risk/benefit
Because homeopathic remedies are usually diluted to the point where none of the original substance remains (often beyond Avogadro’s number), the ethical concerns with this treatment must focus on veracity (truth-telling), patient autonomy, beneficence, and justice. Here are some of the problems that ensue**:
Violations of Veracity and Informed Consent
Informed consent is an essential element of medical ethics and dictates that a patient must be given full, accurate, and evidence-based information regarding a treatment’s nature, mechanisms, risks, and efficacy to make an autonomous decision.
Homeopathy operates on two main principles: “like cures like” (Law of Similars) and the “law of minimum dose” (the more diluted a substance, the more potent it becomes). Scientifically, these principles contradict established kowledge of chemistry, physics, and pharmacology. Presenting these concepts nevertheless as scientifically valid violates veracity.
When a practitioner administers or sells a homeopathic remedy without explicitly stating that it contains no active ingredients and performs no better than a placebo in clinical trials, the patient’s autonomy is compromised. In other words, patients are making a healthcare choice based on deception or omission.
Maleficence
While homeopathics are physically inert and thus unlikely to cause direct harm, homeopathy poses a severe threat via indirect harm.
The most critical ethical issue occurs when patients use homeopathy for severe, progressive, or life-threatening conditions (such as cancer, severe infections, or chronic diseases like diabetes). Delaying or entirely replacing evidence-based medicine with placebo treatments (i.e. homeopathy) violates the duty of non-maleficence (do no harm). It can lead to preventable suffering, worsening of the condition, or even death in extreme cases.
Homeopathic “Vaccines” (Homeoprophylaxis) is an apt example. Some homeopaths offer all sorts of homeopathic vaccinations as alternatives to standard immunizations. Marketing these as effective protection against potentially deadly diseases like measles, polio, or pertussis erodes public herd immunity, leaves individuals entirely unprotected, and can endanger us all. This is a massive failure of both individual and public health ethics.
Beneficence
Beneficence requires healthcare providers to act in the best interest of the patient by offering treatments that provide a tangible, therapeutic benefit.
While the empathetic, unhurried nature of a homeopathic consultation can provide psychological comfort, homeopaths cannot ethically justify charging high fees for what is essentially a placebo wrapped in pseudo-medicine. Relying on a mechanism that depends on the patient remaining ignorant of the treatment’s true nature is fundamentally paternalistic and violates modern standards of beneficence.
Justice and the Exploitation of Vulnerability
The ethical principle of justice involves fairness, equity, and the responsible distribution of healthcare resources. It is regularly violated in the realm of homeopathy.
Homeopathic remedies are cheap to manufacture, yet they are marketed at unjustifiably inflated prices. Targeting vulnerable populations, such as the chronically ill, parents anxious about medication side effects in their children, or low-income individuals seeking cheap alternatives, is an ethical violation of justice.
When public the health insurance programs of certain countries, or mainstream pharmacies fund or promote homeopathic products alongside effective medicines, they misallocate resources and mislead the public. In other words, they give a false stamp of authority to quackery, draining resources that could support evidence-based public health initiatives.
So, how unethical is homeopathy? My short answer is: VERY!
** for a more detailed discussion, please have a look at our book.
The various forms of fasting have many, mostly positive health effects. The most obvious is that of losing weight and body fat. The aim of this study was to investigate the feasibility of measuring the effects of a 14-day Periodic Fasting (PF) intervention (<200 cal) on multi-organs of primary interest (liver, visceral/subcutaneous/bone marrow fat, muscle) using non-invasive advanced magnetic resonance spectroscopic (MRS) and imaging (MRI) methods.
One subject participated in a 14-day PF under daily supervision of nurses and specialized physicians, ingesting a highly reduced intake: 200 Kcal/day coupled with active walking and drinking at least 3 L of liquids/day. The fasting was preceded by a 7-day pre-fasting vegetarian period and followed by 14 days of stepwise reintroduction of food. The longitudinal study collected imaging and biological data before the fast, at peak fasting, and 7 days, 1 month, and 4 months after re-feeding. Body fat mass in the trunk, abdomen, and thigh, liver and muscle mass, were respectively computed using advanced MRI and MRS signal modeling. Fat fraction, MRI relativity index T2* and susceptibility (Chi), as well as Fatty acid composition, were calculated at all-time points.
