements, especially vitamin C, probiotics etc. It can take up to a year to detox the system but it is worth the investment (Autistic children are usually highly toxic – See Treating Autism).

4. Reconsider the routine use of Calpol or similar before or after vaccination. A rise in body temperature is the immune systems healthy response to any attack. Suppressing this reaction will impair its’ ability to deal with the load imposed upon it by the vaccine. Links have been made with the use of Calpol etc after the MMR and autism because the body needs to raise a high temperature to deal with measles. Complications can arise if temperature is bought down too early in cases of measles. See ‘Dealing with Fever Naturally’ under the Health section of this site.

5. Avoid antibiotic use where possible.

Delay vaccines, especially the MMR, within up to 6 months of antibiotics.

The strength of the gut is compromised and the gut is 70% of the immune system. Autistic children often have Gut and Bowel disorders. Antibiotics during pregnancy & breast feeding can also compromise the child’s immune system.

Try not to use antibiotics, as there are links with increased asthma in the vaccinated and also with the overuse of antibiotics in children. Asthma kills 1,300 people a year in the UK and rates have doubled in the last 40 years. This is far higher than the mortality rates as a result of contracting contagious diseases before the vaccines! In the years leading up to the vaccination program between 30-50 people died of measles, for example. Nearly 200 children under 14 years now die of Asthma. Asthma UK puts this this condition down to lack of childhood infections! For most children, as they recover from illness, their immune system is strengthened. The UK, US, New Zealand, Cuba and Australia lead the world with Asthma (Vaccinated populations). Asthma UK says that ‘the goal would be to find a suitable vaccine to provide the beneficial effects of early life infection’!!!

6. Use Probiotics to strengthen the gut, in capsule form rather than from a drinking yogurt product which usually contains sugar and other additives.

7. Consider giving long term Vit B6 as “One of the components of the MMR is Neomycin. This is an antibacterial drug that is used to suppress gastrointestinal bacteria before surgery to avoid infection. …This antibiotic interferes with the absorption of Vitamin B6. An error in the uptake of Vitamin B6 can cause a rare form of epilepsy and children become mentally retarded. Vitamin B6 is the major vitamin for processingamino acids, which are the building blocks of all proteins and a few hormones. There are studies around which support the theory of treating autistic children with Vitamin B6.”

END OF QUOTE

Let me briefly comment on these 7 points.

  1. I am not aware of good evidence supporting this claim.
  2. I am not aware of good evidence supporting this claim.
  3. I am not aware of good evidence supporting this claim.
  4. I am not aware of good evidence supporting this claim.
  5. I am not aware of good evidence supporting this claim.
  6. I am not aware of good evidence supporting this claim.
  7. I am not aware of good evidence supporting this claim.

Of course, I may have missed some important evidence; if that is the case, I would appreciate someone showing it to me in the comments section below, so that we can all benefit from it.

The above advice is from the ‘ARNICA’ group (as the name suggests, they are close to or even led by homeopaths). They believe that the non-vaccinated child is potentially healthier than the vaccinated child.  

They also claim they  want to reduce the fear often felt by parents with their young children on health issues, whether that is to learn how to look after children when they have a fever, or to suggest ways to reduce the adverse reactions from vaccines.

I respectfully suggest that they are dismally failing in their aims. In fact, they seem to promote fear and issue bogus advice.

Grace Dasilva-Hill has just published an article entitled “Autism/ADHD and Vaccines – are we walking a tightrope whilst blindfolded?“. Who is Grace Dasilva-Hill, you will ask.

She is a professional registered homeopath, based in Charing – East Kent, UK. She has been in practice since 1997. During this time she has developed a busy practice, alongside teaching, running students’ clinics and tutorials. She was a team member of the Ghana Homeopathy Project soon after it started, and later became their treasurer as well. Grace has published in the Journal Homeopathy in Practice, and HPathy. She also is an ‘Energy EFT Master Practitioner Trainer’ and a ‘qualified CEASE therapist’.

And what is the Ghana Homeopathy Project ? It is an organization whose goal is the establishment of homeopathy as a recognised part of the health care system in Africa and Ghana in particular. Their objective is the relief and prevention of disease. They support the development of homeopathic education and wish to make homeopathy available to deprived communities as a valid and affordable form of treatment.

