A well-known Hindawi journal had the reassuringly serious name “Evidence-Based Complementary and Alternative Medicine”, eCAM for short. Between 2022 and 2024, the journal experienced one of the largest clean-ups in modern publishing: hundreds of papers were retracted from eCAM, and more than about 10,000 from the publisher’s full catalogue. The reason for these traumatic actions was that investigations had uncovered widespread manipulation of the publication process.

A big part of the story involves “paper mills.” These are commercial yet illegal businesses that will, for a fee, produce a scientific paper with your name on it. No need for actual experiments or real data or the arduous task of writing. Using a mix of recycled material, fabricated results, and increasingly AI-generated texts, these outfits can churn out papers that look perfectly respectable, at least until someone studies them a little more closely. Think of it as fast food for academic careers: quick, convenient, but not especially honest or good for long-term health.

Another key ingredient was the journal’s abundant use of “special issues.” These are themed collections of papers organised by “guest editors”, usually experts invited to oversee a niche topic. In theory, this can be a productive concept. In practice, it turned out to be a bit like handing over the keys to your flat to a bunch of fun-loving youngsters and hoping nobody throws a party.

Investigations found that, in some cases related to eCAM, the system had been even more seriously doctored. Fake or compromised editors, reviewer suggestions pointing to non-existent experts, and tightly coordinated “peer review rings” all meant that papers could sail through the process with both ease and speed but also without a tinge of credibility.

All this had been going on for years and had earned the publisher many millions – after all, eCAM asked hefty fees: the Article Processing Charge Hindawi asked for publishing a paper in eCAM fluctuated over the years, but during the height of the paper mill surge leading up to its closure, it reached $2,400 US per article. On my blog, I had repeatedly pointed out that something was seriously amiss with eCAM (e.g. here and here), yet no action was taken.  

The scam eventually started to fall apart when research integrity teams and independent sleuths noticed odd and concerning patterns: identical images appearing in different papers, statistical results that didn’t add up, and peer reviews that seemed to happen at impossible speed. At that point, Wiley, which by then had acquired Hindawi, stepped in and took a much closer look. The result: mass retractions, suspended special issues, and a lot of nearly identical retraction notices politely stating that the “peer review process had been compromised.”

The fallout hit so-called alternative medicine (SCAM) hard. As we all know, this is an area that already faces plenty of skepticism; discovering that a sizeable chunk of its literature had effectively skipped quality control certainly did not help. More broadly, the episode exposed a structural problem: when publishing lots of papers becomes the goal – for journals and researchers alike – quality tends to become less and less important.

After all this, the journal eCAM ground to a halt. It stopped accepting new submissions, and its future as an active journal seems in doubt. Its archive is still online but now dotted with retraction notices that look like a graveyard of publishing failures. Meanwhile, the new publisher has generally become more cautious, tightening the processes, verifying reviewer identities more carefully, restricting special issues, and deploying tools to catch suspicious patterns early.

If there’s a silver lining, it’s that the system eventually did what it’s supposed to do: spot the problem and correct it. But in the case of eCAM, the correction came worryingly late. Perhaps the episode can serve as a reminder that science cannot run on trust alone; it must also rely on verification. And when that verification slips, things will go wrong at scale.

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The confusion is not accidental. It stems from a lack of understanding of what autonomy in healthcare truly means and how it should be exercised within a system that values ​​evidence-based practice and patient wellbeing. To understand this conceptual trap, we need to distinguish between two very different types of autonomy: formal autonomy and substantial autonomy.

The difference

Formal autonomy is a relatively simple concept: it’s the legal and ethical right we have to make our own decisions, including in healthcare. It’s an important historical achievement, the result of decades of fighting against various forms of authoritarianism, including medical authoritarianism, and is an unquestionable pillar of the modern therapeutic relationship.

Substantial autonomy, on the other hand, is much more complex. It’s not limited to the right to choose, but rather the effective ability to make informed, deliberate choices aligned with one’s values ​​and life goals, based on a clear understanding of the situation. This means genuinely understanding the available options, their risks and benefits, the evidence supporting them, and the consequences of each alternative.

A person may have full formal autonomy – such as the right to refuse a vaccine – without having substantial autonomy, if their decision was based on false information, irrational fears, or a distorted understanding of the risks involved.

Take my driver’s licence as an example: while I regularly drive my car, I have a dual license, which means I have the formal autonomy to decide to ride a motorcycle at any time. But, substantially, it would be risky (for me and others) to do so without further training, since I have not touched a motorcycle since I took the practical test in 2007. The right to do something does not automatically imply the ability to do it safely or beneficially.

Anti-vaccine movements and advocates of alternative therapies discovered some time ago that invoking “patient autonomy” is a powerful rhetorical strategy. By framing dangerous or unscientific decisions as ‘exercising individual freedom’, they can shift the focus from (absent) scientific evidence to issues of personal rights. “You have the right to choose”, they say, transforming a decision that should be based on the best available evidence (and informed dialogue with qualified professionals) into an ideological issue of freedom versus oppression.

This strategy is effective because it leverages two psychological tendencies: a natural aversion to explicit paternalism and a tendency to overestimate one’s ability to evaluate complex information, especially in areas where one lacks expertise. “You know what’s best for you” sounds empowering and respectful. But in practice, it can be a subtle way of abandoning a patient to their own devices amidst an ocean of misinformation.

The problem is compounded when the rhetoric of autonomy is used to legitimise the refusal of interventions with clear and well-documented benefits, or the acceptance of interventions of dubious benefit, proven ineffective, or even dangerous.

Uninformed choice

Here we arrive at an important paradox: defending formal autonomy without guaranteeing the conditions for substantive autonomy can actually undermine true freedom of choice. A person who decides not to vaccinate their child based on the belief that vaccines cause autism (a claim already widely refuted by science and debunked as a fraud) is not exercising genuine autonomy, is being misinformed and, consequently, may be acting against the best interests of their child and public health.

This doesn’t mean we should return to medical paternalism. It means we need a more sophisticated and ethically robust approach, one that recognises that true autonomy requires quality information, time for deliberation, and support to understand complex options. This is where the concept of shared decision-making comes in.

Shared decision-making is not simply informing the patient and letting them decide. It is a structured process that includes: two-way communication about the clinical condition; clear presentation of evidence-based options (including the option of not intervening, when appropriate); exploration of the patient’s values ​​and preferences; collaborative deliberation; and implementation of a consensual decision. It is a process that takes time, requires specific skills, and demands appropriate communication tools. It is a model that aims to empower the patient through knowledge and dialogue, not simply by delegating choices.

What often happens in practice is that healthcare professionals, pressed for time, lacking communication training, or unsure how to deal with patient resistance, end up using the rhetoric of autonomy as a way to avoid conflict or to avoid a deeper professional responsibility. “The patient doesn’t want to get vaccinated? That’s fine, they have the right to choose.” This may seem respectful, but it can be a disguised form of abandonment.

True respect for patient autonomy would require investigating the reasons for the refusal, clarifying doubts, correcting incorrect information, and helping the patient make a genuinely informed decision. This is laborious and doesn’t always work, but it’s what distinguishes patient-centered care from mere formalism.

The problem becomes even more serious when we consider that the ability to exercise substantial autonomy is not equal for everyone. Formal autonomy establishes the universal right to choose and operates according to the principle of equality, treating everyone equally. This approach can end up perpetuating inequalities by failing to consider different individual needs.

In contrast, substantial autonomy is based on the principle of equity, recognising that each individual requires different types and levels of support to exercise full decision-making capacity. The lack of this support disproportionately affects the most marginalised populations.

Structural dimension

This asymmetry in the ability to exercise substantial autonomy reveals a structural issue often ignored in debates on patient rights: autonomy does not exist in a vacuum, but is shaped by material, educational, and social conditions. A working mother who needs to decide about her child’s vaccination but only has access to WhatsApp groups is not operating in the same realm of possibilities as a specialist with direct access to scientific literature and training to interpret it.

This disparity manifests itself in particularly perverse ways in the context of pseudotherapies. Patients in vulnerable situations (whether due to serious illness, financial constraints, or low educational attainment) become prime targets of discourses that promise to “return control” through alternative choices. The rhetoric of autonomy, in these cases, functions as a smokescreen that conceals the exploitation of others’ vulnerability.

Healthcare institutions, in turn, may condone this conceptual confusion, albeit passively. By adopting a stance of apparent neutrality (“we respect the patient’s choice”), they absolve themselves of the responsibility to educate, clarify, and, when necessary, constructively challenge decisions based on incorrect information. This stance constitutes a subtle form of negligence.

The proliferation of health discourse on the internet has exacerbated this paradox: we’ve never had so much access to medical knowledge, but it’s also never been so difficult to distinguish reliable information from sophisticated misinformation. Social media algorithms, designed to maximise engagement, often amplify sensationalist and emotionally charged content to the detriment of more sober and factual scientific information. In this context, defending only the patient’s formal autonomy, without concern for the quality of the informational environment in which they interact, is like offering the freedom to swim in waters known to be unsafe for swimming.

There is a system that claims to respect autonomy while systematically failing to create the conditions for its genuine exercise. Even more troubling is when this same deficient structure is invoked to justify harmful decisions. “The patient was informed and chose this” is the phrase that ends the discussion, regardless of the quality of the information provided or the conditions under which the “choice” was made.

Ethical, effective, and evidence-based healthcare communication thus becomes a technical skill as important as mastery of clinical procedures. It’s not an optional soft skill, but an essential tool.

