Updated Edition!
You may remember my post entitled “How turn a negative trial into a positive one? Simple, just cheat!”
No?
Let me remind you by copying the relevant parts of my original post of 20/2/2018:
…The purpose of their study was to examine the feasibility of Sipjeondaebo-tang (Juzen-taiho-to, Shi-Quan-Da-Bu-Tang) for cancer-related anorexia. A total of 32 participants with cancer anorexia were randomized to either Sipjeondaebo-tang group or placebo group. Participants were given 3 g of Sipjeondaebo-tang or placebo 3 times a day for 4 weeks. The primary outcome was a change in the Anorexia/Cachexia Subscale of Functional Assessment of Anorexia/Cachexia Therapy (FAACT). The secondary outcomes included Visual Analogue Scale (VAS) of anorexia, FAACT scale, and laboratory tests.
The results showed that anorexia and quality of life measured by FAACT and VAS were improved after 4 weeks of Sipjeondaebo-tang treatment. However, there was no significant difference between changes of Sipjeondaebo-tang group and placebo group.
From this, the authors of the study concluded that sipjeondaebo-tang appears to have potential benefit for anorexia management in patients with cancer. Further large-scale studies are needed to ensure the efficacy.
Well, isn’t this just great? Faced with a squarely negative result, one simply ignores it and draws a positive conclusion!
As we all know – and as trialists certainly must know – controlled trials are designed to compare the outcomes of two groups. Changes within one of the groups can be caused by several factors unrelated to the therapy and are therefore largely irrelevant. This means that “no significant difference between changes of Sipjeondaebo-tang group and placebo group” indicates that the herbal mixture had no effect. In turn this means that a conclusion stating that “sipjeondaebo-tang appears to have potential benefit for anorexia” is just fraudulent.
This level of scientific misconduct is remarkable, even for the notoriously poor Evid Based Complement Alternat Med...
END OF QUOTE
This article prompted me to do something I have only done once before: I filed an official complaint with the journal. I received a reply that they would look into it. Then there was silence; then came 2 or 3 emails that they are still considering my complaint. Yesterday, I finally received the following response:
Dear Dr. Ernst,
With reference to our correspondence below, thank you again for raising this matter, we appreciate your careful attention to the reporting of this article. The authors have apologized for the error and said they did not check the abstract carefully enough when revising the article. The board decided that this may be addressed by publishing a corrigendum; please find the notice attached to this email. Please let us know if you would like to be acknowledged in the notice for raising this issue, e.g. as follows: “This error in the reporting was brought to the attention of the journal by Prof. Edzard Ernst, Emeritus Professor of Complementary Medicine, University of Exeter.”
I look forward to hearing from you.
Kind regards…
And the attachment reads as follows:
Corrigendum to “Efficacy and Safety of Sipjeondaebo-Tang for Anorexia in Patients with Cancer: A Pilot, Randomized, Double-Blind, Placebo-Controlled Trial”
Dear Dr. Ernst,
With reference to our correspondence below, thank you again for raising this matter, we appreciate your careful attention to the reporting of this article. The authors have apologized for the error and said they did not check the abstract carefully enough when revising the article. The board decided that this may be addressed by publishing a corrigendum; please find the notice attached to this email. Please let us know if you would like to be acknowledged in the notice for raising this issue, e.g. as follows: “This error in the reporting was brought to the attention of the journal by Prof. Edzard Ernst, Emeritus Professor of Complementary Medicine, University of Exeter.”
I look forward to hearing from you.
Kind regards…
Chunhoo Cheon,1 Jeong-Eun Yoo,2 Hwa-Seung Yoo,2 Chong-Kwan Cho,2 Sohyeon Kang,1 Mia Kim,3 Bo-Hyoung Jang,1 Yong-Cheol Shin,1 and Seong-Gyu Ko1
1Department of Preventive Medicine, Korean Medical College, Kyung Hee University, Seoul, Republic of Korea 2Dunsan Korean Medicine Hospital of Daejeon University, Daejeon, Republic of Korea 3Department of Cardiovascular and Neurologic Disease (Stroke Center), College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
In the article titled “Efficacy and Safety of Sipjeondaebo-Tang for Anorexia in Patients with Cancer: A Pilot, Randomized, Double-Blind, Placebo-Controlled Trial” [1], there was an error in the conclusion of the Abstract where the text reading “Sipjeondaebo-tang appears to have potential benefit for anorexia management in patients with cancer. Further large-scale studies are needed to ensure the efficacy” should be corrected to “In the present study, Sipjeondaebo-tang did not show a significant effect on anorexia in patients with cancer. Further large-scale studies which compensate for the limitations of this study are needed to assess the efficacy”.