The lengthy article by Grace Dasilva-Hill re-hashes all the bogus arguments about immunisation that you could ever wish for. I will show you only what she calls her ‘conclusions’:

START OF QUOTE

…at the present time we have only just scratched the surface of the issue of autism and ADHD; my aim in this article is to challenge the reader to pause, reflect and ask: do vaccines do more good than harm, or it is actually the other way round? Just who is considered to be responsible for my health and that of my family – my doctor, my country’s government or myself? Do we need to stand up as a profession, and be more pro-active?

The big question seems to be, are we not only failing our patients but also the greater good of the world’s populations, unless we question and do not just ‘accept’ what science and medicine tells us, especially as ‘vested interests’ seem to have such a strong influence on what we are told?
The health journalist Phillip Day has done just that in his book ‘Health Wars’ – he argues how the multinationals have a vested interest in keeping all of us ill, for this is the only way that they can continue making money. His propositions are supported by Goldman Sacks Bank which recently stated that they would not invest in the alternative health industry because it tends to cure people, so there is little profit to be made from it.

I invite you to become an advocate for those who are unable or who are too young to ask questions, or to stand up for themselves, or whose parents don’t have the knowledge or tenacity to challenge.
Children and young adults suffering with autism, ADHD, ASD, deserve our loyalty, support and action.

In the UK, we recently shared the anguish and pain felt by baby Alfie Evans’ parents and family. It is impossible for anyone who is caring to witness such horror, and not to ask any questions. Hopefully we will learn much from this very sad event. There are questions not only about causative factors (ie. the role that vaccinations may have played), but also the issue of parental rights versus the State’s perceived protectionist rights.

What has been happening in the field of healthcare is fast becoming unsustainable. On the other hand Homeopathy has so much to offer, being a sustainable form of medicine not influenced by market forces.

One could argue that one of the reasons why the denialists want to see the demise of homeopathy and other natural modalities, is that more and more people are choosing these modes of healthcare in place of conventional medicine which is reductionist in approach and only has drugs to offer.

I find myself wondering whether there is a need for something radically different to happen. As a profession, do we need to do something collectively? Do we need to stand up more, do we need to speak up more? How do we go about doing this? I know that I am asking more questions than providing answers, and this is because at the moment I don’t have the answers either. But I have a deep and sincere desire to do my best to make a difference that will be both worthwhile and sustainable.
I would like to believe that others in our community would like to do the same for the bigger benefit of sustainable and effective healthcare for all.

Footnote: I have just carried out an impromptu, unrepresentative survey of homeopathic colleagues on a homeopathic professional group. I asked them if they knew of any health care professionals (doctors, nurses, midwives) who did not vaccinate their children. Most of those who replied, surprisingly said that they do know of at least one doctor, or nurse or midwife who did not vaccinate their children, and they added that these professionals keep this quiet. I certainly know of two medical doctors who do not vaccinate their children, and again they do not talk about it. It was shared with me in confidence.

END OF QUOTE

Of course, these words are not really ‘conclusions’, they are just a continuation of a barmy rant.

And yes, such articles exist in abundance. Many homeopaths are active campaigners against vaccination.

The Society of Homeopaths (SoH), the professional UK organisation for lay homeopaths, has recently stated that it is unethical for a homeopath to advise a patient against the use of conventional vaccines…  This could not be clearer! Yet, I suspect that the homeopaths put out such statements mainly to cover their backs and subsequently they do what they feel like – and they rarely feel like supporting vaccinations.

They obviously try to give the impression that lay homeopaths are not antivaxers. I fear, however, this impression is wrong: as we have discussed repeatedly on this blog, many homeopaths do advise their patients against immunisation. And many claim that homeopathic immunisations are an effective alternative. It takes not long to find even VIP-members of the SoH putting parents off from immunising their kids. And thanks to the Ghana Homeopathy and several similar projects, this is happening not just in the UK but also in Africa and elsewhere.

Is that not irresponsible?

In my view, it is!

Is that not illegal?

Apparently not, because such homeopaths usually add a clever disclaimer; Grace Dasilva-Hill for instance states that  Any information obtained here is not to be construed as medical OR legal advice. The decision to vaccinate and how you implement that decision is yours and yours alone. 