Final considerations

The misunderstood autonomy trap reveals the conflict between democratic ideals of individual freedom and the reality that genuinely free choices require specific conditions that are not available to everyone.

Overcoming this trap requires more than goodwill or occasional adjustments to clinical practices. It demands a reorganisation of how we think about healthcare, recognising that substantial autonomy is a goal to be built, not a natural condition we passively accept.

This implies investments in health education, the development of more effective and accessible communication tools, training professionals in communication skills, and, fundamentally, the recognition that health is a common good that transcends individual choices, with significant collective implications.

True autonomy in health is not achieved simply by declaring it a right for all human beings, but rather by establishing it as a real possibility through social and institutional structures that give it substance. This is perhaps one of the most urgent and complex challenges in contemporary healthcare.

This story was originally published by Revista Questão de Ciência in Brazil. It is translated and reprinted here with permission.

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Although acupuncture continues to be practised all over the world by some medically qualified doctors, I had thought that at last in the 1990s the practice was beginning to be abandoned by the medical profession in the U.K. A sort of epitaph for it was recently published in The Lancet: 

Whilst careful scientific research can never entirely exclude the possibility that a dwarf is hiding in the corner of the room, many western researchers may now conclude that the existence of the dwarf approaches asymptotically to zero (Editorial, 1990) 

This editorial article examined the evidence for the therapeutic efficacy of acupuncture that had been published in more recent years, and found it sadly flawed. Western medicine has indeed had several periods of dabbling in acupuncture during the past two centuries, but in the last half century scientific method has elbowed its way, against some powerful opposition, into medicine, and acknowledgment of the placebo effect has now attained official recognition.

It was with some surprise, therefore, that on visiting my GP recently I found a folder marked ‘Acupuncture’ on display in the waiting-room for patients to consult. This medical group-practice has the policy of providing its patients with a wealth of popularly written books and folders in the waiting-room which present all sorts of guides to healthy living, and discussion of such topics as asthma, contraception and constipation. 

I looked at the ‘Acupuncture’ folder expecting it to give an informed and balanced account of acupuncture. Not a bit of it; all that the folder contained was material that was simply a glowing puff for acupuncture, such as might be issued by any commercial advertising agency.

Uninformed lay people might well suppose that acupuncture is a tried and tested technique approved by the British Medical Association, and therefore they should be as prepared to spend their money on lay acupuncturists, just as they might on any orthodox private medical practitioners The folder contained three leaflets, plus a list of ‘Useful Addresses’: Acupuncture in the UK Today, published by the British Holistic Medical Association (BHMA); Introductory Leaflet on Acupuncture, also published by the BHMA; and Traditional Acupuncture, published by the Traditional Acupuncture Society. I will describe these three leaflets individually. 

Acupuncture in the UK Today is by Richard James, Director of the Isis Centre for Holistic Health. He has genuine medical qualifications, but he also writes some letters after his name that presumably refer to qualifications in acupuncture. He informs his readers that “Acupuncture is now established as a profession independant (sic) of medicine in the UK”. The leaflet tells us that 

a growing number of doctors are doing very short courses (one weekend) and then taking up the practice of acupuncture. They are then entitled to become Full Members of the British acupuncture Society (MBAS) whose list is circulated to Family Practitioner Committees with the recommendation that GP’s (sic) should refer to acupuncturists on this list and no other. 

Thus, if Necromancy is a profession independent of medicine in the UK (as I’m sure it is ) any GP who wants to earn a little extra income can take a weekend course in it, and thus join the profession, write B. Nec. after his or her genuine medical qualifications, and then practise it in the surgery. 

The leaflet goes on to inform us that: 

This exclusivist position has been pursued aggressively, to the extent of refusing membership to doctor acupuncturists who associate with ‘Quackupuncturists’. The BMAS membership list is also available directly to the public, something for which the BMAS has severely criticised the BAAR in the past. 

The BAAR is apparently the British Acupuncture Association, to which non-medical acupuncturists belong, and which touts for custom, as they are entitled to do, along with iridologists, rediesthetists, reflexologists, naturopaths etc, etc. It is significant that they are being labelled as ‘Quackupuncturists’ by the weekend-course doctors, perhaps to make it quite clear that they, the medical acupuncturists, are not ‘quacks’, as some people might suppose. 

The second leaflet, entitled What is Acupuncture, sets out to inform lay people of the nature of acupuncture in very few words, and gives addresses of societies, both medical and non-medical, where they may apply for treatment. The third leaflet is issued by the Traditional Acupuncture Society, which is non-medical, and sets out to explain the nature of Chinese Medicine. It makes the point that: 

The Traditional Acupuncture Society requires members to have achieved a comprehensive understanding of the theory of Chinese Medicine and a high standard of clinical competence before beginning to practice as members of the Society. 

It does not outline how students receive their training, but presumably those who apply to its Registrar (whose address is given) receive details of how they may set about their studies in order to be accepted as members, and entitled to write various letters after their names. Here is a clear bid to set up the profession of Chinese medicine in the West as an alternative to that which has grown up here over the centuries, and has its roots in Greek and Arab science. 

The leaflet that I obtained from my local GP surgery is over printed at the foot with the address of the local Traditional Acupuncture Clinic, and gives the names of the four non-medical persons who are its staff. Presumably my local doctors pursue a policy of friendly co-operation, instead of outlawing these people as ‘Quackupuncturists’. 

Recent history 

The resurgence of medical interest in acupuncture in the UK was strongly associated with Dr Felix Mann‘s book Acupuncture: The Ancient Chinese Art of Healing (Mann, 1962) which was published at a time when various forms of alternative therapy were attracting attention, and the medical profession was concerned about its status. A considerable boost to acupuncture was given by those interested in pain control, for even though such oddities as diagnosis by means of 12 separate pulses could be dismissed as mere fantasy, it appeared that acupuncture actually could inhibit pain, and this was of considerable theoretical importance.

Researchers such as Melzack and Wall were striving to get their new look gate control theory of pain (Melzack and Wall, 1965) accepted in the face of the conservative opposition of those who favoured the old specificity theory of pain that still featured in most medical textbooks (Schmidt, 1972). Pain-control by means of acupuncture seemed to fit in very nicely with many of the new ideas, and Melzack in a series of publications (Melzack, 1973a; 1973b; 1973d) gave it new respectability among many scientifically oriented people, and with the lay public. His colleague, Patrick Wall, was not so keen to relate acupuncture to gate control theory, and in the course of an article in which he confused mesmerism with hypnosis (a very common confusion) he gave his opinion: 

Let us turn from the traditional acupuncture treatment of general disease, for which we have as yet no proof of therapeutic advantage, to examine acupuncture as a method of anaesthesia in surgery. We have now all heard evidence that it is dramatically successful. My own belief is that, in this context, acupuncture is an effective use of hypnosis (Wall, 1972). 

The evidence that acupuncture is ‘dramatically successful’ in producing anaesthesia or analgesia, raises some hollow laughs today. Felix Mann, who bears much responsibility for originally promoting acupuncture in the medical world, has been obliged to recant on much of his earlier work, and after 20 years he wrote: 

Acupuncture anaesthesia (really analgesia) works only, in my experience (though others who are experts disagree) in the hyperstrong reactor. In 1974 I reported the results of a hundred experiments in acupuncture analgesia and came to the conclusion that it worked reasonably, though not perfectly, in 10% of patients. Since then I have come to the conclusion that the criteria I used were a little optimistic, and the figure should be revised to a mere 5% (Mann, 1983, pages 44-45). 

When Melzack and Wall jointly revised the former’s book (Melzack, 1973a) and issued it as The Challenge of Pain (Melzack and Wall, 1982), they made no mention of the two articles I have cited earlier (Melzack 1973b, 1973c), and they admitted that: 

It became evident that the use of acupuncture to produce analgesia for surgery is relatively rare and undependable. In China, it is used for no more than five to ten per cent of surgical operations, and it is carried out on selected patients who have been thoroughly exposed to acupuncture methods (Melzack and Wall, 1982, p. 322). 

In contrast to the acceptance of acupuncture analgesia as a valid field for study by scientists such as Melzack and his colleagues, and by many clinicians who were less scientifically orientated, there was outright rejection of it by others. In the USA Sweet (1981), after a careful review of the available evidence, dismissed acupuncture as clinically worthless. Skrabanek launched an outright attack on acupuncture, stating: 

By ‘rediscovering’ the five vital principles of Chinese Medicine (equivalent to the four humours of the ancient Greeks) and Chinese acupuncture (equivalent to European bloodletting) we degrade medicine to shamanism. If we can now treat obesity or smoking addiction with a staple in the ear, why not a copper bracelet or red flannel for rheumatism next? Let us leave quackupuncture to quacks and let us tell the misinformed patient the truth, so that he or she can choose (Skrabanek, 1984, p.1171). 

With regard to what evidence there is that acupuncture can sometimes inhibit pain, Skrabanek points out that there is nothing new, or foreign to Western medicine, in the practice of needling to produce analgesia. It was known and written about in the nineteenth century by doctors who had no interest in Chinese medicine.

In modern times the gate control theory of pain would explain it by the fact that if a large-diameter non-nocioceptive sensory nerve fibre is stimulated, it will have an inhibitory effect on the different neural messages that produce the perception of pain. The same is true of ice-massage, transcutaneous electrical stimulation, and other methods that Melzack and Wall refer to as hyperstimulation analgesia, and are not related to the theory of acupuncture. In addition to the physiological effect of such methods, what they all have in common is the placebo effect that any impressive method will have on a patient in pain. 