References
1. Chunhoo Cheon, Jeong-Eun Yoo, Hwa-Seung Yoo, et al., “Efficacy and Safety of Sipjeondaebo-Tang for Anorexia in Patients with Cancer: A Pilot, Randomized, Double-Blind, Placebo-Controlled Trial,” Evidence-Based Complementary and Alternative Medicine, vol. 2017, Article ID 8780325, 9 pages, 2017. doi:10.1155/2017/8780325
So, what should we make of all this?
On the one hand, it is laudable that the Journal does correct the mistake. Bravo!!!
On the other hand, I find it odd that only the authors seem to be found guilty of an ‘error’. Even if it was just a error – and I am happy to give them the benefit of the doubt – there are other parties involved. The reviewers have a responsibility and so does the editor! Should they not own up to it?
In the end, this sorry tale does not restore my confidence in this Journal, quite the opposite. In view of all this, I have to repeat what I stated in my previous post:
I strongly suggest that:
- The journal is de-listed from Medline because similarly misleading nonsense has been coming out of this rag for some time.
- The paper is withdrawn because it can only mislead vulnerable patients.
PS
Needless to say that my reply to the above-cited email was to uphold my complaint and urge the Journal to publish an adequate response that includes and explains the failures of the reviewers and the editor. So: watch this space!
In Germany, homeopathy had been an undisputed favourite for a very long time. Doctors prescribed it, Heilpraktiker recommended it, patients took it and consumers, politicians, journalists, etc. hardly ever questioned it. But recently, this has changed; thanks not least to the INH and the ‘Muensteraner Kreis‘, some Germans are finally objecting to paying for the homeopathic follies of others. Remarkably, this might even have led to a dent in the sizable profits of homeopathy producers: while in 2016 the industry sold about 55 million units of homeopathic preparations, the figure had decreased to ‘just’ ~53 million in 2017.
Enough reason, it seems, for some manufacturers to panic. The largest one is the DHU (Deutsche Homoeopathische Union), and they recently decided to go on the counter attack by investing into a large PR campaign. This article (in German, I’m afraid) explains:
…Unter dem Hashtag #MachAuchDuMit lädt die Initiative Anwenderinnen und Anwender ein, ihre guten Erfahrungen in Sachen Homöopathie zu teilen. “Über 30 Millionen zufriedene Menschen setzen für ihre Gesundheit auf Homöopathie und vertrauen ihr. Mit unserer Initiative wollen wir das Selbstbewusstsein der Menschen stärken, sich für die Homöopathie zu entscheiden oder mindestens für eine freie Wahl einzustehen,” so Peter Braun, Geschäftsführer der DHU…
“Die Therapiefreiheit, die in unserem Slogan mit “Meine Entscheidung!” zum Ausdruck kommt, ist uns das wichtigste in dieser Initiative”, unterstreicht Peter Braun. Und dafür lohnt es sich aktiv zu werden, wie der Schweizer weiß. 2017 haben sich die Menschen in der Schweiz per Volksabstimmung für das Konzept einer integrativen Medizin entschieden. Neben der Schulmedizin können dort auch weitere Therapieverfahren wie Homöopathie oder Naturmedizin zum Einsatz kommen.
In Deutschland will die DHU mit ihrer Initiative Transparenz schaffen und die Homöopathie hinsichtlich Fakten und Erfolge realistisch darstellen. Dafür besteht offensichtlich Bedarf: “Wir als DHU haben in der jüngsten Vergangenheit dutzende spontane Anfragen bekommen, für die Homöopathie Flagge zu zeigen”.
Was die Inhalte der Initiative angeht betont Peter Braun, dass es dabei nie um ein “Entweder-Oder” zwischen Schulmedizin und anderen Therapieverfahren gehen soll: “Die Kombination der jeweils am besten für den Patienten passenden Methode im Sinne von “Hand-in-Hand” ist das Ziel der modernen integrativen Medizin. In keiner Art und Weise ist eine Entscheidung für die Homöopathie eine Entscheidung gegen die Schulmedizin. Beides hat seine Berechtigung und ergänzt sich in vielen Fällen.”
——————————————————————————————————————
For those who do not read German, I will pick out a few central themes from the text.
Amongst other things, the DHU proclaim that:
- Homeopathy has millions of satisfied customers in Germany.
- The campaign aims at defending customers’ choice.
- The campaign declares to present the facts realistically.
- The decision is “never an ‘either or’ between conventional medicine (Schulmedizin) and other methods”; combining those therapies that suit the patient best is the aim of modern Integrative Medicine.
It is clear to anyone who is capable of critical thinking tha
t these 4 points are fallacious to the extreme. For those to whom it isn’t so clear, let me briefly explain:
- The ‘appeal to popularity’ is a classical fallacy.
- Nobody wants to curtail patients’ freedom to chose the therapy they want. The discussion is about who should pay for ineffective remedies. Even if homeopathy will, one day, be no longer reimbursable in Germany, consumers will still be able to buy it with their own money.
