Every day, hundreds of patients are in danger. They are given ineffective medicines and dangerous therapies. Even so, charlatans remain unpunished because they are protected by European Union law. A Spanish organization representing patients harmed by “alternative” medicine, healthcare workers, scientists, and other experts points out the absurdity of this situation. This organization is called “Asociación para Proteger al Enfermo de Terapias Pseudocientificas.” 1

It strives to ensure patient protection from numerous pseudoscientific therapies that can harm them, whether by abandoning scientifically supported treatment, damaging their health, or paying substantial money for false therapies that cannot offer real treatment.

The basic goals of the organization can be divided into several categories:

  1. Work toward classifying illegal activity by charlatans as a criminal offense: - any activity and advertising of therapies presented as curative when they are not and have not been tested according to scientific criteria,

  • the practice and actions of those who, without mandatory medical education and medical degrees required for medical practice, intend to provide a patient with treatment and present it as curative.

  • Inform the relevant person about cases of intervention by non-professionals.

  • Ensure that words such as medicine, treatment, health, therapy (or any other expression that might lead the patient to think they are dealing with a healthcare professional) cannot be used in any promotional or advertising format if the person advertises or promotes themselves, has no corresponding official studies, and does not follow treatment methods developed according to scientific criteria.
  • Work so that hospitals introduce various protocols:
  • the most important is that if a patient refuses treatment and wishes to follow another treatment cycle, the hospital is not limited to signing the appropriate document, but the patient should be informed about the alternative treatment they have chosen and who will perform it. Subsequently, the patient should be informed about the findings, and if there is fraud, the hospital should immediately contact the relevant authorities and take necessary measures to protect the patient.- Work to promote deep health prevention culture in the population and essential lifestyle changes.
  • Work to promote critical, skeptical, objective, and scientific thinking in society on health issues, while distinguishing between science and pseudoscience.
  • Involve healthcare, universities, politics, trade unions, and citizens in our association’s project, goals, and activities.
  • And finally, the most important goal: ensure that no patient is diverted from a coherent and scientific treatment path.

Pseudotherapies, many of them pseudoscientific and also known as “alternative,” “complementary,” or “integrative” therapies, are practices offered as medical acts without scientifically proven effectiveness.

These false therapies represent a major danger for several reasons:

  • there is a risk that patients abandon effective therapies for practices that have no therapeutic value, which can lead to serious health problems and even death,
  • regardless of treatment discontinuation, some pseudotherapies can have negative effects on health,
  • they usually cause patients economic or moral harm. 2

The victims of alternative medicine are real people with specific names. They are often children, students, and also older people, who may reject, for example, oncology treatment and instead choose to be treated with natural vitamin preparations and other dietary supplements. The fates of those who died are recalled by the Pseudoscience Manifesto, which several organizations use to draw attention to the danger of alternative medicine and the absurd situation in which all kinds of charlatans providing their services, often to desperate patients, are protected by European legislation. Behind the document stand several Spanish organizations, including the aforementioned Asociación para Proteger al Enfermo de Terapias Pseudocientíficas (APETP), representing patients harmed by alternative medicine, healthcare workers, scientists, and other experts, Sociedad para el Avance del Pensamiento Crítico, a society for critical thinking, El Círculo Escéptico, a skeptical circle, Farmaciencia, a pharmaceutical association demanding scientific evidence, and Red UNE, an organization helping victims of sects and dangerous religious movements.

The Pseudoscience Manifesto warns that EU legislation permits deceiving patients and their loved ones. Specifically, this concerns Directive 2001/83/EC3 of the European Parliament, granting homeopathic remedies, by law, the legal status of medicinal products even though in practice they are not medicines. This influential campaign has made it possible to define what counts as a medicine. Many believe they can thus cure or improve their health this way, which the manifesto states: the legislative exception for homeopathy, simply allowing preparations without an active ingredient and without any clinical studies on safety and efficacy to be labeled as medicines, in fact kills patients. They are misled into believing they are being treated.