A decrease in body weight (BW: −9.5%), quadriceps muscle volume (−3.2%), Subcutaneous and Visceral Adipose Tissue (SAT −34.4%; VAT −20.8%), liver fat fraction (PDFF = 1.4 vs. 2.6 % at baseline) but increase in Spine Bone Marrow adipose tissue (BMAT) associated with a 10% increase in global adiposity fraction (PDFF: 54.4 vs. 50.9%) was observed. Femoral BMAT showed minimal changes compared to spinal level, with a slight decrease (−3.1%). Interestingly, fatty acid (FA) pattern changes differed depending on the AT locations. In muscle, all lipids increased after fasting, with a greater increase of intramyocellular lipid (IMCL: from 2.7 to 6.3 mmol/kg) after fasting compared to extramyocellular lipid (EMCL: from 6.2 to 9.5 mmol/kg) as well as Carnosine (6.9 to 8.1 mmol/kg). Heterogenous and reverse changes were also observed after re-feeding depending on the organ.
These results suggest that investigating the effects of a 14-day PF intervention using advanced MRI and MRS is feasible. Quantitative MR indexes are a crucial adjunct to further understanding the effective changes in multiple crucial organs especially liver, spin, and muscle, differences between adipose tissue composition and the interplay that occurs during periodic fasting.
This interesting and well-reported study supports the idea that fasting does not just “burn fat” uniformly; it shifts energy stores differently across organs and fat depots. Visceral fat appears more responsive and more durable in its reduction than subcutaneous fat, which is relevant because visceral fat is more strongly linked to cardiometabolic risk. Because this was a case report with one participant, the findings are best viewed as hypothesis-generating rather than definitive.
The long-standing consensus surrounding moderate alcohol consumption has recently been disrupted by a landmark review. Initiated under a US congressional mandate to evaluate the evidence base for the US Dietary Guidelines for Americans, the study—convened by the National Academies of Sciences, Engineering, and Medicine (NASEM) alongside the Department of Health and Human Services (HHS)—concluded that even a single alcoholic beverage per day significantly elevates the risks of serious chronic illness and premature death. After unexplained bureaucratic delays, the release of this taxpayer-funded research delivers a sobering truth: there is no net health benefit derived from alcohol consumption at any level.
For decades, public perception was shaped by data suggesting that a daily glass of wine or beer could act as a cardiovascular shield. This new review systematically dismantles that notion by identifying significant methodological biases in the previous evidence. Chief among these is the “sick quitter” effect, wherein baseline categories of non-drinkers inadvertently included individuals who had abstained precisely because of pre-existing, severe health conditions. By correcting for these distortions, the review demonstrated that health risks accumulate linearly. Alcohol acts as a dose-dependent toxin with no safe lower threshold, and even minimal daily intake accelerates linear risk trajectories for:
- liver cirrhosis,
- severe hypertension,
- various malignancies, including esophageal, colorectal, and breast cancers.
Beyond chronic pathology, low-level consumption also:
- impairs cognitive architecture,
- accelerating brain aging,
- elevates the immediate probability of physical injury.
The friction surrounding the report’s delayed release has exposed systemic vulnerabilities at the intersection of federal policy and corporate lobbying. Historically, US dietary guidelines defined moderate drinking as up to two drinks per day for men and one for women. The new scientific consensus exposes these thresholds as dangerously obsolete, highlighting a stark disconnect between federal health advice and contemporary medical data.
This friction might underscore the impact of the commercial determinants of health, exposing how multi-billion-dollar alcohol conglomerates employ aggressive public relations campaigns and sophisticated scientific interference to preserve market shares. By aggressively marketing alcohol as a benign staple of a healthy lifestyle, the industry had successfully obscured its intrinsic risks. The new evidence shifts the conversation from personal indulgence to an important public health issue.
Update (July 2026): a US government–commissioned analysis of alcohol-related risk was published. Here is its abstract:
The purpose of this study was to estimate the lifetime risk of alcohol-attributable mortality and morbidity in the United States based on a person’s average lifetime weekly alcohol consumption to assess the impact of per-occasion alcohol consumption on health.
Lifetime risks were estimated using a cause-specific modeling approach that combined exposure data from national health surveys, relative risks, population data from the U.S. Census Bureau, mortality data from the Centers for Disease Control and Prevention, and morbidity data from the Institute for Health Metrics and Evaluation. A narrative review assessed the health impact of per-occasion alcohol consumption on health.