- The campaign has so far not presented the facts about homeopathy (i. e. the remedies contain nothing, homeopathy relies on implausible assumptions, the evidence fails to show that highly diluted homeopathic remedies are effective beyond placebo).
- Hahnemann called all homeopaths who combined his remedies with conventional treatments ‘traitors’ (‘Verraeter’) and coined the term ‘Schulmedizin’ to defame mainstream medicine.
The DHU campaign has only started recently, but already it seems to backfire big way. Social media are full with comments pointing out how pathetic it truly is, and many Germans have taken to making fun at it on social media. Personally, I cannot say I blame them – not least because the latest DHU campaign reminds me of the 2012 DHU-sponsored PR campaign. At the time, quackometer reported:
A consortium of pharmaceutical companies in Germany have been paying a journalist €43,000 to run a set of web sites that denigrates an academic who has published research into their products.
These companies, who make homeopathic sugar pills, were exposed in the German newspaper Süddeutsche Zeitung in an article, Schmutzige Methoden der sanften Medizin (The Dirty Tricks of Alternative Medicine.)
This story has not appeared in the UK media. And it should. Because it is a scandal that directly involves the UK’s most prominent academic in Complementary and Alternative Medicine.
The newspaper accuses the companies of funding the journalist, Claus Fritzsche, to denigrate critics of homeopathy. In particular, the accusation is that Fritzsche wrote about UK academic Professor Edzard Ernst on several web sites and then linked them together in order to raise their Google ranking. Fritzsche continually attacks Ernst of being frivolous, incompetent and partisan…
This story ended tragically; Fritzsche committed suicide.
My impression is that the PR-campaigns of homeopaths in general and the DHU in particular are rather ill-fated. Perhaps they should just forget about PR and do what responsible manufacturers should aim at doing: inform the public according to the best evidence currently available, even if this might make a tiny dent in their huge profits.
Regular readers of this blog will find plenty of things that are familiar to them in my new book ‘SCAM’. Many of the thoughts in there were originally conceived on this blog; and quite a few ideas might even be inspired by your comments. In this way, SCAM can be seen as a big ‘thank you’ to all of my readers.
SCAM, of course, stands for ‘So-Called Alternative Medicine’ which might be the name best suited to my field of research. In the book, I explain why I chose this terminology:
Why do I call it SCAM? Why not just ‘alternative medicine’ or one of the many other possible names for it? … Mainly because, whatever it is, it is it is not an alternative:
- if a therapy does not work, it cannot be an alternative to medicine;
- if a therapy does work, it does not belong to alternative medicine but to medicine.
Therefore, I think, that so-called alternative medicine or SCAM is not a bad term to use.
I would be lying to you, if I said I did not want you all to buy my new book – which author does not want people to purchase his product? So, to entice you to do exactly that (and while you are at it, get one for your sister, cousin, grandma, etc. as well), here are two tiny snippets from ‘SCAM’, the preface and the postscript:
PREFACE
I should perhaps start with a warning: this book might unsettle you. If you are a true believer in so-called alternative medicine (SCAM), you may find the things I am about to tell you disturbing. My book was not written for true believers. In my experience, they often are emotionally or intellectually unable to rationalise and to change their minds. Any attempt at opening their eyes and making them think critically might therefore be a waste of time.
This book was written for everyone who has an interest in SCAM and is open to consider the evidence. Yet it is not a guide-book that tells you which SCAM can be employed what condition. It is a compilation of 50 essays about SCAM in more general terms. I ordered them loosely under seven headings and have tried to write them in such a way that they can be read independently. This necessitated a certain amount of repetition of crucial themes which, I hope, is forgivable. My main aim in publishing this book is to stimulate your ability to think critically about healthcare in general and, of course, about SCAM in particular.
The book is based on my 25 years of research in SCAM. It quotes numerous investigations by my team and by other researchers. It also discusses many recently published examples of pseudo-science, misleading information and unethical SCAM-promotion. The text avoids technical language and should be easily understood by anyone. The ‘glossary’ at the end of the book provides additional explanations of more complex issues and terminology. Throughout the book, I use hints of irony, touches of sarcasm, and sometimes even a degree of exaggeration. This makes certain points clearer and might even make you smile from time to time…
POSTSCRIPT
Some people say that I am fighting a losing battle and insist that SCAM cannot be defeated. It will be around for ever, they say.
I quite agree with the latter parts of this statement. Humans seem to need some degree of irrationality in their lives, and SCAM certainly offers plenty of that. Moreover, conventional medicine is never going be totally perfect. Therefore, disgruntled consumers will always search elsewhere, and many of them will then find SCAM.
