risk/benefit
The WHO’s supportive stance on so-called alternative medicine (SCAM) has been discussed on this blog many times before. Now a BMJ editorial criticized the WHO for uncritically promoting SCAM within mainstream health systems. It argues that WHO’s new strategy gives undue legitimacy to interventions whose evidence base is often weak, inconsistent, or absent. The author’s main concern is not cultural respect or patient choice, but the risk that policy language about “integration,” “tradition,” and “people-centred care” can blur the line between evidence-based medicine and therapies that have not demonstrated reliable benefit. The article points out that, while some traditional practices may be harmless or even useful, broad institutional support should depend on rigorous proof of safety and effectiveness. It also warns that promoting such therapies may waste scarce resources, confuse patients, and create false equivalence with established medical care. More broadly, the editorial presents this as a scientific and ethical issue: global health bodies should strengthen standards, not weaken them. The WHO should prioritize robust clinical evidence, transparent regulation, and careful harm-benefit assessment before endorsing any therapy for widespread use. In short, the article sees WHO’s current approach as a misguided attempt to accommodate alternative medicine rather than critically evaluate it.
The team of international authors of the editorial argue that an ideal strategy should mandate pharmacovigilance, including adverse event reporting, as a prerequisite. Large workforces should be redirected toward evidence-based primary care, such as screening, vaccination, chronic disease identification and maternal health. Research funding should prioritise independent clinical trials with negative results published as systematically as positive ones. The WHO Traditional Medicine Global Library must catalogue documented harms alongside knowledge claims. Commercial conflicts of interest must be transparent. And WHO’s messaging must remain unequivocally aligned with scientific consensus – a proven tool against misinformation that mixed messaging would fatally undermine.
The authors conclude that “billions use traditional medicine – many from uninformed choices. The ethical response is not to validate what remains unvalidated, but to expand access to what withstands scrutiny. Patients everywhere deserve nothing less.”
Readers might remember that I posted my own critique of the WHO’s new strategy on this blog already on 6/11/2025. Here is an excerpt of my post:
The WHO aim to “advance the contribution of evidence-based traditional, complementary and integrative medicine” seems laudable, yet it also raises concerns: once any form of medicine is “evidence-based”, it is not “traditional, complementary and integrative”. Then it is by definition EBM, evidence-based medicine! Thus, the entire premise of the WHO Global traditional medicine strategy 2025–2034 makes no sense.
The fact that “traditional medicine is the primary or preferred care for billions of people worldwide” does not necessarily mean that its “clinical potential is considerable”. More likely it means that billions have to rely on obsolete forms of medicine from the dark ages because they cannot afford effective treatments. This is far from an opportunity; it is a challenge for us to improve this inhuman situation.
The fact that “acupuncture is recommended for migraine”, while the evidence for this (and almost all similar) recommendations are not supported by sound evidence, amounts to a scandal. One would have hoped that, instead of promoting unproven ‘traditional medicine’, an urgent task of the WHO would be to warn people of bogus and often dangerous claims that are ubiquitous in this sector.
The fact that “1% of global health research funding is dedicated to traditional medicine” might look unfair at first glance. But global health research funding is in the range of US$ 200 billion per year. Thus 1% would amount to 2 billion, and I suggest that one could do plenty of good research with this money. Instead, the sector tends to waste its funds on lousy pseudo-research, as anyone interested can confirm by reading this blog. Why does the WHO not point this out and take measures to stop pseudo-science in the realm of ‘traditional medicine’? Do they really think that offensive ideological platitudes such as “restoring balance is a scientific, rights-based and sustainability imperative” cuts the mustard?
My recommendation to the WHO is as simple as it is important: if you want to create meaningful articles, documents or strategies on ‘traditional medicine’ (or indeed any other subject), don’t charge biased proponents with the task but recruit a few well-informed critical thinkers as well.
It is good that the BMJ editorial concurs with my assessment. The question is, will it have an effect? Considering the multiple times we had to criticise the WHO for its irresponsible stance on SCAM, it would be high time for adopting an evidence-based attitude.
In the realm of so-called alternative medicine (SCAM), “chemical” has long been a dirty word. This phenomenon, known as chemophobia – an irrational fear of synthetic substances – drives a multi-billion-dollar industry obsessed with the “all-natural.” While it stems from an understandable desire for safety (and for making money out of the fear of the public), the chemophobia of SCAM relies on a fundamental misunderstanding of basic chemistry and toxicology, building a false dichotomy between wholesome nature and malicious chemistry.