At low levels of consumption, no protective net effect of alcohol consumption on health was observed. Elevated mortality and morbidity risks were associated with alcohol consumption starting at relatively low levels. Males consuming >6.5 (95% CI [<1, 13.5]) and females consuming >7.0 (95% CI [<1, 11.5]) drinks per week had life-time alcohol-attributable mortality risks >1:1,000. At >8.5 (95% CI [2.5, 13]) drinks per week for both males and females, these risks increased to >1:100. At 14 drinks per week for males (the upper limit of the former Dietary Guidelines for males), the risk of an alcohol-caused death was 1:25 (4%). Drinking patterns also impacted risk. Above 1 drink per occasion, higher consumption was associated with progressively increased risks of breast cancer, cardiovascular disease, and injury.
Alcohol consumption, including at what may be perceived as “moderate” levels, is associated with increased mortality and morbidity risks. These results support tightening alcohol use guidance in the United States, for both males and females, to no more than 1 drink per day.
Public health significance statement: The Alcohol Intake and Health Study shows that for Americans, even what is socially considered “moderate drinking” increases the risk of dying or developing health problems, helping people better understand the net health impact of alcohol. Furthermore, by identifying the levels of alcohol use that raise the risk of cancer, cardiovascular disease, and injury, these findings can guide individuals, families, and communities in making safer choices about drinking patterns. The results also support changing the U.S. Dietary Guidelines on alcohol to recommend that current adult drinkers consume 1 drink or less in a day.
Authors and independent observers have described the report as having been sidelined during the Trump administration, citing conflicts with industry interests and existing “moderate drinking is safe” messaging.
Drugging soldiers seems to be an odd idea. Yet, it is not without precedent, e.g.:
- Nazi Germany (WWII): The Wehrmacht and Luftwaffe were systematically supplied with Pervitin (methamphetamine), with tens of millions of tablets issued to keep soldiers and pilots awake, alert and aggressive during the war.
- Britain/US (WWII air operations): Allied air forces issued amphetamine and caffeine tablets to bomber crews and other soldiers to counter fatigue on long missions, representing a state‑sanctioned stimulant program for performance enhancement.
- US (Vietnam War): soldiers were routinely given Dexedrine (dextroamphetamine) and other psychoactive drugs to sustain long patrols and suppress combat stress; hundreds of millions of tablets were thus distributed with official approval.
- Soviet Union (Cold War): State‑run sports programmes, closely tied to military and security structures, systematically administered anabolic steroids and testosterone derivatives to elite athletes to boost strength and recovery, normalising pharmacological enhancement in a militarised setting.
Now, the US Defence Secretary Pete Hegseth’s recent “High-T” initiative mandates annual testosterone screening for US troops aged 30 and older, coupled with optional hormone replacement therapy (TRT). This is a striking case of policy outrunning clinical evidence. While announced as a readiness initiative to keep the joint force on the “leading edge of lethality,” the proposal glosses over critical medical, ethical, and operational realities.
First, the medical rationale for mass screening is weak, to put it mildly. Established clinical guidelines recommend testing only men presenting with specific symptoms and risk factors, not broad, asymptomatic populations. Screening hundreds of thousands of personnel annually risks over-diagnosis and over-treatment, particularly in a young force where borderline-low values are common, highly fluctuating, and often transient. In a word: the “High-T initiative” is nonsense.
Second, oral testosterone undecanoate (TU) shares general testosterone risks, e.g. erythrocytosis, prostate effects (worsening BPH symptoms, small PSA rises, contraindication in prostate cancer), suppression of spermatogenesis and infertility, acne, fluid retention, mood changes, and possible lipid alterations. Compared with transdermal or injectable formulations, oral TU offers convenience but requires strict baseline and ongoing monitoring of blood pressure, haematocrit, PSA, and testosterone levels, and is best reserved for men without uncontrolled hypertension, high cardiovascular risk, or near-term fertility plans, and only after considering safer first-line options. In particular, TRT-induced suppression of spermatogenesis presents a serious threat to fertility for service members of reproductive age, introducing severe clinical trade-offs without clear medical indications. In a word: the “High-T initiative” is likely to do more harm than good.
Third, the policy dangerously blurs the line between therapeutic medicine and performance enhancement. Mass-screening healthy soldiers and offering TRT to asymptomatic individuals normalizes the pharmacological optimization of the force. This sets a dangerous precedent: once hormonal levels are treated as adjustable parameters for “readiness,” the boundary between standard healthcare and state-sponsored enhancement dissolves. In a word: the “High-T initiative” is unethical.