In 2005, I published a systematic review of ophthalmic adverse effects after spinal manipulations. At the time, I found 14 case reports. Clinical symptoms and signs were diverse and included loss of vision, ophthalmoplegia, diplopia and Horner’s syndrome. The underlying mechanism was arterial wall dissection in most cases. The eventual outcome varied and often included permanent deficits. Causality was frequently deemed likely or certain.

I concluded that upper spinal manipulation is associated with ophthalmological adverse effects of unknown frequency. Ophthalmologists should be aware of its risks. Rigorous investigations must be conducted to establish reliable incidence figures.

Now a new article has emerged that throws more light on this issue:

A 46-year-old healthy male with a history of chronic musculoskeletal neck pain presented to the emergency department with left sided weakness after a syncopal episode. The patient had been treated with frequent chiropractic neck manipulations over the past seven years, with his last session one month prior to presentation. One week prior to presentation, the patient developed a new headache, anisocoria, and ptosis of his right upper eyelid. Computed tomography angiography (CTA) of the head and neck showed an internal carotid occlusion with right middle cerebral artery zone of ischemia, and tissue plasminogen activator (tPA) was administered. Subsequently, the patient experienced vision loss in his right eye. MRI and CTA were repeated, revealing a right ICA dissection from below the ophthalmic artery to the posterior communicating artery. On examination, vision in the right eye was no light perception (NLP) and the pupil was amaurotic. Fundus exam showed vascular attenuation, severe pallor of the optic nerve and retina, without a cherry red spot. A diagnosis of ophthalmic artery occlusion was made.

Inpatient workup revealed no stroke risk factors, and he was discharged on aspirin and clopidogrel therapy. Follow up imaging showed re-cannulation of the ICA, although vision remained NLP at outpatient evaluation the following month. Macular spectral domain optical coherence tomography (SDOCT) showed hyperreflectivity of the inner retina diffusely and of the outer retina and retinal pigment epithelium (RPE) centrally. Fluorescein angiography revealed patchy choroidal filling, delayed arterial filling, and macular nonperfusion. Three months after presentation, vision had improved to light perception, and remains stable at one year after the dissection.

Central retinal artery occlusion (CRAO) has been previously described after neck manipulation; however, these cases have been attributed to a dislodged embolic plaque rather than arterial dissection as in this case. Carotid artery dissection after neck manipulation is rare, although the exact incidence is unknown, and may be fatal.

The authors of this case report concluded that internal carotid artery dissection in this case was permanently devastating to the vision of a previously healthy young patient.

What follows is simple:

  1. upper spinal manipulations have no or very little proven benefit;
  2. they are associated with a finite risk;
  3. thus, their risk/benefit balance fails to be positive;
  4. consequently, upper spinal manipulations cannot be recommended as a treatment of any condition.

Our good friend Dana Ullman commented on my last post that doctors are being unethical by NOT prescribing homeopathic medicines because they are breaking one of the most important medical guidelines: “First, do no harm.” Here I do not want to discuss in-depth the nonsense about homeopathy in his sentence, rather I want to focus on the notion that doctors are obliged to foremost do no harm.

The sentence ‘first do no harm’ is supposed to originate from the Hippocratic oath which allegedly all doctors have to take when finishing medical school. This is twice wrong:

  1. we don’t take this oath – I have read it, and it is something utterly non-applicable to today;
  2. the famous sentence does not appear in the oath.

But never mind the history and all that! Doctors are nevertheless obliged to ‘first do no harm’ because it is an important principle of medical ethics.

This is also not true, I’m afraid.

If it were true, doctors would have to stop practicing much of medicine instantly. Clinicians do harm all the time. Their injections hurt, their diagnostic procedures can be unpleasant and painful, their medications cause adverse effects, their surgical interventions are full of risks, etc., etc. None of this would be remotely acceptable, if it did not also some good.

And that is why the ethical imperative of doing no harm has sensibly been changed to the imperative of doing more good than harm. Of course, doctors must be allowed to do even quite serious harm, as long as their actions can be expected to generate even more good. In more common medical terms, we speak of the risk/benefit balance of an intervention:

  • if the known risks of a treatment are greater than the expected benefits, we cannot ethically prescribe it;
  • if the benefits outweigh the risks, we can consider it as a reasonable option.

That is all very well, but it can only apply to treatments where both the risks and the benefits are well-understood. What about the many treatments where there is uncertainty regarding either or both of these factors? This question is impossible to answer in the abstract. We need to look at the best evidence we have for each specific case and, together with the patient, try to make an informed judgement.

