Edzard Ernst

MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Amidst the current controversy of chiropractic spinal manipulation for new-born babies, the previous director of Chiropractor’s Association of Australia NSW, Alex Fielding, published an interesting article. In it, he declared:

  1. I do not condone the chiropractic treatment of children for non-musculoskeletal conditions it is simply not our place. There is little to no evidence for it and it should not be done. If a chiro is report them to AHPRA.
  2. There is no evidence for “subluxation” it simply has not been shown to exist by any credible source.
  3. Chiropractic does not equal spinal manipulative therapy (SMT) or adjustment. We are trained to assess and treat musculoskeletal conditions, use exercise rehab, various forms of manual therapy including SMT, give sound evidence based advice and refer to better suited health professionals in the appropriate circumstance. To say there is no evidence for chiropractic is an ill informed politically charged statement, if you mean SMT, say SMT.

Here I only want to comment on his last point. I think it is important, not least because we hear it ad nauseam. As soon as there emerges new evidence to show that SMT does little for back or neck pain or is ineffective for non-spinal conditions, chiropractors insist that they do so much more than just SMT, and therefore any such findings do not ever lend themselves to a verdict about chiropractic care.

In my view, this argument is a bit like ‘wanting the cake and eat it’ (chiros want to be different from physios by adhering to SMT, but they don’t want to be judged by the uselessness of SMT). It begs the following questions:

  1. What other modalities do chiros use?
  2. For which conditions do they use them?
  3. What is the evidence for or against them?
  4. In what percentage of patients do chiros use SMT?

The last question may be the most important one. I am not aware of data from ‘down under’ but, in the UK, the percentage is close to 100%. This is why I often call SMT the ‘hallmark therapy of chiropractors’. No other profession employ it more frequently. It is the treatment that defines the chiropractic profession.

If the evidence for SMT is flimsy or negative or non-existent, it seems not unreasonable to voice doubts about the profession that uses it most. The fact that chiropractors also administer other modalities – most of which, by the way, have a shaky evidence-base too – is simply a smoke-screen used to mislead us.

An example might make this a bit clearer. Imagine a surgeon who takes out the tonsils of every patient he sees, regardless of any tonsillitis or other tonsil-related condition (historically, this fad once existed; tonsillectomy was even used to treat depression). This surgeon also does all sorts of other things: he prescribes pain-killers, gives antibiotics, orders bed-rest, gives life-style advice etc. etc. Yet he is a charlatan because his hallmark intervention is not effective and even puts patients at unnecessary risks.

I know, the analogy is not perfect, but it makes the point: chiropractors refuse to be judged by the uselessness of SMT. Yet it is what defines them and they continue using SMT pretty much regardless of the evidence. Fielding pleads: To say there is no evidence for chiropractic is an ill informed politically charged statement, if you mean SMT, say SMT. I’d say there is no good evidence for SMT nor for chiropractic care that includes SMT.

My advice for chiropractors therefore is: abandon SMT and become physiotherapists. This will make you a bit better grounded in evidence, but at least you would have rid yourself of the Palmer-cult with all the BS that comes with it.

Informed consent is an essential ethical precondition for any therapeutic intervention. This obviously cannot exclude alternative medicine. Yet, one gets the impression that alternative therapists systematically ignore informed consent. Chiropractors in the UK, for instance, have been shown to often take this issue more than a little light-heartedly.

The General Chiropractic Council (GCC) has issued guidance to its members about informed consent. Here is a passage from their website which I find particularly interesting:

The information you provide to the patient must be clear, accurate and presented in a way that the patient can understand… Patients must be fully informed about their care. You must not rely on a patient to ask questions about their care, the responsibility to fully inform patients about their care lies with you.  When discussing with patients the expected outcomes of their care, chiropractors must fully discuss the risks as well as the benefits and explore with the patient what other factors they may see as relevant to making a decision.