Fourth, the operational logistics remain unresolved. Mandating annual blood draws will strain military medical systems, must generate an influx of equivocal results, and will create a massive administrative trail of counselling, monitoring, and liability. In a word: the “High-T initiative” is unpractical.
Fifth, the policy’s ambiguity regarding female service members exposes a glaring double standard: the Pentagon has not clarified whether women will be screened for sex-hormone deficiencies, or if this “restorative” care is reserved strictly for men. In a word: the “High-T initiative” is sexist.
Sixth, the political optics are highly suspect. The initiative directly mirrors broader administration efforts to liberalize testosterone prescribing, raising concerns that ideology, rather than rigorous military medicine, is driving policy. In a word: the “High-T initiative” is ideological.
Unsurprisingly, many experts have criticised the initiative sharply, e.g.:
- Stuart Phillips, a medical professor at McMaster University, told The Washington Post: “A blanket policy like we’re going to screen everybody over the age of 30 is kind of a ridiculous notion.”
- Adriane Fugh-Berman, a Georgetown University professor of pharmacology and physiology, warned: Hegseth’s claims are “non‑evidence‑based and could cause harm.”
Overall, Hegseth’s policy is out-running clinical evidence, and his stupidity is out-doing common sense. There is no doubt in my mind that his testosterone obsession is extremely ill-advised and – if not urgently stopped – will do an abundance of harm.
Medical ethics rests on 4 core principles: autonomy, beneficence, non-maleficence, and justice, along with the crucial rule of veracity (truth-telling). In the realm of chiropractic, the most significant ethical issues/problems generally fall into the following ethical categories:
- Compromised Informed Consent & Veracity
Informed consent requires that a patient fully understands the nature, risks, benefits, and scientific backing of a treatment before proceeding.
1.1.The “Subluxation” Theory: A sizable segment of the chiropractic community still adheres to the erroneous belief that spinal “vertebral subluxations” cause a disruption in the body’s “innate intelligence,” leading to systemic disease. From an ethical standpoint, promoting an unproven, pseudo-scientific premise as medical fact violates veracity and compromises patient autonomy, as patients cannot give truly informed consent based on erroneous concepts.
1.2. Over-claiming Scope of Efficacy: While evidence might support spinal manipulation for acute lower back pain (if one were to interpret the dtat optimistically), most chiropractors claim they can treat many other illnesses, including non-musculoskeletal conditions such as asthma, allergies, infantile colic, ADHD, and high blood pressure. Marketing these services without robust clinical trial backing misleads vulnerable populations.
- Violations of Non-Maleficence
The principle of non-maleficence requires practitioners to avoid inflicting unnecessary harm or exposing patients to disproportionate risks.
2.1. Cervical Manipulation and Stroke Risk: One of the most severe ethical concerns involves high-velocity, low-amplitude (HVLA) thrusts to the upper neck, the hallmark modality of chiropractors. This procedure has been linked to vertebral artery dissection (VAD), which can cause strokes and deaths. The ethical failure is most obvious when chiropractors perform these adjustments without warning the patient of this and other adverse outcomes.
2.2. Paediatric Chiropractic: Performing spinal adjustments on infants and toddlers (whose spines are primarily cartilage and still developing) poses distinct physical risks. Because infants cannot consent and the evidence of benefit for childhood ailments is practically non-existent, this behaviour violates non-maleficence.
- Secondary Harm: Delay of Standard Medical Care
Harm does not only come from physical injury; it also comes from omitting or delaying necessary medical treatment.
3.1. Anti-Vaccine and Anti-Medicine Sentiments: A large proportion of the chiropractic profession advise patients against conventional medicine, pharmaceuticals, and vaccination. When a chiropractor discourages a patient from seeking standard medical care, they are actively contributing to potentially life-threatening delays in care.
- Violations of Beneficence and Justice
Beneficence means acting in the patient’s best interest, while justice involves the fair and equitable distribution of healthcare resources.
4.1. The “Maintenance Care” Business Model: A common predatory practice of chiropractors involves convincing patients that they require lifelong, regular spinal adjustments to “stay aligned” and prevent disease, often locked into expensive upfront contracts. Recommending continuous, costly treatments that lack clinical evidence of long-term benefit shifts the focus from patient welfare (beneficence) to practitioner financial gain.
