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

survey

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This study used a US nationally representative 11-year sample of office-based visits to physicians from the National Ambulatory Medical Care Survey (NAMCS), to examine a comprehensive list of factors believed to be associated with visits where complementary health approaches were recommended or provided.

NAMCS is a national health care survey designed to collect data on the provision and use of ambulatory medical care services provided by office-based physicians in the United States. Patient medical records were abstracted from a random sample of office-based physician visits. The investigators examined several visit characteristics, including patient demographics, physician specialty, documented health conditions, and reasons for a health visit. They ran chi-square analyses to test bivariate associations between visit factors and whether complementary health approaches were recommended or provided to guide the development of logistic regression models.

Of the 550,114 office visits abstracted, 4.43% contained a report that complementary health approaches were ordered, supplied, administered, or continued. Among complementary health visits, 87% of patient charts mentioned nonvitamin nonmineral dietary supplements. The prevalence of complementary health visits significantly increased from 2% in 2005 to almost 8% in 2015. Returning patient status, survey year, physician specialty and degree, menopause, cardiovascular, and musculoskeletal diagnoses were significantly associated with complementary health visits, as was seeking preventative care or care for a chronic problem.

The authors concluded that these data confirm the growing popularity of complementary health approaches in the United States, provide a baseline for further studies, and inform subsequent investigations of integrative health care.

The authors used the same dataset for a 2nd paper which examined the reasons why office-based physicians do or do not recommend four selected complementary health approaches to their patients in the context of the Andersen Behavioral Model. Descriptive estimates were employed of physician-level data from the 2012 National Ambulatory Medical Care Survey (NAMCS) Physician Induction Interview, a nationally representative survey of office-based physicians (N = 5622, weighted response rate = 59.7%). The endpoints were the reasons for the recommendation or lack thereof to patients for:

  • herbs,
  • other non-vitamin supplements,
  • chiropractic/osteopathic manipulation,
  • acupuncture,
  • mind-body therapies (including meditation, guided imagery, and progressive relaxation).

Differences by physician sex and medical specialty were described.

For each of the four complementary health approaches, more than half of the physicians who made recommendations indicated that they were influenced by scientific evidence in peer-reviewed journals (ranging from 52.0% for chiropractic/osteopathic manipulation [95% confidence interval, CI = 47.6-56.3] to 71.3% for herbs and other non-vitamin supplements [95% CI = 66.9-75.4]). More than 60% of all physicians recommended each of the four complementary health approaches because of patient requests. A higher percentage of female physicians reported evidence in peer-reviewed journals as a rationale for recommending herbs and non-vitamin supplements or chiropractic/osteopathic manipulation when compared with male physicians (herbs and non-vitamin supplements: 78.8% [95% CI = 72.4-84.3] vs. 66.6% [95% CI = 60.8-72.2]; chiropractic/osteopathic manipulation: 62.3% [95% CI = 54.7-69.4] vs. 47.5% [95% CI = 42.3-52.7]).

For each of the four complementary health approaches, a lack of perceived benefit was the most frequently reported reason by both sexes for not recommending. Lack of information sources was reported more often by female versus male physicians as a reason to not recommend herbs and non-vitamin supplements (31.4% [95% CI = 26.8-36.3] vs. 23.4% [95% CI = 21.0-25.9]).

The authors concluded that there are limited nationally representative data on the reasons as to why office-based physicians decide to recommend complementary health approaches to patients. Developing a more nuanced understanding of influencing factors in physicians’ decision making regarding complementary health approaches may better inform researchers and educators, and aid physicians in making evidence-based recommendations for patients.

I am not sure what these papers really offer in terms of information that is not obvious or that makes a meaningful contribution to progress. It almost seems that, because the data of such surveys are available, such analyses get done and published. The far better reason for doing research is, of course, the desire to answer a burning and relevant research question.

A problem then arises when researchers, who perceive the use of so-called alternative medicine (SCAM) as a fundamentally good thing, write a paper that smells more of SCAM promotion than meaningful science. Having said that, I find it encouraging to read in the two papers that

  • the prevalence of SCAM remains quite low,
  • more than 60% of all physicians recommended SCAM not because they were convinced of its value but because of patient requests,
  • the lack of perceived benefit was the most frequently reported reason for not recommending it.

During the last two years, I have written more often than I care to remember about the numerous links between so-called alternative medicine (SCAM) and COVID-19 vaccination hesitancy. For instance:

Whenever I publish a post on these subjects, some enthusiasts of SCAM argue that, despite all this evidence, they are not really against COVID vaccinations. But who is correct? What proportions of SCAM practitioners are pro or contra? One way to find out is to check how they themselves behave. Do they get vaccinated or not?

Here are some recent data from Canada that seem to provide an answer.

A breakdown of vaccination rates among Canadian healthcare professions has been released, based on data gathered from 17 of B.C.’s 18 regulated colleges. The findings are most revealing:

  • dieticians, physicians, and surgeons lead the way, with vaccination rates of 98%,
  • occupational therapists were at 97%,
  • Chinese medicine practitioners and acupuncturists were at 79%,
  • chiropractors at 78%
  • naturopaths at 69%.

The provincial health officer Dr. Bonnie Henry said the province is still working with the colleges on how to notify patients about their practitioner’s vaccination status. “We are working with each college on how to build it into professional standards. The overriding principle is patient status,” she told a news conference. “It may be things like when you call to book, you are asked whether you would prefer to see a vaccinated or unvaccinated professional. We are trying to protect privacy and provide agency to make the decision.”

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As far as I am aware, these are unique data. It would be interesting to see additional evidence. If anyone knows about vaccination rates in other countries of acupuncturists, herbalists, homeopaths, osteopaths, Heilpraktiker, etc. I would love to learn more.

Harad Matthes, the boss of the anthroposophical Krankenhaus Havelhoehe and professor for Integrative and Anthroposophical Medicine at the Charite in Berlin, has featured on my blog before (see here and here). Now he is making headlines again.

Die Zeit‘ reported that Matthes went on German TV to claim that the rate of severe adverse effects of COVID-19 vaccinations is about 40 times higher than the official figures indicate. In the MDR broadcast ‘Umschau’ Matthes said that his unpublished data show a rate of 0,8% of severe adverse effects. In an interview, he later confirmed this notion. Yet, the official figures in Germany indicate that the rate is 0,02%.

How can this be?

Die ZEIT ONLINE did some research and found that Matthes’ data are based on extremely shoddy science and mistakes. The Carite also distanced themselves from Matthes’ evaluation: “The investigation is an open survey and not really a scientific study. The data are not suitable for drawing definitive conclusions regarding incidence figures in the population that can be generalized” The problems with Matthes’ ‘study’ seem to be sevenfold:

  1. The data are not published and can thus not be scrutinized.
  2. Matthes’ definition of a severe adverse effect is not in keeping with the generally accepted definition.
  3. Matthes did not verify the adverse effects but relied on the information volunteered by people over the Internet.
  4. Matthes’ survey is based on an online questionnaire accessible to anyone. Thus it is wide open to selection bias.
  5. The sample size of the survey is around 10 000 which is far too small for generalizable conclusions.
  6. There is no control group which makes it impossible to differentiate a meaningful signal from mere background noise.
  7. The data contradict those from numerous other studies that were considerably more rigorous.