We may ask why medical journals such as The Lancet still trouble to print articles and letters that mention acupuncture. Occasionally there are angry protests from correspondents such as Dr Day who writes: “Having read The Lancet for 60 years, I feel I have a right to criticise your editorial on acupuncture… I am sorry that you dignify this charlatanism by an editorial” (Day, 1987, p. 387). Occasionally there are letters in the medical press that treat the whole matter as a huge joke, a source of fun that lightens the serious world of medicine. One such lighthearted letter treats acupuncture as though it were a form of witchcraft: 

Sir – I am surprised that some of your correspondents still feel compelled to assert the efficacy of acupuncture… Not only does it work, but it works at a distance. During the 1950s the senior medical staff of a hospital with which I am acquainted kept in secret a small wax image of the then group secretary, into which from time to time sharp needles were inserted and waggled about. This practice was abandoned when it became clear that its only observable effect was to keep the so-and-so in the best of health (Zuck, 1984, p. 175). 

But Skrabanek is serious, and makes an outright attack on the mercenary motives of his colleagues who persist in claiming that acupuncture is of general therapeutic value in the treatment of diseases, including “viral hepatitis, malaria, hereditary ataxia, infantile paralysis, hydrocephalus, mammary hyperplasia… deafness… schizophrenia.” He writes that, “since the popular demand for acupuncture is great, it is not surprising that medically qualified acupuncturists are afraid of ‘non-professional’ competitors in the lucrative market”(Skrabanek, 1984, p. 1170). 

Is it all a financial racket then, in which mercenary doctors conceal the known truth from their patients, and con them into spending money on a useless treatment? It is not as simple as that. 

First, we must consider that no-one likes to admit to having been duped. The propaganda for acupuncture that emanated from Maoist China was sufficiently impressive to induce serious Western doctors to make the long journey East and visit their hospitals. Not all doctors are very good scientists, or adept in observing phenomena with the careful eye of a skeptic, so that sincere doctors such as Brown (1972) reported that perhaps as high a proportion as 90 per cent of Chinese patients underwent surgical operations depending solely on acupuncture analgesia. Now they are licking the egg off their faces, but naturally maintain that, still, there must be something valuable in Chinese medicine that the West could learn. 

Again, the charge of being moved by mercenary motives can hardly be levelled at the doctors in the practice I attend who actually advertise the local Traditional Acupuncture Clinic, where none of the staff is medically qualified. What is the truth of the matter? I shall attempt, as a non-medical man, to sum up the attitude of a skeptical doctor who permits, even encourages, the odd patient to try acupuncture for his ill-defined disorders: 

‘We live in an age of unreason where the public at large are sold on all sorts of superstitious ideas, and there is really nothing much we doctors can do about it. They come to us expecting miracles and refusing to accept the plain fact that we don’t know what’s wrong with a lot of them, and probably never will know, for many of their ills are engendered by their imagination, and the silly way they conduct their lives. We would like to operate within the bounds of rational medicine, but they demand that we act as shamans and priests. Medicine has done wonders for the population at large, but they want the impossible – always to be free of all pain and sickness. A lot of them privately sneer at the limitations of conventional medicine and want something better, hence their ignorant demand to have their Chi manipulated, and their yin balanced with their yang. They have read about it in some magazine. Well, if they want acupuncture, let them have it – and pay through the nose for it. If we keep it to ourselves, and discourage patients from going to lay acupuncturists, at least our medical colleagues will operate with aseptic needles and not give them hepatitis, AIDS or some other filthy disease. Also, they will be better able to diagnose when patients are really suffering from some recognisable disease, and not try needling them for miliary tuberculosis. But if we pursue this policy, then we are accused of pursuing restrictive practices, and selfishly stopping patients from receiving the benefits of all these lay acupuncturists who prattle on about yin and yang, feeling their twelve pulses, and calming the ‘triple warmer’. Perhaps a middle course is better; to shunt off all these hypochondriacal bores that clutter up our surgeries with nothing much wrong with them to local quack acupuncturists and let’s see whether the placebo response can help them. Meanwhile, we will get on with our proper job of promoting the health of those we can help.’ 

Well, what is an ethical course for the honest doctor to pursue in a society that is riddled with superstition? 

References

• Brown. P.E. ( 1972) Use of acupuncture in Major surgery. The Lancet. i. 1328-1330.
• Day, R.L. (1987) Acupuncture, The Lancet, i, 397. Editorial (1990) Many points to needle.The Lancet, ii, 20-21.
• Mann, F. (1983) Acupuncture: The Ancient Chinese Art of Healing. London: Heinemann.
• Mann, F. ( 1983) Scientific Aspects of Acupuncture. London: Heinemann. Melzack, R. (1973a)The Puzzle of Pain.
• Harmondsworth: Penguin Books. Melzack, R. (1973b) How acupuncture can block pain.Impact of Science on Society, 3, 65-75.
• Melzack, R. (1973c) Why acupuncture works. Psychology Today, 1, 28-37,
• Melzack, R. and Wall, P.D. (1965) Pain mechanisms: a new theory. Science, 150, 97 1-979.
• Melzack, R. and Wall, P.D. (1982) The Challenge of Pain. Harmondsworth: Penguin Books.
• Schmidt, R.F. (1972) The gate control theory of pain: an unlikely hypothesis. In J.P. Payne and R.A.P. Burt (eds.) Pain. London: Churchill-Livingston.
• Skrabanek, P. (1984) Acupuncture and the age of unreason. The Lancet, i, 1 169-1 171.
• Sweet, W.H. (1981) Some current problems in pain research and therapy (including needle puncture, ‘acupuncture’). Pain, 10, 297-309.
• Wall, P. (1972) An eye on the needle. New Scientist, 20 July.
• Zuck, D. (1984) Letter, The Lancet, ii, 175. 

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The BBC’s account of the case is devastating. Kate Shemirani even sent messages in all caps to Paloma’s boyfriend: “TELL PALOMA NOT TO SIGN OR VERBALLY CONSENT TO CHEMO OR ANY TREATMENT.” Hospital staff wrote down their “concern about maternal influence” on the patient, but acknowledged that Paloma had the legal capacity to make her own decisions. A young woman who was gradually convinced that the medicine that could save her was, in fact, her enemy.

This case tragically illustrates a phenomenon I observe frequently. With almost weekly regularity, I encounter comments like “the pharmaceutical industry doesn’t want a cure for cancer to be found” or, even more dramatically, “they even kill those who find the cure”.

These statements are, to some extent, understandable because they stem from a collective distrust of large corporations. The problem is that this almost-skeptical stance ends up being manipulated and directed to fuel misinformation about how medical science works.

What the data shows

To understand the true scale of the problem, we can examine a study published in the journal JAMA Oncology in 2018. Researchers analysed data from nearly 2 million patients diagnosed with curable cancers (breast, prostate, lung, and colon) in the United States between 2004 and 2013, from more than 1,500 accredited cancer treatment centers. They used a methodology that adjusted for variables such as age, clinical stage, comorbidities, insurance type, ethnicity, and cancer type.

In the sample studied, they identified 258 patients who used complementary medicine, specifically defined as “unproven treatments administered by non-medical personnel”, in addition to conventional treatment. This seemingly small number actually reflects the difficulty of documenting the use of these practices, as many patients do not disclose to their physicians that they are using alternative therapies and, when they do, it is not always documented in their medical records.

The results are worrying. Patients who opted for complementary medicine had higher rates of refusal of conventional treatments: 7% refused surgery (compared to only 0.1% of the control group), 34.1% refused chemotherapy (compared to 3.2%), 53% refused radiotherapy (compared to 2.3%), and 33.7% refused hormone therapy (compared to 2.8%).

Most importantly, 5-year survival was 82.2% in the group using complementary medicine, compared to 86.6% in the control group, an absolute difference of 4.4% that, although it may seem modest, represents thousands of preventable deaths when extrapolated to the general population, considering the approximately 700,000 new cases of cancer diagnosed annually in Brazil.

The difference in mortality disappeared when researchers adjusted the data to account for refusal of conventional treatments. In other words, it is not the complementary intervention itself that appears to increase mortality, but rather the systematic tendency of users to refuse treatments with scientifically proven efficacy.

Another interesting aspect of the study was the demographic profile of “complementary medicine” users. Patients who opted for these therapies were, on average, younger, more educated, had better access to private health insurance, and had a higher median family income. A profile similar to that of Paloma Shemirani.

Conspiracy ideas

Let’s return to the phrase I hear almost weekly: “The pharmaceutical industry doesn’t want a cure for cancer to be found”. While it sounds shocking, it ignores the fact that:

1. Many cancers are already cured

Several types of cancer currently have high cure rates. Breast cancer, detected early, has a survival rate of over 90%. Childhood leukemia, which was practically a death sentence just a few decades ago, now has cure rates above 80%. Thyroid cancer has a 5-year survival rate of over 98%. Testicular tumors, even when metastatic (having spread from the original site), have a remission rate of over 90% in cases with a good prognosis. Melanomas detected early have a 99% survival rate.

If there really were a corporate conspiracy to hide cures and keep patients sick indefinitely, how would we explain these widely documented, celebrated, and publicised advances? Is it a curiously incompetent conspiracy, systematically “forgetting” to suppress successes in certain areas while obsessively focusing on others?

Or perhaps it’s simply the naturally uneven and progressive scientific development that characterises all medical research. Some problems are easier to solve than others, some organs are more surgically accessible, some tumors respond better to chemotherapy. It’s biological reality being confused with conspiracy.

