survey
“Crusade Against Naturopathy” (Kreuzzug gegen Naturheilkunde) is the title of a recent article (in German – so, I translated for you) published in ‘MULTIPOLAR‘. It is a defence of – no, not naturopathy – quackery. The authors first defend the indefencible Heilpraktiker. Subsequently, they address what they call ‘The Homeopathy Controversy‘. This is particularly ridiculous because homeopathy is not a form of naturopathy. Yes, it uses some natural materials, but it also employs any synthetic substance that you can think of.
The section on homeopathy contains many more amusing surprises; therefore, I have translated it for you [and added a few numers in square brackets that refer to my brief comments below]:
According to a representative survey conducted by the Allensbach Institute for Public Opinion Research in 2023, 35 per cent of homeopathy users are fully convinced of its effectiveness, while 55 per cent rate it as partially effective. Only nine per cent of respondents described homeopathic medicines as completely ineffective. [1]
Nevertheless, Health Minister Karl Lauterbach announced at the beginning of 2024 that he wanted to abolish homeopathy as a health insurance benefit. Stefan Schmidt-Troschke, paediatrician and managing director of the ‘Gesundheit Aktiv Association’, then launched a petition for the preservation of homeopathic medicines as statutory benefits in statutory health insurance. The petition was signed by more than 200,000 people. In March 2024, the cancellation of homeopathy and anthroposophic medicines as additional statutory benefits was revoked. [2]
Shortly afterwards, in May 2024, the ‘German Medical Assembly’ passed a motion against homeopathy to bring about a total ban for doctors. Dr Marc Hanefeld, official supporter of the ‘Informationsnetzwerk Homöopathie’, was behind the motion. Doctors should be banned from practising homeopathy in future, as well as billing via statutory and private health insurance. [3]
The case of the Charité University Hospital in Berlin shows just how much influence opponents of homeopathy have: for years, the hospital’s website stated ‘that homeopathic medicine can cure or improve even the most serious conditions’. After fierce protests – including from the health journalism portal MedWatch – the statement was removed. [4]
My comments:
- Effectiveness is not something to be quantified by popular votes. Responsible healthcare professionals employ rigorous clinical trials for that purpose.
- Lauterbach caved in because of the pressure from the Green Party and insists that his plans are merely postponed.
- The ‘German Medical Assembly’ decided that the use of homoeopathy in diagnostics and therapy does not constitute rational medicine. German doctors continue to be free to practice homeopathy, if they so wish.
- The notion that ‘homeopathic medicine can cure or improve even the most serious conditions’ is so obviously and dangerously wrong that it had to be corrected. This has little to do with the influence of opponents but is due to the influence of the evidence.
I feel that, if proponents of homeopathy want to save their beloved quackery from the face of the earth, they could at least get their facts right and think of some agruments that are a little less ridiculous.
- mind-body medicine (32.0%),
- massage (16.1%),
- chiropractic (14.4%),
- acupuncture (3.4%),
- naturopathy (2.2%),
- art and/or music therapy (2.1%).
Reporting post-COVID-19 was associated with an increased likelihood of using any SCAM in the last 12 months (AOR = 1.18, 95% CI [1.03, 1.34], p = 0.014) and specifically to visit an art and/or music therapist (AOR = 2.56, 95% CI [1.58, 4.41], p < 0.001). The overall use of any SCAM was more likely among post-COVID-19 respondents under 65 years old, females, those with an ethnical background other than Hispanic, African-American, Asian or Non-Hispanic Whites, having a higher educational level, living in large metropolitan areas and having a private health insurance.
So-called alternative medicine (SCAM) in the UK is subject to voluntary, publicly funded regulation. SCAM practitioners are known to make misleading health claims. This study used an artificial intelligence (AI) tool to measure the prevalence of such claims. Websites operated by practitioners of SCAM, registered with the UK ‘Complementary and Natural Healthcare Council’, were downloaded and assessed by the AI, which determined whether a website was relevant to the investigation and, if so, identified health-related claims that it judged as false or misleading, supplying a rationale.
Of 6096 registrants, 1326 met the selection criteria, of which 872 clinics had 725 relevant and operational websites. The AI assessed text from 11 771 web pages, identifying false or misleading claims in 704 (97%) of the websites. The AI’s performance was quality-assured by four human assessors, who manually reviewed 23 relevant web pages. Humans identified on average 39.5 claims likely to be judged false or misleading by advertising regulators, the AI identified 36. Humans misidentified an average of 4.8 claims, AI misidentified two.
