CBC news (Canada) reported yesterday that, more than a decade ago, the Manitoba Chiropractic Health Care Commission had been tasked to review the cost effectiveness of chiropractic services. It therefore prepared a report in 2004 for the Manitoba province and the Manitoba Chiropractors Association. Since then, this report has been kept secret. The report makes 37 recommendations, including:
- Manitoba Health should limit its funding to “chiropractic treatment of acute lower back pain.”
- Manitoba Health should provide “limited coverage of the treatment of neck pain.” The report called the literature around the efficacy of chiropractic care for neck pain “ambiguous or at best weakly supportive” and noted such treatment carried a “not insignificant safety risk.”
- Manitoba Health should not fund chiropractic treatment anyone under 18 “as the literature does not unequivocally justify” the “efficacy or safety” of such treatment.
A Manitoba Ombudsman’s Office report from 2012 might shed some light on why the Manitoba Chiropractic Health Care Commission’s report was never made public. Someone had attempted to get a copy of the report, but large parts of it were redacted. “Access to this record was refused on the basis that disclosure would be harmful to a third party’s business interest,” the ombudsman report notes, “and harm the economic or financial interests or negotiating position of a public body.”
The report also challenged claims that chiropractic treatments can be address a wide variety of medical conditions. It stated that there was not enough evidence to conclude chiropractic treatments are effective in treating muscle tension, migraines, HIV, carpal tunnel syndrome, gastrointestinal problems, infertility or cancer, or as a preventive care treatment. It also said there was not enough evidence to conclude chiropractic treatments are effective for children.
The report urged Manitoba Health to establish a monitoring system to keep a closer eye on “the advertising practices of the Manitoba Chiropractors Association and its members to ensure claims regarding treatments are restricted to those for which proof of efficacy and safety exist.” It suggested the government should have regulatory powers over chiropractic ads.
A recent CBC I-Team investigation found Manitoba chiropractors advertising treatment for a wide range of conditions including Alzheimer’s, autism and pediatric services. The commission report contained sharp criticisms of previous reports that suggested funding chiropractic care could save the health-care system money. Dr. Pranlal Manga authored two widely cited reports which claim that by offering publicly funded chiropractic care, provinces can cut health-care costs. “The Manga study on Manitoba must be rejected as a guide to public policy,” the commission report states, “because its assumptions, methodology and costing of recommendations are all deeply flawed.” The reports states, “What limited evidence the Commission has suggests he [Manga] grossly exaggerates possible medical savings.” Dr. Manga did not respond to CBC’s repeated attempts to contact him.
The commission report also made recommendations around the use of X-ray machines by chiropractors. It suggested chiropractors not own and operate X-ray machines “Given the restrictive conditions under which X-rays are advisable, their poor correlation with low-back problems, their apparent limitation as a guide to appropriate treatment …[and] the apparent complete lack of monitoring [of] the use of X-ray by chiropractors.” Instead, it recommended consulting with radiologists when imaging is deemed necessary. “The Commission is of the view that the public interest, and even chiropractic itself, would be better served if chiropractors had access to radiologists for this service, rather than perform it themselves,” the report said.
All three report authors declined comment. Calls to Dave Chomiak, who was health minister at the time the report was prepared, were not returned. In an email to CBC, Manitoba Chiropractors Association president Perry Taylor said, “I personally have never seen this 13-year-old document and [it] pre-dates my time as President. As such I have no comment on this.” The CBC I-Team offered to go through the report with Taylor but he did not respond.
This report seems to confirm much of what we have discussed repeatedly on this blog: Chiropractic is not nearly as effective and safe as chiropractors try to make us believe. To hide this fact is certainly dishonest and unethical, but it is in some ways understandable: this knowledge would directly threaten the income of most chiropractors.
Yesterday I commented on another post: “the conflict of interest seems obvious: if homeopaths speak the truth, they are out of business. therefore, they are taught untruths from the first day of their training and eventually end up believing them. there is only one solution, as far as I can see: regulators must prevent them from making false claims. if not, this will go on for another 200 years and damage many patients’ health”. In the light of the above report, I will now re-phrase this: the conflict of interest seems obvious: if chiropractors allowed the truth to be known, they would soon be out of business. Therefore, they are taught untruths from the first day of their training and many end up believing them. There is only one solution, as far as I can see: regulators must prevent chiropractors from making false claims. If not, this abuse will go on for another 120 years and damage many patients’ health.
D D Palmer was born on March 7, 1845; so, why do chiros celebrate the ‘CHIROPRACTIC AWARENESS WEEK’ from 10 – 16 of April? Perhaps out of sympathy with the homeopaths (many US chiros also use homeopathy) who had their ‘big week’ during the same period? Please tell me, I want to know!
Anyway, the HAW almost ‘drowned’ the CAW – but only almost.
The British Chiropractic Association did its best to make sure we don’t forget the CAW. On their website, we find an article that alerts us to their newest bit of research. Here are some excerpts:
The consumer survey by the British Chiropractic Association (BCA) of more than 2,000 UK adults who currently suffer from back or neck pain, or have done so in the past, found that almost three in five (56%) people experienced pain after using some form of technological device. Despite this, only 27% of people surveyed had limited or stopped using their devices due to concerns for their back or neck health and posture. The research showed people were most likely to experience back or neck pain after using the following technological devices:
• Laptop computer (35%)
• Desktop computer (35%)
• Smart phone (22%)
• Tablet (20%)
• Games console (17%)
The age group most likely to experience back or neck pain when using their smart phone were 16-24 year olds, while nearly half (45%) of young adults 25-34 year olds) admitted to experiencing back or neck pain after using a laptop. One in seven (14%) 16-24 year olds attributed their back or neck pain to virtual reality headsets.