2. “Cancer” is not just one disease

Herein lies perhaps the greatest conceptual error fuelling conspiracy theories: the idea that ‘cancer’ exists as a single entity. In reality, the term encompasses more than 200 molecularly distinct diseases, each with its own genetic, behavioural, and therapeutic characteristics, differences amplified by the particularities of each individual’s immune system.

Lung adenocarcinoma is as different from acute lymphoblastic leukemia as the flu is from malaria. Both are ‘diseases’, but their mechanisms, treatments, and prognoses have almost nothing in common. Searching for a “universal cure” for cancer is like searching for a single medicine that simultaneously cures the flu, tuberculosis, malaria, meningitis, AIDS, and syphilis.

3. The economic paradox

Here we encounter a fundamental economic paradox. A company that developed a ‘guaranteed and effective’ cure for just one of the most common cancers would automatically become one of the most valuable corporations in history. The global oncology market is indeed worth billions of dollars annually. A company holding the patent for a revolutionary cure for, say, lung cancer, could charge virtually any price and still have guaranteed global demand.

Why would a corporation voluntarily give up the largest profit in the history of medicine? Conspiracy logic would require all the world’s major pharmaceutical companies –companies that compete fiercely for market share, sue each other for patent infringement, and engage in industrial espionage – to maintain an unbreakable secret pact to forgo trillions of dollars in profits.

4. Who profits from the conspiracy?

Those who profit most from the systematic distrust of conventional medicine are the sellers of “alternative cures.” Kate Shemirani’s case is a perfect case study of what I previously called the Chameleon Lobby: the strategy of using criticism of corporations to shield one’s own questionable business practices.

Kate charges £70 for annual memberships on her website and £195 for individual consultations, selling everything from apricot seeds with “potential health benefits” to personalised 12-week programmes for cancer patients.

The global alternative medicine market also generates billions of dollars annually, growing at rates exceeding 20%. Unproven treatments, “miracle” supplements, pseudoscientific therapies, and “superfoods” thrive because they don’t need to demonstrate efficacy or safety through rigorous studies. It’s a market that operates with stratospheric profit margins (after all, how much does it cost to produce a bottle of “energised water” or a juice-based “detox” program)?

5. Persistence of aggressive treatments

But why, then, do doctors sometimes insist on chemotherapy, even in very advanced cases with bleak prognoses? Why do they continue to offer “another line of treatment” when the chances of benefit are statistically minimal? Is it because they’re serving the industry?

The answer lies in the complex intersection between our collective cultural difficulty in accepting the finitude of life, the still incipient evolution of palliative care in Brazil, and the psychological pressures inherent in medical practice. It is, in fact, a human limitation that reflects the cultural relationship with death. Health professionals are trained to heal, to intervene, to ‘do something‘. The idea that sometimes the best medicine is to not medicate goes against decades of conditioning.

Patients and families, in turn, tend to interpret the lack of active treatment as ‘giving up’ or ‘abandonment’. There is enormous social and emotional pressure to ‘fight to the end’, even when that fight becomes a prolongation of death, not life. This reflects what we’ve already discussed about heroic medicine: the psychological pressure to act, even when the best course of action would be to accept that we’ve reached the limits of what medicine can offer.

6. A real question

There’s a documented and growing problem in modern oncology that deserves serious discussion: overdiagnosis. Increasingly sensitive tests detect cellular changes that technically fall under the definition of ‘cancer’, but would never cause significant clinical problems if left untreated.

These indolent lesions end up being treated as ‘real’ cancer, subjecting patients to invasive procedures, anxiety, costs, and side effects to treat irrelevant diseases.

This is especially true of poorly designed screening programs and the growing epidemic of unnecessary checkups (a phenomenon we already addressed when discussing quaternary prevention). Paradoxically, some of today’s oncology ‘successes’ may reflect this ability to detect and treat cancers that never needed treatment, rather than actual advances in curing clinically significant cancers.

But it’s important to note: this is a real problem that the medical community recognises and is working to correct. And how? Not through conspiracy, suppression of information, or denial, but through open scientific research, transparent discussion of the medical literature, guideline revisions, and continuing professional education.

Final considerations

Cancer conspiracy theories often urge the public to ‘research for themselves’ and ‘question everything’, but they rarely present evidence that stands up to rigorous scientific scrutiny. When specifically questioned about biological mechanisms, statistical methodologies, peer review, or replicability of results, the claims invariably turn out to be based on biased testimony, conceptual misunderstandings, or deliberately fabricated misinformation.

It is a form of performative skepticism: it uses the language and values ​​of legitimate scientific inquiry but selectively, applying asymmetric standards of evidence that require extraordinary evidence for conventional claims and accept minimal evidence for extraordinary claims.

Oncology medicine faces real limitations that deserve honest discussion and constructive criticism: costs that make treatments inaccessible to millions of people, side effects that can be physically and emotionally devastating, protocols that sometimes prolong suffering unnecessarily, unequal access based on geography and class, conflicts of interest in research, overdiagnosis, etc.

These are complex and important issues that can be resolved with more high-quality science, transparent research, public investment in palliative care, more equitable health policies, and rigorous health regulations. These are problems that require sophisticated, evidence-based solutions implemented through transparent, democratic processes. And they definitely cannot be resolved with conspiracy theories that ultimately enrich modern-day crooks and kill people like Paloma Shemirani.

This story was originally published by Revista Questão de Ciência in Brazil. It is translated and reprinted here with permission.

The post The high price of anti-science paranoia and fake cancer-cure conspiracies appeared first on The Skeptic.

Yet, despite the intuitive appeal of this moral claim, when you argue that it is very bad that we have normalised the selling of snake oil on countless fronts, you can expect a surprising amount of pushback. Even as the effects of mainstreaming and commodifying woo wreak havoc on America’s federal approach to everything from vaccines to milk pasteurisation, there remains a strong resistance to the idea that it should be illegal to sell a product using claims not supported by sufficient evidence.

So, in the interests of ethical clarity, I want to work through the objections that most frequently arise when you argue against the legalisation of selling snake oil. I’ve divided the arguments up into those meant to defend the selling of products by claiming it actually works, and arguments meant to defend the selling of products irrespective of whether they actually work.

Part 1: Arguments based on the product actually working

These objections attempt to defend snake-oil sales by claiming that the products do, in fact, work – just not in ways mainstream science recognises or can measure.

“Quantum physics proves it works.”

The most direct sorts of arguments in favour of snake oil are that you shouldn’t call it snake oil because cutting-edge science shows that it actually works, or at least provides a mechanism for how it could work. One of the forms of this, if not the most common, is what physicists have come to call “quantum woo” – the misappropriation of quantum mechanical concepts to lend a veneer of scientific legitimacy to pseudoscience.

You’ve likely encountered some version of this: consciousness affects reality at the quantum level, everything is vibration and energy, and the observer effect proves that your thoughts shape the physical world. Therefore, practices dismissed as woo are actually tapping into deep truths about the universe that mainstream science is only beginning to understand. No figure embodies this tendency more than Deepak Chopra, whose books (like Quantum Healing) argue that we can learn to manifest changes in quantum states that in turn impact our health and wellbeing.

Quantum woo fails as an explanatory mechanism for manifestation or any other form of snake oil on at least two points. Firstly, it requires that our minds somehow impact things at the quantum level, and secondly that changes at the quantum level then somehow ‘bubble up’ to produce changes at our level of existence. Both sorts of interaction are incompatible with current research in quantum physics research.

Advocates of quantum woo often point to the observer effect as proof that our minds impact quantum states, but the observer effect only refers to the interaction of measurement devices with quantum systems, not to human consciousness magically altering reality at the quantum level through intention or observation. Even if our minds could impact quantum states, the idea that changes at the quantum level somehow reliably “bubble up” to impact things at our level is also disproven by research on the nature of quantum entanglement, where indeterminacy at the quantum level does not translate into indeterminacy for us medium-sized dry goods.

On top of those theoretical objections, the quantum woo framework has a specific intellectual history that should make us default towards skepticism. As with so many problems I’ve previously covered, from racist pseudohistory to the worst parts of High Weirdness, quantum woo has its roots in the New Thought movement that arose in the 19th century. New Thought is the Western world’s patient zero for all things ‘mind over matter’, as well as a bunch of other loosely related snake oils. It cursed us with concepts of the “Law of Attraction”, which provides the basis for modern manifestation woo through books like Rhonda Byrne’s The Secret.

Long before there was any quantum physics to invoke, Phineas Quimby and other New Thought ‘pioneers’ were already claiming that the mind shapes reality and that we attract our circumstances, including all physical illness or other negative experiences, through mental vibrations.

When quantum mechanics came along, it simply provided a scientific-sounding rebranding of pre-existing beliefs. High Weirdness books like Fritjof Capra’s The Tao of Physics and Gary Zukav’s The Dancing Wu Li Masters established the template: find superficial linguistic parallels between quantum mechanics and Eastern mysticism, then declare that physics has validated ancient spiritual wisdom.

This history of ideas matters, because it reveals the quantum woo argument as fundamentally post-hoc rationalisation. Proponents aren’t following the evidence from quantum physics to conclusions about healing; they’re starting with conclusions inherited from 19th-century metaphysical movements and retrofitting quantum language onto them. The same beliefs that were once justified by appeals to animal magnetism, vital force, and thought vibration are now justified by appeals to wave function collapse and quantum entanglement. The packaging changes; the product remains the same.