However, I disagree with the first part of the above assumption: I did not write this book with the aim of fighting a battle against SCAM. I can even see several positive sides of SCAM. For instance, the current SCAM-boom might finally force conventional healthcare professionals to remember that time, compassion and empathy are some of their core values which cannot be delegated to others. Whatever the current popularity signifies, it is a poignant criticism of what is going on in conventional healthcare – and we would be ill-advised to ignore this criticism.
In the preface, I stated that my main aim in publishing this book was to stimulate my readers’ ability to think critically about SCAM and healthcare generally. My book is therefore not a text against but as a plea for something. If reading it has, in fact, made some of my readers a little less gullible, it … could improve both their health and their bank balance.
The above advertisement, apparently from the German woman’s magazine ‘Brigitte’, came to me via Twitter. Naturally, I thought someone had made a joke. Just to be sure, I quickly conducted a simple search for ‘astro-homeopathy’ and found numerous articles which collectively made my theory most unlikely.
Yes, there are people out there who advocate astro-homeopathy. This website, for instance informs us that:
Astro homeopathy is based on a very unique idea of relating homeopathy with astrology. Many people follow the astrohomeopathy principles and lead a healthy life. You can also try astro homeopathy healing methods so that you can lead a life free from health hazards and fitness problems.
Astrology and homeopathy are bridged in astro homeopathy. An astrohomeopathy reading for you finds out your sun sign and the body parts related to your sign of the zodiac, and tells you the health problems you have the possibility to suffer from (if, of course, there is any). In addition, you also come to know the homeopathic remedies for the health problems.
Being aware of the possible health problems is an advantage. If you want to know your astrohomeopathy profile, you can get an astrology homeopathy test. You can plan your diet, habits and lifestyle according to your astro homeopathy report. You can also use the astro homeopathy remedies, if anything is suggested in your astrology homeopathy test…
Another website is even more revealing:
… In Astrohomoeopathy, which is a beautiful blend of Astrology and Homoeopathy, the horoscope serves as an invaluable diagnostic tool to provide a unique insight into the patient’s mental, emotional and physical makeup, which is indicated by the placement of planets in various signs and houses at the time of birth.
Each planet and its sign have certain characteristics, which may be weak or strong, depending on their placement in the horoscope. By matching these characteristics of the planets and their signs with the symptoms of Homoeopathic remedies, it is possible to connect them in order to select the right medicine.
By knowing the characteristic of houses and planets in ones horoscope, one can determine the key features and disposition of patient, the most important characteristics/features in the chart and the remedies to be covered.
After a complete case study, the physician comes to a group of remedies with the Horoscope which helps to distinguish these medicines by considering the key points.
From a Horoscope one can also understand how strong is the constitution by knowing the condition of his Ascendant and its Lord which will explained further with examples.The main keys to health are the state of Ascendant, its Lord and strength of malefic in the chart. I wouldn’t go in detail with regard to Astrology basics as one can learn the basic principals from a range of Astrology books available.
My outlook would be as to how to correlate Homoeopathy and Astrology and use it as a important diagnostic tool to differentiate various remedies when indicated in a patient so to come close to constitutional similitude to cure the patient in shortest possible time…
A third article concluded: Homeopathy, astrology and psychology are two of the most fascinating humanistic disciplines. They can be an invaluable combination. For finding the simillimum, astrology is not needed every time, yet it remains in our toolbox for when needed and as a constant support.
It seems that Einstein (as reported by my late friend Gustav Born) was wrong when he stated that: “If one were to lock up 10 very clever people in a room and told them they were only allowed out once they had come up with the most stupid idea conceivable, they would soon come up with homeopathy.”
The 10 very clever people would have had to come up with astro-homeopathy!
As you know, my ambition is to cover all (or at least most) alternative methods on this blog _ by no means an easy task because there is a sheer endless list of treatments and a sizable one of diagnostic techniques. One intervention that we have not yet discussed is ZERO BALANCING.
What is it?
This website explains it fairly well:
Developed by Fritz Smith, MD in the early 1970s, Zero Balancing is a powerful body-mind therapy that uses skilled touch to address the relationship between energy and structures of the body. Following a protocol that typically lasts 30 to 45 minutes, the practitioner uses finger pressure and gentle traction on areas of tension in the bones, joints and soft tissue to create fulcrums, or points of balance, around which the body can relax and reorganize. Zero Balancing focuses primarily on key joints of our skeleton that conduct and balance forces of gravity, posture and movement. By addressing the deepest and densest tissues of the body along with soft tissue and energy fields, Zero Balancing helps to clear blocks in the body’s energy flow, amplify vitality and contribute to better postural alignment. A Zero Balancing session leaves you with a wonderful feeling of inner harmony and organization.
Did I just say ‘fairly well’? I retract this statement. Zero Balancing turns out to be one of the more nebulous alternative treatments.