To truly dismantle this anxiety, one needs to look no further than a perfect example from nature: the humble apple. If an organic, all-natural apple were required to carry an ingredient label written by a chemist, it would look far more intimidating than any processed food label. A single bite of an apple delivers a complex cocktail of chemical compounds. Beyond its bulk structure of water, dietary pectin, and sugars like fructose and sucrose, an apple is a dense matrix of amino acids—including glutamic acid, aspartic acid, and tyrosine—and fatty acids like linoleic and palmitic acid. It is enriched with vitamins and minerals, from ascorbic acid and alpha-tocopherol to potassium and magnesium. Even its delightful aromas and flavors are synthesized by nature using a mixture of volatile organic compounds: esters like butyl acetate, alcohols like hexan-1-ol, aldehydes like trans-2-hexenal, and a sharp dose of malic acid. More surprisingly perhaps, this wholesome fruit features nature’s own “toxins.” Apples naturally contain trace amounts of formaldehyde, and their seeds contain amygdalin, a cyanogenic glycoside that degrades into deadly hydrogen cyanide when digested.
The chemical reality of this simple apple highlights the core fallacy of chemophobia: the belief that natural compounds are inherently safe, while synthetic ones are unavoidably toxic. In reality, nature is a master chemist, and the foundational rule of toxicology dictates that it is mostly the dose that makes the poison. Anything can be toxic in excess—even water—and many synthetic molecules are identical to, or safer than, their natural counterparts. Aspirin, for instance, has less side-effects that an extract of willow bark!
The chemophobia of SCAM proponents strips away all nuance and treats the mere presence of a complicated chemical name as an absolute hazard. By fostering a deep-seated distrust of science, it steers ill-informed individuals away from life-saving conventional treatments towards unproven quackery. True health literacy requires moving past misleading branding and recognising that everything in our universe, from a crisp apple to a synthetic antibiotic, is made of chemicals.
Robert F. Kennedy Jr., the U.S. Health and Human Services secretary, is demanding that the journal Toxicology Reports explain in detail why it removed a 2021 paper he has cited in support of his anti-vaccine stance. The study had concluded that “While the findings in this paper are not proof of an association between infant vaccines and infant deaths, they are highly suggestive of a causal relationship.”
In his letter to the editors, Kennedy accuses the journal of suppressing research linking vaccines to sudden infant death. However, the evidence reveals quite clearly that Kennedy is not seeking transparency but rather attempting to bully a peer-reviewed journal that correctly identified fatal methodological flaws in a paper Kennedy continues to promote.
The removed study claimed to link vaccines to infant deaths using data from the Vaccine Adverse Event Reporting System (VAERS). The journal removed the paper because VAERS is a passive reporting system that cannot establish causality. Any conclusion claiming vaccines cause deaths from such data is therefore not valid. The editors determined the methodology was seriously flawed and that the author’s responses to critiques were unsatisfactory. Consequently, the paper would mislead readers and harm the public. In this situation, it would have been unethical NOT to retract!
Kennedy’s demand for a “full explanation” ignores that the journal had already provided a clear, evidence-based removal notice. He wants to know who reviewed the paper and what standards were applied, yet these are standard peer-review procedures. Framing a legitimate scientific correction as censorship reveals Kennedy’s disregard for science and evidence-based medicine. As HHS secretary, he is responsible for protecting public health, yet he continues to cite fraudulent research that contradicts established scientific consensus on vaccine safety.
The story is reminiscent of the ongoing conflict over the landmark Danish vaccine study published in the Annals of Internal Medicine. It tracked over 1.2 million children born in Denmark between 1997 and 2018. Exploiting a natural experiment created by evolving national immunization schedules, researchers analyzed the dose-response relationship of aluminum adjuvants. The study found no evidence linking increased cumulative exposure to an elevated risk of 50 chronic pediatric conditions, including neurodevelopmental, autoimmune, and allergic disorders.
Despite its massive scale and rigorous design, Kennedy labeled the research a “deceitful propaganda stunt” and demanded its retraction. However, Kennedy’s criticisms rely on data misrepresentation and a fundamental misunderstanding of epidemiological methodology. First, Kennedy cherry-picked non-significant supplementary data, falsely claiming a 67% increased risk of Asperger’s syndrome. In reality, the finding had a wide confidence interval, lacked statistical significance, and completely vanished when researchers analyzed the full follow-up data. Second, Kennedy objected to the lack of a completely unvaccinated control group. Experts counter that the unvaccinated cohort (1.2%) was too small to measure rare outcomes accurately and would introduce severe confounding bias due to differing family lifestyles. Finally, Kennedy levelled inaccurate claims of financial corruption against Denmark’s Statens Serum Institut, a public research body that had long since divested its vaccine manufacturing arm.
