Updated Edition!
This open-label, randomized, controlled trial was aimed to assess the effectiveness and safety of Vuong Hoat (VH) natural health supplement for reducing the negative impact of low back pain, improving the quality of life, and enhancing functional activities in patients with lumbar degenerative disc disease (LDD).
The study involved 60 patients suffering from low back pain caused by LDD. The participants were randomly assigned to:
- a study group (SG) comprising 30 subjects who received VH in conjunction with the same electro-acupuncture,
- a control group (CG) comprising 30 subjects who received treatment with electro-acupuncture.
These treatments lasted for 28 days.
The clinical progression and tolerability of both groups were compared based on seven objective measurements:
- visual analog scale index,
- Schober test,
- fingertip-to-floor distance,
- spinal flexion,
- spinal extension,
- spinal tilt,
- spinal rotation.
Already after 14 days of treatment, the SG showed a significant improvement in overall outcomes compared to the CG. Specifically, 43.3% of SG patients achieved very good results, 53.3% had good results, and 3.4% had moderate results, whereas corresponding figures for the CG were 6.7%, 76.7%, and 16.6%, respectively (P < .05).
After 28 days of treatment, both groups demonstrated a shift toward very good results, with the SG continuing to show better outcomes than the CG (P < .05). In the SG, the very good results increased to 76.7%, good results decreased to 20%, and moderate results were 3.3%. On the other hand, the CG had 46.7% very good results, 43.3% good results, and 10% moderate results. Notably, no side effects were reported from the VH treatments during the study.
The authors concluded that their findings of this study indicate that VH health supplement is a safe and effective approach for managing low back pain and limited spinal movement in patients with LDD.
I have several concerns and questions, some are trivial others are not:
- What does VH contain? I have no free access to the actual paper but even the abstract should mention this information.
- How do the investigators know that low back pain was caused by LDD? Lots of people have LDD without pain and vice versa.
- The A+B vs B design is known to produce false positive results due to its failure to control for placebo effects; why not use a placebo (which would have been very easy in this case)?
- Contrary to the authors statement, the outcome measures are NOT objective.
- It seems highly implausible that no side effects of VH occurred. Even placebos cause side-effects in ~6% of all cases.
- Conclusions about safety are NEVER warranted based on just 30 patients.
- Why does an allegedly respectable journal publish such rubbish?
Chronic back pain is a prevalent and debilitating condition, significantly impacting quality of life and functional independence. While conventional interventions, including physical therapy and pharmacological treatments, are commonly utilized, complementary practices like yoga are increasingly explored for their potential benefits in pain management and functional improvement.
This scoping review aimed to assess the existing evidence on the effectiveness of yoga compared to conventional interventions in reducing pain and back-related disability in older adults, highlighting key findings and identifying gaps for future research. The review followed the Arksey and O’Malley scoping review framework, systematically searching databases including PubMed, Scopus, and Web of Science. Studies were included if they:
- (1) involved older adults (aged 60 and above),
- (2) compared yoga with conventional back pain interventions,
- (3) measured outcomes related to pain intensity and back-related disability,
- (4) were published in peer reviewed journals.
A thematic analysis was performed to identify common findings, trends, and research gaps in the literature.
Twenty-four studies met the inclusion criteria, including randomized controlled trials, cohort studies, and observational research. Findings generally support the efficacy of yoga in reducing pain and disability among older adults, with many studies demonstrating comparable or superior results to conventional physical therapy interventions. Yoga was associated with additional benefits in psychological well-being, flexibility, and balance, which were less frequently addressed by conventional treatments. However, the studies varied in intervention types, duration, and measurement tools, limiting cross-study comparisons. Few studies examined long-term outcomes, highlighting a need for further longitudinal research.
The authors concluded that this evidence suggests that yoga is a viable alternative or adjunct to conventional back pain interventions in older adults, offering potential benefits for pain reduction, functional mobility, and quality of life. Despite these promising findings, the heterogeneity of studies and lack of long-term data indicate a need for further high-quality research to establish standardized protocols and evaluate sustained effects. Future studies should focus on randomized controlled designs with consistent measures to better inform clinical guidelines on integrating yoga into back pain management for older adults.
“Yoga is a viable alternative or adjunct to conventional back pain interventions”?
Really?
Based on what precisely?