The therapy might be defined by lots of nonsensical terminology, but that does not necessarily mean it is rubbish. Judging from the claims made for Zero Balancing, it might even be a most useful therapy. Here are just some of the claims frequently made for zero balancing:
- Increases feelings of health and well-being
- Releases stress and improves the flow of energy in our bodies
- Reduces pain and discomfort
- Enhances stability, balance and freedom
- Amplifies the sense of connection, peace and happiness
- Releases mental, emotional and physical tension
- Supports us through transitions and transformations
- Improves quality of life and increases capacity for enjoyment
These claims are testable, and we must, of course, ask by what evidence they are being supported. I did a quick Medline-search to find out.
And the result?
Zero!
… now the rather odd name of the treatment begins to make sense: ZERO BALANCING, ZERO EVIDENCE.
We recently discussed the deplorable case of Larry Nassar and the fact that the ‘American Osteopathic Association’ stated that intravaginal manipulations are indeed an approved osteopathic treatment. At the time, I thought this was a shocking claim. So, imagine my surprise when I was alerted to a German trial of osteopathic intravaginal manipulations.
Here is the full and unaltered abstract of the study:
Introduction: 50 to 80% of pregnant women suffer from low back pain (LBP) or pelvic pain (Sabino und Grauer, 2008). There is evidence for the effectiveness of manual therapy like osteopathy, chiropractic and physiotherapy in pregnant women with LBP or pelvic pain (Liccardione et al., 2010). Anatomical, functional and neural connections support the relationship between intrapelvic dysfunctions and lumbar and pelvic pain (Kanakaris et al., 2011). Strain, pressure and stretch of visceral and parietal peritoneum, bladder, urethra, rectum and fascial tissue can result in pain and secondary in muscle spasm. Visceral mobility, especially of the uterus and rectum, can induce tension on the inferior hypogastric plexus, which may influence its function. Thus, stretching the broad ligament of the uterus and the intrapelvic fascia tissue during pregnancy can reinforce the influence of the inferior hypogastric plexus. Based on above facts an additional intravaginal treatment seems to be a considerable approach in the treatment of low back pain in pregnant women.
Objective: The purpose of this study was to compare the effect of osteopathic treatment including intravaginal techniques versus osteopathic treatment only in females with pregnancy-related low back pain.
Methods: Design: The study was performed as a randomized controlled trial. The participants were randomized by drawing lots, either into the intervention group including osteopathic and additional intravaginal treatment (IV) or a control group with osteopathic treatment only (OI). Setting: Medical practice in south of Germany.
Participants 46 patients were recruited between the 30th and 36th week of pregnancy suffering from low back pain.
Intervention Both groups received three treatments within a period of three weeks. Both groups were treated with visceral, mobilization, and myofascial techniques in the cervical, thoracic and lumbar spine, the pelvic and the abdominal region (American Osteopathic Association Guidelines, 2010). The IV group received an additional treatment with intravaginal techniques in supine position. This included myofascial techniques of the M. levator ani and the internal obturator muscles, the vaginal tissue, the pubovesical and uterosacral ligaments as well as the inferior hypogastric plexus.
Main outcome measures As primary outcome the back pain intensity was measured by Visual Analogue Scale (VAS). Secondary outcome was the disability index assessed by Oswestry-Low-Back-Pain-Disability-Index (ODI), and Pregnancy-Mobility-Index (PMI).
Results: 46 participants were randomly assigned into the intervention group (IV; n = 23; age: 29.0 ±4.8 years; height: 170.1 ±5.8 cm; weight: 64.2 ±10.3 kg; BMI: 21.9 ±2.6 kg/m2) and the control group (OI; n = 23; age: 32.0 ±3.9 years; height: 168.1 ±3.5 cm; weight: 62.3 ±7.9 kg; BMI: 22.1 ±3.2 kg/m2). Data from 42 patients were included in the final analyses (IV: n=20; OI: n=22), whereas four patients dropped out due to general pregnancy complications. Back pain intensity (VAS) changed significantly in both groups: in the intervention group (IV) from 59.8 ±14.8 to 19.6 ±8.4 (p<0.05) and in the control group (OI) from 57.4 ±11.3 to 24.7 ±12.8. The difference between groups of 7.5 (95%CI: -16.3 to 1.3) failed to demonstrate statistical significance (p=0.93). Pregnancy-Mobility-Index (PMI) changed significantly in both groups, too. IV group: from 33.4 ±8.9 to 29.6 ±6.6 (p<0.05), control group (OI): from 36.3 ±5.2 to 29.7 ±6.8. The difference between groups of 2.6 (95%CI: -5.9 to 0.6) was not statistically significant (p=0.109). Oswestry-Low-Back-Pain-Disability-Index (ODI) changed significantly in the intervention group (IV) from 15.1 ±7.8 to 9.2 ±3.6 (p<0.05) and also significantly in the control group (OI) from 13.8 ±4.9 to 9.2 ±3.0. Between-groups difference of 1.3 (95%CI: -1.5 to 4.1) was not statistically significant (p=0.357).