When explaining risks, you must provide the patient with clear, accurate and up-to-date information about the risks of the proposed treatment and the risks of any reasonable alternative options, in a way that the patient can understand. You must discuss risks that occur often, those that are serious even if very unlikely and those that a patient is likely to think are important. You must encourage patients to ask questions, so that you can understand whether they have particular concerns that may influence their decision and you must answer honestly.

I have repeatedly written about the fact that, in alternative medicine, informed consent has remained an almost alien concept. Yet, there can be no doubt, it is an ethical imperative in ALL healthcare. The above guideline makes this perfectly clear. Essentially, it proscribes that a chiropractor has to inform each patient who is about to be treated with a spinal manipulation – virtually 100% of all patients consulting chiropractors – that:

  • this treatment has not been shown to be effective for non-spinal conditions,
  • for back and neck pain, it might help but not better than other conservative therapies,
  • in about half of all patients, it leads to mild to moderate adverse effects that typically last 2-3 days and are severe enough to interfere with the patient’s quality of life,
  • in an unknown number of patients, it might lead to severe complications, including stroke and death,
  • there are other options for your problem that are more effective and/or less harmful.

The chiropractor then has to document the patient’s consent. Only then can he start treatments.

My question to the GCC is: have you tested how many patients would consent under these conditions?

I suspect the answer is No.

And my questions to UK chiropractors is: who is actually following these guidelines?

I suspect the answer is VERY FEW. If that were true, most chiropractors would violate their own ethical guidelines and could therefore be struck of the GCC’s register. Or did I get this wrong?

The current issues of ‘homeopathy 4 everyone’ (April 2016) carries several articles on homeoprophylaxis, the use of homeopathic remedies for the prevention of mostly infectious diseases promoted by homeopathy as a safe and effective alternative to immunizations. They are worth reading – but watch your blood pressure! Here I will give you a flavour by citing from one of these articles:

“…As I have been teaching about Homeoprophylaxis (“HP”) throughout the United States and in Europe, some things have become unmistakably clear.  One is the ever increasing desire of people to know that there is a nontoxic alternative when it comes to disease prevention.  Another is a profound misunderstanding or, perhaps better said, a lack of education among many regarding HP…

The effectiveness of HP is being shown fairly consistently to be about 90%1, which is comparable to any vaccine.  With this in mind, too, those who utilize homeoprophylaxis work to help their clients understand fundamentally that disease is generally not to be feared—that disease-causing pathogens are a necessary part of our environment and that the body generally becomes healthier once it has been exposed to a disease and has worked its way through it…

My passion regarding spreading the word and helping people learn about homeoprophylaxis led to my becoming the co-founder/director of the first international conference of its type in the world—Homeoprophylaxis: A Worldwide Choice, which took place in Dallas, Texas, USA in October, 2015.  Isaac Golden was our keynote speaker…

Frequently seen is the protocol Isaac Golden utilizes. This is a once monthly method, where one single remedy/nosode is introduced at potency.  If following, for example, a pediatric regimen that lists several nosodes, it will be the next month that either a larger dose of that same nosode is taken, or the next nosode is introduced.  For pediatric HP, this is cycled through until all nosodes in the protocol are taken, the higher potency being started after the lower potency is completed. A booklet is provided to the clientele to keep track of these…

Ultimately, homeoprophylaxis has been in use since the days of Hahnemann.  What is apparent when one considers the entire picture, noting the meticulous studies that have been and are yet being done as well as the current increasing demand of people worldwide— perhaps especially parents— for a nontoxic alternative for disease prevention, it truly makes sense to be promoting  homeoprophylaxis.  Our children are the most vulnerable in our society and deserve our utmost attention and concern.  Not every practitioner needs to utilize HP.  However, because there are many who do, support of this should be encouraged.  It is an alternative people deserve to know about so that they can make an educated choice, and health for our society, especially our children, can be promoted.”