We cannot know, because the paper does not even reference the primary studies. Nor does it provide essential details about them. Nor does it reveal what the ‘conventional interventions’ were. Nor does it address the problem of bias or methodological quality of the primary studies.
What we do know is that some (but not how many) uncontrolled studies were included. This means that the evidence is likely to be flimsy indeed.
It is, of course, possible that some form of yoga is an effective therapy for back pain but the above paper does not come anywhere near proving this hypothesis. Personally, I suspect that most treatments that include an element of exercise might be marginally helpful, but somehow doubt that one is dramatically better than the next.
The Internet is increasingly used as a primary source of information for patients. Many private physiotherapy practices provide informative content on low back pain (LBP) and neck pain (NP) on their websites, but the extent to which this information is biopsychosocial, guidelines-consistent, and fear-inducing is unknown. The aim of this study was to analyse the information on websites of private physiotherapy practices in the Netherlands about LBP and NP regarding consistency with the guidelines and the biopsychosocial model and to explore the use of fear-inducing language.
The content of all existing Dutch private physiotherapy practice websites was examined in a cross sectional study design. Content analysis was based on predetermined criteria of the biopsychosocial model and evidence-based guidelines. Descriptive statistics were applied.
After removing duplicates and sites without information, 834 (10%) of 8707 websites remained. Information about LBP was found on 449 (54%) websites and 295 (35%) websites informed about NP. A majority of websites (LBP: n = 287, 64%; NP: n = 174, 59%) were biomedically oriented. Treatment advice was given 1855 times on n = 560 (67%) websites. Most of the recommended interventions were inconsistent with or not mentioned in the guidelines. Fear-inducing language was provided n = 1624 (69%) times.
The interventions that were inconsistent with the guidelines included several so-called alternative medicine (SCAM) options, including:
- dry needling (for LBP),
- medical tape (for LBP),
- trigger point therapy (for LBP),
- dry needling (for NP),
- trigger point therapy (for NP).
The authors concluded that their study shows that most Dutch private physiotherapy practice website are not a reliable source of information for patients with LPB and NP. The Dutch physiotherapy community needs to take action to comprehensively review and update the information on their websites to align with high‐quality best practice recommendations and guidelines for LBP and NP. It is important to strive for better information for patients to reduce fear, to support them in making better recovery choices, to achieve less disability, and to improve their quality of life.
To be honest, I would never have expected Dutch private physiotherapy practice website to be a reliable source of information for patients with LPB and NP. In general, private websites from healthcare practitioners are not reliable sources for anything, as we have so often seen on this blog. They are promotional by nature and have the purpose of boosting business.
I fear that the only thing positive I can say about the private physiotherapy practice websites is that they are not nearly as bad as those of:
- acupuncturists,
- aromatherapists,
- chiropractors,
- energy healers,
- herbalists,
- homeopaths,
- naturopaths,
- osteopath,
- reflexologists,
- etc, etc.
(If you need evidence for these bold statements, please look through the last 3 000 posts of this blog.)
As misinformation can cause untold harm, we need to ask: what is the solution to this problem? I think it’s disarmingly simple: for health-related information, stay away from websites that are evidently promotional by nature!
This blog is now almost 13 years old. In well over 3 000 (!) posts, I have been trying to alert consumers to the things that are wrong with much of so-called alternative medicine (SCAM). In this new series of posts entitled ‘WHAT HAPPENED NEXT? …’ I intend to re-visit some of my early posts and ask: WHAT HAPPENED NEXT?
This might show us
- what has changed,
- what has remained the same
- and what needs to change.
Here we go:
In my blog post of 17/12/2012 about Craniosacral Therapy (CST) I concluded that:
1) ineffective therapies, such as CST, may seem harmless but, through their ineffectiveness, they constitute a serious threat to our health;
2) bogus treatments become bogus through the false claims which are being made for them;
3) seriously flawed studies can be worse than none at all: they generate false positive results and send us straight up the garden path.
Almost 13 years after writing this, I fear that the notion ‘SCAM MAY BE INEFFECTIVE BUT IT CANNOT DO ANY HARM!’ is still as popular as it was before. Equally, the dismal quality of research into SCAM is still a problem. And, of course, CST is still around with unsupported, often dangerous claims.
So, has anything changed at all?
I am not sure.
If nothing much has changed, what does that mean for me, my motivation and this blog?