Despite these obvious flaws Matthes insisted in a conversation with ZEIT ONLINE that the German official incidence figures are incorrect. As Germany already has its fair share of anti-vaxxers, Matthes’ unfounded and irresponsible claims contribute significantly to the public sentiments against COVID vaccinations. They thus endangering public health.

In my view, such behavior amounts to serious professional misconduct. I, therefore, feel that his professional body, the Aerztekammer, should look into it and prevent further harm.

I just stumbled over a paper we published way back in 1997. It reports a questionnaire survey of all primary care physicians working in the health service in Devon and Cornwall. Here is an excerpt:

Replies were received from 461 GPs, a response rate of 47%. A total of 314 GPs (68%, range 32-85%) had been involved in complementary medicine in some way during the previous week. One or other form of complementary medicine was practised by 74 of the respondents (16%), the two most common being homoeopathy (5.9%) and acupuncture (4.3%). In addition, 115 of the respondents (25%) had referred at least one patient to a complementary therapist in the previous week, and 253 (55%) had endorsed or recommended treatment with complementary medicine. Chiropractic, acupuncture and osteopathy were rated as the three most effective therapies, and the majority of respondents believed that these three therapies should be funded by the health service. A total of 176 (38%) respondents reported adverse effects, most commonly after manipulation.

What I found particularly interesting (and had totally forgotten about) were the details of these adverse effects: Serious adverse effects of spinal manipulation included the following:

  • paraplegia,
  • spinal cord transection,
  • fractured vertebra,
  • unspecified bone fractures,
  • fractured neck of femur,
  • severe pain for years after manipulation.

Adverse effects not related to manipulation included:

  • death after a coffee enema,
  • liver toxicity,
  • anaphylaxis,
  • 17 cases of delay of adequate medical attention,
  • 11 cases of adverse psychological effects,
  • 14 cases of feeling to have wasted money.

If I remember correctly, none of the adverse effects had been reported anywhere which would make the incidence of underreporting 100% (exactly the same as in a survey we published in 2001 of adverse effects after spinal manipulations).

Today is WORLD ASTHMA DAY, a good opportunity perhaps to revisit a few of our own evaluations of so-called alternative medicine (SCAM) for asthma. Here are the abstracts of some of our systematic reviews on the subject:

YOGA

Objective: The objective of this systematic review was to assess the effectiveness of yoga as a treatment option for asthma.

Method: Seven databases were searched from their inception to October 2010. Randomized clinical trials (RCTs) and non-randomized clinical trials (NRCTs) were considered, if they investigated any type of yoga in patients with asthma. The selection of studies, data extraction, and validation were performed independently by two reviewers.

Results: Six RCTs and one NRCT met the inclusion criteria. Their methodological quality was mostly poor. Three RCTs and one NRCT suggested that yoga leads to a significantly greater reduction in spirometric measures, airway hyperresponsivity, dose of histamine needed to provoke a 20% reduction in forced expiratory volume in the first second, weekly number of asthma attacks, and need for drug treatment. Three RCTs showed no positive effects compared to various control interventions.

Conclusions: The belief that yoga alleviates asthma is not supported by sound evidence. Further, more rigorous trials are warranted.

SPINAL MANIPULATION

Some clinicians believe that spinal manipulation is an effective treatment for asthma. The aim of this systematic review was to critically evaluate the evidence for or against this claim. Four electronic databases were searched without language restrictions from their inceptions to September 2008. Bibliographies and departmental files were hand-searched. The methodological quality of all included studies was assessed with the Jadad score. Only randomised clinical trials of spinal manipulation as a treatment of asthma were included. Three studies met these criteria. All of them were of excellent methodological quality (Jadad score 5) and all used sham-manipulation as the control intervention. None of the studies showed that real manipulation was more effective than sham-manipulation in improving lung function or subjective symptoms. It is concluded that, according to the evidence of the most rigorous studies available to date, spinal manipulation is not an effective treatment for asthma.

ACUPUNCTURE

Contradictory results from randomised controlled trials of acupuncture in asthma suggest both a beneficial and detrimental effect. The authors conducted a formal systematic review and meta-analysis of all randomised clinical trials in the published literature that have compared acupuncture at real and placebo points in asthma patients. The authors searched for trials published in the period 1970-2000. Trials had to measure at least one of the following objective outcomes: peak expiratory flow rate, forced expiratory volume in one second (FEV1) and forced vital capacity. Estimates of the standarised mean difference, between acupuncture and placebo were computed for each trial and combined to estimate the overall effect. Hetereogeneity was investigated in terms of the characteristics of the individual studies. Twelve trials met the inclusion criteria but data from one could not be obtained. Individual patient data were available in only three. Standardised differences between means ranging from 0.071 to 0.133, in favour of acupuncture, were obtained. The overall effect was not conventionally significant and it corresponds to an approximate difference in FEV1 means of 1.7. After exploring hetereogenenity, it was found that studies where bronchoconstriction was induced during the experiment showed a conventionally significant effect. This meta-analysis did not find evidence of an effect of acupuncture in reducing asthma. However, the meta-analysis was limited by shortcomings of the individual trials, in terms of sample size, missing information, adjustment of baseline characteristics and a possible bias against acupuncture introduced by the use of placebo points that may not be completely inactive. There was a suggestion of preferential publication of trials in favour of acupuncture. There is an obvious need to conduct a full-scale randomised clinical trial addressing these limitations and the prognostic value of the aetiology of the disease.

RELAXATION THERAPIES

Background: Emotional stress can either precipitate or exacerbate both acute and chronic asthma. There is a large body of literature available on the use of relaxation techniques for the treatment of asthma symptoms. The aim of this systematic review was to determine if there is any evidence for or against the clinical efficacy of such interventions.

Methods: Four independent literature searches were performed on Medline, Cochrane Library, CISCOM, and Embase. Only randomised clinical trials (RCTs) were included. There were no restrictions on the language of publication. The data from trials that statistically compared the treatment group with that of the control were extracted in a standardised predefined manner and assessed critically by two independent reviewers.

Results: Fifteen trials were identified, of which nine compared the treatment group with the control group appropriately. Five RCTs tested progressive muscle relaxation or mental and muscular relaxation, two of which showed significant effects of therapy. One RCT investigating hypnotherapy, one of autogenic training, and two of biofeedback techniques revealed no therapeutic effects. Overall, the methodological quality of the studies was poor.

Conclusions: There is a lack of evidence for the efficacy of relaxation therapies in the management of asthma. This deficiency is due to the poor methodology of the studies as well as the inherent problems of conducting such trials. There is some evidence that muscular relaxation improves lung function of patients with asthma but no evidence for any other relaxation technique.

HERBAL MEDICINE

Background: Asthma is one of the most common chronic diseases in modern society and there is increasing evidence to suggest that its incidence and severity are increasing. There is a high prevalence of usage of complementary medicine for asthma. Herbal preparations have been cited as the third most popular complementary treatment modality by British asthma sufferers. This study was undertaken to determine if there is any evidence for the clinical efficacy of herbal preparations for the treatment of asthma symptoms.

Methods: Four independent literature searches were performed on Medline, Pubmed, Cochrane Library, and Embase. Only randomised clinical trials were included. There were no restrictions on the language of publication. The data were extracted in a standardised, predefined manner and assessed critically.

Results: Seventeen randomised clinical trials were found, six of which concerned the use of traditional Chinese herbal medicine and eight described traditional Indian medicine, of which five investigated Tylophora indica. Three other randomised trials tested a Japanese Kampo medicine, marihuana, and dried ivy leaf extract. Nine of the 17 trials reported a clinically relevant improvement in lung function and/or symptom scores.