The medical community has firmly rejected Kennedy’s attacks. The journal refused his retraction demand, and independent experts have defended the study as the strongest available evidence of vaccine aluminum safety. After all, aluminum salts have been used safely for a century, and vaccine-derived amounts are eclipsed by daily environmental and dietary intake.
The inescapable conclusion is that Kennedy’s campaigns are not about accountability or about promoting scientific rigor; they are about promoting his dangerous type of misinformation. His continued advocacy of pseudoscience exposes his commitment to ideology over evidence, a truly dangerous stance for anyone leading the nation’s health agency. It is high time, I feel, that he gets sacked before he does any more lasting damage to public health in the US and beyond!
Needle-based acupuncture is used in some detoxification settings. However, its efficacy for illicit drug use disorders remains uncertain because prior reviews often mixed comparator types, co-interventions, or non-needle modalities. This review aimed to evaluate needle-based acupuncture monotherapy using comparator-stratified meta-analysis.
The authors searched PubMed, Embase, Web of Science, Cochrane Library, CNKI, CBM/SinoMed, trial registries, and supplementary sources from inception to September 12, 2025. The quantitative synthesis was restricted to randomized trials of manual acupuncture, electroacupuncture, or needle-insertion auricular acupuncture delivered without concomitant pharmacotherapy or psychotherapy. Although the registered protocol allowed non-randomized comparative studies, none were pooled because of insufficient comparability and a higher risk of confounding. Sensitivity analyses excluded trials with moxibustion co-treatment.
Thirteen randomized trials (n = 1,027) were included in the meta-analysis. For the prespecified primary outcome of withdrawal severity at the end of treatment, acupuncture favored blank/no-acupuncture controls [g = −2.089, 95% confidence interval (CI): −2.869 to −1.309; τ² = 0.712; I² = 82.9%], but the prediction interval (PI) crossed the null (PI: −4.306 to 0.128). Against active non-acupuncture comparators, the pooled effect was imprecise (g = −1.70, 95% CI: −5.43 to 2.02; PI: −23.49 to 20.09). Against sham acupuncture, two comparisons yielded an imprecise estimate (g = −1.45, 95% CI −9.41 to 6.51), and no PI was estimated. Among secondary outcomes, anxiety favored acupuncture over blank/no-acupuncture controls (g = −1.537, 95% CI: −2.047 to −1.026; PI: −2.939 to −0.134), whereas evidence from sham-controlled studies was less certain (g = −0.998, 95% CI: −1.744 to −0.252; PI: −2.828 to 0.832). For depression outcomes, PIs crossed the null in both blank- and sham-controlled analyses. The certainty of the evidence was low to very low.
The authors concluded that acupuncture exhibited favorable average effects on withdrawal severity, but null-crossing PIs limited confidence in the reproducibility of these effects across different settings and treatment protocols. Anxiety was interpreted as a secondary finding. No serious acupuncture-related adverse events were explicitly reported, although surveillance was often passive or insufficiently described.
The review treats acupuncture as “effective” for illicit drug disorders by highlighting short-term improvements in craving or anxiety, while the outcomes that matter for addiction – abstinence, relapse, use frequency, and retention – show no reliable benefit.
This, I think, is a classic case of presenting a negative result as a positive finding!
The review explicitly found no consistent difference between acupuncture and comparators for substance use endpoints, and the apparent positive outcomes were limited by low-quality evidence and publication bias. By foregrounding surrogate outcomes and obscuring the lack of clinically decisive effects, the paper misleads readers into perceiving acupuncture as a viable monotherapy for drug use disorders. Yet the evidence does clearly not support that conclusion.
For several decades, eggs were commonly portrayed as a major cause of raised cholesterol and cardiovascular disease. That position has been substantially revised: current evidence suggests that dietary cholesterol has a relatively modest effect on blood cholesterol in most people, whereas saturated and trans fats are more important determinants of LDL cholesterol and cardiovascular risk.