When I started my blog I already had ~20 years experience in full-time SCAM research. If that experience had taught me anything at all, it was not to expect too much. SCAM is a most resistant phenomenon. I don’t see my blog as an instrument for abolishing SCAM (an outright impossibility, in my view). I prefer to think of it as a means of damage limitation.
Having said all this, I must admit that the often dismal quality of research and the tolerance of pseudoscience by journal editors and consumers do disappoint me. But my conclusion is not to give up and resign but to work a bit harder trying my best to prevent harm!
Removing the chest tube in cardiac patients after surgery is one of the worst experiences of hospitalization in the intensive care units. Various pharmacological and non-pharmacological methods are available to control pain in these patients. This study aimed to investigate the combined effect of reflexology massage and respiratory relaxation on pain following chest tube removal in cardiac surgery patients of Shahid Beheshti Hospital in Shiraz, Iran, in 2023.
The study was a double-blind randomized clinical trial performed on 140 patients who underwent heart surgery and had a chest tube in Shiraz, Iran. The samples were randomly divided into four groups:
1- control group,
2- respiratory relaxation group,
3- foot reflex massage group,
4- a combination of respiratory relaxation and reflexology massage.
To collect data, two demographic questionnaires, and a visual analog scale were used.
The participants of the 4 groups were not meaningfully different in terms of age, BMI, duration of surgical operation, gender, job, education, place of residency, number of chest tubes, history of operation (P = 0.99, 0.31, 0.06, 0.81, 0.97, 0.96, 0.17, 0.10, 0.89 respectively).
The mean scores of pain intensity during chest tube removal, and 15 min after chest tube removal were not statistically different among the 4 groups. However, just after chest tube removal, the mean scores of pain intensity differed meaningfully among four groups (P = 0.008).
The authors concluded that the results showed that reflexology massage and respiratory relaxation both reduce pain immediately after chest tube removal in heart surgery patients. Also, the combination of these two techniques was more effective in reducing patients’ average pain.
Double blind?
Really?
How did they do that?
Here is their description:
“For the blinding purpose of the study, a nurse who worked at the ICU had to record the pain intensity and the data, so the possible researcher bias did not impact the results. Also, the patients knew the concept of the study but did not know that there were whether in single relaxation groups or mixed methods groups and did not know that other patients had different methods used for them. Also, the pain intensity data for the control group was routinely checked by the nurses, and along with the fact that they had no information that some of the patients were in the intervention groups and received complementary and alternative therapies, therefore, their data were also considered blinded. Therefore, the study could have their initial aim to use the double-blinded design.”
Double blind usually means that the therapist and the patient were masked as to the group alloca. Blinding the nurse is fine, but the therapists were not blind and could therefore have influenced the patients via verbal and non-verbal communications.
According to the authors, patients did not know whether they were “in single relaxation groups or mixed methods groups”. I think that cannot be true. Even if it were, what about the control group? Surely every patient knows whether or not he/she receives a reflexology massage!
It follows, I think, that the study was NOT double-blind, not even single-blind!
Does that matter?
Yes!
Firstly, I don’t want to be misled in this way.
Secondly, as blinding did not happern, the findings can be explaind by the effects of patient expectation and might therefore NOT be the result of the therapies. In other words, the conclusions drawn by the authors are not warranted.
The full title of this paper is “Role of Energy Medicine in enhancing hemoglobin levels – A case study”. Readers who thus expect to learn about the effects of ENERGY MEDICINE (a branch of so-called alternative medicine based on the belief that healers can channel “healing energy” into patients and effect positive results) might be disappointed.
The abstract reveals that the article “explores the potential benefits of Acupuncture and Energy Medicine as energy therapies in managing anemia”. If you now expect to learn something about the combination of ACUPUNCTURE and ENERGY MEDICINE, you would be mistaken.
Here is the abstract of the case report:
A 43-year-old female with severe anemia (hemoglobin 6.5 g/dL) participated in a three-month treatment plan that combined acupuncture and energy therapy. Acupuncture targets specific points to enhance Qi flow, stimulate blood production, and restore energy balance. The energy therapy plan focused on blood-nourishing foods aimed at supporting hematopoiesis.