END OF QUOTE

By now, you are probably wondering who wrote this article. It was Cathy Lemmon, BA, C.HP, D.Psc,  Co-Founder/Director of Homeoprophylaxis: A Worldwide Choice for Disease Prevention, she is also working on future conferences for the promotion of HP. She has studied HP with Isaac Golden of Australia and Ravi Roy and Carola Lage-Roy of Germany. She also has certificates in homeopathic treatment of vaccine injury as well as, through the ARHF in the Netherlands, treatment of epidemics and trauma. She completed studies at the School of Homeopathy and is completing specialized homeopathic studies through Gesundes Bewußtsein in Germany as well as post-graduate work in homeopathy through the College of Practical Homeopathy in London.

With all these ‘qualifications’, she has obviously escaped any education in real science and evidence-based medicine; if not she would know that her views are not just wrong but also dangerous. To Be clear:

  • Homeoprophylaxis is not biologically plausible.
  • There is no evidence that it works.
  • The concept misleads people to think that conventional immunizations are superfluous.
  • This has the potential to kill thousands.

Osteopathy is a confusing subject about which I have reported regularly on this blog (for instance here and here).

Recently, I came across a good article where someone had assessed 100 websites by UK osteopaths. The findings are impressive:

57% of websites in the survey published the ‘self-healing’ claim

70% publicised the fact they offered cranial therapy;

61% made a claim to treat one or more specific ailments not related to the musculoskeletal system;

48% of practitioners also personally offered another CAM therapy;

71% of all sites surveyed located in a setting where other CAM was immediately available.

In total, 93% of the randomly selected websites checked at least one, often more, of the criteria for pseudoscientific claims. The author concluded that quackery is far from existing only on the fringe of osteopathic practice.

In a previous article, the author had stated that “there’s some (not strong) evidence that manual therapy may have some benefit in the case of lower back pain.” This evidence for the assumption that osteopathy works for back pain seems to rely heavily on one researcher: Licciardone JC. He comes from ‘The Osteopathic Research Center, University of North Texas Health Science Center, Fort Worth‘. which also is the flag-ship of research into osteopathy with plenty of funds and a worldwide reputation.

In 2005, he and his team published a systematic review/meta-analysis of RCTs which concluded that “osteopathic manipulative therapy (OMT) significantly reduces low back pain. The level of pain reduction is greater than expected from placebo effects alone and persists for at least three months. Additional research is warranted to elucidate mechanistically how OMT exerts its effects, to determine if OMT benefits are long lasting, and to assess the cost-effectiveness of OMT as a complementary treatment for low back pain.”

This is the article cited regularly to support the statement that osteopathy is an effective therapy for back pain. As the paper is now over 10 years old, we clearly need a more up-to-date systematic review. Such an assessment of clinical research into osteopathic intervention for chronic non-specific low back pain (CNSLBP) was recently published by an Australian team. A thorough search of the literature in multiple electronic databases was undertaken, and all articles were included that reported clinical trials; had adult participants; tested the effectiveness and/or efficacy of osteopathic manual therapies applied by osteopaths, and had a study condition of CNSLBP. The quality of the trials was assessed using the Cochrane criteria. Initial searches located 809 papers, 772 of which were excluded on the basis of abstract alone. The remaining 37 papers were subjected to a detailed analysis of the full text, which resulted in 35 further articles being excluded. There were thus only two studies assessing the effectiveness of manual therapies applied by osteopaths in adult patients with CNSLBP. The results of one trial suggested that the osteopathic intervention was similar in effect to a sham intervention, and the other implies equivalence of effect between osteopathic intervention, exercise and physiotherapy.

In other words, there seems to be an overt contradiction between the conclusions of Licciardone JC and those of the Australian team. Why? we may well ask. Perhaps the Osteopathic Research Center is not in the best position to be impartial? In order to check them out, I decided to have a closer look at their publications.

This team has published around 80 articles mostly in very low-impact osteopathic journals. They include several RCTs, and I decided to extract the conclusions of the last 10 papers reporting RCTs. Here they are:

RCT No 1 (2016)

Subgrouping according to baseline levels of chronic LBP intensity and back-specific functioning appears to be a simple strategy for identifying sizeable numbers of patients who achieve substantial improvement with OMT and may thereby be less likely to use more costly and invasive interventions.