The manifesto warns that Europe must stop not only promoting homeopathy, but also actively fight health-related fraud. Drug abuse, multidrug-resistant bacteria, or financial strains on public healthcare systems are already sufficiently serious on their own, so it is not necessary to add yet more gurus, fake healers, or even qualified doctors who claim they can treat any disease by manipulating chakras, forcing people to eat sugar, or using “quantum frequency.”

The document addresses the common argument that patients have the right to freely choose how they want to be treated and therefore can choose an alternative. Under Article 25 of the Universal Declaration of Human Rights,4 every person has the right to medical care. Deceiving patients for the purpose of selling ineffective products that can kill is a violation of the right to truthful information. Similarly, a patient has the right, based on provided information, to refuse treatment. But no one has the right to lie in order to profit at the expense of another person's health or life. An example of a concrete and unfortunately common lie that leads patients to abandon treatment, whose effectiveness has been reliably proven by a sufficient amount of evidence, is scaring them about side effects of conventional treatment and offering natural therapy, yet this therapy itself may be dangerous. This applies, among others, to various preparations of “traditional Chinese medicine.” A 2016 study in the journal Toxicological & Environmental Chemistry showed that these preparations commonly contain heavy metals such as arsenic or mercury, and their composition is practically not controlled at all.

The signatories of the Pseudomedicine Manifesto warn that it is unacceptable for European laws to allow “distortion of scientific facts” and the deception of the sick. According to the participating organizations, Europe has reached a situation in which homeopathy, acupuncture, iris diagnosis, and many other pseudoscientific therapies are commonly provided and their popularity is growing. Therefore, the people signing this manifesto call on European governments to end a problem that has already taken many lives. 5

Truly natural, without unpleasant side effects and effective, these are the usual descriptors of the various methods of alternative medicine. These promises mean hope for recovery for the sick and their loved ones, regardless of how false they are. People know little about the risks associated with alternative medicine. Even the basic right of every patient, that is, the right to clear explanation of the intended examination and proposed treatment with regard to the patient's ability to understand what lies ahead, is routinely violated. Before treatment begins, every healthcare professional must obtain informed consent. Patients' rights constitute a complex whole and help resolve the different situations in which patients may find themselves. For example, if they are unsure whether to undergo a difficult operation or want to know whether there are other treatment options than those offered to them. A basic patient right is the right to information. It is the doctor's duty to explain everything so that the patient understands what awaits them. Only after the patient has obtained the necessary information is it up to them to decide. This free and informed consent does not necessarily need to be in writing, but it is often required before certain procedures or before the start of hospitalization.

The many methods of “alternative” medicine differ fundamentally from those used in evidence-based medicine in that they undergo no control either before market introduction or afterward. Information on the effectiveness of these methods is incomplete. 6

A medical degree alone does not guarantee that patients will not be offered non-scientific procedures. On the contrary, the white coat gives charlatanism of all kinds a superficial aura of quality and effectiveness, regardless of missing scientific evidence. Professor Edzard Ernst, who founded a research center at the University of Exeter in Britain specializing in the study of complementary and alternative medicine, reveals the most common tricks used by charlatans operating in medicine.

It is necessary to find the true cause of problems, support the immune system, and work with energies so they are in balance. The fact that you feel worse is actually good, because it is a sign of detoxification. The pharmaceutical industry tries to conceal this discovery, which is why doctors usually do not tell you about it, even though there are thousands of so-called cured patients. If patients encounter such statements, they have almost certainly encountered a charlatan who profits from human credulity and an inability to think critically. Professor Edzard Ernst has been conducting scientific research for years into what is usually called complementary and alternative medicine. Among other things, he leads the journals Focus on Alternative and Complementary Therapies and Medicine. At the same time, he works to uncover the tricks used by various charlatans. Turning to superstitions, beliefs, and nonsense is not the domain of therapists, counselors, or healers, but unfortunately also of some doctors.

There is nothing more favorable to improving a charlatan’s financial situation than diagnosing a non-existent disease. Many alternative healers have built their businesses on this. Typical false diagnoses include lack of vital energy, parasites, or body acidification. An elegant feature of a non-existent diagnosis is that it can be treated for as long as the client has money or patience. Right before a situation reaches this point, the charlatan usually declares the client cured.