After three months of treatment, the patient’s hemoglobin levels increased by 4.9 g/dL, reaching 11.4 g/dL. Clinical symptoms, including fatigue, dizziness, and weakness, showed marked improvement. Additionally, the patient reported better sleep, enhanced mood, and an increase in appetite, all of which contributed to an improved overall sense of well-being.
The authors concluded that the results suggest that Acupuncture and Energy Medicine can serve as effective energy therapies in managing anemia, particularly for cases that do not respond well to conventional treatments. This case study provides preliminary evidence of their potential to improve hemoglobin levels and alleviate anemia-related symptoms. However, further research is necessary to validate these findings and explore the broader application of acupuncture and energy medicine in anemia management.
The authors of this paper, who come from the ‘International Institute of Yoga and Naturopathy Medical Sciences‘, Chengalpattu, Tamilnadu, India, never bothered to explain what type of ENERGY MEDICINE they applied to their patient. As it turns out, they used no ENERGY MEDICINE at all! Here is what they disclosed about the treatments in the full paper:
The patient was treated with energy medicine and the treatment protocol includes Acupuncture, Diet therapy that was designed in such a way to improve the blood circulation, balance energy flow, and address underlying deficiencies in Qi and blood, particularly in relation to the Spleen, Liver and Kidney meridians, which are believed to play a role in blood production in Traditional Chinese Medicine.
So, we now know that the case report entitled “Role of Energy Medicine in enhancing hemoglobin levels – A case study” was, in fact, about a patient receiving ACUPUNCTURE and DIET.
Next, we might wonder what condition the patient had been suffering from (anemia is not a disease but a sign that can be caused by a range of diseases). All we learn from the paper is this:
She had been diagnosed with anemia three months prior and had been taking iron supplements without significant improvement in her hemoglobin (Hb) levels.
So, we now know that despite the title of the paper ( “Role of Energy Medicine in enhancing hemoglobin levels – A case study”), the authors used no ENERGY MEDICINE. We also know thet they did not bother to adequately diagnose the patient. But we are told that the case shows that Acupuncture and Energy Medicine can serve as effective energy therapies in managing anemia, particularly for cases that do not respond well to conventional treatments. Just to be clear: if a doctor sees a patient with a dangerously low hemoglobin and does not bother to establish the cause and treats her with acupuncture and diet, the physician is, in my view, guilty of criminal neglect.
At this point, I have to admit that I lost the will to live – well, not quite, perhaps. But I certainly have lost the will to take the ‘International Institute of Yoga and Naturopathy Medical Sciences‘, Chengalpattu, Tamilnadu, India, seriously. In fact, I seriously doubt that this institution should be allowed to educate future doctors. If they are able of doing anything useful, they could try to publish a book on:
HOW NOT TO WRITE A MEDICAL PAPER.
This study evaluated the recurrence of acute upper respiratory tract infections (aURTI) and the number of antibiotic prescriptions within 12-month follow-up in patients prescribed with either homeopathic medicines or medicines from one of four conventional medication classes for aURTI therapy.
This explorative cohort study used real-world electronic healthcare data from the Disease Analyzer database (IQVIA). Included were patients of all ages from Germany with an index diagnosis of a URTI between 2010 and 2018, who had prescriptions for either homeopathic, conventional cough & cold, nasal, or throat medicines, or nonopioid analgesics on the day of diagnosis or within six days afterwards. URTI recurrences were assessed by multivariable logistic regression, the number of antibiotic prescriptions by multivariable negative binomial regression.
From 3,628,295 patients with aURTI diagnosis initially identified in the database in the relevant time interval, a total of 610,118 patients, fulfilling the in- and not violating the exclusion criteria, were retained for analysis. In the multivariate analyses on all patients, prescriptions of nasal medicines were associated with a significant, slightly higher (OR: 1.18, CI: 1.10-1.26, p<0.001) risk of aURTI recurrence compared to homeopathic medicines within 12 months. Prescriptions of cough & cold (OR: 0.92, CI: 0.86-0.97, statistically significant, p=0.005) as well as throat medicines (OR: 0.93, CI: 0.86-1.01, p=0.086), and nonopioid analgesics (OR: 0.95, CI: 0.89-1.02, p=0.181) were associated with slightly lower risk of aURTI recurrence compared to homeopathic medicines. In the analysis of the age-dependent subgroups, there were some deviations from the overall population in terms of statistical significance; however, the directions of the effect estimates were unchanged. Almost all results of negative binomial regression analyses assessing differences in the frequency of antibiotic prescriptions during follow-up, both in all patients and in the age-dependent subgroups were statistically significant in favor of homeopathic medicines.