The physiology is more nuanced than the older “cholesterol-in, cholesterol-out” model implied. The liver does synthesise cholesterol endogenously, and many people compensate for increased dietary cholesterol by reducing hepatic production, but the degree of compensation varies considerably between individuals. For that reason, eggs are not best understood as “heart-healthy” in all circumstances, but rather as a food whose impact depends on the wider dietary pattern and the individual’s metabolic risk profile.
There is stronger support for improving lipid profiles by changing the quality of dietary fat and increasing fibre intake. Replacing saturated fats with unsaturated fats, particularly polyunsaturated fats, is associated with lower LDL cholesterol and a reduced risk of cardiovascular events, while soluble fibre helps lower LDL cholesterol by interrupting enterohepatic bile acid recycling. In practical terms, this means that foods such as olive oil, nuts, seeds, legumes, oats, vegetables, and oily fish are more consistently supported than a narrow focus on single items such as eggs.
Low-carbohydrate and ketogenic diets are more complex. Many people lose weight on them, which may improve some cardiometabolic markers, but a subset of lean individuals show pronounced rises in LDL cholesterol and related atherogenic markers during carbohydrate restriction. Emerging evidence also indicates that gut microbial changes may contribute to altered lipid metabolism, although this area is still developing and should not be overstated.
Highly restrictive “detox” or “alternative” dietary programs are unsupported by clinical evidence and may be nutritionally unbalanced and thus harmful. They might be claimed to “purify” the body or reset metabolism, but heart health is better served by sustainable patterns that improve LDL cholesterol, support fibre intake, and minimise excess saturated fat.
What does all that mean in practice? Here are a few simple rules that follow from the new insights:
- Do not over-emphasize dietary cholesterol (e.g., eggs) as a primary driver of cardiovascular risk.
- Focus instead on reducing saturated and trans fat intake.
- Replace saturated fats with unsaturated fats, especially polyunsaturated fats (e.g., use olive oil, eat nuts and seeds).
- Increase intake of soluble fibre (e.g., oats, legumes, vegetables) to help lower LDL cholesterol.
- Consider overall dietary patterns rather than judging single foods in isolation.
- Recognize that individual responses to dietary cholesterol vary; tailor intake accordingly if lipid levels are a concern.
- Include foods with consistent cardiovascular benefit, such as oily fish, plant-based foods, and whole grains.
- Be cautious with low-carbohydrate or ketogenic diets, particularly if lean, and monitor lipid profiles if following such diets.
- Prioritize sustainable, balanced eating patterns over restrictive or extreme diets.
- Avoid “detox” or alternative dietary regimens lacking clinical evidence, as they are ineffective or harmful.
Key references
- Carson JAS, Lichtenstein AH, Anderson CAM, et al. Dietary cholesterol and cardiovascular risk: a science advisory from the American Heart Association. Circulation. 2020;141:e39–e53.
- Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368:1279–1290.
- Hooper L, Martin N, Jimoh OF, et al. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev. 2020;(5):CD011730.
- British Heart Foundation. Healthy eating – reduce your risk of developing heart disease. 2023. – Search
- NHS. Facts about fat. 2022. – Search
- Ketogenic Diet reduces friendly gut bacteria and raises cholesterol levels
- Gut bacteria can break down cholesterol | Nature Reviews Cardiology
- Healthy eating: applying All Our Health – GOV.UK
On May 27, 2026, the U.S. Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) announced they are investigating a 3rd multistate outbreak of Salmonella infections linked to moringa powder supplements in 2026. Moringa oleifera supplements (including green powders and capsules) are heavily marketed as a “superfood” and a natural multivitamin powerhouse. They are primarily promoted for:
- Nutritional Support: Providing high concentrations of protein, iron, calcium, and vitamins A, C, and E.
- Energy & Metabolism: Boosting daily vitality and supporting healthy weight management.
- Blood Sugar & Heart Health: Helping to regulate glucose levels, lower cholesterol, and manage blood pressure.
- Immune & Inflammation Support: Using rich antioxidant content (like quercetin) to combat cellular stress and ease joint pain or chronic inflammation.
The agencies re-opened an outbreak investigation originally closed on March 17 after discovering 22 new illnesses from 4 US states. The total now stands at 119 patients across 36 states infected with Salmonella Typhimurium or Salmonella Newport strains, including 32 hospitalizations and no deaths. Illness onset dates range from August 22, 2025, to April 26, 2026.
Among 79 interviewed patients, 70 reported consuming moringa leaf powder products. The recalled product list expanded to include TNvitamins-brand Ultra Potent Complete Green Superfood Moringa capsules and Doctor’s Pride Complete Green Superfood Ultra Potent Moringa capsules distributed by Total Nutrition Inc., plus Why Not Natural Pure Organic Moringa capsules and All Live it Up-brand Super Greens dietary supplement powders.