Finally, even if we found that quantum effects were relevant to human biology at the scales that matter for health, this would not validate any particular alternative treatment. Demonstrating that quantum mechanics is weird and counterintuitive does not demonstrate that homeopathy works. The logical gap between ‘reality is stranger than we thought’ and ‘therefore, buy my supplements’ is vast, and quantum woo systematically obscures it.

There are many other forms of pseudoscientific explanations raised in defence of snake oils, often arising from other strands of New Thought, but they all face similar challenges from experts in the sciences they seek to ape. Another extremely popular one is one version of appeals to the placebo effect, where the claim is that the mental power exhibited in the placebo effect can produce objectively better outcomes, even curing illness. These arguments rely on poorly designed studies and misrepresentations of research, as documented extensively by Mike Hall and others.

These methods for defending snake oil are particularly insidious, because they readily exploit public unfamiliarity with the complexities of actual physics and the scientific method to make pseudoscience feel cutting edge. But dressing up 19th-century vitalism in 21st-century science jargon doesn’t make it true. It just makes the deception harder to spot.

“Scientists are unwilling or unable to study everything”

Instead of presenting evidence that science supports a particular snake oil, the epistemic humility gambit attempts to flip the script by positioning skeptics as the arrogant ones for assuming such a thing is necessary or even possible. The central claim is that scientists either can’t effectively study a particular phenomenon – like the mind’s impact on the body – or that they refuse to do so, because of conspiracy or academic taboos. After all, scientific consensus has been wrong before, and we know it’s wrong about some things right now, so who are we to even say whether or not a particular treatment works with enough confidence to regulate it?

Epistemic humility cuts both ways, though. Yes, we should be humble about the limits of current scientific knowledge. But we should also be humble about our ability to identify genuine treatments without rigorous testing. Much of the history of medicine before the scientific method was essentially a long experiment in trusting intuition, authority, and tradition that resulted in centuries of bloodletting, mercury treatments, and radium suppositories. The demand for evidence is not arrogance; it is the hard-won recognition that humans are spectacularly bad at figuring out what works without systematic controls.

If we consider what genuine epistemic humility would mean for policy, one could argue we should simply err on the side of caution and ban the sale of all unproven products and services. We don’t let companies sell cars without rigorous testing, so why give a free pass to other products, especially ones that carry significant risks of harm? Some might see that as overreach, and might object by shifting to one of the arguments for why we shouldn’t see a lack of current scientific evidence as sufficient to restrict a product or service. That said, we should at least be able to restrict the selling of products using efficacy claims that lack sufficient evidential support.

If we want to compromise and require people to loudly proclaim ‘there is no evidence that this product works and we’re not allowed to even imply that it does’ before selling their snake oil, that would still be a vast improvement over the current situation. Once you’ve got there, though, it raises the question what value there is in allowing even that, especially given concerns that individuals will heavily discount disclaimers when they’re desperate for options.

“You’re dismissing indigenous and traditional ways of knowing”

This objection has gained significant traction on the political left in recent years, often framed as a matter of cultural respect, or even anti-colonialism. One popular version of the argument is that Western science is just one way of knowing among many, and that dismissing untested traditional medicine as “woo” perpetuates colonial hierarchies of knowledge. One might even point out that the derogatory “snake oil” originated from con-men co-opting traditional medicines that may actually work, and replacing the ingredients with garbage, and that we shouldn’t hold such things against traditional medicines.

There is a kernel of legitimacy here. Traditional medical systems have sometimes identified genuinely effective treatments that Western medicine later validated – aspirin’s origins in willow bark being the canonical example. And the history of Western society’s dismissal of non-Western practices is indeed central to racialised colonialism.

However, the claim that there are multiple ways of knowing and therefore we should exempt traditional practices from evidential scrutiny does not follow. This argument is itself condescending, as it suggests that traditional practices cannot survive contact with scientific testing. It would be a form of bigotry of low expectations to act as though the best we can do for indigenous knowledge is protect it from evaluation. If a traditional treatment actually works, rigorous study will demonstrate that. If it doesn’t work, hiding that information would harm the very communities whose traditions are being invoked, and commodifying it spreads that harm for profit.

Part 2: Arguments that don’t assume the product works

These objections accept, at least implicitly, that snake-oil products may not deliver on their promises, and instead argue that there are other reasons to permit their sale.

“If it makes people feel better, what’s the harm?”

Some appeals to placebo effects don’t claim the treatment works because of “mind over matter”, rather they acknowledge that an alternative treatment lacks efficacy but that this doesn’t matter as long as people subjectively benefit from them. There’s something to this. Subjective outcomes, in the sense of how a person feels, really do matter, and many things can provide comfort, attention, and a sense of agency that can be hard to come by in medical settings.

However, even if we buy that there are subjective benefits, they come with serious harms. Firstly, there are opportunity costs: people who rely on ineffective treatments may delay seeking effective care until their conditions become harder to treat. This is not hypothetical. Oncologists regularly see patients who tried to treat their cancers with diet, supplements, or prayer, before reluctantly turning to chemotherapy. Research published in the Journal of the National Cancer Institute found that patients who chose alternative medicine instead of conventional cancer treatment had a more than twofold increased risk of death, with breast cancer patients facing a more than fivefold increase in mortality risk.

Secondly, there are direct financial harms. The wellness industry now exceeds $6.3 trillion globally, extracting money from people who can often least afford it, promising solutions to problems that require systemic rather than individual intervention. The person buying mushroom blends to manage their chronic stress might be better served by structural changes to their working conditions, but the supplement industry would prefer they keep buying the mushrooms.

Thirdly, and most philosophically troubling: do we have a right to be deceived into feeling better? I’m reminded of one of my favourite articles by The Onion, Woman Takes Short Half-Hour Break From Being Feminist To Enjoy TV Show. However, while the urge to indulge sometimes is understandable, making it easy for people to habitually purchase self-deception has clearly contributed to a worse epistemic and health climate for all involved.

“Adults should be free to spend their money however they want”

The autonomy objection is typically the next line of defence after attempts to claim the product objectively or subjectively works, and just as with those arguments there’s some bit of truth here. Respecting individual liberty means allowing people to make choices we disagree with, including choices we consider irrational and to some degree self-harming, such as engaging in dangerous sports. If someone wants to spend their money on homeopathy or healing crystals, who are we to stop them?

The problem is that this objection conflates two very different things: the freedom to make choices and the freedom to be deceived. Genuine autonomy requires informed consent, which means having access to accurate information about what you’re buying. When a supplement company claims their product “supports immune health” or “promotes natural detoxification”, they are not facilitating autonomous choice – they are exploiting the gap between what those phrases legally require them to prove (nothing) and what consumers reasonably infer them to mean (that the product does something).

The autonomy objection also tends to assume a model of human cognition that doesn’t match reality. We are not perfectly rational agents calmly weighing evidence before each purchase. We are exhausted, hopeful, sometimes desperate, and subject to a host of cognitive biases that snake-oil merchants have become experts at exploiting.

The same people who would never argue that fraud laws violate autonomy somehow treat medical fraud as a matter of personal choice. This is not respecting autonomy; it is abandoning people to predators while feeling virtuous about it.

“What about religious freedom?”

When the snake oil in question comes wrapped in religious packaging, such as faith healing, fortune telling, or blessed objects, a different set of considerations unfortunately come into play. In many jurisdictions, religious exemptions create carve-outs that allow practices that would otherwise be regulated or prohibited, and that is likely to some extent unavoidable in a free society.

I want to be clear about the limits of my argument here. I am not arguing that religious belief should be illegal, or that churches shouldn’t be allowed to offer prayer. What I am arguing is that the moment someone begins selling a product or service with explicit or implied claims about better outcomes, they should be subject to the same evidential standards as everyone else, regardless of whether those claims are framed in religious terms.

The religious exemption framework will always be a problematic shield for a wide range of harms, but limiting the commodification of snake oil via that exemption is likely to limit the scope of those harms. The prosperity gospel pastor selling miracle cures to vulnerable people he will never meet has more in common with a supplement company than with a local pastor praying over a sick congregant. The commercial intent exacerbates the cost to everyone for allowing any degree of localised autonomy on this front.

“First they came for the homeopaths…”

The slippery slope objection predicts regulatory overreach: once we start banning snake oil, where does it stop? Will vitamins be next? Will we need a prescription to buy herbal tea?

Once more, these concerns are not entirely without merit, as regulatory agencies can indeed overreach, and the line between ‘unproven’ and ‘disproven’ is not always crisp. However, we already regulate claims in other domains. Pharmaceutical companies cannot claim their drugs treat conditions without evidence. Food companies face restrictions on health claims. The supplements industry exists in its current form largely because of specific legislative carve-outs, particularly the 1994 Dietary Supplement Health and Education Act in the US, which were the result of industry lobbying, not some principled commitment to consumer freedom.

The question is not whether we should regulate claims at all, since we already do, but whether the current exemptions for supplements, alternative medicine, and wellness products are justified. I don’t see how they are.

The costs of inaction

What ultimately undermines all these objections is the mounting evidence of real-world harm from our current permissive approach. The wellness-to-conspiracy pipeline has been well documented, and researchers have coined the term “conspirituality” to describe how alternative spiritual beliefs and wellness culture can funnel people into far-right conspiracy theories.