The authors concluded that the study demonstrated that follow-up recurrence and antibiotic prescriptions in patients with uncomplicated aURTI are at least comparable between patients treated with homeopathic and conventional medicines in real-world practice. Despite some methodological limitations inherent to the used database, the results of this study indicate that homeopathic medicines present a valuable therapeutic option for managing aURTI.
This study has a long list of fatal or near-fatal flaws:
- The patients who received homeopathic prescriptions surely differed in many ways from those who had conventional prescriptions.
- Information on medicines used without prescription were not accounted for.
- There is no way of telling who took the prescibed medicines and who did not.
- The database does not contain information on the severity or duration of the URTIs.
- The database does not contain information on socioeconomic status and lifestyle-related
risk factors such as smoking, alcohol consumption or physical activity. - URTI recurrences were not verified, and the primary outcome measure is thus not reliable.
- The observation of patients is limited to a single practice each. Patients who initially consulted a homeopaths and suffered a recurrence might have gone to consult a conventional doctor. In this case, their recurrence was not registered.
- Most patients self-prescribe medicines for URTIs; this phenomenon was not accounted for.
- The lower use of antibiotics and other conventional drugs in one group merely shows that 1) homeopaths tend to avoid these medications, 2) patients who consult homeopaths often reject conventional drugs.
So, does the study provide any useful information?
No!
Why was it conceived, conducted and published then?
The conflict of interest and funding statements give us a clue:
- NB has received a fee from Deutsche Homöopathie-Union for providing advice during preparation of the manuscript. SDJ and SN are employees of Deutsche Homöopathie-Union, TR is employee of Dr. Willmar Schwabe GmbH & Co.KG.
- The analysis of the available data from Disease Analyzer Database by IQVIA was commissioned and funded by Deutsche Homöopathie-Union (DHU-Arzneimittel GmbH & Co. KG. 76227 Karlsruhe, Germany).
So, what does all this amount to:
- A flawed study?
- Pseudoscience?
- Scientific misconduct?
- Fraud?
Please let me know.
Probiotics are live microorganisms promoted claimed to provide health benefits when consumed, generally by improving or restoring the gut microbiota. Prebiotics are compounds in food that foster growth or activity of beneficial microorganisms such as bacteria and fungi. Both are sold as dietary supplements, and there is hardly a human disease or symptom for which these supplements are not said to be effective.
One such claim is that the ingestion of prebiotics during pregnancy and lactation has immunomodulatory benefits for the developing fetal and infant immune system and provide a potential dietary strategy to reduce the risk of allergic diseases.
This study sought to determine whether maternal supplementation with dietary prebiotics reduces the risk of allergic outcomes in infants with hereditary risk.
A double-blind randomized controlled trial was conducted in which pregnant women were allocated to consume prebiotics (14.2 g daily of galacto-oligosaccharides and fructo-oligosaccharides in the ratio 9:1) or placebo (8.7 g daily of maltodextrin) powder. The treatment lasted from less than 21 weeks’ gestation until 6 months postnatal during lactation. All eligible women had infants with a first-degree relative with a history of medically diagnosed allergic disease. The primary outcome was medically diagnosed infant eczema by age 1 year, and secondary outcomes included allergen sensitization, food allergy, and recurrent wheeze by age 1 year.
A total of 652 women were randomized between June 2016 and November 2021 (329 in the prebiotics group and 323 in the placebo group). There was no significant difference between groups in the percentage of infants with medically diagnosed eczema by age 1 year (prebiotics 31.5% [103 of 327 infants] vs placebo 32.6% [105 of 322 infants]; adjusted relative risk, 0.98; 95% CI, 0.77-1.23; P = .84). Secondary outcomes and safety measures also did not significantly differ between groups.
The authors concluded that they found little evidence that maternal prebiotics supplementation during pregnancy and lactation reduces the risk of medically diagnosed infant eczema by age 1 year in infants who are at hereditary risk of allergic disease.
It is rare that we come across a well-planned, well-conducted and well-reported study of pro/prebiotics. When we do, it often casts doubts on the numerous claims made for these products.