RCT No 2 (2016)

The OMT regimen was associated with significant and clinically relevant measures for recovery from chronic LBP. A trial of OMT may be useful before progressing to other more costly or invasive interventions in the medical management of patients with chronic LBP.

RCT No 3 (2014)

Overall, 49 (52%) patients in the OMT group attained or maintained a clinical response at week 12 vs. 23 (25%) patients in the sham OMT group (RR, 2.04; 95% CI, 1.36-3.05). The large effect size for short-term efficacy of OMT was driven by stable responders who did not relapse.

RCT No 4 (2014)

These findings suggest that remission of psoas syndrome may be an important and previously unrecognized mechanism explaining clinical improvement in patients with chronic LBP following OMT.

RCT No 5 (2013)

The large effect size for OMT in providing substantial pain reduction in patients with chronic LBP of high severity was associated with clinically important improvement in back-specific functioning. Thus, OMT may be an attractive option in such patients before proceeding to more invasive and costly treatments.

RCT No 6 (2013)

The OMT regimen met or exceeded the Cochrane Back Review Group criterion for a medium effect size in relieving chronic low back pain. It was safe, parsimonious, and well accepted by patients.

RCT No 7 (2012)

This study found associations between IL-1β and IL-6 concentrations and the number of key osteopathic lesions and between IL-6 and LBP severity at baseline. However, only TNF-α concentration changed significantly after 12 weeks in response to OMT. These discordant findings indicate that additional research is needed to elucidate the underlying mechanisms of action of OMT in patients with nonspecific chronic LBP.

RCT No 8 (2010)

Osteopathic manipulative treatment slows or halts the deterioration of back-specific functioning during the third trimester of pregnancy.

RCT No 8 (2004)

The OMT protocol used does not appear to be efficacious in this hospital rehabilitation population.

RCT No 9 (2003)

Osteopathic manipulative treatment and sham manipulation both appear to provide some benefits when used in addition to usual care for the treatment of chronic nonspecific low back pain. It remains unclear whether the benefits of osteopathic manipulative treatment can be attributed to the manipulative techniques themselves or whether they are related to other aspects of osteopathic manipulative treatment, such as range of motion activities or time spent interacting with patients, which may represent placebo effects.

RCT No 10

Sorry, there is no 10th paper reporting an RCT.

Most of the remaining articles listed on Medline are comments and opinion papers. Crucially, it would be erroneous to assume that they conducted a total of 9 RCTs. Several of the above cited articles refer to the same RCT.

However, the most remarkable feature, in my view, is that the conclusions are almost invariably positive. Whenever I find a research team that manages to publish almost nothing but positive findings on one subject which most other experts are sceptical about, my alarm-bells start ringing.

In a previous blog, I have explained this in greater detail. Suffice to say that, according to my theory, the trustworthiness of the ‘Osteopathic Research Center’ is nothing to write home about.

What, I wonder, does that tell us about the reliability of the claim that osteopathy is effective for back pain?

Many cancer patients use some form of alternative therapy. Most of them combine it with conventional oncological treatments which begs the important question whether the two can interact.

The aim of this new investigation was firstly to assess prevalence of interactions between alternative medicines (AMs) and drugs for comorbidities from a large survey on melanoma patients and secondly to classify herb-drug interactions with regard to their potential to harm. Consecutive melanoma outpatients of seven skin cancer centers in Germany were asked to complete a standardized questionnaire including questions about their AM-use and their taken medication for comorbidities and cancer. Each combination of conventional drugs and AMs was evaluated for their potential of interaction.

1089 questionnaires were eligible for evaluation. From these, 61.6 % of patients reported taking drugs regularly from which 34.4 % used biological-based AMs. Risk evaluation for interaction was possible for 180 AM users who listed the names or substances they took for comorbidities. From those patients, we found 37.2 % at risk of interaction of their co-consumption of conventional drugs and AMs. Almost all patients using Chinese herbs were at risk (88.6 %).

The authors concluded that with a high rate of AM usage at risk of interactions between AMs and drugs taken for comorbidities, implementation of a regular assessment of AM usage and drugs for comorbidities is mandatory in cancer care.