The current US administration’s hostility to basic public health measures didn’t emerge from nowhere. It grew in soil that the alternative health industry has been cultivating for decades. As PBS has reported, more than 420 anti-science bills attacking long-standing public health protections have been introduced in US statehouses this year alone, pushed by people with close ties to the current Health and Human Services Secretary – someone who I first wrote on back when he was a virtual guest of honour at the Better-Way Antivaxxer conference.

We have, as a society, decided that it is acceptable for whole industries to profit from claims they cannot substantiate, often targeted at particularly vulnerable people in the midst of some sort of life crisis. We have allowed “wellness” to become a multi-trillion-dollar sector built on the principle that feelings matter more than actual outcomes. And we have watched as this epistemic rot has spread from the supplement aisle to the halls of government.

The objections I’ve addressed here are not frivolous. They reflect genuine tensions between individual liberty and public protection, between intellectual humility and universal epistemological standards. But none of them, individually or collectively, justifies the status quo.

Selling people things that don’t work, using claims designed to mislead, remains wrong. It’s long past time our laws and norms reflected that basic moral truth.

The post Rights over regulation? The moral case against legalised snake oil appeared first on The Skeptic.

TikTok is flooded with skincare routines. Girls are promoting snail mucus, skincare acids, and red-light therapy masks. Inspirational content promises empowerment and feminism; it is hard to detect the harm through the fluffy bathrobes and serene voiceovers. But the skincare trend is posing a threat to women’s health and sense of self-worth. Their message is clear: perfection is achievable if only you follow the right steps.

Researchers in Australia showed that brief exposure to beauty-related TikToks increases face-related shame, anxiety, and upward social comparisons. In other words, after just a few minutes on the platform, women feel worse about their appearance. A Dutch study found a similar pattern: frequent exposure to sexualising media (content that emphasised body attributes rather than personal attributes) makes women adopt appearance ideals as their own personal standards. This internalisation then leads them to monitor attractive peers online. These are behaviours that, over time, increase self-objectification and constant body surveillance.

One person who has felt pressured by skincare routines on TikTok is Ingrid Nyman, a 22-year-old student at Singapore Management University. She downloaded the app when she was 15 years old, around the time it was launched. For six years, she has been fed daily videos preaching how to achieve the desirable aesthetic lifestyle. “When I saw girls with perfect skin promote a serum and say it helped them get rid of acne, I thought I needed that product”, she told me. “I thought my pimples were something I needed to get rid of.”

This kind of content is inflicting harm beyond surveillance. Girls as young as eight have been influenced to start using products formulated for adults, containing acids, retinols, and exfoliants far too harsh for developing skin. Dermatologists have warned that these ingredients can cause long-term damage. The BBC recently reported cases of young girls developing eczema and chemical burns because they were following routines intended for 30-year-olds. Now children are endangering their health, skincare obsession has become an urgent issue.

This is also an extremely lucrative industry, with the skincare market estimated to be worth $192.8 billion in 2025, and forecast to more than double in size to $432.1 billion by 2035. Social media has acted as a driver in this market growth. According to Future Market Insight:

Digital engagement and social media-fuelled education have played an influential role in shortening product adoption cycles and expanding access to younger demographics.

The use of influencer marketing has increased rapidly, as it is more powerful than traditional advertising, driving sales with a message that seems personal and genuine.

When in need for inspiration to buy new products, Ingrid turned to TikTok. “I found it useful to watch product reviews, it’s the easiest way to gather information about a product on TikTok because of how the algorithm is designed” Ingrid said.

There is a rising demand for a wide range of skincare products. Retinoid products made up 22% of revenues in 2025, despite their risks of causing skin irritation, flaking, and increased photosensitivity. Consumers want ‘safe ingredients’, while dermatologists say the safest skincare routine is doing less.

One of my friends began using 13 different serums after she saw them recommended on TikTok. Within weeks, her face erupted in painful rashes. When she saw a doctor, the first question he asked was: “Do you use serum?” She said: “Yes, I do.” He replied: “Stop immediately. I meet people daily who seek medical attention due to rashes from serums.” She stopped, and her rashes disappeared.

Strong acids, like retinol, in skincare have been normalised. Influencer Victoria Nelson recently went public with her story of a facial treatment she got in Beverly Hills four years ago – a chemical peel, which inflicted severe burns. This treatment left her with permanent skin damage, such as scars and large pigment spots.

In 2021, researchers from Texas studied dermatological discussion threads on social media platforms. They found that 71% of posts were offering advice on improving wellbeing. However, many posts lacked scientific support or evidence, and pseudoscientific recommendations were accepted as factual. In the online communities where dermatological advice is shared daily, this advice circulates as a normative practice, creating a false rule book of the right way to wash your face.

Dermatologist Petra Verga Kan blames the beauty industry for pushing unnecessary products to drive consumption, saying: “We don’t need all these products”. This industry has created a demand out of thin air. Big brands are earning fortunes from selling a solution to a problem customers never had.

Instead of recognising the danger in children’s growing interest in skincare, big brands have merely exploited their demand and targeted customer segments of teenagers. Explaining the launch of a product range targeting 13-year-olds, Superdrug’s Head of Own Brand, Emma Monaghan, proudly proclaimed: “We identified a real gap in the market for skincare that meets the needs of younger consumers who are increasingly sophisticated in their routines.”

Actress Shay Mitchell targeted even smaller children when she released a facial mask for toddlers, while children’s cosmetics company Rini describe their brand as “where skincare meets play”, giving the impression that skincare products are now being sold as toys. Rini’s co-founders claim their facial mask has a mission to nurture “healthy habits, spark confidence, and make thoughtfully crafted daily care essentials and play products accessible to every family”.

Dermatologist Emma Wedgeworth is unconvinced, explaining that small children are naturally unselfconscious, and “we don’t want to encourage them to focus on appearance or create anxiety about how their skin looks”. Why should a toddler’s first memory include applying a facial mask, as if their baby skin was not perfect already?

After six years spent on TikTok, Ingrid had reached her limit and deleted the app. She explains how she eventually felt herself sinking into a rabbit hole where she was constantly being pressured. “All I could feel was that I was not pretty enough.” she recalled.

The TikTok algorithm is strong… and faulty. Research from Amnesty highlighted how quickly expressing interest in one topic, through likes and shares, can lead you into a deep rabbit hole of content, in under four hours – including tips on how to take your own life. The platform ignores its systemic design risks, and takes little responsibility for the harm its algorithm may cause. It shows how browsing lifestyle videos can end up feeding you the message that you’re not enough to live.

Social media acts as a tool for self-surveillance. Professors Ana Sofia Elias and Rosalind Gill argue women are positioned as subjects who should continuously monitor their appearance and bodies. This is making self-optimisation the norm, and self-monitoring a personal habit. Similarly, Professor Talia Welsh criticises the modern self-care and wellness culture for creating ‘feminist subject ideals,’ where women are expected to take responsibility for their health, make the ’right’ choices, and optimise their lives within capitalistic frameworks. Wellness culture has redefined empowerment as perfection, and self-care as self-surveillance. There is no feminism in the message ‘a woman’s value lies in her looks’.

For four years now, the ‘that girl’ trend has thrived on TikTok. She rises at 5:00am, meditates, drinks a matcha latte, does yoga and her skincare routine all before the alarms belonging to the rest of the world have gone off. Despite how exhausting this sounds, this is an aesthetic many wish to achieve. The ‘ThatGirl’ hashtag on TikTok holds nearly two million posts, endless videos of young women performing discipline and self-mastery.

In Cosmopolitan Magazine, Maya Sargent says of the ‘that girl’ trend:

On the surface, she’s an untouchable female power force that attacks her day with vigour and confidence, powered by flipclock alarms and a skincare fridge.

The trend positioning an aesthetic of an empowered woman, when in fact it promotes a template you must follow in order to qualify as an empowered woman. One of the reasons Ingrid left TikTok was because she got sick of the rule book and template:

When you see skincare routines, it’s hard not to reevaluate your own routines. ‘That girl’ routines are ‘put together’. Of course, you feel like you want to have the same routines, to feel ‘put together’.

Many of my friends have started to repost skincare routines as inspirational content. I recognise that these videos might seem inspiring to some people, and may bring them joy. For some, these videos are harmless inspiration. But for others – those who feel they are always falling behind, always inadequate, always wrong – this content could be an everyday battle. And the latter group may be larger than we realise. They suffer quietly, scrolling through micro-doses of self-doubt every day.

Today, people can make a living by posting how they perform everyday chores aesthetically. Researchers at Stockholm University are currently investigating how influencers, particularly women, romanticise a housewife role on social media – Josefine Wall Scherer, a doctoral student involved in the study, explained:

It is linked to ideas of ‘post-feminism,’ where some women choose traditional roles but do so through modern digital platforms, creating a new form of ‘work’ and identity.

Social media makes it easier to ‘export’ a retro ideal, but this export may affect how women’s work and value are perceived. Society has given room to an occupation that profits from women showing how they perfect their appearance, reinventing the stay-at-home wife. The feminist development and technological revolution might be working against each other.

In counter to this movement in society, a phrase was coined: ‘choice feminism’. Essy Klingberg, a Swedish culture editor, explains the phenomenon as “the belief that women’s individual choices are inherently feminist, regardless of the choice itself.” Thus, you could excuse any action as feminism, even inflicting pressure upon other women.

We will always be influenced; by advertising, by friends, by parents, and by politicians, to name a few. That is something we will have to navigate throughout our entire lives. Social media is simply a new channel, and perhaps the most seductive.

Trends have immense power because belonging feels safe, and resisting feels lonely. But trends are not truths. They are not moral guidelines. And they should not dictate how we wash our faces, structure our mornings, or measure our worth.