4.2.Over-Utilization of X-rays: Some chiropractic clinics mandate full-spine X-rays for every new patient, regardless of symptoms, and repeat them frequently to “prove” alignment changes. Exposing patients to unnecessary ionizing radiation for marketing or diagnostic justification is a direct violation of both non-maleficence and the ethical use of healthcare resources.
For a more detailed account of the ethical problems in so-called alternative medicine, please see our book on this very subject.
Religiosity has been linked to a wide range of health outcomes, with evidence for both benefits and harms.
Alleged positive effects
Many studies have found positive associations between religious involvement and physical and mental health, including lower mortality, better self-rated health and greater psychological well‑being. However, most of this literature is methodologically weak, with selection bias, poor control for confounders and selective reporting, so firm causal conclusions are difficult.
Religiosity and spirituality have frequently been associated with positive effects on mental health, such as higher levels of life satisfaction, meaning in life, hope, optimism and lower rates of depression, substance misuse and some forms of suicidal behaviour. Proposed mechanisms include social support from religious communities, promotion of coping resources, encouragement of health‑promoting behaviours and cognitive frameworks that help some people make sense of adversity.
In addition, observational studies have linked religious participation with positive effects on physical endpoints, such as reduced smoking, more moderate alcohol use and in some cases better cardiovascular outcomes and lower all‑cause mortality, though effect sizes are usually modest. Cross‑national analyses show that religious people sometimes report better self‑rated health, but these associations vary widely by country and are sensitive to socioeconomic and cultural context.onlinelibrary.
Alleged negative effects
Some aspects of religiosity might be harmful: religious struggles—such as feeling punished by God, spiritual discontent or conflict with religious communities—are consistently associated with higher levels of depression, anxiety and distress. Some studies also suggest that rigid or punitive religious beliefs can exacerbate guilt, internalized stigma (for example around sexuality) and delay help‑seeking for mental illness.
In highly secular societies, belonging to a religious minority may correlate with poorer health, possibly via discrimination, lower social integration or economic disadvantage. A critical economic analysis even reports a negative relationship between religious background and some health indicators once socioeconomic factors are carefully controlled, challenging simple “religion is good for you” narratives.
Methodological problems
Much of the evidence relies on observational studies, making it difficult to be sure about causality: healthier or more socially integrated people may be more likely to be religiously active. Measures of religiosity and spirituality are heterogeneous, ranging from attendance to private practices to diffuse “spiritual well‑being”, which complicates comparisons and may inflate positive findings. In other words, the effects of religiosity on health are less that certain or clear.
The IGeL-Monitor is a German information portal that reviews self-pay medical services offered in doctors’ offices. It summarizes the likely benefit and harm of these services in plain language so patients can make more informed decisions. It is run by the “Medizinischer Dienst Bund” and uses evidence-based assessments rather than advertising or provider opinion.
The IGeL‑Monitor has recently focussed on osteopathy for non‑specific low back pain and judged the evidence as “unclear” stating that the current evidence does not reliably show a benefit, nor does it demonstrate meaningful harm. The reassessment pooled evidence from ten randomised clinical trials including about 1,160 participants. While some trials suggested small improvements in pain or function, the overall certainty of these findings was low due to methodological weaknesses in the primary studies. The reviewers therefore concluded that there is no convincing, high‑quality proof that osteopathic manual therapy provides a clinically relevant advantage over sham or usual care.
A further concern highlighted in the assessment is publication bias: positive trials may be preferentially published. This phenomenon that exaggerates apparent benefits.
No clear pattern of harm from osteopathic treatment was identified. Adverse events were inconsistently and inadequately recorded in the trials. This fact not only limits the confidence about safety, but is also a clear breach of medical ethics.
The IGeL‑Monitor reiterates its previous (2018) position: with current data one cannot reliably endorse osteopathy as an effective out‑of‑pocket intervention for non‑specific low back pain, nor can one identify significant risk. Hence the label “unclear.” For patients considering osteopathy as a self‑paid service, the IGeL‑Monitor recommends being informed about the uncertain benefit and the weak evidence base when weighing potential costs against likely outcomes.
The new assessment is in agreement with much that I have been saying on this blog. I nevertheless would like to add one important point: back pain is the one condition for which the evidence is relatively sound. There are many other conditions for which osteopathy is being relentlessly promoted as an effective therapy with even less or no reliable evidence at all.
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!