On this blog, I have mentioned this problem repeatedly. For instance, I reported about a survey of 1,500 members of the German non-medically trained practitioner (NMP) associations. Its results showed that the treatments employed by NMPs were heterogeneous. Homeopathy was used by 45% of the NMPs, and 10% believed it to be a treatment directly against cancer. Herbal therapy, vitamins, orthomolecular medicine, ordinal therapy, mistletoe preparations, acupuncture, and cancer diets were used by more than 10% of the NMPs. None of the treatments were discussed with the respective physician on a regular basis. The authors concluded from these findings that many therapies provided by NMPs are biologically based and therefore may interfere with conventional cancer therapy. Thus, patients are at risk of interactions, especially as most NMPs do not adjust their therapies to those of the oncologist. Moreover, risks may arise from these CAM methods as NMPs partly believe them to be useful anticancer treatments. This may lead to the delay or even omission of effective therapies.

One problem regarding herb-drug interactions is that we currently have to rely more on speculations than on facts. The only exception is the issue of interactions with St John’s Wort (SJW). Some time ago, I reported on this blog about a study assessing how often SJW is prescribed with medications that interact dangerously with it. The researchers conducted a retrospective analysis of nationally representative data from the National Ambulatory Medical Care Survey. Twenty-eight percent of SJW visits involved a drug that has a potentially dangerous interaction with SJW. These included selective serotonin reuptake inhibitors, benzodiazepines, warfarin, statins, verapamil, digoxin, and oral contraceptives. The authors concluded that SJW is frequently used in potentially dangerous combinations. Physicians should be aware of these common interactions and warn patients appropriately.

My conclusion at the time is as true and important today: physicians ought to know about the potential of herbal remedies to interact with drugs but, considering the frequency of self-prescription of such treatments, raising  consumers’ awareness of the risks associated with herbal medicines is at least as important.

The madness of some homeopaths who claim they can cure cancer has irritated me and others repeatedly, for instance here and here. Many apologists of homeopathy say that responsible homeopaths would never make such a claim. They may be right – but the sad reality is than there are far too many irresponsible homeopaths.

This article by Dr Pankaj Aggarwal, a ‘senior homeopathic physician’, marks in my view a new record in homeopathic ineptitude and irresponsibility. Here is an excerpt (it seems that the actual article has disappeared; luckily I saved it before):

“In homeopathy, non-toxic medicines are used to treat this cancer. There are no side-effects associated with homeo medicines for cervical cancer. If this problem is diagnosed at earlier stages, it becomes easier to treat and takes very less time. In advanced stages, more time is required to improve the situation. It is actually possible to treat cancer with homeopathic medicines. In fact, homeopathy is the only treatment method that can completely cure this disease. There are different approaches to treat this disease in homeopathy. Good homeo practitioners usually use a combination of these approaches while treating a cancer patient.

Treatment Approach 1

The first philosophy to treat cancer is to directly target the cancer tumors. In this way, the practitioner selects the proper medicines that match the symptom picture of tumors. An example of such medicine is Conium Maculatum, which can be used to treat immovable, hard and slowly developing tumors. In this approach, other symptoms of patient are also taken into consideration and are treated. This approach targets tumors and reverses their growth to the point where they no more exist or become harmless.

Treatment Approach 2

The second or indirect approach is to strengthen the cell detoxification process and eliminative channels of patients like liver, lymphatic system, urinary tract and kidneys. From this approach, the homeopathy practitioner uses low potency drainage remedies that detoxify particular substances like heavy metals or target particular body systems. The particular medicines used for this drainage is selected after thorough analysis of the particular cancer case.

Treatment Approach 3

In this approach, a complete interview of the patient’s emotional, physical, and mental symptoms is conducted. After that, best matching remedies are selected to address the complete constitution of the patient. Most of the times these homeopathy medicines will affect and target the cancer tumors directly. This treatment, if done properly, can result in complete removal of cancer tumors, resulting in full recovery.”