My Christmas wish is that a 14-year-old’s wish list reflects what a 14-year-old truly wants. Hopefully, it won’t be a gift bearing permanent skin burns. Hopefully, not something that implies that her only value is in her looks. Hopefully, not a household appliance disguised as empowerment.

The post Superficial empowerment: the hidden cost of TikTok’s skincare obsession appeared first on The Skeptic.

Every clinical trial is built on the backs of volunteers. These individuals often risk side effects and sacrifice their time, while assuming they’re contributing to scientific progress. When researchers launch a study with a flawed design – one destined to produce an uninterpretable or misleading outcome – they are effectively abusing the goodwill of their subjects. To submit a human being to medical experimentation for a result that has no relevance is not just incompetent, it is predatory.

What’s more, the resources poured into poorly conceived trials represent an often-staggering waste. We are not just talking about the waste of scarce research funds – usually hundreds of thousands of pounds – we are also talking about the waste of intellectual resources. Every hour a researcher spends massaging the data of a flawed SCAM study is an hour that could have been spent on proper, productive research. In a world of finite resources, funding and conducting shoddy science is a regrettable misuse of opportunity.

Perhaps the most insidious danger of poor research is the fact that it mis-attributes an illusion of legitimacy. When an implausible or disproven form of SCAM is granted a veneer of scientific credibility through a flawed investigation, the consequences can be dire. Consumers are lured away from evidence-based medicine towards chasing the false promises of irresponsible quackery. This isn’t just misleading; it is a dangerous game that sends patients up the garden path and generates preventable suffering and, in a worst-case scenario, death.

Finally, the pseudo-research of nonsensical studies erodes the fragile foundation of public trust. When science is continuously being misused as a tool to promote snake oil, the public might eventually stop believing in science altogether. We are currently living through a crisis of confidence in medicine, fuelled largely by the realisation that many published findings are not reproducible and thus not worth the paper they are printed on.

The directive for investigators is clear: if you cannot or will not design a trial with adequate rigor, get out of research. There is no room for pseudo-scientists in healthcare. Science is a tool for creating progress and not for promoting nonsense.

The post The dangers of flawed clinical trials appeared first on The Skeptic.

Prominent figures in the Black movement accused the mayor of “religious racism.” City Hall issued a statement (reprinted on the G1 news website) stating that the revocation complied with the principles of a secular state and respect for science. These are undoubtedly good principles. But it would be easier to take the justification seriously, at least in the case of the appeal to good science, if the Rio de Janeiro SUS did not offer consultations with acupuncturists and homeopaths (adult and child), both practices without scientific support and based on magical thinking. Abundant information and references on this subject can be found in the book Que Bobagem!, which I wrote in partnership with Natalia Pasternak.

Pressure for the integration of Afro-Brazilian practices into the Unified Health System (SUS) has been building since the publication of the National Health Council’s Guideline 46, which is cited in the original decree issued by Rio de Janeiro City Hall. Given the way the list of procedures covered by the Unified Health System’s National Policy for Integrative and Complementary Practices (PNPIC) is structured – lobbyists get their way, science be damned – this is an understandable and natural development.

The intertwining of Afro-Brazilian healing practices with religious beliefs and rituals certainly complicates the situation. With the precedent set, what will prevent SUS funds from being used to pay for, among other things, “unburdening sessions” in millionaire neo-Pentecostal temples? However, the underlying problem is the very existence of the PNPIC.

This policy was born with a vague appeal to “tradition”, and in this aspect the incorporation of Afro-Brazilian healing practices makes much more sense than that of family constellations, ozone therapy, chiropractic and several other modalities created in North America or Europe less than two hundred years ago (in some cases, just a few decades ago), that were virtually unknown in Brazil until a few years ago.

By abandoning quality scientific evidence as a guiding criterion, the PNPIC becomes a free-for-all where the only real criterion for inclusion or exclusion is the political power of the interested groups. And even if the Policy did in fact only contemplate traditional and popular practices, antiquity and popularity do not guarantee efficacy or safety. Examples such as bloodletting – recorded in all parts of the world – or the use of the toxic and carcinogenic herb Aristolochia – consumed in medicinal preparations in Europe and Asia – show that “healing” practices that actually shorten patients’ lives and increase their suffering can survive for millennia as part of culture, until they are exposed by adequate scientific testing.

The decree revoked by Mayor Eduardo Paes provided, in its final article, that those involved in health care should respect the patient’s beliefs and traditions, adopting an approach free from prejudice and taking into account any dietary and clothing restrictions of a religious nature.

This final point should have been preserved. Respect for scientific evidence is a necessary condition for effective health care, but it is far from sufficient. The PNPIC is sometimes defended as an attempt to fill the gap, but it doesn’t achieve enough by undermining or downplaying what is necessary.

This story was originally published by Revista Questão de Ciência in Brazil. It is translated and reprinted here with permission.

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This argument sounds convincing for two reasons. Firstly, it is intuitive: we all know the story of Galileo, so pseudoscientists quickly cast themselves as unrecognised geniuses. Secondly, it neutralises any scientific evidence – if pseudoscience is supposedly unprofitable for scientists, then failed experiments can be written off as part of the conspiracy.

But would pseudoscience really be disadvantageous to scientists if it actually worked? If we think about it, wouldn’t working pseudoscience offer scientists personal, collective and existential benefits?

Personal benefits

School simplifies the biographies of geniuses. Great writers write books because they are great writers; artists paint because how else could it be. We habitually think that scientists live according to the pattern “born, discovered, died” – and forget about personal (and not always attractive) motives. Yet it is precisely these motives that show that working pseudoscience could be beneficial to scientists.

A person who discovers that homeopathy really works will end up TikTok famous and part of the school curriculum. Scientists are not immune to normal human vanity – they want to be the faces in the textbooks that slackers of the future draw moustaches onto. And the more radical your scientific conclusion, the higher the probability it could be your face getting the doodle treatment.

The pioneer of scientific palmistry would become the leading expert in the field, and earn money from corporate courses for HR managers on determining diligence by the line of life. They might even take part in a state programme for the preventive fight against poverty along the “line of destiny.”

Astrology has undergone plenty of scientific testing. For example, researchers have studied “astrological twins” – people born at the same time in the same place – to see whether their lives show any meaningful similarities. Alas, none were found – because if they had been, scientists would have been the first to announce it. All the while continuing to mock pop-astrologers – after all, any “new scientific astrology” would have to distance itself from amateurs.

Of course, there are examples where personal ambitions hinder science. Hugh Everett’s many-worlds interpretation of quantum mechanics was not recognised by many physicists for a long time simply because it seemed implausible to Niels Bohr. But the situation with the many-worlds interpretation is quite different from ignoring any proof we found of Bigfoot. The question of interpretation matters far more to the public than to most scientists. Many quantum physicists follow the “shut up and calculate” principle – conducting research without trying to force the quantum world to match the logic of the everyday world we experience.

Also, notably, despite Bohr’s criticism, the many-worlds interpretation eventually took root without any involvement from Everett, who, feeling overlooked, left science. Everett’s “pseudoscientific according to Bohr” idea was later defended by other physicists – because, in addition to personal benefits, scientists also gain collective benefits from anomalous ideas.

Collective benefits

Anyone who has opened Google Scholar knows that science reaches new heights by standing on the shoulders of giants of the past. As soon as the first scientific “giant” appears in hypothetical astrology, followers will immediately climb onto their shoulders – not out of a desire for truth, but for purely mercantile reasons.

It is not individual scientists but the scientific community that holds the monopoly on interpretation. If the existence of ghosts is proven, it will be scientists, not YouTube ghost hunters, who build careers on explaining the phenomenon. If pseudosciences work, their recognition would lead to rapid institutional growth. Astrological departments, journals and conferences would appear. Researchers would seek grants to study the influence of zodiac signs on drug tolerance. If the lines on the hand can predict fate, perhaps they can also predict a tendency toward criminal behaviour. If homeopathy works, it would require state certification – and trained specialists.

Politicians are not particularly interested in the world’s oceans at the moment. But if it turns out that a megalodon is swimming along the route of a cruise ship carrying voters, it would be far easier to convince them that not only the shark, but also other marine species that make up its potential prey, need study. And let’s not forget about patents. If bio-fields really exist, the first company to develop a device to measure them would become richer than OpenAI.

Of course, the main goal of a true scientist is the search for truth. And recognising pseudoscience that works would fully align with that goal. But even if we leave noble motives aside, scientists know how to turn anomalies into money.

Yet even these benefits pale in comparison to deeper – and equally self-interested – motives.

Existential benefits

Existential benefits are the kinds of benefits that can make even highly educated people support pseudoscience. When we watch a horror film about a resurrected killer who hunts teenagers, we forget that if the killer returned from the afterlife, it means the afterlife exists at all. In the film adaptation of Stephen King’s ‘1408’ – this is not in the original story – John Cusack’s character stays in “haunted hotels” not only to write another exposé bestseller. His daughter has died. He is a skeptic, but he longs to encounter the paranormal because it would give him hope for an afterlife.

Scientists are people too. Scientists don’t want to die, either. If convincing reasons to believe in ghosts appeared, there is no reason why scientists would not cling to that hope, just like everyone else.

But death is not the only existential problem that pseudoscience helps to solve. Many young people do not know what to do with their lives. Believing that the fate of your rock band is determined by a fortune-teller may lead to disappointment later – but here and now it makes it easier to choose a direction and believe it is the right one. We meet many people in our lives – and if horary compatibility worked, scientists would trust their personal lives to the stars in exactly the same way.