The authors concluded that the overwhelming majority of practitioners registered with the CNHC who use pseudoscientific modalities are making false and/or misleading claims on their websites. This puts them in breach of their terms of registration. An AI tool can be used to monitor websites of practitioners promoting pseudoscientific modalities for breaches of compliance with regulators’ codes of conduct for advertising, and does so with a level of accuracy comparable with that of human assessors. It presents an opportunity for regulators to offer more effective consumer protection from their members’ online misinformation than at present.
The investigation was an unfunded project conducted entirely by volunteer scientists, motivated by the wish to protect consumers from health misinformation. The researchers acknowledge a grant of £550 from WePlanet to cover the cost of AI tokens used and thank University College London for paying the journal’s publication fee to enable the public to access their research.
The authors of this paper — emeritus professors David Colquhoun and Susan Bewley; retired clinical research consultant and HealthSense trustee Les Rose, and HealthSense newsletter editor Mandy Payne as well as IT scientist Simon Perry — feel that AI could be a game-changer in protecting the public by supporting regulators to quickly and cheaply clamp down on health misinformation so that the public can put their trust in the PSA Quality Mark logo displayed.
I congratulate the authors on their important study and hope they are correct – but I am not holding my breath.
This study aimed to explore women with breast cancer (WBC) lived experiences on the use of So-Called Alternative Medicine (SCAM) for breast cancer management. In-depth interviews guided by semi-structured questions were conducted with 21 WBC recruited using convenience sampling. The thematic analysis generated four main themes:
- Access, affordability and support for medical treatment.
- Beliefs in SCAM treatment.
- Feeling the potential benefits of SCAM.
- Acknowledging the negative aspects of SCAM.
The outcomes from using SCAM based on the lived experiences of WBC indicated that some SCAM treatments could improve quality of life. However, some fraudulent SCAM obtained from unprofessional SCAM providers could cause harmful effects, delay medical cancer treatment, and increase breast cancer treatment costs.
The authors concluded that there is an urgent need to enhance the awareness of appropriate treatment, including evidence-based SCAM, for WBC. Improved understanding in the use of SCAM as a part of quality breast cancer care services could contribute to increasing the quality of life and survival rates of women with breast cancer.
This is a very strange paper, in my view. If we disregard the fact that a small interview study cannot possibly yield reliable outcomes, we essentially have two results:
- Some SCAM treatments could improve quality of life and survival.
- Some fraudulent SCAM obtained from unprofessional SCAM providers could cause harm.
So, which SCAM is good and which bad?
By definition, such an investigation cannot answer this crucial question.
If you do nevertheless want answers, I recommend you read my evidence-based assessments summarised in a recent book. For those who don’t want to wait, here is the answer in a nutshell:
- A few SCAMs are indeed proven to inprove the quality of life of cancer patients.
- No SCAM has been shown to improve survival.
- Almost all SCAMs have the potential to harm cancer patients.
My conclusion:
“Lived experiences” may sound interesting, but scientific evidence is the only reliable guide.
Some people seem to be impressed by the amount of publications that is currently being published on so-called alternative medicine (SCAM). Last year, for example, Mediline listed around 1 500 articles on the subject.
Is that really impressive?
No!
- Firstly, compared to other subjects, the number is small. If you look in Medline for ‘pharmacological treatments’, for instance, the number is 10 times larger.
- Scecondly, and more importantly, most of the SCAM articles are complete rubbish.
Let me give you just one example of a paper I came across the other day. It is typical in that there are hundreds of very similar articles every week. Its title is “Assessing Perceived Healthcare Access and Attitudes Towards Complementary and Alternative Medicine Amongst Parents in Cebu City”
(Cebu City is in the Philippines.)
Let’s for a moment assume that the information in the paper is of interest to a wider audience. In this case, such information should also be interestiong form the hundreds of other cities in the region. And if that is so, why focus on the Philippines? There are hundreds of thousands of cities around the world that would matter at least as much as Cebu City.
And why survey just parents? Why not childless adults, or children, or older people?
And why just healthy individuals? Surely, this information would be even more relevant, if it related to ill people!
As there are thousands of different illnesses, we would need thousands of different papers reporting the relevant information.