Conclusions: No definitive evidence for any of the herbal preparations emerged. Considering the popularity of herbal medicine with asthma patients, there is urgent need for stringently designed clinically relevant randomised clinical trials for herbal preparations in the treatment of asthma.

BREATHING TECHNIQUES

Breathing techniques are used by a large proportion of asthma sufferers. This systematic review was aimed at determining whether or not these interventions are effective. Four independent literature searches identified six randomized controlled trials. The results of these studies are not uniform. Collectively the data imply that physiotherapeutic breathing techniques may have some potential in benefiting patients with asthma. The safety issue has so far not been addressed satisfactorily. It is concluded that too few studies have been carried out to warrant firm judgements. Further rigorous trials should be carried out in order to redress this situation.

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So, if you suffer from asthma, my advice is to stay away from SCAM. This might be easier said than done because SCAM practitioners are only too willing to lure asthma patients into their cult. In 2003, we have demonstrated this phenomenon by conducting a survey with chiropractors. Here is our short paper in full:

Classic chiropractic theory claims that vertebral subluxation blocks the flow of ‘‘innate intelligence’’ which, in turn, affects the health of asthma patients (1). Chiropractictors often use spinal manipulation (SM) to correct such malalignments and treat asthma (2). Several clinical trials of chiropractic SM exist, but the most rigorous ones are clearly negative (3,4). Chronic medication with corticosteroids can lead to osteoporosis, a condition, which is a contra-indication to chiropractic SM (5). Given this background, we aimed to determine whether chiropractors would advise an asthma patient on long-term corticosteroids (5 years) to try chiropractic as a treatment for this condition.

All 350 e-mail addresses listed at www.interadcom.com/chiro/html were randomised into two groups. A (deceptive) letter from a (fictitious) patient was sent to group A while group B was asked for advice on chiropractic treatment for asthma as part of a research project. Thus, groups A and B were asked the same question in di¡erent contexts: is chiropractic safe and e¡ective for an asthma patient on long-term steroids. After data collection, respondents from group A were informed that the e-mail had been part of a research project.

Of 97 e-mails in group A, we received 31 responses (response rate = 32% (95% CI, 0.23^ 0.41)). Seventy-four per cent (23 respondents) recommended visiting a chiropractor (95% CI, 0.59^ 0.89). Thirty-five per cent (11 respondents) mentioned minimal or no adverse effects of SM (95% CI, 0.18 ^ 0.52). Three chiropractors responded that some adverse e¡ects exist, e.g. risk of bone fracture, or stroke. Two respondents noted that other investigations (X-rays, spinal and neurological examination) were required before chiropractic treatment. Three respondents suggested additional treatments and one warned about a possible connection between asthma and the measles vaccine. Of 77 e-mails sent to group B, we received 16 responses (response rate = 21% (95% CI, 0.17^ 0.25)). Eleven respondents (69%) recommended visiting a chiropractor (95% CI, 0.46 ^ 0.91). Ten respondents mentioned minimal or no adverse effects of SM (95% CI, 0.39^ 0.87). Five chiropractors responded that adverse effects of SM exist (e.g. bone fracture). Five respondents suggested pre-testing the patient to check bone density, allergy, diet, exercise level, hydration and blood. Additional treatments were recommended by three respondents. The pooled results of groups A and B suggested that the majority of chiropractors recommend chiropractic treatment for asthma and the minority mention any adverse effects.

Our results demonstrate that chiropractic advice on asthma therapy is as readily available over the Internet as it is likely to be misleading. The majority of respondents from both groups (72%) recommended chiropractic treatment. This usually entails SM, a treatment modality which has been demonstrated to be ineffective in rigorous clinical trials (3,4,6). The advice may also be dangerous: the minority of the respondents of both groups (17%) caution of the risk of bone fracture. Our findings also suggest that, for the research question asked, a degree of deception is necessary. The response rate in group B was 12% lower than that of group A, and the answers received differed considerably between groups. In group A, 10% acknowledged the possibility of adverse e¡ects, this figure was 33% in group B. In conclusion, chiropractors readily provide advice regarding asthma treatment, which is often not evidence-based and has the potential to put patients at risk.

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As I stated above: if you suffer from asthma, my advice is to

stay away from SCAM.

What motivates a doctor to work as an integrative medical practitioner? This is a question I asked myself often. Despite trying to find answers through several methods, I was not very successful. The question does not seem well-researched at all. Here is what I found so far:

Our own 1996 survey of GPs participating in a course at Exeter that was aimed at familiarizing them with so-called alternative medicine (SCAM) found that the main perceived advantage of SCAM, apart from the potential intrinsic value of the techniques themselves, was the time available for establishing a good therapeutic relationship with the patient.

A UK survey from 2001 suggested that doctors are motivated by issues ranging from feeling a responsibility to respond to their patients’ interests and needs to developing “another string to their bow.” Some are attracted to its study in its own right, others by a wish to focus some of their energy away from conventional medical practice, which they may find stressful and unfulfilling. Doctors studying complementary and alternative medicine often call on different personality traits and report a variety of positive benefits from training, including welcoming the opportunity to engage their feelings, trust their intuition, and enjoy therapeutic touch. Comments from attendees at one homoeopathic course were “I started to enjoy seeing patients again,” “Training had improved my conventional history taking,” and “Having another approach made treating heart-sink patients easier.”

A German focus group in 2008 with 17 GP suggested that scientific evidence and patient preference were the main criteria used by these doctors in deciding whether to apply a SCAM or not.

An interview study published in 2011 with Australian doctors provided some details. The researchers invited 43 doctors to participate. Twenty-three agreed to take part in either a face-to-face (n = 7) or telephone (n = 16) interviews. Here is the passage entitled “Motivations to work as an integrative medical practitioner” from their paper:

‘Family of origin health beliefs and practices’ were an important influence on the doctors’ philosophical approach and their decisions to work as an integrative medical practitioner.

…When I grew up it was not uncommon that I would see my aunties and uncles preparing all sorts of things. My auntie laying me on her lap and putting breast milk in my ear and drinking chamomile tea for a sore belly…there was lots of things that influenced me. (Female, 23 years in practice)

…There is a long tradition in [country of origin] of using a herbalist. I heard things from my mum and my grandma and those ideas were there. (Male, 16 years in practice)

The ‘personal or close family illness experiences’ reported by doctors were also influential in motivating them to practice integrative medicine. These experiences included non-conventional approaches to health and illness and the use of CAM as treatment modalities.

…I had my own illness – depression and a very bad back. I’d been on medication for years and I got sick of taking medications and I was given a prognosis of chronic illness with relapses and I really didn’t like it. So I started to look elsewhere and that took me in to the world of mind-body medicine. (Female, 24 years in practice)

Other doctors cited ‘professional experiences’, often early in their careers, of different theoretical approaches to medicine as being a powerful stimulus to practice integrative medicine. These included being inspired by a medical lecturer, an interesting, usually non-conventional experience during a placement as a medical student, and professional experiences of CAM modalities during their residency or early medical career.