A fairly reliable sign of fraud is the word energy, which sounds modern and impressive to a broad range of clients. The idea that alternative medicine cares for the whole person attracts many clients. Charlatans also frequently claim that unlike doctors, they treat the true cause of the client’s problems. They claim they do not focus on symptoms, but think holistically. 7

Alternative or unconventional medicine is a broad term referring to a set of therapeutic and preventive systems, practices, and products that are not part of conventional medicine. These are methods based on alternative philosophical views, most of which the healer applies. These methods are considered non-standard procedures in treatment and are not part of any medical specialties. Alternative methods are divided by orientation as follows:

  1. Methods based on natural means: phototherapy, aromatherapy, hydrotherapy, thermotherapy.
  2. Manual methods: osteopathy or massage.
  3. Paranormal methods: psychotronics, aura imaging.

Some methods can be divided by age, because their origin has ancient history, whether herbalism, astrology, or Chinese healing methods. Among newer methods one can include acupuncture or laser acupuncture, but one of the most widespread areas of alternative treatment is homeopathy. Its core principle is “like cures like,” meaning that a certain substance (if known) produces symptoms of a disease in a person and this substance is prescribed as medicine. Treatment consists in the use of various natural substances such as plants, minerals, and animal products, but not in their original form—rather in very diluted forms.

Alternative medicine is evaluated negatively mainly by physicians or clients of healers who have poor experiences with the therapy or were even harmed by it. The danger may also lie in reckless advice from some healers, when a client is told to stop taking medications and replace them with herbs. Such a recommendation can have fatal consequences. Risk can also arise when the healer lacks sufficient education to recognize a serious disease and their method is ineffective, especially in serious cases. Even so, among healthcare professionals there are people who support alternative medicine or even practice it on others. Some healers come from doctors’ circles or are members of associations that promote certain methods of alternative medicine and approve using some selected procedures. Their objections are directed primarily against lay provision of healthcare. 8

The World Health Organization defines health as a state of complete physical, mental, and social well-being, not merely the absence of disease and infirmity. It is clear that this is a state that is not permanent or fixed, because there is continuous mutual influence of the organism and the environment. Alternative medicine leans toward defining health as inner energetic balance in the body. We can simplify this as non-invasive treatment without the use of pharmaceutical preparations that often have unfavorable side effects. In English it is called CAM (complementary and alternative medicine). This includes, for example, traditional Chinese medicine, Ayurveda, acupuncture, homeopathy, Bach flower therapy, aromatherapy, meditation, herbalism, yoga, reflex therapy, massage, and osteopathy. Several alternative therapies are accepted and used not only by the general public but also by Western medicine, which is identified as official, modern, scientific, pharmaceutical, orthodox, classical, allopathic, or conventional medicine.

It should be noted that instead of the term alternative medicine, the term healing is sometimes used, which leads to many misunderstandings. Healing is an activity performed by a person without corresponding medical education, that is, a healer, while alternative medicine is considered a set of specific diagnostic and therapeutic methods, regardless of whether they are used by a physician or a healer.

People have suffered from illnesses since time immemorial, so in all nations there were individuals who tried to treat, and this gradually gave rise to the profession of healer and various treatment means. Healing effects of herbs were discovered, and people realized that health depends also on many physical factors such as temperature, humidity, air quality, nutrition, but also lifestyle, physical activity, and mental activity. These folk medicine practices, used for hundreds of years, are based on observation of nature and folk wisdom. They are most often called “natural folk medicine” or “treatment with natural means.” This includes herbalism, heat and cold treatment, light treatment, movement treatment, detoxification, and others.

Natural folk medicine is classified among alternative therapies, although western scientific medicine drew on its knowledge in its origins and is in fact also used to some degree in western medicine as a complementary method.

If we compare western and alternative medicine, medicine as such has existed since time immemorial, although in different forms. It has been not only natural folk medicine, regionally highly diverse, but also extensive, developed systems such as Chinese or Indian medicine. Even though these systems differed significantly in principles and methods from each other, they were all called medicine, yet unlike today’s Western model.