I am sure you see where I am going. If the hundreds of papers like Assessing Perceived Healthcare Access and Attitudes Towards Complementary and Alternative Medicine Amongst Parents in Cebu City are interesting to sufficient amounts of people to merit publication, we need millions of similar papers to cover the subject properly. What is more, as the situation about perceived healthcare access changes rapidly depending on a whole host of factors, we really would require yearly updates. That would mean millions of papers each year for the sole reason of monitoring the perceived healthcare access of various group of people in various locations. This means we need millions of researchers spending millions of hours and millions of dollars conducting millions of surveys.
Alternatively, we could take a step back and ask whether my above-made assumption (that the named paper is interesting) was correct. It does not require much contemplation to conclude it was, in fact, incorrect: the paper is neither interesting nor relevant to anybody.
And, once you look at the myriad of useless papers that are being published in SCAM, you arrive at the conclusion that the effort and funds needed for conducting these nonsensical pseudoscientific studies must urgently be re-directed towards answering some of the many more meaningful research questions. To me, this is nothing less than an ethical imperative.
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END OF RANT
Pharmacists often advise patients on the use of over-the counter (OTC) medications, including homeopathics. Yet, little is known about student pharmacist education about homeopathy. The objectives of this study were to:
- describe homeopathic topics being taught in pharmacy schools,
- evaluate faculty views about pharmacists’ roles in counseling patients about homeopathic products.
An explanatory sequential mixed methods approach was used. Online surveys were distributed to 3,300 pharmacy practice faculty members representing all schools accredited in the US. Frequencies were calculated to describe faculty characteristics and their responses. Moreover, 18 interviews of faculty involved with teaching homeopathy were conducted to learn about homeopathy teaching and expectations about roles of pharmacists in counseling patients.
Survey data were collected from 365 respondents. Over half (84 of 137) of the responding pharmacy schools reported teaching
homeopathy to pharmacy students. In addition, the responses from most of the interviewed faculty were summarized into two themes
which emphasized that pharmacists should be knowledgeable and able to counsel patients effectively to ensure they benefit from
taking homeopathic products.
The authors concluded that over half of US pharmacy schools are teaching students about homeopathy topics. Further, there was support for pharmacists being able to counsel effectively about homeopathic products.
Oh, dear!
The sampling method of “3,300 pharmacy practice faculty members representing all schools accredited in the US” seems nonsensical. It means, if I understand it correctly, that some schools will be represented multiple times, while others are not represented at all. The response rate (~11%) is dismal which means that the data allow no generalisable conclusion whatsoever.
If we forget about these fatal flaws for just a minute and take the findings of the survey seriously, we are perhaps surprised that over half of the schools teach homeopathy. This fact in itself might, however, not necessarily be a bad thing. The students could simply learn that (and why) homeopathy is an obsolete therapy. What makes me shudder is this statement: “pharmacists should be knowledgeable and able to counsel patients effectively to ensure they benefit from taking homeopathic products”.
How can you teach students to counsel patients in such a way that they benefit from an ineffective therapy?, I wonder.
Cancer often causes reduced resilience, quality of life (QoL) and poorer overall well-being. To mitigate these problems, so-called alternative medicine (SCAM) is often advocated for patients with cancer. This study aimed to evaluate the long-term effects of an interdisciplinary integrative oncology group-based program (IO-GP) on the resilience and use of SCAM in patients with cancer.
This was a prospective, observational, single-center study. Resilience (RS-13), SCAM usage (I-CAM-G), QoL (SF-12) and health-related lifestyle factor (nutrition, smoking, alcohol consumption and physical exercise) data were collected for 70 patients who participated in a 10-week IO-GP between January 2019 and June 2022 due to cancer. The IO-GP was offered at the setting of a university hospital and was open to adult patients with cancer. It contained elements from mind-body medicine and positive psychology, as well as recommendations on healthy diet, exercise and SCAM approaches. Patients who completed the IO-GP at least 12months prior (1-4.5years ago) were included in this study. Statistical analysis included descriptive analysis and parametric and nonparametric tests to identify significant differences (P<.05).
Resilience increased significantly ≥12months after participation in the IO-GP (n=44, P=.006, F=8.274) and had a medium effect size (r=.410). The time since the IO-GP was completed (“12-24months,” “24-36months,” and “>36months”) showed no statistically significant interaction with changes in resilience (P=.226, F=1.544). The most frequently used SCAM modalities within the past 12months were vitamins/minerals (85.7%), relaxation techniques (54.3%), herbs and plant medicine (41.1%), yoga (41.4%) and meditation (41.4%). The IO-GP was the most common source informing study participants about relaxation techniques (n=24, 64.9%), meditation (n=21, 72.4%) and taking vitamin D (n=16, 40.0%). Significantly greater levels of resilience were found in those practicing meditation (P=.010, d=−.642) or visualization (P=.003, d=−.805) compared to non-practitioners.