…We had this subject Medical Studies 3, where there was a discussion of the French fur trapper in the Yukon who had shot himself in the stomach and the local doctor who was experimenting with various emotional states. There was just that sort of moment, of thinking, that’s the sort of area that I want to work in. (Male, 26 years in practice)

…I found myself doing a clinical attachment at a hospital in Switzerland that used integrated medicine, they had a course and I thought I’ll just do this for interest. I came in contact with an Indian person who did homeopathy and I found his stories quite interesting. (Male, 22 years in practice)

‘Dissatisfaction with the conventional approach to medicine’, which was perceived to be too illness focused or commercialized, was also cited by some doctors as a precursor to adopting an integrative approach to medical practice.

…More and more I’m realising that medicine is a personalised thing. We need to learn the art of treating people individually rather than en masse as a sick lung or a sick toe or a sick whatever because it doesn’t work like that. (Male, 22 years in practice)

…Medicine was hijacked by the market; i.e.: big pharmaceutical companies. And they have seduced the government, the colleges, the universities, general practice, everybody. GPs, in my opinion, have been deskilled. (Female, 19 years in practice).

An Australian survey from 2021 suggested that GPs were attracted to SCAM because they thought it to be relatively safe and effective, offering additional, holistic benefits to patients.

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Collectively these investigations suggest that doctors’ motivation to work as integrated medical practitioners vary greatly. They seem to include:

  • positive evidence for SCAM’s safety and efficacy,
  • having the time to establish a good therapeutic relationship,
  • wanting to use all therapeutic options,
  • dissatisfaction with conventional medicine,
  • patient preferences,
  • wanting to practice in a more human and holistic way,
  • personal and professional experiences.

But surely, there are other factors as well (from my personal experience in dealing with doctors of integrative medicine, I could list a few that are less than flattering). In any case, I would be most interested to hear your thought and read more published evidence that you might know about.

The DAILY EXPRESS (DE) is not my favorite newspaper – perhaps even the opposite. During the last years, I have often been questioned by journalists on matters relating to so-called alternative medicine (SCAM). I do not recall, however, being interviewed by the DE (I might have forgotten, of course, but it certainly did not happen very often). I was therefore surprised to find that, in the last 13 years (this is as far back as I was able to search), the DE quoted me 22 times. Therefore, I decided to do a quick analysis of these 22 articles rating them (generously) for accuracy on a scale of 0 (totally inaccurate) to 10 (totally accurate).

 1. Title (date of publication): Tracking down the safe alternatives (25 March 2008)

Subject: a new regulatory body (the Complementary and Natural Healthcare Council (CNHC)) might help separate the cranks from the credible.

Quote: The CNHC has been described as complementary medicine’s equivalent of the General Medical Council – the body which sets standards for GPs. It will investigate complaints and therapists who fall below expected standards could be struck off. The new organisation has been set up by Prince Charles’s Foundation for Integrated Health and receives part funding from the NHS. The Prince, who is a fan of homeopathy, believes that complementary therapies should have a greater role within the NHS…

Edzard Ernst, the UK’s first professor of complementary medicine, is scathing, describing the £2million cost of founding the CNHC as a waste of money. He says the new body does not challenge the safety or effectiveness of the therapies. “This organisation could give the public false confidence. Some of these therapies can do more harm than good. It will give them a status they don’t deserve.”

My comment (score): The subject matter was relevant. The article seems correct and my comment is true; the CNHC did, in fact, turn out to be a waste of space. (10)

2. Title (date of publication): Chinese Medicine: A risky remedy? (19 May 2008)

Subject: How much do we really know about how they work and could they actually be harmful to our health?

Quote: Traditional Chinese Medicine (TCM) is enjoying a boom with hundreds of shops appearing on high streets. The herbal medicine industry, which includes Chinese medicines, is worth an estimated £200million in the UK as thousands place their faith in ancient remedies for everything from acne to infertility…

Edzard Ernst, professor of complementary medicine at the University of Exeter and co-author of the book Trick Or Treatment: Alternative Medicine On Trial, says: “People think that because something is ancient or natural it must be good. That’s simply not true. Plenty of these medicines have side effects and can be dangerous. “TCMs are grossly under-researched in the UK. China’s research is hard to access and hard to understand. TCMs are frequently contaminated with toxic heavy metals. “This is because of poor quality, because soil is contaminated and supplying procedures are unregulated. The most worrying thing about TCMs is that they are regularly found to contain synthetic prescription drugs, which in extreme cases, taken wrongly, can kill.”

My comment (score): The subject matter was relevant. The article seems correct and my comment is true. (10)

3. Title (date of publication): Alternative treatments face calls for regulation (17 June 2008)

Subject: Alternative medicines must be regulated to protect patients from harm, according to an influential group of experts.

Quote: A government-appointed steering group said it was ridiculous that eight years after regulation was first called for, nothing had been done. And in a report to UK ministers, who have reserved powers on regulating health professionals, they warned it must be introduced “without delay”…

Prof Edzard Ernst, professor of complementary medicine at the University of Exeter, said there was no scientific evidence that homoeopathy works. Homoeopathy is the treatment of disease using minute doses of drugs diluted in water. Prof Ernst and author Simon Singh have pledged to give £10,000 to anyone who could prove, in a scientific way, that these treatments work as well as conventional medicines.

My comment (score): The subject matter was relevant. The article seems a bit confused. My comment seems to be from elsewhere and is out of context. (5)

4. Title (date of publication): Thank you for the music (28 June  2008)

Subject: Nerve disorder fibromyalgia left musician Emily Maguire housebound and in constant pain. As she prepares to play the Glastonbury festival she tells ABIGAIL JACKSON how her love of music pulled her through…

Quote: Dr Peter Fisher from the Royal London Homeopathic Hospital … has claimed to have success in treating fibro­myalgia patients with homeopathic remedies. He prescribed ignacia, used as a remedy for numerous complaints from depression and sleeplessness to backache. A month later, Emily says the pain was gone. “I couldn’t believe it,” she says. “I feel so blessed.”

Although Emily is confident that taking ignacia (as well as maintaining a healthy lifestyle) did the trick, there are growing concerns over whether homeopathic remedies have any effect. Last week Edzard Ernst, the UK’s only professor of complementary medicine, offered £10,000 for any proof of a successful homeopathic treatment.

My comment (score): The subject matter is basically a case report which is not very relevant. The article seems confused and goes from the positive effects of music to homeopathy. What the article reports about our £10, 000 challenge is not relevant. (3)

5. Title (date of publication): Charles hit by ‘dodgy’ detox quackery row (11 March 2009)

Subject: Prince Charles was accused yesterday of using “quackery” to exploit gullible people after his Duchy Originals label launched a controversial detox tincture.

Quote: Andrew Baker, chief executive of Duchy Originals… said: “Duchy Herbals Detox Tincture is traded as a food supplement and in accordance with all of the relevant sections of both UK and European food laws. It is a natural aid to digestion and supports the body’s natural elimination processes. It is not – and has never been described as – a medicine, remedy or cure for any disease.”

Prof Ernst said: …“Products like this are a dangerous waste of money. Charles is exploiting gullible people during hard times. It’s outright quackery.” The academic, who has been a professor at Exeter for 15 years, labelled the Prince’s firm “Dodgy Originals”.

My comment (score): The subject matter was relevant, in my view. The article and my comments are both correct. (10)

6. Title (date of publication): Homeopathy: A ‘cure’ that is all in the mind? (11 February 2010)

Subject: Imagine if an electronics store publicly admitted that an entire range of the products it sold didn’t work. It wasn’t that the DVD players were not very good quality, it simply didn’t have any evidence that they played DVDs at all.