END OF QUOTE

The facts about homeopathy are very clear and tell a totally different story:

  • the assumptions that underpin homeopathy are implausible,
  • homeopathic remedies usually are far too dilute to have any effects whatsoever,
  • there is no evidence to support any of the above claims,
  • believing such claims will almost inevitably cause great harm to patients.

What follows is simple: HOMEOPATHS WHO MAKE THERAPEUTIC CLAIMS BEHAVE UNETHICALLY, ARGUABLY EVEN CRIMINALLY

For many years, I have been impressed with the high quality and originality of chiropractic research. Here is the abstract of a particularly remarkable, new investigation.

The purpose of this study was to compare characteristics, likelihood to use, and actual use of chiropractic care for US survey respondents with positive and negative perceptions of doctors of chiropractic (DCs) and chiropractic care.

From a 2015 nationally representative survey of 5422 adults (response rate, 29%), we used respondents’ answers to identify those with positive and negative perceptions of DCs or chiropractic care. We used the χ2 test to compare other survey responses for these groups.

Positive perceptions of DCs were more common than those for chiropractic care, whereas negative perceptions of chiropractic care were more common than those for DCs. Respondents with negative perceptions of DCs or chiropractic care were less likely to know whether chiropractic care was covered by their insurance, more likely to want to see a medical doctor first if they were experiencing neck or back pain, less likely to indicate that they would see a DC for neck or back pain, and less likely to have ever seen a DC as a patient, particularly in the recent past. Positive perceptions of chiropractic care and negative perceptions of DCs appear to have greater influence on DC utilization rates than their converses.

CONCLUSION:

We found that US adults generally perceive DCs in a positive manner but that a relatively high proportion has negative perceptions of chiropractic care, particularly the costs and number of visits required by such care. Characteristics of respondents with positive and negative perceptions were similar, but those with positive perceptions were more likely to plan to use-and to have already received-chiropractic care.

END OF ABSTRACT

I bet you are dying to learn who the authors of this impressive article are. Here is the full list and their affiliations:
Weeks WB1, Goertz CM2, Meeker WC3, Marchiori DM4.

  • 1Chair, Clinical and Health Services Research Program, Palmer Center for Chiropractic Research, Davenport, IA; Professor, The Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH. Electronic address: wbw@dartmouth.edu.
  • 2Vice Chancellor, Research and Health Policy, Palmer College of Chiropractic, Palmer Center for Chiropractic Research, Davenport, IA.
  • 3President, Palmer College of Chiropractic West Campus, San Jose, CA.
  • 4Chancellor, Palmer College of Chiropractic, Davenport, Iowa.

 

Not just inexperienced novices then! The authors belong to the crème de la crème of the chiropractic establishment and research!!!

In comparison, I feel like a mere beginner. But let me nevertheless try to design my own study along similar lines. It is so brilliant that I might even get the Nobel Prize for it. Here we go:

The purpose of my study would be to compare characteristics, likelihood to use, and actual use of spectacles for survey respondents with positive and negative perceptions of spectacles and opticians***. From a nationally representative survey of about 5000 adults, I would use the respondents’ answers to identify those with positive and negative perceptions of spectacles and opticians. My results would show that positive perceptions of opticians are more common than those for spectacles, whereas negative perceptions of spectacles are more common than those for opticians. Respondents with negative perceptions of opticians or spectacles were less likely to know whether spectacles were covered by their insurance, more likely to want to see a medical doctor first, if they were experiencing poor eye-sight, less likely to indicate that they would see an optician for poor eye-sight, and less likely to have ever seen an optician as a patient, particularly in the recent past. Positive perceptions of spectacles and negative perceptions of opticians appear to have greater influence on optician utilization rates than their converses. From these data, I would conclude that my sample generally perceive opticians in a positive manner but that a relatively high proportion has negative perceptions of spectacles, particularly the costs and number of visits required for getting them. Characteristics of respondents with positive and negative perceptions were similar, but those with positive perceptions were more likely to plan to use – and to have already received – care from opticians.