The emergence of modern scientific medicine dates to the 18th century, so this is a comparatively new, modern, evidence-based form of medicine. Its basis is anatomy and physiology of the organism, which means it is primarily material medicine. It sees matter, studies it, and derives conclusions from such study.

Western scientific medicine has advantages as well as limitations. It can be used to treat problems that alternative medicine does not handle well, for example in rapid surgical procedures or rapid life-saving care. The often negative current form of Western medicine is due to many shortcomings in the organization, funding, and management of healthcare, but above all due to pressure from health insurers and pharmaceutical companies. It is criticized, for example, for being over-technologized, for regarding the body as a machine made of many parts and treating individual parts separately from one another. It is also criticized for an impersonal approach and lack of interest in mental or emotional factors that may contribute to disease onset, development, or progression. It is criticized for treating symptoms manifesting in the physical body without deeper investigation into what causes the problem, and for chemical treatment that is often accompanied by unwanted side effects.

Holistic (alternative) therapies are based on the assumption that nothing in a person exists separately from the whole and that the human being as a whole has physical, emotional, mental, and spiritual levels of being. Balance should exist among these levels, so a state of imbalance among them is called disease. A holistic therapist is concerned with the overall reaction of the person and connections at all levels, and their task is mainly to harmonize all levels so as to stimulate the self-healing capacities of the organism.

Explanation of the causes of disease is one of the main differences between scientific and non-scientific medicine.

Alternative medicine is based on the assumption that illness, i.e. an imbalance, begins in the subconscious and that the person does not become ill only as a body but as a whole person. Alternative and complementary therapies offer us new ways to address our problems so that we can again find our lost balance.

The difference between Western scientific medicine and alternative medicine is obvious, especially in basic principles, therapist approaches, and concrete therapies. Criticism of alternative medicine includes insufficient and missing evidence of effectiveness, use of imprecise terms, a spiritual mechanism of action, placebo effect, holistic treatment, contradiction with scientific knowledge, lack of professional competence of therapists where serious consequences may arise, and many fraudsters. The central aim of all alternative therapies is to create the right environment for self-healing of body and soul and to re-establish inner balance. 9

This is aptly expressed by a well-known Hopi Indigenous wisdom: “We do not need to look backward to find lost wisdom, nor rush forward to find a better future. It is enough to find our own center of balance and harmony in the present moment.”

Conclusion

There are serious reasons why patients seek alternative medicine. People are dissatisfied with dehumanized medicine, where the patient is often perceived as a diagnosis. The relatively low cost of some methods, a feeling of premium treatment, religious conviction or life philosophy, negative experiences with some doctors, recommendations from acquaintances, the influence of misleading advertisements, and the like also play a role.

In recent times, alternative medicine presents a major ethical problem. A physician should help a patient in the most effective way and therefore should avoid methods whose effectiveness is doubtful, low, or nil. A physician should not actively use alternative medicine; a positive attitude by doctors toward alternative medicine can lead to a loss of trust among patients who view these methods as charlatanism, or as being performed by lay healers. 10

The greatest risk in using alternative medicine methods is that they can lead a patient away from medical care that the person truly needs at a given time, both in terms of diagnosis and treatment. A healer should in no case be the first person to whom a sick person turns.

At present, dozens of complaints have been recorded against healers, and in some of them bizarre treatment methods are documented that not only failed to help the patient but directly harmed them, usually because the patient relied on the healer and did not seek healthcare. We believe, however, that some charlatans are almost untouchable in the current legal system. In any legal dispute, the plaintiff has no evidence, or unlike healthcare professionals, healers do not keep medical documentation of treatment. Court cases due to bodily injury caused by healers are rare and, in essence, unwinnable, because in criminal prosecution the burden is on the defendant to prove that the healer harmed the patient. An important path to remediation is reforming legal regulation concerning folk healing. It should define which methods and procedures are unacceptable, and healers should have a duty to keep detailed documentation of patient visits and pay income taxes. 11

As for Slovak legal regulation, neither in the legal order of the Slovak Republic is there a defined term for “healer,” nor is there legal regulation governing their legal status or position, including resulting rights and obligations, as well as issues of liability, and there is no specific legal act regulating their activities. For this reason, anyone can present themselves as a healer, including a person without medical knowledge. They can perform their activities without restriction, because no legal act sets the conditions a person must meet if they decide to practice healing. The only legal limits for healer activity are set by the Criminal Code, but in an insufficient scope, because there is no criminal offense that penalizes paid healers who perform their activity for remuneration without fulfilling relevant qualifying professional requirements. A discussion on introducing a new offense of unauthorized performance of regulated activity, which should have belonged among economic offenses that endanger market order, was held already in 2015, but unfortunately without success.