Quote: A report published yesterday by the House of Commons Science and Technology Committee said the products were no more effective than a dummy pill and recommended the NHS stop funding them. Back in October last year Paul Bennett, the professional standards director of Boots, appeared in front of the Committee’s inquiry into alternative medicine. When asked if he believed that homeopathic products worked he said: “There is certainly a consumer demand for these products. I have no evidence to suggest they are efficacious.”

Scientists say there is no evidence water has such a memory or that homeopathy works at all beyond a basic placebo effect. “The principles are simply implausible,” says Professor Edzard Ernst, Professor of Complementary Medicine at the Peninsular Medical School in Exeter. “It might be OK that the principle is implausible if the method still worked but rigorous clinical trials have demonstrated that the method doesn’t work. On both levels the result is negative.”

My comment (score): The subject matter was relevant. The article seems correct but my comment seems a bit confusing. (8)

7. Title (date of publication): Acupuncture ‘a waste of time’ for couples trying for a baby (10 March 2010)

Subject: Couples who have acupuncture to boost their chances of becoming parents are wasting their time and money, experts said yesterday.

Quote: New guidelines from the British Fertility Society, which represents fertility clinics, said there was “no evidence” that either acupuncture or traditional Chinese herbal remedies could improve the success rate of In-Vitro Fertilisation.

Edzard Ernst, professor of complementary medicine at the Peninsula Medical School, based at the universities of Exeter and Plymouth, said: “This is a long-overdue clarification. Infertile women have been misled for some time now to think that traditional Chinese medicine can help them getting pregnant. This analysis shows two things very clearly: The totality of the acupuncture trials does not support this notion, and for Chinese herbs, we have no evidence at all. This will help infertile women not to waste their money.”

My comment (score): The subject matter was relevant. The article seems correct and my comment is true. (10)

8. Title (date of publication): Prince Charles’s charity in £150 000 fraud quiz (4 April 2010)

Subject: One of Prince Charles’s charities is being investigated by police amid ­allegations of a £150,000 fraud.

Quote: The Prince’s Foundation for Integrated Health … which campaigns for the wider use of complementary therapies, has failed to file its annual return. According to the Charity Commission website it is 154 days overdue. A spokesman for the foundation said: “Due to staff and structural changes, there was a delay in preparing the 2008 accounts. While getting these accounts ready for filing, our auditors Kingston Smith questioned some of the transactions. A t their recommendation a complaint has been made to the police. ” … Dr Michael Dixon, medical director for the foundation, said: “We should not abandon patients we cannot help with conventional scientific medicine. If homeopathy is getting results for those patients then of course we should ­continue to use it.”

The complaint also claimed the foundation’s trustees allowed staff to pursue a “vendetta” against a prominent critic , Edzard Ernst, ­professor of complementary medicine at Exeter University. Republic accused the foundation of being partly responsible for the ­imminent closure of Professor Ernst’s department after he publicly attacked its draft guide to complementary medicines as “outrageous and deeply flawed”.

My comment (score): The subject matter was relevant. The article seems correct albeit slightly confusing (the ‘vendetta’ is not really relevant here) the quotes are somewhat beside the point; mine seems copied from elsewhere. (7)

9. Title (date of publication): Prince Charles’s charity amid £300k fraud inquiry (30 April 2010)

Subject: PRINCE Charles’s homeopathy charity has been shut down amid a Scotland Yard investigation into a £300,000 fraud.

Quote: The 49-year-old man was arrested on Monday with a 54-year-old woman, both on suspicion of the same offences, after an investigation into £300,000 of unaccounted funds in the charity’s books.

… while the foundation has enjoyed successes, sometimes working with the Prince’s Duchy Originals company to produce alternative health care products, it has also become embroiled in a series of controversies. Critics have accused it of promoting “unscientific” approaches to health care. In February, MPs on the Commons Science and Technology Committee called for an end to homeopathy treatment on the NHS, arguing there was no evidence to support its effectiveness. Edzard Ernst, professor of complementary medicine at Exeter University, last year described a detox tincture made by Duchy Originals as “outright quackery” and regulators ordered the firm to withdraw misleading advertising claims about the effectiveness of two natural remedies.

My comment (score): The subject matter was relevant. The article seems correct and my comment seems copied from elsewhere and is beside the point. (8)

10. Title (date of publication): ‘Snake oil seller’ Prince Charles cost me my job, claims professor (26 July 2011)

Subject: A university professor, who labelled Prince Charles and other supporters of complementary medicine as “snake-oil salesmen”, last night accused the heir to the throne of costing him his job.

Quote: Edzard Ernst, a consistent critic of Prince Charles and his Duchy Originals food company, is stepping down from his post at Exeter University as Britain’s only professor of complementary medicine after a long-running dispute with the Prince about the merits of alternative therapies. He said: “Almost directly, Prince Charles has managed to interfere in my professional life and almost managed to close my unit.” He blamed Charles, a prominent advocate of alternative therapies such as acupuncture, herbal remedies and homeopathy, for undermining him and leading his bosses to lose faith in him.

A spokeswoman for Charles claimed last night that the Prince was unaware that his private secretary had complained about the professor. She declined to respond to the description of her boss as a “snake-oil salesman”.

My comment (score): The subject matter was relevant. The article seems correct and my comment is true. (10)

11. Title (date of publication): Do detox diets work? (10 January 2012)

Subject: Most of us overdo it during the festive season. No wonder January is the most popular month for detox diets which typically involve drinking pints of water each day, eating a very restricted diet and taking particular supplements.

Quote: The theory is toxins from unhealthy types of food and drink build up in the body and can lead to health problems. Purging these toxins is meant to leave you feeling full of energy and thinner.

The principle of detox goes back to medieval times but it is anti-science, agrees Professor Edzard Ernst, Britain’s first professor of complementary medicine, who works at Peninsula College of Medicine & Dentistry in Exeter. “You can’t overindulge on food and drink, then wave some magic wand,” he says. “The only thing that detox removes is money from your wallet.”

My comment (score): The subject matter was relevant. The article seems correct and my comment is true. (10)

12. Title (date of publication): Kevin Sorbo: Three strokes left me fighting for my life (28 February 2012)

Subject: Becoming a key speaker at a medical conference may seem an unlikely part for a Hollywood tough guy. Nevertheless that’s the role Hercules star Kevin Sorbo took after breaking his silence over three life-threatening strokes.

Quote: He made an appointment with his chiropractor. “I had been seeing this guy for eight years and he never cracked my neck,” recalls Kevin. “He knew I didn’t like it.” So he was surprised when the therapist did crack his neck. When he asked him why, the chiropractor responded by saying “I felt you needed it”. Irritated, the star paid his bill and started driving back to the home of his girlfriend, now wife, Sam. “I heard two very loud pops in the back of my head and my vision went crazy. I felt like I was falling backwards and I couldn’t stop. It was like that feeling you get when you stand up too quickly and get dizzy but multiplied by 10,” he says. Kevin managed to drive to Sam’s apartment and despite hearing two more “pops” went on to appear on a TV chat show after his agent insisted he could not pull out at the last minute. “I don’t remember what we discussed. I was on auto-pilot. The entire world was spinning, my head was throbbing. It was the best acting of my life, acting as though I was healthy.”