*** instead of opticians and spectacles, I might also opt for other things like

  • acupuncturists and needles,
  • aroma-therapists and essential oils,
  • herbalists and herbs,
  • fast food restaurants and hamburgers,
  • politicians and politics,
  • priests and religion,
  • etc., etc.

YOU MUST AGREE, THIS DESERVES A NOBEL PRIZE!

I thank the authors of the above paper for having inspired me with their ground-breaking science. In case they receive a Nobel Prize before I do, I congratulate them on their extraordinary achievement in designing, conducting and publishing this truly cutting-edge investigation.

I just came across this article which I find remarkable in several ways. Here is the abstract:

OBJECTIVE:
The purpose of this report is to describe 2 patients with coronary artery disease presenting with musculoskeletal symptoms to a chiropractic clinic.
CLINICAL FEATURES:
A 48-year-old male new patient had thoracic spine pain aggravated by physical exertion. A 61-year-old man under routine care for low back pain experienced a secondary complaint of acute chest pain during a reevaluation.
INTERVENTION AND OUTCOME:
In both cases, the patients were strongly encouraged to consult their medical physician and were subsequently diagnosed with coronary artery disease. Following their diagnoses, each patient underwent surgical angioplasty procedures with stenting.
CONCLUSION:
Patients may present for chiropractic care with what appears to be musculoskeletal chest pain when the pain may be generating from coronary artery disease necessitating medical and possibly emergency care.

I FIND THIS REMARKABLE FOR AT LEAST 3 REASONS:

  1. I don’t remember coming across the term ‘medical physician’ before. It is clear what the author meant by it. But it is also quite clear that such phraseology is nonsensical. My Oxford Dictionary defines ‘physician’ as: “A person qualified to practise medicine, especially one who specializes in diagnosis and medical treatment as distinct from surgery.” Therefore, a ‘medical physician’ would be ‘a medical person qualified to practise medicine.’ This begs the question why this term is used in a chiro-journal. The answer is probably quite simple: they want to arrive at a point where we all accept that there are two types of physicians: medical and chiropractic. But, using again my dictionary, this would be not just a little confusing. A chiropractic physician would be ‘a chiropractor qualified to practice medicine.’ And for that you need to go not to chiro-college but to medical school.
  2. The two case reports are remarkable in themselves, I find. They show that “patients may present for chiropractic care with what appears to be musculoskeletal chest pain when the pain may be generating from coronary artery disease necessitating medical and possibly emergency care.” The remarkable thing about this is that such basic knowledge ever merited a mention and publication in a journal. It should be clear to anyone who is in healthcare! I even know shop assistants who have called an ambulance because a customer suffered from what might have been misdiagnosed as a muscular problem in the left arm but was in truth due to coronary hear disease. The fact that chiros and editors of their journals feel that it worthy of publication seems a bit worrying and begs the question: how many other elementary things about the human body (known even to shop assistants) are unknown to the average chiro?
  3. Lastly, I must praise the chiro-profession for the progress they now seem to start making. About 120 years ago, DD Palmer, the founding father of chiropractic, famously treated a man with coronary heart disease by adjusting his spine. The author of the above article did not do that! Yes, progress was painfully slow, but the above article seems to indicate that at least some chiros have come around to agreeing with real physicians that the Palmer-gospel is based on little more than wishful thinking.

This is the conclusion Britt Hermes draws in her new blog post about US naturopaths claiming to be competent to treat children.

Britt is a most remarkable and courageous woman. She clearly knows what she is talking about: “My experience puts me in a unique position to show what naturopathic training looks like from the inside and why, especially for children, naturopathic care is dangerous. I support this point with a critical review of pediatrics syllabi from Bastyr University (Seattle, WA) and Southwest College of Naturopathic Medicine (Phoenix, AZ) and correspondences with a number of pediatricians in the U.S. and Canada.