Conclusions: In this sample a series of osteopathic treatments showed significant effects in reducing pain and increasing the lumbar range of motion in pregnant women with low back pain. Both groups attained clinically significant improvement in functional disability, activity and quality of life. Furthermore, no benefit of additional intravaginal treatment was observed.
END OF QUOTE
My first thoughts after reading this were: how on earth did the investigators get this past an ethics committee? It cannot be ethical, in my view, to allow osteopaths (in Germany, they have no relevant training to speak of) to manipulate women intravaginally. How deluded must an osteopath be to plan and conduct such a trial? What were the patients told before giving informed consent? Surely not the truth!
My second thoughts were about the scientific validity of this study: the hypothesis which this trial claims to be testing is a far-fetched extrapolation, to put it mildly; in fact, it is not a hypothesis, it’s a very daft idea. The control-intervention is inadequate in that it cannot control for the (probably large) placebo effects of intravaginal manipulations. The observed outcomes are based on within-group comparisons and are therefore most likely unrelated to the treatments applied. The conclusion is as barmy as it gets; a proper conclusion should clearly and openly state that the results did not show any effects of the intravaginal manipulations.
In summary, this is a breathtakingly idiotic trial, and everyone involved in it (ethics committee, funding body, investigators, statistician, reviewers, journal editor) should be deeply ashamed and apologise to the poor women who were abused in a most deplorable fashion.
A recent comment by Richard Rawlins stated: “In healthcare, people who act as wannabe doctors and make false claims are quacks. If they make money at it, they are frauds. But fools they are not.”
I hope you agree that this is a notion well-worth exploring a bit closer. Specifically, I want to try and differentiate the ‘fools’ from the ‘frauds’.
But how?
Perhaps by listing some of the qualities that characterise the two categories.
FRAUDS
The hallmarks of a fraud in medicine are, I think, that a) he is lying and b) he is trying to get at your money (as much of it as possible). By ‘lying’ I mean presenting untruths as facts, despite knowing they are not correct. Essentially, this means that a fraud is dishonest and might even be guilty of a criminal offence (in turn, this means that we ought to be able to take legal action against him).
Frauds are egoistic and do not care much about their clients or the fact that they might cause harm.
FOOLS
By contrast, fools in medicine are naïve and deluded. They are not necessarily dishonest because, even though they tell untruths, they believe them to be true (in a way, fools have fallen for their own lies). Like frauds, fools might also try to get at your money (some of it), but they would claim that they simply need to be paid for their services in order to make a living.
Fools often live under the impression of being altruistic and they are convinced they do a lot of good.
WHO IS WHO?
The distinction between fools and frauds in the realm of alternative medicine is often less than obvious; there is plenty of overlap between the two. I have met hundreds of alternative practitioners and, if I try to retrospectively allocate them into either of the two categories, I run into considerable difficulties. Many belong to neither of them; and most have qualities that are reminiscent of both. But if I was forced to make a binary choice, I would probably put most of them in the camp of fools. Perhaps I was fortunate, but I have not many outright frauds amongst alternative practitioners.
WHO IS MORE DANGEROUS?
Did I say I was ‘fortunate’? Yes, fortunate for not having to deal all that often with dishonest crooks. But in terms of potential for harm, there is nothing fortunate about the fools. For the consumer, frauds are usually easier to recognise than fools, and once identified, they become far less harmful. Fools are often so convinced of their ‘truths’ that desperate patients easily fall for their falsehoods. And this is precisely what constitutes the main danger of fools in (alternative) medicine: they tend to be so convincing and so sure of doing something positive that people tend to find them credible. Consequently, many consumers, patients, politicians, journalists etc. follow their foolish and often harmful advice.
CONCLUSION
We tend to find frauds immoral and despicable and are often perceive fools as ethically and socially more acceptable. However, considering their potential for doing harm, the fools are frequently far worse than the frauds. I therefore conclude we must be vigilant about frauds but, at the same time, become more weary about fools.
On this blog, we have seen more than enough evidence of how some proponents of alternative medicine can react when they feel cornered by critics. They often direct vitriol in their direction. Ad hominem attacks are far from being rarities. A more forceful option is to sue them for libel. In my own case, Prince Charles went one decisive step further and made sure that my entire department was closed down. In China, they have recently and dramatically gone even further.
This article in Nature tells the full story:
A Chinese doctor who was arrested after he criticized a best-selling traditional Chinese remedy has been released, after more than three months in detention. Tan Qindong had been held at the Liangcheng county detention centre since January, when police said a post Tan had made on social media damaged the reputation of the traditional medicine and the company that makes it.