Whether or not the cracking technique is dangerous is a controversial issue. A study by Professor Edzard Ernst, director of complementary medicine at the UK’s Peninsula Medical School says: “Numerous deaths have occurred after chiropractic manipulations.” He thinks the risks of this treatment by far outweigh its benefit and adds: “In my view a chiropractor should not go near the neck.”

However Haymo Thiel, vice-principal of the Anglo-European College of Chiropractic, says: “There is risk in anything. It would be foolish to say not. But there is a difference between coincidence of timing and causation.”

My comment (score): Even though this is merely a case report, the subject matter seems relevant. The article seems correct and my comments are true. The Thiel comment at the end might serve as a nice example of false balance. (8)

13. Title (date of publication): Menopause: Natural remedies vs HRT (29 January 2013)

Subject: Are natural remedies best for the menopause, or is HRT still the strongest defence against its many unpleasant symptoms?

Quote: Since two major studies called hormone replacement therapy into question a decade ago – raising fears of breast cancer, stroke and heart disease – women confronting the menopause have faced a confusing choice.

“Few of the herbal remedies have been properly studied,” says Edzard Ernst, professor of complementary medicine at the university of Exeter. “Some promising evidence has emerged for black cohosh and red clover, but even these are not as strongly beneficial as HRT.”

My comment (score): The subject matter was relevant. The article seems correct and my comment is true. (10)

14. Title (date of publication): How safe is our herbal medicine? (19 March 2013)

Subject: For many of us hoping to take care of our aches and pains, boost our immune system or improve our mood, herbal remedies are often the first resort. Seen as a healthier and more natural option than conventional medication few of us stop to ask how safe these supplements actually are.

Quote: High street health chain Holland & Barrett is the most recent to fall foul of these rules. In January it was ordered to recall a blend of black cohosh and agnus castus called Flash Fighters which it was selling as a food supplement. A spokesman for the chain confirmed: “The MHRA stated the product’s name implied it could be used to treat ‘hot flushes’.” He added that the store is undergoing the process of having Flash Fighters reclassified under the Traditional Herbal Medicine Registration Scheme (THR).

Professor Edzard Ernst, world’s first professor of complementary medicine, warns: “The notion that natural equals safe can be dangerously misleading.”

My comment (score): The subject matter was relevant. The article seems correct and my comment is true. (10)

15. Title (date of publication): Prince Charles SLAMMED as ‘immoral’ for peddling ‘rubbish’ alternative medicines (18 January 2018)

Subject: Charles is under fire from a renowned scientist who accuses him of being an “immoral snake oil salesman” for promoting alternative medicines in a shocking new book that lambasts the future monarch.

Quote: Professor Edzard Ernst, who previously accused Charles of “selling snake oil”, has now hit out with a new book called “More Harm than Good?” He scalds Charles for being a vocal supporter of homeopathy, lobbying health ministers to set up a register of holistic practitioners and making impassioned speeches at the World Health Assembly and British Medical Association. The authors of the book, Professor Ernst and Dr Kevin Smith, of Abertay University in Dundee, said alternative medicines are “immoral”. Professor Ernst said: “You can’t have alternative medicine just because Prince Charles likes it, because that is not in the best interest of the patients.

My comment (score): The basis for the article was a presentation of a new book at the ‘Science Media Centre’. The book merely mentioned Charles merely in passing. The article and our comments seem correct, however, they were not to focus of our presentation. (7)

16. Title (date of publication): Weight loss pills: Are they actually effective in helping you lose weight? (10 September 2018)

Subject: Weight loss pills claiming to help you lose weight, are widely advertised. But do they actually live up to their claims; are they effective in helping you to lose weight or are they simply a con?

Quote: More than one-third of adults are overweight in England alone, with nearly one-quarter obese, and growing numbers of people are turning to weight loss pills and products as a means to shed excess weight. Many weight loss pills claim to contain herbs or natural substances that speed up metabolism or make you feel full up to discourage you from eating. But according to the NHS, there is little evidence that some products sold by reputable retailers and over the internet actually work, and could even be packed with harmful substances. Even products marketed as ‘guaranteed, clinically-proven and 100 per cent natural’ come with no guarantees, the NHS warned.

Some manufacturers of weight loss products also only focus on positive trials, failing to mention the negative or failed trials. “Manufacturers cherry-pick and only ever mention the positive trials,” said academic physician and researcher Edzard Ernst. “They then also fail to mention the mostly poor quality of their studies. Desperate people are being misled to buy unproven treatments at considerable expense.”

My comment (score): The subject matter was relevant. The article seems correct and my comment is true. (10)

17. Title (date of publication): Prince Charles under fire for becoming patron of 175-year-old homeopathy group (26 June 2019)

Subject: The Prince of Wales has been criticised after being made a patron of a 175-year-old homeopathy group, which supports medical professionals with alternative treatments.

Quote: Charles has long advocated homeopathic medicine, which is seen as an alternative to regular chemical-based treatments. Homeopathy attempts to treat some conditions, including headaches and colds, so the body will get better by itself. But after Charles was accused of being an “immoral snake oil salesman” by a medical professor in 2017, it seems more are lining up to take aim at the future monarch for further endorsement of alternative medicine.

Professor Edzard Ernst, who made the initial criticisms of Charles last year, told the Guardian: “In view of Charles’s long love affair with homeopathy, this news is unsurprising. The question is whether this will change anything about the sharp decline homeopathy has taken in this and several other countries, and whether it will alter the verdicts of dozens of independent organisations which recently have certified it to be a pure placebo therapy.”

My comment (score): The subject matter was relevant. The article seems correct my quotes are borrowed from elsewhere. (7)

18. Title (date of publication): China sparks fresh coronavirus fears by turning to traditional medicine to fight virus (29 June 2020)

Subject: Chinese government papers have revealed that a shocking majority of the country’s cases have been treated with traditional medicine.

Quote: Coronavirus currently has very little universally approved and clinically proven treatments, but scientists have made some discoveries into potentially effective drugs.

Edzard Ernst, a retired UK-based researcher of complementary medicines, said that there is no science behind the recommendation to support it’s usage. He said to Nature: “For TCM there is no good evidence and therefore its use is not just unjustified, but dangerous.”

My comment (score): The subject matter was relevant. The article seems correct my quotes are borrowed from elsewhere. (7)

19. Title (date of publication): Prince Charles fury: Scientist’s shock claim royal ‘treated him like dirt’ exposed (1 July 2020)

Subject: Prince Charles is known to be enthusiastic about alternative medicines and therapies. Yet, Professor Edzard Ernst, who has several times criticised the royal for his influence in the world of pseudo-medicine, once claimed that the prince “silenced” and treated him “like dirt”, a shocking unearthed report revealed.

Quote: 

Prince Charles for decades has welcomed alternative medicines and therapies to apparently “cure” his ailments. One of the pseudo-sciences most popular with the prince appears to be homeopathy. Homeopathy is the largely discredited practice of treating illness with diluted substances to trigger the body’s own healing mechanisms.

In 2015, Professor Edzard Ernst, claimed he had been “treated like dirt” as a result of Charles trying to “silence” him. Prof Ernst is a staunch critic of using alternative medicines such as homeopathy as a direct means of treatment. He instead champions complementary medicine – the process of using alternative medicines to help alleviate the negative aspects of standard medicines – having held the first complementary medicine post in the world at the University of Exeter. His unscrupulous and rigorous application of evidence-based science and outspoken views found him at loggerheads with Charles.