Now, let’s please our good friend Dana and do such an evaluation for homeopathy, as one of many examples of an alternative therapy:

Therefore, one might argue that the balance of risk versus benefit might not look all that bad. Dana and his colleagues would thus feel that it ethically legitimate to routinely use homeopathy. But this line of thought would ignore an important issue: harm can be done not just by the remedy itself. The harm caused by applying an ineffective treatment for conditions that are otherwise effectively treatable (usually referred to as neglect) can be considerable, even fatal. So, for homeopathy the true situation presents itself as follows:

This results in a negative risk/benefit balance which means, as outlined above, we cannot ethically use homeopathy.

… and, of course, Dana’s statement (doctors are being unethical by NOT prescribing homeopathic medicines because they are breaking one of the most important medical guidelines: “First, do no harm.” ) turns out to be wrong on several levels.

My previous post was about the question whether lay-homeopaths can practise homeopathy without breaking their code of ethics. The answer was NO, because they lack most of the skills needed to obtain informed consent.

What about doctor homeopaths?

Can they practice homeopathy ethically?

Doctors are, of course, also obliged to follow their ethical code, and that means they too must obtain informed consent from their patients before starting a therapy. This is, for instance, what the UK General Medical Council tells their members:

You must give patients the information they want or need about:

  1. the diagnosis and prognosis
  2. any uncertainties about the diagnosis or prognosis, including options for further investigations
  3. options for treating or managing the condition, including the option not to treat
  4. the purpose of any proposed investigation or treatment and what it will involve
  5. the potential benefits, risks and burdens, and the likelihood of success, for each option; this should include information, if available, about whether the benefits or risks are affected by which organisation or doctor is chosen to provide care
  6. whether a proposed investigation or treatment is part of a research programme or is an innovative treatment designed specifically for their benefit4 
  7. the people who will be mainly responsible for and involved in their care, what their roles are, and to what extent students may be involved
  8. their right to refuse to take part in teaching or research
  9. their right to seek a second opinion
  10. any bills they will have to pay
  11. any conflicts of interest that you, or your organisation, may have
  12. any treatments that you believe have greater potential benefit for the patient than those you or your organisation can offer.

You should explore these matters with patients, listen to their concerns, ask for and respect their views, and encourage them to ask questions.

You should check whether patients have understood the information they have been given, and whether or not they would like more information before making a decision. You must make it clear that they can change their mind about a decision.

Following the 8 points from my previous post (I am trying to apply the same criteria to both types of homeopaths), a medical homeopath might tell her patient (whose stomach pain turns out to be caused, let’s assume, by a stomach ulcer) roughly this:

  1. The tests show that you are suffering from stomach ulcer.
  2. The natural history of this condition is usually benign, but it needs effective treatment; if not, the problem would become serious.
  3. Conventional medicine has several effective therapeutic options.
  4. I nevertheless propose to treat you with a homeopathic remedy.
  5. There is no good evidence that it will work beyond a placebo effect.
  6. The remedy is harmless, but not giving you an effective treatment might cause considerable harm.
  7. The cost of the consultation is £80, and the remedy will cost you around £15.
  8. I suggest you come again in a week or two; perhaps we need quite a few consultations altogether.

Again, as with the lay-homeopath from my previous post, any sensible patient would walk away without accepting the treatment. This means that our doctor homeopath can only practice homeopathy, if she does not inform her patient about points 5 and 6. In other words, doctors who practice homeopathy cannot obtain adequately informed consent. We have recently seen a real case of this happening and ending in the death of the patient.

Of course, the homeopath might send her patient to a specialist; or she might decide to administer a conventional therapy herself. Either way, she would not be practising homeopathy.

The dilemma is real, yet it is rarely considered. Here is a short passage from our book where we discuss the ethics of alternative medicine in full detail:

Genuine informed consent is unattainable for most CAM modalities. This presents a serious and intractable ethical problem for CAM practitioners. Attempts to square this circle by watering down or redefining the criteria for informed consent are ethically indefensible. The concept of informed consent and its centrality in medical ethics therefore renders most CAM practice unacceptable. Conventional healthcare subscribes to the ethical principle ‘no consent, no treatment’; we are not aware of the existence of any good reasons to excuse CAM from this dictum.