On 17 April, a provincial court found the police evidence for the case insufficient. Tan, a former anaesthesiologist who has founded several biomedical companies, was released on bail on that day. Tan, who lives in Guangzhou in southern China, is now awaiting trial. Lawyers familiar with Chinese criminal law told Nature that police have a year to collect more evidence or the case will be dismissed. They say the trial is unlikely to go ahead…
The episode highlights the sensitivities over traditional Chinese medicines (TCMs) in China. Although most of these therapies have not been tested for efficacy in randomized clinical trials — and serious side effects have been reported in some1 — TCM has support from the highest levels of government. Criticism of remedies is often blocked on the Internet in China. Some lawyers and physicians worry that Tan’s arrest will make people even more hesitant to criticize traditional therapies…
Tan’s post about a medicine called Hongmao liquor was published on the Chinese social-media app Meipian on 19 December…Three days later, the liquor’s maker, Hongmao Pharmaceuticals in Liangcheng county of Inner Mongolia autonomous region, told local police that Tan had defamed the company. Liangcheng police hired an accountant who estimated that the damage to the company’s reputation was 1.4 million Chinese yuan (US$220,000), according to official state media, the Beijing Youth Daily. In January, Liangcheng police travelled to Guangzhou to arrest Tan and escort him back to Liangcheng, according to a police statement.
Sales of Hongmao liquor reached 1.63 billion yuan in 2016, making it the second best-selling TCM in China that year. It was approved to be sold by licensed TCM shops and physicians in 1992 and approved for sale over the counter in 2003. Hongmao Pharmaceuticals says that the liquor can treat dozens of different disorders, including problems with the spleen, stomach and kidney, as well as backaches…
Hongmao Pharmaceuticals did not respond to Nature’s request for an interview. However, Wang Shengwang, general manager of the production center of Hongmao Liquor, and Han Jun, assistant to the general manager, gave an interview to The Paper on 16 April. The pair said the company did not need not publicize clinical trial data because Hongmao liquor is a “protected TCM composition”. Wang denied allegations in Chinese media that the company pressured the police to pursue Tan or that it dispatched staff to accompany the police…
Xia is worried that the case could further silence public criticism of TCMs, environmental degredation, and other fields where comment from experts is crucial. The Tan arrest “could cause fear among scientists” and dissuade them from posting scientific comments, he says.
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On this blog, we have repeatedly discussed concerns over the validity of TCM data/material that comes out of China (see for instance here, here and here). This chilling case, I am afraid, is not prone to increase our confidence.
My friend Gustav Born FRS died on 16 April 2018.
Gustav was born into a Jewish family that emigrated from 1930s Goettingen (Germany) to the UK. His father Max, a friend of Einstein, was a physicist who received a Nobel Prize for his work in quantum mechanics. Gustav served in the British forces as a doctor during WW2. After the war, he became a pharmacologist in London and Cambridge who had many achievements to his name. For instance, he discovered the mechanisms through which the body stops bleeding and initiates blood clotting. He also invented the platelet aggregometer that is still used universally to quantify platelet activity and which he never patented so that not he but mankind would benefit from it. Gustav was indefatigable and continued his research for many years after his retirement. His work was crowned with uncounted scientific awards.
There have been numerous, much more detailed obituaries honouring Gustav e. g.:
https://www.theguardian.com/science/2018/apr/26/gustav-born-obituary
https://www.thetimes.co.uk/article/gustav-born-obituary-gt5k9r8jc
Mine is merely a personal tribute. I met Gustav in the early 1990s while working in Vienna. We became close friends, and he took me under his wings, encouraged me to come to the UK, wrote a glowing reference when I applied for the Exeter post, and gave me moral support whenever I needed it.
After I had moved to the UK, we regularly met, and he even came to my 50th birthday party insisting to make a speech. About 15 years ago, he once attended one of my public lectures on alternative medicine; afterwards his comment was: “you know, your work is going to save lives.” Since my retirement, he kept phoning me at home (apparently Gustav had an irresistible attraction to the telephone) and urged me, usually speaking in German, to arrange a meeting. We always concluded that this must be soon; sadly, however, this did not happen.
Gustav was a great story-teller. One of his preferred anecdotes related to homeopathy. He recounted (interrupting himself giggling) that, when Einstein and his father once were talking, someone mentioned homeopathy and asked them what they thought of it. Einstein reflected for a little while and then said: “If one were to lock up 10 very clever people in a room and told them they were only allowed out once they had come up with the most stupid idea conceivable, they would soon come up with homeopathy.”
It is therefore not surprising that, when I invited Gustav to contribute a chapter to my book ‘HEALING, HYPE OR HARM?‘, he agreed to write an essay entitled ‘HOMEOPATHY IN CONTEXT’. Here is a short extract from it: What can be done to counteract the persistence of homeopathy? Its unwarranted claims must be continuously exposed. The diversion of public money from the proper purposed of the NHS must be stopped.