My comment (score): The subject matter was only marginally relevant. I am pretty sure that I never said Charles treated me like dirt. I did say, however, that my university did treat me like dirt when dealing with the complaint from Charles’s first private secretary, Sir Michael Peat. My comments are borrowed from elsewhere. (4)

20. Title (date of publication): Prince Charles’ ‘plot’ with Andy Burnham for UK healthcare unveiled: ‘He was open to it’ (23 October 2020)

Subject: Prince Charles was once in agreement with Andy Burnham on the future direction of the UK’s healthcare, letters have revealed.

Quote: …this is not the first time Mr Burnham has been caught up in a divisive matter over healthcare. In 2009, the Greater Manchester Mayor was the Health Secretary under then Prime Minister Gordon Brown and was found to be corresponding with the Prince of Wales about the UK healthcare system. Charles has a reputation for being a “meddling” royal, particularly after his so-called ‘black spider memos’ to Government ministers were published in 2015.

Professor of complementary medicine Edzard Ernst told The Guardian in 2015: “The letters demonstrate yet again that Prince Charles relentlessly meddles in UK health politics and thus disrespects his constitutional role. “His arguments in favour of CAM [complementary and alternative medicine] and in particular homeopathy, show a devastating lack of knowledge and understanding; they are ill-informed, invalid and embarrassingly naive – but at the same time they are remarkably persistent.”

My comment (score): The subject matter was relevant. The article seems confusing my quotes are borrowed from elsewhere. (7)

21. Title (date of publication): Meghan Markle warning: Charles’ business blunder exposed amid new career move (17 December 2020)

Subject: Meghan Marle has just moved into the business sector after investing in a start-up – but she should be careful to avoid Prince Charles’ previous industry error which triggered a public outcry.

Quote: The Duchess of Sussex has ventured into the investment sector this week. It was announced that she has invested in Clevr Blends, a California-based sustainable start-up which sells four flavours of instant oat milk lattes. The company says its produce is sustainable, ethically sourced and healthy with organic ingredients, while its shipping materials are 100 percent recyclable.

However, Meghan’s father-in-law was accused of exploiting the public when Britain was still recovering from the recession with his Duchy Originals line. The UK’s first professor of complementary medicine, Edzard Ernst, dubbed the Duchy Originals detox tincture — which was being sold on the market at the time — “outright quackery”. The product, called Duchy Herbals’ Detox Tincture, was advertised as a “natural aid to digestion and supports the body’s elimination processes” and a “food supplement to help eliminate toxins and aid digestion”. The artichoke and dandelion mix cost £10 for a 50ml bottle.

My comment (score): The subject matter seems fairly irrelevant and far-fetched. My quotes belong to a different story. (2)

22. Title (date of publication): Prince Charles rejected by experts before Gwyneth Paltrow’s long Covid row: ‘Witchcraft’ (25 February 2021)

Subject: Prince Charles was rejected by scientists for his views on “witchcraft” alternative medicine well before Gwyneth Paltrow became embroiled in a row over her unapproved treatments for long Covid.

Quote: Gwyneth Paltrow has been urged to stop spreading misinformation by the medical director of NHS England after she suggested on her blog Goop that long Covid could be treated with various alternative medicines. The Hollywood star described how she herself had caught coronavirus and had since suffered with “long-tail fatigue and brain fog”. However, she claimed to have successfully treated it with “intuitive fasting”, herbal cocktails and regular visits to an “infrared sauna”.

The Prince of Wales has been specifically called out for advocating the controversial treatments, too. He was branded an “immoral snake oil salesman” by renowned scientist Professor Edzard Ernst in his book ‘More Harm Than Good?’ Prof Ernst founded the department of Complementary Medicine at the University of Exeter, became the world’s first academic on the subject and has founded two medical journals. Over the years, he has published a lot of critical research exposing methods that lack documentation of efficacy. The expert lambasted Charles for lobbying health ministers to set up a register of holistic practitioners and making impassioned speeches at the World Health Assembly and British Medical Association. He said: “You can’t have alternative medicine just because Prince Charles likes it, because that is not in the best interest of the patients. “The quality of the research is not just bad, but dismal. It ignores harms. There is a whole shelf of rubbish being sold and that is simply unethical.” His co-author, Dr Kevin Smith ‒ a senior lecturer at Abertay University specialising in Complementary and Alternative Medicine and genetics ‒ agreed that these alternative medicines are “immoral”. He added: “We certainly are very worried about the future King being a proponent.

My comment (score): The subject matter seems fairly irrelevant and far-fetched. My quotes belong to a different story. (2)

________________________________________

When I set out doing this analysis, I expected to find rather poor reporting by the DE. Yet, I was pleasantly surprised. Quite a lot of it is good. A few things did nevertheless occur to me:

  • I find it remarkable how often Prince Charles is the focus of these stories. Occasionally, my various disputes with Charles were ‘pulled in’ even though they do not really fit into the context of the article.
  • It is noticeable, I think, that the quality of the reporting deteriorated quite dramatically over time.
  • The DE repeatedly borrows quotes from other publications and even from different stories altogether. This seems to me to be lazy and rather poor journalism.

My point is that there is really no need for lazy or poor journalism on SCAM. Journalists should do their work properly; they can always reach me via the contact option of this blog (I invariably reply swiftly). I feel they owe it to their readers to do at least this minimal and quick amount of effort.

 

There is a lack of data describing the state of naturopathic or complementary veterinary medicine in Germany. This survey maps the currently used treatment modalities, indications, existing qualifications, and information pathways. It records the advantages and disadvantages of these medicines as experienced by veterinarians. Demographic influences are investigated to describe the distributional impacts of using veterinary naturopathy and complementary medicine.

A standardized questionnaire was used for the cross-sectional survey. It was distributed throughout Germany in a written and digital format from September 2016 to January 2018. Because of the open nature of data collection, the return rate of questionnaires could not be calculated. To establish a feasible timeframe, active data collection stopped when the previously calculated limit of 1061 questionnaires was reached.

With the included incoming questionnaires of that day, a total of 1087 questionnaires were collected. Completely blank questionnaires and those where participants did not meet the inclusion criteria were not included, leaving 870 out of 1087 questionnaires to be evaluated. A literature review and the first test run of the questionnaire identified the following treatment modalities:

  • homeopathy,
  • phytotherapy,
  • traditional Chinese medicine (TCM),
  • biophysical treatments,
  • manual treatments,
  • Bach Flower Remedies,
  • neural therapy,
  • homotoxicology,
  • organotherapy,
  • hirudotherapy.

These were included in the questionnaire. Categorical items were processed using descriptive statistics in absolute and relative numbers based on the population of completed answers provided for each item. Multiple choices were possible.

Overall 85.4% of all the questionnaire participants used naturopathy and complementary medicine. The treatments most commonly used were:

  • complex homoeopathy (70.4%, n = 478),
  • phytotherapy (60.2%, n = 409),
  • classic homoeopathy (44.3%, n = 301),
  • biophysical treatments (40.1%, n = 272).

The most common indications were:

  • orthopedic (n = 1798),
  • geriatric (n = 1428),
  • metabolic diseases (n = 1124).

Over the last five years, owner demand for naturopathy and complementary treatments was rated as growing by 57.9% of respondents (n = 457 of total 789). Veterinarians most commonly used scientific journals and publications as sources for information about naturopathic and complementary contents (60.8%, n = 479 of total 788). These were followed by advanced training acknowledged by the ATF (Academy for Veterinary Continuing Education, an organisation that certifies independent veterinary continuing education in Germany) (48.6%, n = 383). The current information about naturopathy and complementary medicine was rated as adequate or nearly adequate by many (39.5%, n = 308) of the respondents.