The authors concluded that IO-GPs have the potential to empower patients with cancer to continue using SCAM practices—especially from mind-body medicine—even 1 to 4.5 years after completing the program. Additionally, resilience levels increased. These findings provide notable insight into the long-term effects of integrative oncology interventions on resilience and the use of SCAM, especially in patients with breast cancer.
Really?
“Long-term effects of integrative oncology interventions”?
I am sorry, but I see no effects here at all. All I do see are correlations.
For all we know, the outcomes might have even been better if no SCAMs had been offered.
For all we know, the main reason for the observed changes is simply the passage of time.
CORRELATION IS NOT CAUSATION!
There is, of course, little wrong with conductiong studies of this nature – even though they are never really informative, in my view – but there is much wrong when the bias of the authors kicks in and they imply (in the title and throughout the text of their paper) that their interventions were the cause of the observed outcome. This does not provide “notable insight”, it merely misleads some people who are less able to think critically.
WISHFUL THINKING IS NOT SCIENCE!
Sadly, this simple lesson seems to be ever so hard to comprehend by SCAM researchers. One does not need to look far to find hundreds of SCAM studies that are plagued by the same or similar biases. As a result, SCAM research is gradually becoming the laughing stock of real scientists.
This prospective, community-based, active surveillance study aimed to report the incidence of moderate, severe, and serious adverse events (AEs) after chiropractic (n = 100) / physiotherapist (n = 50) visit in offices throughout North America between October-2015 and December-2017.
Three content-validated questionnaires were used to collect AE information: two completed by the patient (pre-treatment [T0] and 2-7 days post-treatment [T2]) and one completed by the provider immediately post-treatment [T1]. Any new or worsened symptom was considered an AE and further classified as mild, moderate, severe or serious.
From the 42 participating providers (31 chiropractors; 11 physiotherapists), 3819 patient visits had complete T0 and T1 assessments. The patients were on average 50±18 years of age and 62.5% females. Neck/back pain was the most common presenting condition (70.0%) with 24.3% of patients reporting no condition/preventative care.
From the patients visits with a complete T2 assessment (n = 2136 patient visits, 55.9%), 21.3% reported an AE, of which:
- 7.9% were mild,
- 6.2% moderate,
- 3.7% severe,
- 1.5% serious,
- 2.0% had missing severity rating.
The most common symptoms reported with moderate or higher severity were:
- discomfort/pain,
- stiffness,
- difficulty walking,
- headache.
The authors concluded that this study provides valuable information for patients and providers regarding incidence and severity of AEs following patient visits in multiple community-based professions. These findings can be used to inform patients of what AEs may occur and future research opportunities can focus on mitigating common AEs.
They also note that:
- The incidence of AEs reported in their study was lower than the 30%-50% reported in a recent scoping review of 250 observational and experimental studies of manual treatments of the spine.
- A similar prospective clinic-based survey collected data from 4712 encounters from Norwegian chiropractors found that 55% of these encounters had an AE.
- A clinical trial of chiropractic care for patients with neck pain found that 30% reported an AE.
- The Scandinavian College of Naprapathic Manual Medicine collected AE information from 767 patients and found that 51% of those who had at least 3 SMT treatments reported an AE.
The authors did not mention our systematic review:
The aim of this systematic review was to summarize the evidence about the risks of spinal manipulation. Articles were located through searching three electronic databases (MEDLINE, EMBASE, Cochrane Library), contacting experts (n =9), scanning reference lists of relevant articles, and searching departmental files. Reports in any language containing data relating to risks associated with spinal manipulation were included, irrespective of the profession of the therapist. Where available, systematic reviews were used as the basis of this article. All papers were evaluated independently by the authors. Data from prospective studies suggest that minor, transient adverse events occur in approximately half of all patients receiving spinal manipulation. The most common serious adverse events are vertebrobasilar accidents, disk herniation, and cauda equina syndrome. Estimates of the incidence of serious complications range from 1 per 2 million manipulations to 1 per 400,000. Given the popularity of spinal manipulation, its safety requires rigorous investigation.
Whatever the true rate of AEs turns out to be, one thing is very clear: it is unacceptably high, particularly if we consider that the benefits of spinal manipulations are doubtful and at best small.