Here we have such a study.
I congratulate the Australian authors for conducting it.
The ‘Code of Professional Practice‘ for UK chiropractors (applicaple from 1.1.2026) has just been published by the UK General Chiropractic Council (GCC). It demands in no uncertain terms numerous things from chiropractors:
- You must put the interests of patients first
- You must ensure safety and quality in clinical practice
- You must act with honesty and integrity and maintain
- You must provide a good standard of clinical care and professional practice
- You must establish and maintain clear professional
- You must obtain appropriate, valid consent from patients
- You must communicate professionally, properly and effectively
- You must foster collaborative healthcare, effective professional relationships and safe, supportive workplace practice
- You must maintain, develop and work within your professional knowledge and skills
- You must maintain and protect patient information
It seems obvious to me that many of these demands cannot possibly met. Let me just pick two examples. The code explains that, as a chiropractor, you must:
- protect patients by promoting and maintaining a culture of safety, seeking to prevent harm before it occurs.
- use the findings of the clinical assessment and the best quality of evidence that is available at the time, to propose (and record) a plan of care for the patient. You must tell the patient where your proposals are not supported by evidence of accepted quality and record your rationale and discussions.
Ad 1
Chiropractors administer spinal manipulations to well over 90% of their patients regardless of their condition or complaint. As we have often discussed on this blog, such treatments are not free of serious risks. It follows that preventing harm from patients and earning your living as a chiro is not really possible. Either you do one or you do the other; to be able to do both at the same time seems pure fantasy.
Ad 2
If chiropractors were to use the findings of the best quality of evidence that is available at the time, they would have to stop using spinal manipulation, a treatment that is, for many indications chiros use it, not supported by the best available evidence. But, as I already mentioned, spinal manipulation is the main therapy of chiros. Following the GCC’s demand is therefore an impossibility.
What is the solution?
Will the new code really disallow UK chiropractors to practice?
No! I fear that the solution is much simpler than it may look at first glance.
The GCC has in the past issued similar demands only to then do nothing to enforce them. Like past documents, the new code will turn out to be a document that changes nothing, except that it makes GCC members feel good: it allows them (and some consumers) the illusion that UK chiropractic an evidence-based, ethical and well-regulated profession.
Do you remember the case of Katie May who died “as the result of visiting a chiropractor for an adjustment, which ultimately left her with a fatal tear to an artery in her neck”?
Here is the abstract:
A 34-year-old female suffered a fatal stroke 7.5 h after cervical spine manipulation (CSM) performed by a chiropractic physician. Imaging noted vertebral artery dissection (VAD), basilar artery occlusion, and thromboembolic stroke. The medical examiner opined that CSM caused the VAD which embolized to cause the fatal stroke. However, causation of VAD by CSM is not supported by the research.
We utilized an intuitive approach to causation analysis to determine the cause of the VAD and the stroke. Causation of the VAD and the stroke by CSM could not be established as more likely than not. The malpractice case was settled by bringing allegations of misdiagnosis and failure to diagnose and refer the VAD to medical emergency.
We conclude that in the absence of convincing evidence that CSM could cause VAD, forensic professionals should consider VAD as a presenting symptom prior to CSM in such cases. Adherence to the standard of care for the chiropractic profession with attention to differential diagnosis could prevent such cases.
The author states that the objectives of this case report were to:
- Perform a forensic analysis to determine the most likely causal mechanism of the VAD.
- Perform a forensic analysis to determine the most likely causal mechanism of the stroke.
- Perform a medicolegal analysis of the standard of care with the aim of determining how this case could have been prevented, and how future such cases could be prevented.
There are, as far as I can see, at least three major problems with these objectives:
- The author is not qualified as a forensic analyst.
- He is merely a chiro (and acupuncturist) with a massive conflict of interest.
- Neither does he seem to be medically nor legally qualified for doing a medicolegal analysis (Dr. Brown received his undergraduate degree in Philosophy and History from Illinois State University in 1989. He went on to attend one semester of Law school at California Western School of Law in San Diego.)
The author even states that his information was taken from publicly available court documents. Background information was taken from publicly available investigative journalism and media coverage of this case. Any information that has not been made public is not reflected in this analysis. Images of the forensic microscopic review of the vertebral arteries were not available for review.
So, how valuable is chiro Brown’s medicolegal second opinion?