The most commonly named advantages in using veterinary naturopathy and complementary medicine were:

  • expansion of treatment modalities (73.5%, n = 566 of total 770),
  • customer satisfaction (70.8%, n = 545),
  • lower side effects (63.2%, n = 487).

The ambiguity and unclear evidence of the mode of action and effectiveness (62.1%, n = 483) and high expectations of owners (50.5%, n = 393) were the disadvantages mentioned most frequently. Classic homoeopathy, in particular, has been named in this context (78.4%, n = 333 of total 425). Age, gender, and type of employment showed a statistically significant impact on the use of naturopathy and complementary medicine by veterinarians (p < 0.001). The university of final graduation showed a weaker but still statistically significant impact (p = 0.027). Users of veterinary naturopathy and complementary medicine tended to be older, female, self-employed and a higher percentage of them completed their studies at the University of Berlin. The working environment (rural or urban space) showed no statistical impact on the veterinary naturopathy or complementary medicine profession.

The authors concluded that this is the first study to provide German data on the actual use of naturopathy and complementary medicine in small animal science. Despite a potential bias due to voluntary participation, it shows a large number of applications for various indications. Homoeopathy was mentioned most frequently as the treatment option with the most potential disadvantages. However, it is also the most frequently used treatment option in this study. The presented study, despite its restrictions, supports the need for a discussion about evidence, official regulations, and the need for acknowledged qualifications because of the widespread application of veterinary naturopathy and complementary medicine. More data regarding the effectiveness and the mode of action is needed to enable veterinarians to provide evidence-based advice to pet owners.

I can only hope that the findings are seriously biased and not a true reflection of the real situation. The methodology used for recruiting participants (it is fair to assume that those vets who had no interest in SCAM did not bother to respond) strongly indicates that this might be the case. If, however, the findings were true, one would have to conclude that, for German vets, evidence-based healthcare is still an alien concept. The evidence that the preferred SCAMs are effective for the listed conditions is very weak or even negative. If the findings were true, one would need to wonder how much of veterinary SCAM use amounts to animal abuse.

The objective of this study was to compare chronic low back pain patients’ perspectives on the use of spinal manipulative therapy (SMT) compared to prescription drug therapy (PDT) with regard to health-related quality of life (HRQoL), patient beliefs, and satisfaction with treatment.

Four cohorts of Medicare beneficiaries were assembled according to previous treatment received as evidenced in claims data:

  1. The SMT group began long-term management with SMT but no prescribed drugs.
  2. The PDT group began long-term management with prescription drug therapy but no spinal manipulation.
  3. This group employed SMT for chronic back pain, followed by initiation of long-term management with PDT in the same year.
  4. This group used PDT for chronic back pain followed by initiation of long-term management with SMT in the same year.

A total of 1986 surveys were sent out and 195 participants completed the survey. The respondents were predominantly female and white, with a mean age of approx. 77-78 years. Outcome measures used were a 0-to-10 numeric rating scale to measure satisfaction, the Low Back Pain Treatment Beliefs Questionnaire to measure patient beliefs, and the 12-item Short-Form Health Survey to measure HRQoL.

Recipients of SMT were more likely to be very satisfied with their care (84%) than recipients of PDT (50%; P = .002). The SMT cohort self-reported significantly higher HRQoL compared to the PDT cohort; mean differences in physical and mental health scores on the 12-item Short Form Health Survey were 12.85 and 9.92, respectively. The SMT cohort had a lower degree of concern regarding chiropractic care for their back pain compared to the PDT cohort’s reported concern about PDT (P = .03).

The authors concluded that among older Medicare beneficiaries with chronic low back pain, long-term recipients of SMT had higher self-reported rates of HRQoL and greater satisfaction with their modality of care than long-term recipients of PDT. Participants who had longer-term management of care were more likely to have positive attitudes and beliefs toward the mode of care they received.

The main issue here is that the ‘study’ was a mere survey which by definition cannot establish cause and effect. The groups were different in many respects which rendered them not comparable. For instance, participants who received SMT had higher self-reported physical and mental health on average than those who received PDT. Differences also existed between the SMT and the PDT groups for agreement with the notion that “spinal manipulation for LBP makes a lot of sense”; 96% of the SMT group and 35% of the PDT group agreed with it. Compare this with another statement, “taking /having prescription drug therapy for LBP makes a lot of sense” and we find that only 13% of the SMT cohort agreed with, 95% of the PDT cohort agreed. Thus, a powerful bias exists toward the type of therapy that each person had chosen. Another determinant of the outcome is the fact that SMT means hands-on treatments with time, compassion, and empathy given to the patient, whereas PDT does not necessarily include such features. Add to these limitations the dismal response rate, recall bias, and numerous potential confounders and you have a survey that is hardly worth the paper it is printed on. In fact, it is little more than a marketing exercise for chiropractic.

In summary, the findings of this survey are influenced by a whole range of known and unknown factors other than the SMT. The authors are clever to avoid causal inferences in their conclusions. I doubt, however, that many chiropractors reading the paper think critically enough to do the same.

This study describes the use of so-called alternative medicine (SCAM) among older adults who report being hampered in daily activities due to musculoskeletal pain. The characteristics of older adults with debilitating musculoskeletal pain who report SCAM use is also examined. For this purpose, the cross-sectional European Social Survey Round 7 from 21 countries was employed. It examined participants aged 55 years and older, who reported musculoskeletal pain that hampered daily activities in the past 12 months.

Of the 4950 older adult participants, the majority (63.5%) were from the West of Europe, reported secondary education or less (78.2%), and reported at least one other health-related problem (74.6%). In total, 1657 (33.5%) reported using at least one SCAM treatment in the previous year.

The most commonly used SCAMs were:

  • manual body-based therapies (MBBTs) including massage therapy (17.9%),
  • osteopathy (7.0%),
  • homeopathy (6.5%)
  • herbal treatments (5.3%).

SCAM use was positively associated with:

  • younger age,
  • physiotherapy use,
  • female gender,
  • higher levels of education,
  • being in employment,
  • living in West Europe,
  • multiple health problems.

(Many years ago, I have summarized the most consistent determinants of SCAM use with the acronym ‘FAME‘ [female, affluent, middle-aged, educated])

The authors concluded that a third of older Europeans with musculoskeletal pain report SCAM use in the previous 12 months. Certain subgroups with higher rates of SCAM use could be identified. Clinicians should comprehensively and routinely assess SCAM use among older adults with musculoskeletal pain.

I often mutter about the plethora of SCAM surveys that report nothing meaningful. This one is better than most. Yet, much of what it shows has been demonstrated before.

I think what this survey confirms foremost is the fact that the popularity of a particular SCAM and the evidence that it is effective are two factors that are largely unrelated. In my view, this means that more, much more, needs to be done to inform the public responsibly. This would entail making it much clearer:

  • which forms of SCAM are effective for which condition or symptom,
  • which are not effective,
  • which are dangerous,
  • and which treatment (SCAM or conventional) has the best risk/benefit balance.

Such information could help prevent unnecessary suffering (the use of ineffective SCAMs must inevitably lead to fewer symptoms being optimally treated) as well as reduce the evidently huge waste of money spent on useless SCAMs.

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