Author: JUDr. Alica Fedorová UPJŠ in Košice, Faculty of Law, external PhD student, Department of History of State and Law

List of used literature

  1. Alternative medicine [online] [cited 21.11.2023]. Available online: https://www.modernylekar.sk/podla-vykonu/alternativna-medicina.
  2. Alternative medicine hides risks to patients, warns Professor Ernst [online] [cited 21.11.2023]. Available online: https://www.zdravotnickydenik.cz/2017/06/alternativni-medicina-neeticka-taji-rizika-nemocne-upozornuje-profesor-ernst/.
  3. Alternative medicine in Bohemia [online] [cited 21.11.2023]. Available online: https://www.lf1.cuni.cz/alternativni-medicina-v-cechach.
  4. Asociación para Proteger al Enfermo de Terapias Pseudocientificas [online] [cited 21.11.2023]. Available online: https://www.apetp.com/.
  5. Directive 2001/83/EC of the European Parliament and of the Council of 6 November 2001 on the Community code relating to medicinal products for human use [online] [cited 21.11.2023]. Available online: https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=celex%3A32001L0083.
  6. FEDOROVÁ, A. Negative consequences of the lack of a statutory offense targeting paid healers in the legal order of the Slovak Republic [online] [cited 21.11.2023]. In: Projustice. Available online: https://www.projustice.sk/trestne-pravo/negativne-nasledky-absencie-skutkovej-podstaty-trestneho-cinu-postihujuceho-pokutnych-liecitelov.
  7. HAMPLOVÁ, L. Alternative medicine kills, and European legislation protects it [online] [cited 21.11.2023]. Available online: https://www.zdravotnickydenik.cz/2019/07/alternativni-medicina-zabiji-evropska-legislativa-chrani/.
  8. Position paper on alternative medicine [online] [cited 21.11.2023]. Available online: https://www.cls.cz/stanovisko-k-alternativni-medicine.
  9. Universal Declaration of Human Rights [online] [cited 21.11.2023]. Available online: http://amnesty.sk/všeobecna-deklaracia-ľudskych-prav.
  10. Health from the perspective of scientific and alternative medicine [online] [cited 21.11.2023]. Available online: https://www.paula.sk/alternativne-terapie/zdravie-z-pohadu-vedeckej-alternativnej-mediciny/.
  11. Comparative references on alternative medicine in the Czech Republic [online] [cited 21.11.2023]. Available online: https://www.lf1.cuni.cz/alternativni-medicina-v-cechach.

1 https://www.zdravotnickydenik.cz/2019/07/alternativni-medicina-zabiji-evropska-legislativa-chrani/ 2 https://www.apetp.com/ 3 https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=celex%3A32001L0083 4 Všeobecná deklarácia ľudských práv 5 https://www.zdravotnickydenik.cz/2019/07/alternativni-medicina-zabiji-evropska-legislativa-chrani/ 6 https://www.zdravotnickydenik.cz/2017/06/alternativni-medicina-neeticka-taji-rizika-nemocne-upozornuje-profesor-ernst/ 7 https://www.zdravotnickydenik.cz/2017/02/mluvi-vas-lekar-o-energiich-utajovanem-vyzkumu-ci-celostnim-pristupu-pak-jste-v-rukou-sarlatana/ 8 https://www.modernylekar.sk/podla-vykonu/alternativna-medicina 9 https://www.paula.sk/alternativne-terapie/zdravie-z-pohadu-vedeckej-alternativnej-mediciny/ 10 https://www.cls.cz/stanovisko-k-alternativni-medicine 11 https://www.lf1.cuni.cz/alternativni-medicina-v-cechach