The new investigation involves Salmonella Typhimurium infections linked to MOGO-brand moringa powder capsules distributed by MOGO Moringa LLC of St. Louis. 18 people infected with the outbreak strain have been reported from 14 states, with illness onset from February 3 to April 7, 2026. Of 8 interviewed individuals, 6 reported consuming moringa powder capsules, including 4 who specifically consumed MOGO-brand products. Seven hospitalizations occurred with no deaths reported. MOGO Moringa LLC has recalled specific lots (#15525AA EXP 6/2027 and #00926AA EXP 1/2028) of MOGO-brand Pure Moringa Oleifera capsules. The FDA is conducting traceback investigations to identify the contamination source and working with state partners to collect samples.
In April 2026, the FDA closed a separate outbreak investigation involving moringa supplements contaminated with “extensively drug-resistant” Salmonella. This outbreak linked to Rosabella-brand moringa powder capsules distributed by Ambrosia Brands LLC resulted in seven illnesses across seven states, with three hospitalizations.
Three moringa-related outbreaks in a single year underscore systemic issues affecting botanical ingredients in the global natural health industry, particularly regarding imported moringa leaf powder contamination. Health officials urge consumers who used moringa products and developed symptoms – diarrhea, abdominal cramps, fever within 12-72 hours – to seek medical attention and inform doctors about potential Salmonella exposure. Healthy adults typically remain ill for 4-7 days. Severe diarrhea may require hospitalization.
Update, 7/6/26:
Following the May 27, 2026, announcements, Total Nutrition Inc. expanded its voluntary recall on June 2 to include Lot 2748 (Exp. 07/2027) for both TNVitamins and Doctor’s Pride brands after a traceability review linked it to previously contaminated raw materials. Meanwhile, the active investigation into MOGO-brand capsules remains unchanged with 18 reported illnesses, and the FDA continues to urge consumers to check their pantries for any remaining Rosabella-brand products from the closed April outbreak. Federal and state health officials are actively working with major online platforms—including Amazon, Walmart, and TikTok Shop—to ensure all recalled moringa supplements are fully removed from the market, while reminding consumers to seek medical care if they experience Salmonella symptoms.
Dr. Toby Rogers, a political economist and fellow at the libertarian Brownstone Institute, ignited a firestorm in March 2026 when he declared the current childhood vaccination program “one of the greatest crimes in human history” (“libertarian” refers to someone who advocates for extreme individual liberty—particularly freedom from government mandates and regulations—believing that the state should be minimized and that individuals should have absolute autonomy over their own bodies, property, and choices without state coercion).
Rogers’ 2026 statement is not an isolated outburst but the culmination of years of vaccine skepticism. After his partner’s son was diagnosed with autism in 2015, Rogers abandoned his original doctoral focus to study autism’s causes, reviewing nearly 1,000 studies over four years. He concluded that vaccines are the primary driver of the autism epidemic. The overwhelming scientific consensus, however, is that vaccines are safe and that autism’s rise stems from improved diagnosis, broader criteria, and complex genetic and environmental factors unrelated to immunization (see the plethora of previous posts on this subject). His PhD thesis, The Political Economy of Autism, and subsequent publications have been widely criticized by the scientific community. Its methodological flaws include:
- selection bias,
- cherry-picking,
- inclusion of weak studies,
- dismissing robust epidemiological research.
Rogers’ 2026 statement elevates personal conviction and contested research over scientific rigor and public health reality. Rogers argues that children receive too many vaccines too early, warning of “cumulative effects” on developing immune systems. Yet the Institute of Medicine has found no evidence of major safety concerns with the current childhood immunization schedule, and the National Academy of Sciences has repeatedly affirmed that vaccines are safe and effective. Rogers dismisses the 22 major studies confirming vaccine safety as “worthless” because they lacked a true unvaccinated control group—a standard that is both ethically impossible and scientifically unnecessary given the massive population data demonstrating vaccine safety over decades.
Rogers’ evidence relies heavily on a handful of independent studies to support his claims. These studies have been criticized for small sample sizes, selection bias, failure to control for confounders, and methodological flaws so severe that some of Rogers’ co-authored papers, such as “Autism Tsunami,” were retracted from peer-reviewed journals. His claim that vaccinated children have dramatically higher rates of autism and chronic disease rests on research that has not withstood independent replication or scrutiny by mainstream scientists. By contrast, the scientific community’s confidence in vaccine safety derives from massive, longitudinal studies involving millions of children, rigorous clinical trials, and decades of population surveillance.