I shall miss Gustav for his clear thinking, his wry humour, his unfailing support and fatherly friendship.
The RCC is a relatively new organisation. It is a registered charity claiming to promote “professional excellence, quality and safety in chiropractic… The organisation promotes and supports high standards of education, practice and research, enabling chiropractors to provide, and to be recognised for providing, high quality care for patients.”
I have to admit that I was not impressed by the creation of the RCC and lately have not followed what they are up to – not a lot, I assumed. But now they seem to plan a flurry of most laudable activities:
The Royal College of Chiropractors is developing a range of initiatives designed to help chiropractors actively engage with health promotion, with a particular focus on key areas of public health including physical activity, obesity and mental wellbeing.
Dr Mark Gurden, Chair of the RCC Health Policy Unit, commented:
“Chiropractors are well placed to participate in public health initiatives. Collectively, they have several million opportunities every year in the UK to support people in making positive changes to their general health and wellbeing, as well as helping them manage their musculoskeletal health of course.
Our recent AGM & Winter Conference highlighted the RCC’s intentions to encourage chiropractors to engage with a public health agenda and we are now embarking on a programme to:
- Help chiropractors recognise the importance of their public health role;
- Help chiropractors enhance their knowledge and skills in providing advice and support to patients in key areas of public health through provision of information, guidance and training;
- Help chiropractors measure and recognise the impact they can have in key areas of public health.
To take this work forward, we will be exploring the possibility of launching an RCC Public Health Promotion & Wellbeing Society with a view to establishing a new Specialist Faculty in due course.”
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A ‘Public Health Promotion & Wellbeing Society’. Great!
As this must be new ground for the RCC, let me list a few suggestions as to how they could make more meaningful contributions to public health:
- They could tell their members that immunisations are interventions that save millions of lives and are therefore in the interest of public health. Many chiropractors still have a very disturbed attitude towards immunisation: anti-vaccination attitudes still abound within the chiropractic profession. Despite a growing body of evidence about the safety and efficacy of vaccination, many chiropractors do not believe in vaccination, will not recommend it to their patients, and place emphasis on risk rather than benefit. In case you wonder where this odd behaviour comes from, you best look into the history of chiropractic. D. D. Palmer, the magnetic healer who ‘invented’ chiropractic about 120 years ago, left no doubt about his profound disgust for immunisation: “It is the very height of absurdity to strive to ‘protect’ any person from smallpox and other malady by inoculating them with a filthy animal poison… No one will ever pollute the blood of any member of my family unless he cares to walk over my dead body… ” (D. D. Palmer, 1910)
- They could tell their members that chiropractic for children is little else than a dangerous nonsense for the sake of making money. Not only is there ‘not a jot of evidence‘ that it is effective for paediatric conditions, it can also cause serious harm. I fear that this suggestion is unlikely to be well-received by the RCC; they even have something called a ‘Paediatrics Faculty’!
- They could tell their members that making bogus claims is not just naughty but hinders public health. Whenever I look on the Internet, I find more false than true claims made by chiropractors, RCC members or not.
- They could tell their members that informed consent is not an option but an ethical imperative. Actually, the RCC do say something about the issue: The BMJ has highlighted a recent UK Supreme Court ruling that effectively means a doctor can no longer decide what a patient needs to know about the risks of treatment when seeking consent. Doctors will now have to take reasonable care to ensure the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments. Furthermore, what counts as material risk can no longer be based on a responsible body of medical opinion, but rather on the view of ‘a reasonable person in the patient’s position’. The BMJ article is available here. The RCC feels it is important for chiropractors to be aware of this development which is relevant to all healthcare professionals. That’s splendid! So, chiropractors are finally being instructed to obtain informed consent from all their patients before starting treatment. This means that patients must be told that spinal manipulation is associated with very serious risks, AND that, in addition, ~ 50% of all patients will suffer from mild to moderate side effects, AND that there are always less risky and more effective treatments available for any condition from other healthcare providers.
- The RCC could, for the benefit of public health, establish a compulsory register of adverse effects after spinal manipulations and make the data from it available to the public. At present such a register does not exist, and therefore its introduction would be a significant step in the right direction.
- The RCC could make it mandatory for all members to adhere to the above points and establish a mechanism of monitoring their behaviour to make sure that, for the sake of public health, they all do take these issues seriously.
I do realise that the RCC may not currently have the expertise and know-how to adopt my suggestions, as these issues are rather new to them. To support the RCC in their praiseworthy endeavours, I herewith offer to give one or more evidence-based lectures on these subjects (at a date and place of their choice) in an attempt to familiarise the RCC and its members with these important aspects of public health. I also realise that the RCC may not have the funds to pay professorial lecture fees. Therefore, in the interest of both progress and public health, I offer to give these lectures for free.
I can be contacted via this blog.