We are all doomed to freedom – and the “predictive power” of pseudoscience reduces existential anxiety. It helps us feel that we are on the right path, even if we are not. It gives us the very self-confidence that psychologists say we desperately lack. And if pseudoscience worked, scientists would not miss the opportunity to use it to fill the God-shaped hole that, as Pascal described – though not in those exact words – lies in each of us.

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Those who ply their trade in the market place of unorthodox remedies and practices have an ambivalent attitude to science. Their reluctance to expose their notions and products to scientific examination, and their not-infrequent insistence that these are beyond such scrutiny, are commonly equalled by their keenness to promote them by reference to ideas and phenomena derived from or refined by science. Thus we have an industry of quasi-science whose entrepreneurs covet all the advantages of science, but none of its discipline. Maybe this has always been so, but in a paradoxical way the success and popularity of modern science and technology feed this industry, just as they do – quite legitimately – science fiction.

The inevitable outcome of this is that scientific concepts, phenomena and discoveries become extended beyond their range of validity or useful application, and even become endowed with almost magical properties. ‘Force’, ‘energy’, ‘vibrations’, ‘ field’, ‘magnetism’ and ‘gravity’ have long fallen victim to this kind of plundering. More recently we have witnessed the same with ‘vitamins’, ‘biorhythms’, ‘biofeedback’, ‘allergy’, ‘subliminal perception’, ‘alpha rhythm’, and the ‘right and left brain’. The latest scientific finding to be exploited in this way is ‘endorphins’. “It increases the body’s endorphins” is the claim of purveyors of the ‘flotation chamber’, a relaxation device in which the user floats blissfully in a tank of epsom salt solution.

The flotation chamber is one of a number of pieces of pseudo-scientific technology available from the anti-stress and ‘mind-bending’ industries. They are not quite New Age material because they are promoted on the basis, not of mysticism, but of scientific knowledge, albeit a misrepresentation of that knowledge.

Another example is the ‘Synchro-Energiser’, manufactured by Synchro-Tech of Cleveland, Ohio. Not only is it claimed that this device will assist the operator to achieve desirable states of tranquility, creativity and mental balance, but it is also presented as a panacea, curing phobias, improving sexual functioning, correcting learning difficulties, eliminating pain, boosting intelligence and so on. I should like to present an account of this device which I was asked to prepare not so long ago for the producers of a television documentary.

The Synchro-Energiser: a high-tech computer-driven brain balancer

From my reading of the information on this device, I understand that the operator wears a pair of goggles and a pair of earphones. He or she hears a series of sound pulses and observes a series of white light pulses. (In fact, repeated stimulation by white light pulses at low frequency may cause epileptic auras and convulsions in some susceptible people, and discotheque strobes are required to be set outside of these frequencies.)

In the Synchro-Energiser, the frequencies of both sets of pulses can be controlled and varied within a range of 1 to 60 per second and the two eyes and ears may be stimulated in various combinations (both eyes and both ears, left ear and left eye only, and so on). The blurb also speaks of an additional form of stimulation (‘light/sound and electromagnetic stimulation’). I have difficulty in understanding how the operator is experiencing this third type of stimulation. Light is, of course, electromagnetic energy of a particular wavelength and frequency to which the eye is sensitive. However, the blurb states that there is an electromagnetic field ‘heard separately through the goggles and the earphones’. Of course a person cannot hear through goggles, and the ears are responsive to vibrations and sound waves, which are not electromagnetic waves. None of this makes any sense.

The blurb informs us that certain mental states such as alert concentration, relaxation and sleep, are associated with certain bands of frequencies observed in the EEG recordings of the brain. Here, electrodes attached to the skull pick up the electrical activity of the brain and although the pattern of activity (the electroencephalogram or EEG) involves many different frequencies, the composition of these frequencies changes under different circumstances, including the mental state of the person. Four bands of frequencies have been identified as particularly significant and these have been designated by the Greek letters alpha, beta, gamma and delta. The distribution of these frequencies across the brain also changes according to the type of activity in which the person is engaged – speaking, visualising, performing arithmetical calculations, remembering, performing skilled tasks, sleeping, dreaming, and so on.

It is apparently assumed that visually and auditorally stimulating the brain to produce more of a particular band of frequency creates the kinds of mental states associated with those frequency bands. This is a complete fallacy. There is no one-to-one relationship between EEG frequency and mental state. For example, when a person relaxes, more alpha rhythm is detected in the EEG, but alpha rhythm may be abundant in the recordings of people who are far from relaxed, and a sizeable minority of people produce little or no alpha rhythm at all, yet have no problem in relaxing. An analogy is the relationship of anxiety and sweating: an anxious person sweats more, but you do not make a person anxious by causing him or her to sweat, say by increasing the room temperature.

All sorts of experiments have now been performed in training people in alpha production and the general finding seems to be that it is the expectancy of achieving a tranquil mental state which is the crucial factor rather than increasing alpha activity. If people are trained to suppress alpha but are informed that this will lead to a calm meditative state, they are as likely to report achieving that state as people likewise instructed to enhance their alpha. So there is nothing to suppose that receiving the kinds of stimulation produced by this device will have any special effect on the operator’s mind and state of consciousness, other than that produced by the expectation created by the information given in the instructions. Probably, alpha rhythm is linked to something like the relaxation of visual attentiveness which is associated with, but not necessarily dependent on, mental relaxation.

In addition to these fallacies regarding EEG rhythms, there are a number of blatant factual errors. For example, it is implied that stimulating the ears separately with sound is equivalent to stimulating the two sides of the brain separately. This is not so. The nerve fibres from each ear go to both sides of the left hemisphere. So it would be more accurate to talk about stimulating the two hemispheres by presenting stimuli in the two visual fields separately. However, since the information is passed to the other side of the brain in a fraction of a second, the whole idea is a nonstarter.

It must be remembered that although the upper part of the brain is divided into two halves, the two halves function as one unit and it can be demonstrated by monitoring the on-going activity of the brain, that whatever the brain is doing involves an integrated pattern of activity over the whole of the brain. It is true that when the brain is interfered with in some drastic way – such as temporarily deactivating one hemisphere by electro-convulsive therapy, or the injection of drugs, or severing the connections between the two sides, each hemisphere can be shown to have a particular way of functioning which, under these extraordinary circumstances, can proceed independently of the other hemisphere. However, in the intact brain, information received via the senses is distributed, processed and integrated by the whole brain. It is meaningless to talk about stimulating the two sides of the brain separately, and the current hype over left and right brain thinking (for example, developing your left and right brain) is largely misplaced and erroneous.

In addition to the above, the manufacturers claim that the machine will enable the user to achieve some impressive sounding state or condition which, with the benefit of a little thought and knowledge, can be seen to be meaningless. One example is ‘total awareness’. Another is ‘enhanced cognition’. We also have ‘mood equilibriation’ and ‘brain balancing’. The latter presumably has something to do with the later-mentioned notion of ‘most of your brain cells working in harmony’ and the ultimate claim of being able to ‘synchronise the entire nervous system’. None of these ideas has any basis in neurophysiology or neuropsychology; likewise ‘the ability to shift from left to right hemisphere whenever needed, ‘(integrated) right and left hemispheres’, ‘(weaving) to the left-right and front-back quadrants of the brain’, ‘a more comprehensive, scanning type of awareness’, ‘a balance between the visual and auditory… cortex’, something called ‘automatic receptivity for learning new subjects’, and ‘dipping into a body rhythm’. These ideas, though they sound impressive and extraordinary, have little or no meaning in neurophysiology or neuropsychology.

The manufacturers’ blurb also refers to scientific concepts which have little or no meaning in the context in which they occur. As mentioned above, they speak of the left and right sides of the brain, EEG rhythms (alpha, beta, and so on) and an electromagnetic field. We are told that as a result of the stimulation from the device, there is a following response elicited in the brain cells and this creates a ‘magnetic induction field’. We are also informed that the visual effects such as colours and shapes, produced by the light pulses, are a “psychedelic experience… influenced by what chemicals the brain secretes”. More likely they are examples of the commonly observed effects of white light on/off stimulation which, for example, results in different colours being seen.

You can see this effect if you observe the after-image of a bright light. You will see that it goes through a flight of colours as it gradually fades. Also, if you look at a rotating black and white disc you will see an interesting display of different colours. This phenomenon is caused by the different rates of fatigue and recovery of nerve cells which respond to different wavelengths of the light and thus give the experience of colour.

Conclusions

What principles are at work here? One of them, which interests me greatly, is the extension of ideas and methods beyond the range of their validity or demonstrated effectiveness. This commonly happens in medicine, whether mainstream or unorthodox, and other treatment systems such as psychological therapies. It may also be observed with methods of assessing or predicting human characteristics or behaviour.

Sometimes the range of validity will be minimal or non-existent. Astrology is a good example; ‘biorhythms’, subliminal perception and certain alternative medicines are others. Sometimes there is a range of valid application but the methods and ideas are extended beyond that. Biofeedback, graphology and mainstream medical remedies such as antibiotics, antidepressants and tranquillisers are examples of these.

The forces which determine the actual (as opposed to the theoretical) range of applications of ideas and procedures are complex and are such as to allow even completely invalid practices to flourish indefinitely (like astrology). Such forces include the needs (personal and financial) of the practitioner. I have discussed some of these thoughts elsewhere and I hope to pursue them at a later stage.

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