As I said, the ethical practice of homeopathy is a practical impossibility.

Or do you think I got this wrong?

I am not a regular reader of the ‘HALTERNER ZEITUNG’, I have to admit; but this article from the paper came to me because of my interest in homeopathy. It tells a tragic story of a German women who paid dearly for consulting a homeopath.

Here is an excerpt – as it is in German, I will sum up the essence of the story below in English.

_______________________________________________________________________________________________

…Die traurige Geschichte beginnt im Jahr 2012. Die später verstorbene Frau aus Haltern lässt sich von ihrer Ärztin wegen Heiserkeit behandeln und bekommt homöopathische Mittel. Rund zehn Monate später wechselt die Seniorin den Arzt und muss umgehend ins Krankenhaus: Luftröhrenschnitt, Kehlkopf-Entfernung, Krebs. Die Frau verstirbt nach vierjähriger Leidenszeit.

Für Schwester und Tochter war das nicht nur ein Schock, sie machen der Ärztin nun auch schwere Vorwürfe. Aus ihrer Sicht hätte praktisch sofort eine Überweisung zu einem HNO-Arzt und damit eine schulmedizinische Behandlung erfolgen müssen.

Genau das habe die Patientin aber nicht gewollt, sagte die Ärztin. „Sie hat sich immer dagegen gewehrt.“ Angeblich soll das auch dokumentiert sein. Doch auch das ist umstritten. Die Hinterbliebenen werfen der Ärztin nämlich vor, die Unterlagen gefälscht zu haben.

150.000 Euro haben sie als Schmerzensgeld eingeklagt. Dafür sah die Medizinkammer zum jetzigen Zeitpunkt jedoch keine Grundlage. „Die Haftung ist vollkommen offen“, sagte Richter Norbert Schalla.

Man wolle die Leiden der Frau zwar nicht in Abrede stellen. Die Frage sei jedoch, inwieweit die Behandlung eines krankheitsbedingten Leidens tatsächlich verzögert worden sei. „Wir müssten erstens eine Pflichtverletzung und zweitens die Kausalität feststellen“, so Schalla. Beides sei aber außerordentlich schwierig, weil es außer der Ärztin keine Zeugen gebe.

Trotzdem hatten die Richter am Essener Landgericht am Ende eine „Goodwill-Zahlung“ vorgeschlagen, um einen möglicherweise jahrelangen Rechtsstreit zu verhindern. „Manchmal ist es besser, zu einem Abschluss zu kommen, damit man seinen inneren Frieden wiederfinden kann.“

Genau so hat es die Ärztin am Ende wohl auch gesehen. Ob die 10.000 Euro aber wirklich gezahlt werden, hängt allerdings noch von ihrer Haftpflicht-Versicherung ab. Die kann in den nächsten zwei Wochen noch ihr Veto einlegen.

Auch die Hinterbliebenen können die Einigung noch immer widerrufen. Sie müssen von dem Geld nämlich 94 Prozent der Prozesskosten tragen.

_______________________________________________________________________________________________

Here is my summary:

  • An elderly woman with a sore throat consults her doctor who happens to be a homeopath.
  • The doctor prescribes homeopathic remedies.
  • The homeopathic treatment continues for months, evidently without success.
  • 10 months later, the patient changes her doctor, and her new physician sends her straight away into hospital.
  • There she is diagnosed with throat cancer.
  • After 4 years of suffering, the woman dies.
  • The patients relatives sue the homeopath for the relatively modest sum of 150 000 Euros.
  • The homeopath claims that the old woman had refused to be referred to a specialist and that the case notes provide proof for that claim.
  • The relatives suspect that the case notes have been altered retrospectively.
  • The judge suggest a ‘good will’ payment of 10 000 Euro.
  • The homeopath accepts, but it remains unclear whether the insurance agrees to pay this sum.
  • The relatives have to pay 94% of the costs for the court proceedings.

_______________________________________________________________________________________________

Anyone who claims that homeopathy is harmless should remember this story. Similar (but hopefully less dramatic) things happen almost every time a homeopath treats a patient, we argue in our book. The practice of homeopathy is by and large medical neglect. Because homeopathy is employed mostly for minor, self-limiting conditions, the neglect usually remains invisible. However, as soon as homeopath venture to treat serious diseases, the neglect (the deliberate treatment of a disease with an ineffective therapy) becomes obvious.

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