Alternative cancer clinics (I’d prefer to call them SCAM cancer clinics), that provide treatments associated with hastening death, actively seek to create favorable views of their services online. An unexplored means where such clinics can shape their public appeal is their Google search results.
For this study, a team of researchers retrieved the Google listing and Google reviews of 47 prominent SCAM cancer clinics. They then conducted a content analysis to assess the information cancer patients are faced with online.
The results show that Google listings of alternative treatment providers rarely declare that the clinic is a SCAM clinic versus a conventional primary cancer treatment provider (12.8% declared; 83.0% undeclared). The clinics were highly rated (median, 4.5 stars of 5). Reasons for positive reviews included:
- treatment quality (n = 519),
- care (n = 420),
- outcomes (n = 316).
288 reviews claimed that the clinics cured or improved cancer. Negative reviews presented SCAM clinics to:
- financially exploit patients with ineffective treatment (n = 98),
- worsen patients’ condition (n = 72),
- provide poor care (n = 41),
- misrepresent outcomes (n = 23).
The authors concluded that the favorable Google listing and reviews of alternative clinics contribute to harmful online ecosystems. Reviews provide compelling narratives but are an ineffective indicator of treatment outcomes. Google lacks safeguards for truthful reviews and should not be used for medical decision-making.
These findings suggest that the Google listings and reviews of SCAM cancer clinic create a favorable online impression to prospective patients. Google listings and reviews are thus part of a most effective multi-level propaganda network promoting SCAM even for the most desperately ill of all patients. As discussed some time ago, in the UK, such misinformation can even be traced back to King Charles. In nearly all cases, these clinics were labeled as speciality primary cancer options. Only a few clinics were marked as an ‘alternative’ option. Positive reviews stated that alternative treatments can cure cancer or prolong life, even in terminal cases. Positive reviews also undermine evidence-based cancer treatments in favor of SCAM. They generate an impression that dangerously misleads patients. As we have seen repeatedly on this blog, the results can be devastating, e.g.:
- SCAM: So-Called Alternative Medicine (Societas): Amazon.co.uk: Ernst, Edzard: 9781845409708: Books
- So-called alternative medicine (SCAM) for cancer: does it prolong survival?
- Leah Bracknell (1964-2019): another victim of cancer quackery?
- Germany, the ‘promised land’ for cancer quacks
- Use of alternative medicine hastens death of cancer patients
- Fatalities in a German alternative medicine clinic caused by 3BP?
- Suzanne Somers has died – another victim of so-called alternative medicine?
I better start this post with an appology: I am going to try and explain something that is rather obvious to rational thinkers. But recently, we had comments on this blog that made it clear to me that some of my readers are are far from rational. They have suggested that the real life test of a therapy like homeopathy is the survival rate of hospitals where this therapy is being used.
So why are the mortality rates in homeopathic hospitals lower that for normal hosptials?
Does that fact not prove the value of homeopathy?
No!
Why not?
Because with every comparison we need to make sure that we compare comparable things.
Patients who are admitted to homeopathic hospitals are very different from those in a normal hospital. To put it in a nutshell: THEY ARE FAR LESS SERIOUSLY ILL.
I should know that because I worked both in a homeopathic hospital and in several normal ones.
Most patients who chose to go to a homeopathic hospital are chronically unwell. Some do have a chronic illness but many others are not truly ill. Hardly anyone has a life-threatening disease.
During the months I worked in a homeopathic hospital, we only had to report one single fatality. I do remember many patients with asthma, allergies, neck pain, obseity, insomnia and similar conditions. During a comparable time period when I worked in a normal hospital of a similar size, we had dozens of fatalities.
I am sure that we all have sad experiences of a seriously ill relative or friend. Because her diesease is so serious she gets worse and worse. Eventually, home care does not suffice and she is admitted to hospital. We hope that there her life will be saved. Sadly, this is not always the case.
In other words, moribund patients are often rushed to hospital where many of them die. They are not rushed to a homeopathic hospital!
Or, to put it bluntly, the ‘real life test’ of measuring death rates of homeopathic (or naturopathic, integrative, etc.) hospitals and comparing them with the usually high mortality rates of normal hospitals is not just unreliable, it is meaningless rubbish.
As I stated above, all of this is entirely obvious – except, of course, for the deluded.
PS
There are comparisons between two or more hospitals that can provide useful information; they usually relate to specific conditions or interventions, e.g. hip replacement in hospital A versus hip replacement in hospital B.