Rogers’ credibility is compromised not least because he is a regular contributor to Children’s Health Defense, an anti-vaccine organization founded by Robert F. Kennedy Jr. that has a long history of spreading debunked claims. Roger’s testimony before the US Senate Subcommittee on Investigations in September 2025, titled “How the Corruption of Science has Impacted Public Perception and Policies Regarding Vaccines,” tried to position him as a whistleblower exposing “flawed science.” In reality, it relied on the same flawed studies and conspiracy narratives that have been repeatedly discredited by the scientific community.
Rogers receives funding from several anti-vaccine and libertarian organizations, though specific salary figures are not publicly disclosed :
- Brownstone Institute is a libertarian think tank founded by economist Jeffrey Tucker that promotes vaccine skepticism, “medical freedom,” and opposition to public health mandates. The institute is funded by libertarian donors and provides fellowships to researchers who align with its ideology.
- Children’s Health Defense is explicitly an anti-vaccine organization led by Mary Holland (CEO) and founded by Robert F. Kennedy Jr. The organization has illuminated funding sources through IRS 990 filings, showing it raised millions of dollars and pays researchers, speakers, and staff. In Rogers’ Senate testimony, he explicitly stated: “Since then I’ve continued my research with Children’s Health Defense, as an independent journalist, and as a Fellow at Brownstone Institute”.
- Rogers also appears at MAHA Institute conferences (Make America Healthy Again), which is aligned with HHS Secretary Robert F. Kennedy Jr.’s movement and features speakers from anti-vaccine organizations including Children’s Health Defense.
Rogers’s financial ties to anti-vaccine organizations create clear conflicts of interest. His research supports the organizational mission of Children’s Health Defense and Brownstone Institute, and his income appears tied to producing content that aligns with these organizations’ anti-vaccine advocacy. The political economy of Rogers’ work is thus ironic: while he critiques the “political economy of autism” and government response, his own research is funded by private organizations with clear ideological and financial incentives to promote vaccine skepticism.
Rogers is not a medical doctor. He has a doctorate in political economy from the University of Sydney and a Master’s in public policy. He holds no medical degree or formal training in medicine, immunology, epidemiology, or vaccine science. His expertise is in political economy, not medical or vaccine research, which means his claims about vaccine safety and autism lack the scientific credentials required to make authoritative medical assertions.
Quackademia, a term created [as far as I remember] by David Colquhoun for the infiltration of quackery into academia, has often been discussed on this blog, e.g.:
- Quackademia in Canada: the first bachelor’s degree in Traditional Chinese Medicine
- Quackademia galore: An Oxford ‘university’ starts a course in ‘veterinary chiropractic’
- Quackademia at its most rampant: the ‘Certificate in Holistic Health and Healing Arts’ (HHHA) at the University of New Mexico
- Another blow to quackademia: TCM course at a Sydney university is to be stopped
- Vienna 2019: the end of quackademia
- Quackademia down under
- Quackademia revisited
- Quackademia
Now growing backlash against quackademia seems to finally emerge also in France – opposition against university programs that give academic legitimacy to unproven so-called alternative medicine (SCAM). The Higher Council for the Evaluation of Research and Higher Education is preparing to review these courses, after criticism that universities are lending credibility to practices that have not been scientifically validated.
Across France, more than 200 university diplomas are said to exist in areas such as reflexology, aromatherapy, auriculotherapy, hypnosis, acupuncture, homeopathy, meditation, and related practices. Critics argue that this amounts to a form of institutional “entryism,” because the university label can make such practices look medically endorsed even when they are not.
The main concern is not just whether these therapies work, but whether universities should be teaching them at all. A January report on health misinformation reportedly recommended banning the academic labeling of healthcare practices that have not been validated, and that recommendation is at the center of the debate. Experts warn that, if a SCAM is scientifically validated, it belongs in medicine; if it is not, it may still be studied, but should not be taught as an academic medical qualification. They also warn that these programs can mislead the public and create a false impression of legitimacy. Yet, some deans and faculty leaders say that certain courses, especially acupuncture, hypnosis, or mindfulness, can be acceptable when used for specific indications and when properly framed. They distinguish those from programs in naturopathy, aromatherapy, or homeopathy, which they see as much harder to justify inside medical faculties.