At Bastyr, I took pediatrics 1 and 2 (NM 7314 and 7315) and an additional elective course in “advanced pediatrics” (NM 9316) from 2010-2011. I also opted to take the elective pediatrics clinical shift at Bastyr’s outpatient teaching clinic. Only pediatrics 1 and 2 were required for graduation. Each class met for 2 hours per week for 10 weeks, not including the 11th week for a final exam. By taking the advanced course, I received a total of 60 hours, but remember, only 40 hours was required. (In the year after I graduated from Bastyr, the curriculum changed to a systems-based program, which folded pediatric instruction into courses linked by medical theme.)…

Here’s the bottom line: a pediatrician gets a combined 20,000 hours of training in medical school and residency; a licensed naturopath has the option of doing a naturopathic residency for 1,300 hours after having done 30 to 40 hours of lecture hours in paediatrics…”

If you think that is bad… it gets worse:

A serious concern with this course syllabus is the book list. Current and Nelson’s Pediatrics are considered standard texts, but these were not even required to read in order to do well in the course. I didn’t buy either book and didn’t complete any of the assigned readings but passed with flying colors.

It should be appalling for anyone to see Dana Ullman’s Homeopathy for Children and Infants and Dr. Bob Sears’s The Vaccine Book, not once, but twice in the list! All of my syllabi for the Bastyr pediatrics courses include these texts. The syllabus for pediatrics at SCNM does not, but its instructor is a known promoter of vaccine myths

Naturopathic students are essentially trained in alternative vaccines schedules, perhaps leading them not to vaccinate. If this isn’t smoking gun proof that naturopaths are anti-vaccine to the core, then what is?”

Britt’s final conclusion is that “Naturopathic programs do not provide their students with medical training that should instil public confidence. Yet, naturopaths argue that they deserve licensure based on the quality of their training and practice.”

I agree completely with Britt’s view and encourage everyone to read her article in full.

‘Homeopaths without Borders’ have been the subject of this blog before. I repeat what David Shaw, senior research fellow, Institute for Biomedical Ethics, University of Basel, Switzerland, wrote about this organisation in a BMJ-article: Despite Homeopaths Without Borders’ claims to the contrary, “homeopathic humanitarian help” is a contradiction in terms. Although providing food, water, and solace to people in areas affected by wars and natural disasters certainly constitutes valuable humanitarian work, any homeopathic treatment deceives patients into thinking they are receiving real treatment when they are not. Furthermore, training local people as homeopaths in affected areas amounts to exploiting vulnerable people to increase the reach of homeopathy. Much as an opportunistic infection can take hold when a person’s immune system is weakened, so Homeopaths Without Borders strikes when a country is weakened by a disaster. However, infections are expunged once the immune system recovers but Homeopaths Without Borders’ methods ensure that homeopathy persists in these countries long after the initial catastrophe has passed. Homeopathy is neither helpful nor humanitarian, and to claim otherwise to the victims of disasters amounts to exploitation of those in need of genuine aid.

Now ‘Homeopathy without Borders’ seem to promote the idea – or should I say madness? – that homeopathy offers a cure for the Zika virus infection. Given their track record this was to be expected. Whenever the world is facing a serious medical problem, homeopaths are at the ready to help. Only that they don’t really help; they make false promises and distract from the task of solving the problem. Need I to remind you of the disaster they almost caused when they set out to treat Ebola?

Tragically, ‘Homeopaths without Borders’ are not alone. Other homeopaths seem to agree with them and promote the madness of a homeopathic cure fro Zika. For instance, Dr Vikas Sharma, a homeopath from India, informs us that “Homeopathic medicines Eupatorium Perfoliatum, Belladonna, Rhus Tox can be safely used in Zika virus infection treatment. These medicines come the closest in treating the symptoms of Zika virus infection. In an epidemics when a huge number of person are attacked by acute and similar sufferings from similar cause, Homeopathy can be of great prophylactic help. Homeopathy has been highly successful in treating epidemic diseases. Among them are cholera, dengue fever, yellow fever typhus, and conjunctivitis. “

Confronted with stupidity on such a scale, I am lost for words. Luckily, David Shaw already said it all: Homeopathy is neither helpful nor humanitarian, and to claim otherwise to the victims of disasters amounts to exploitation of those in need of genuine aid.

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