As the Conference of Medical Deans is preparing to examine the issue rigorously, they should – I feel – also consider the ethical implications. Teaching dangerous nonsense to naive students is not just not academic, it is deeply unethical. If done well, this excercise should lead to a major cleanup of universities regarding SCAM, or at the very least to much tighter rules about what can carry an academic label.
Having observed French quackademia for decades, I am tempted to exclaim:
BETTER LATE THAN NEVER!
The effect of calcium, vitamin D, or combined supplementation on fractures and falls in adults were assessed in this systematic review and meta-analysis. Randomised clinical trials were eligible, if they compared calcium, vitamin D, or combined supplementation with placebo or no treatment in adults (≥18 years) not receiving drug treatment for osteoporosis. The primary outcome was the risk of any fracture. Secondary outcomes included the risk of hip fracture, non-vertebral fracture, vertebral fracture, and falling, as well as the total number of falls. Pairs of reviewers independently screened trials, extracted data, and assessed risk of bias using the second version of Cochrane’s risk of bias tool. Findings were synthesised using random effects meta-analyses and appraised using Grading of Recommendations Assessment, Development and Evaluation, with application of thresholds for absolute effects considered important.
The review included 69 trials involving 153 902 participants. Participants in most of the trials were community dwelling (87%) and not at high risk of fractures or falls (73%). For the primary outcome of any fracture, little to no effect was found from use of calcium supplements (11 trials, 9067 participants; risk ratio 0.91, 95% confidence interval 0.81 to 1.01; moderate certainty), vitamin D supplements (36 trials, 92 045 participants; 1.00, 0.95 to 1.06; high certainty), or combined supplementation (15 trials, 51 126 participants; 0.91, 0.84 to 0.99; high certainty). Calcium, vitamin D, or combined supplementation appeared to have little to no effect on other fracture and fall outcomes, based largely on moderate to high certainty of evidence. The findings remained robust after an extensive exploration of heterogeneity across multiple subgroup analyses. Evidence for high risk patients or those requiring residential care was limited for many outcomes for calcium monotherapy and for combined supplementation.
The authors concluded that, based on absolute risk reductions and thresholds considered clinically meaningful, this review found little to no benefits from use of calcium, vitamin D, or combined supplementation on the prevention of fractures and falls.
An accompanying BMJ editorial points out that observational studies have associated low dietary calcium and low serum levels of vitamin D with low bone density and falls. Consequently, calcium, vitamin D, or combined supplementation has been widely promoted for preventive musculoskeletal health in older adults…
Th editorial concludes that other interventions, such as balance and resistance exercise, and several multicomponent interventions (eg, combining exercise, hazard assessment, or education with other interventions tailored to risk assessment) have been shown to offer meaningful prevention of falls and falls related injuries.
This new systematic review is a prime example for the slaying of a beautiful hypothesis with an ugly fact. But all is not negative – think of the money that can now be saved and put to better use!
Homoeopathy and I is the title of a paper that I published in 2009. My aim was to denounce the popular notion that held I had started my research with a grudge against homeopathy. The honest truth is that – if anything – my attitude was even slightly positive. Here is the key section from this 2009 paper:
In 1993, I was appointed to the world’s first Chair in Complementary Medicine, and it became my job to investigate scientifically all sorts of complementary treatments, including homoeopathy. In the course of this activity, my co-workers and I published numerous articles on homoeopathy. Systematically, reviewing the totality of my publication list, I found a total of 46 papers with ‘homeopathy’ in the title. The following quotes from these articles were selected to best describe my attitude toward homoeopathy at the time:
• Homeopathicremedies are believed by doctors and patients to be almost totally safe (8).
• It might be argued that arnica …is ineffective but homeopathy may still works (9).
•…only 23% of Australian homeopaths believe that immunisation is important (10).
• Homeopathy, I fear, has soon to come up with … more convincing evidence (11)…
• Future evaluations of homeopathy should be performed to a high scientific standard (12)…
•…studies on the safety of the practice of homeopathy must not be ignored (13)…
•…systematic reviews based on Medline searches can lead to similar (possibly slightly less positive) overall conclusions (14)…
•…a detailed eye-witness account claiming that all attempts [by researchers during the ‘Third Reich’] to show that homeopathy works has led to negative results (15).
•…the best way forward is clearly to do rigorous research (16)…
• Thus, the question of whether homeopathy works or not has remained unanswered for 200 years (17).
• The most pressing question, ‘Is homeopathy clinically more effective than placebo’, needs to be answered conclusively (18).
• There is evidence that homeopathic treatment can reduce the duration of ileus (19)…
• Some of the well-argued cases against homeopathy should become essential reading for all homeopaths (20).
•…the published evidence to date does not support the hypothesis that homeopathic remedies … are more efficacious than placebo (21)…
•…homeopathic remedies are associated with the same clinical effects as placebo (22).
•…the picture painted by Linde and colleagues … may well be slightly more positive (23)…
•…[our] goal is to conduct rigorous, impartial research in [homeopathy] (24)
• The claim that homeopathic arnica is efficacious beyond a placebo effect is not supported by rigorous clinical trials (25).
• The results of recent systematic reviews are not uniform (26).
•…at present, the relative efficacy of homeopathic remedies is not known (27).
• The results of recent systematic reviews are obviously far from uniform (28).
•…the trial data … do not suggest that homeopathy is effective (29)…
•…the definitive answer, in my view, has to come from a series of rigorous trials (30).
• Large, multicentre trials of homeopathic remedies … represent the best way of advancing the debate (31).
•…the re-analysis of Linde et al. can be seen as the ultimate epidemiological proof that homeopathic remedies are, in fact, placebos (32).
•…randomised clinical trials … do not allow a firm conclusion as to the effectiveness of homeopathic remedies (33).
•…both homeopaths and university heads of medical departments clearly advocate further research into the effectiveness of homeopathy (34).
•…homeopathy is not different from placebo (35).
•…the best clinical evidence … does not warrant positive recommendations (36).
•…the evidence is insufficient for firm recommendations (37).
•…the results of this trial do not suggest that homeopathic arnica has an advantage over placebo (38)…
-
- This study provides no evidence that adjunctive homeopathic remedies … are superior to placebo(39).
•…this systematic review does not provide clear evidence that the phenomenon of homeopathic aggravations exists (40).
•…Mathie’s methodology was not as strong as it should have been, and this deficit has led to conclusions that may be falsely positive (41).
•…homeopathy may actually be more expensive than good conventional care (42).
•…the proven benefits of highly dilute homeopathic remedies … do not outweight the potential for harm (43).
•… homeopathic remedies are placebos, but homeopaths can be skilled doctors who may significantly help their patients (44).
• Our analysis … found insufficient evidence to support clinical efficacy of homeopathic therapy (45)…
•… promotion can be regrettably misleading, dangerous and counterproductive (46).
•…do we condone treatments because of their popularity or their effectiveness? (47)
•…homeopathy is not based on solid evidence and, over time, this evidence seems to get more negative (48).
• The evidence from rigorous clinical trials … testing homeopathy for childhood and adolescence ailments is not convincing enough for recommendations in any condition (49).
• There is no evidence at all that homeopathic remedies can change the natural history of any cancer (50).
•…context effects of homeopathy … are entirely sufficient to explain the benefit many patients experience (51)…
• Amongst all the placebos that exist, homeopathy has the potential to be an exceptionally powerful one (52)…
•…recommendations by professional homeopathic associations are not based on the evidence (53)…
[all references can be found in the original paper]
Since then (2009) I – often together with others – have published several further articles with “homeopathy” in the title. This means that my original paper needs updating. Here are the titles of (and links to) these articles (appologies, if I missed a few):
- Should we maintain an open mind about homeopathy?
- Homeopathy
- Homeopathy: what does the “best” evidence tell us?
- Homeopathy, non-specific effects and good medicine.
- A systematic review of homoeopathy for the treatment of fibromyalgia.
- Homeopathy, a “helpful placebo” or an unethical intervention?
- The ethics of British professional homoeopaths.
- Homoeopathy debate. Protecting patients?
- Pharmacists and homeopathic remedies.
- Homeopathy in severe sepsis.
- Call for doctors not to practice homeopathy or refer to homeopaths.
- Homeopathy for eczema: a systematic review of controlled clinical trials.
- The most thorough assessment to date of homeopathy
- Should doctors recommend homeopathy?
If you study these articles, you will find that my arguments around homeopathy remained entirely evidence-based. The overall point is, I hope, clear: I did not embark on my research into homeopathy aiming to disprove it or to dismiss it outright [a claim I still hear with some regularity]. To begin with (in 1993), I was not only open but positively inclined. At all times, however, I was keen to follow the best available evidence. If my attitudes/verdicts became less and less positive, it is merely because the evidence became more and more overtly negative.