As part of Chiropractic Awareness Week (10-16 April) the BCA is calling for technology companies to design devices with posture in mind, to help tech proof our back health. BCA chiropractor Rishi Loatey comments: “We all know how easy it is to remain glued to our smart phone or tablet, messaging friends or scrolling through social media. However, this addiction to technology could be causing changes to posture, which can lead to increased pressure on the muscles, joints and discs in the spine. Technology companies are now starting to issue older phone models which hark back to a time before smart phones enabled people to do everything from check emails and take pictures, to internet banking. Returning to a time of basic functionality, which may see people look to limit the time spent on their phone, can only be good news for our backs. Yet, in an age where people can now track their health and wellbeing using their phone, technology companies should also start looking at ways to make their devices posture friendly from the outset, encouraging us to take time away from our desks and breaks from our scrolling, gaming and messaging.”
END OF QUOTE
So, here we have it: another piece of compelling, cutting edge research by the BCA. They have made us giggle before but rarely have I laughed so heartily about a ‘professional’ organisation confusing so unprofessionally correlation with causation.
Considering the amount of highly public blunders they managed to inflict on the profession in recent years, I have come to the conclusion that the BCA is a cover organisation of BIG PHARMA with the aim of giving chiropractic a bad name!
The world of homeopathy is getting very excited: HOMEOPATHY AWARENESS WEEK is approaching (it’s starting 10 April). An ideal occasion, I think, for making a celebratory offer to all homeopaths:
I am suggesting to give a free lecture on any homeopathy-related subject of your choosing. This, I hope, might increase homeopaths’ awareness of the science, research and evidence for or against homeopathy.
Which professional organisation could possibly say no to such a generous offer?
None with an interest in evidence, surely!
Homeopathy has been the number one subject on this blog from its very beginnings. It regularly attracts lively discussions, and I am confident that I could generate an even better dialogue, if you let me present the evidence. I think I am almost uniquely qualified to give such a lecture, not least because I have the following types of expertise:
- I have given about 800 lectures on alternative medicine and therefore know what to do,
- I have a sound knowledge of evidence-based medicine,
- I possess the ability to tell good from poor science,
- I have experience as a patient treated by a homeopath,
- I have research experience in homeopathy (clinical trials, systematic reviews, etc.),
- I have published many scientific papers on the subject,
- I possess many years of clinical experience,
- I have been trained in homeopathy and used it as a clinician,
- I can think critically,
- I regularly review the emerging literature,
- finally, I have recently published a book entitled HOMEOPATHY, THE UNDILUTED FACTS.
The specifics of my offer are as follows:
- I will give a 45-min lecture to your organisation.
- I will then answer questions for up to 30 min.
- This can be scheduled at a location and a time of day that suits you.
- I will not charge a lecture fee.
- You will cover my travel cost from my home in Suffolk to your venue.
- Depending on the location of the venue and timing of the lecture, I might need to stay overnight and would hope you can foot the bill for that.
- There will be no other costs involved.
- My offer is limited to a time-window during which I plan to be in the UK. The best time for me would be July and August.
I am convinced that we all might profit from such lectures:
- You might learn about science, the evidence, the need for thinking critically, etc.
- And I might learn a bit more about the views and concerns of homeopaths.
Therefore, I hope that my offer will find plenty of takers. If you are interested, please contact me via this blog.
Is spinal manipulative therapy (SMT) dangerous? This question has kept us on this blog busy for quite some time now. To me, there is little doubt that SMT can cause adverse effects some of which are serious. But many chiropractors seem totally unconvinced. Perhaps this new overview of reviews might help to clarify the issue. Its aim was to elucidate and quantify the risk of serious adverse events (SAEs) associated with SMT.
The authors searched five electronic databases from inception to December 8, 2015 and included reviews on any type of studies, patients, and SMT technique. The primary outcome was SAEs. The quality of the included reviews was assessed using a measurement tool to assess systematic reviews (AMSTAR). Since there were insufficient data for calculating incidence rates of SAEs, they used an alternative approach; the conclusions regarding safety of SMT were extracted for each review, and the communicated opinion were judged by two reviewers independently as safe, harmful, or neutral/unclear. Risk ratios (RRs) of a review communicating that SMT is safe and meeting the requirements for each AMSTAR item, were calculated.
A total of 283 eligible reviews were identified, but only 118 provided data for synthesis. The most frequently described adverse events (AEs) were stroke, headache, and vertebral artery dissection. Fifty-four reviews (46%) expressed that SMT is safe, 15 (13%) expressed that SMT is harmful, and 49 reviews (42%) were neutral or unclear. Thirteen reviews reported incidence estimates for SAEs, roughly ranging from 1 in 20,000 to 1 in 250,000,000 manipulations. Low methodological quality was present, with a median of 4 of 11 AMSTAR items met (interquartile range, 3 to 6). Reviews meeting the requirements for each of the AMSTAR items (i.e. good internal validity) had a higher chance of expressing that SMT is safe.
The authors concluded that it is currently not possible to provide an overall conclusion about the safety of SMT; however, the types of SAEs reported can indeed be significant, sustaining that some risk is present. High quality research and consistent reporting of AEs and SAEs are needed.
This article is valuable, if only for the wealth of information one can extract from it. There are, however, numerous problems. One is that the overview included mostly reviews of the effectiveness of SMT for various conditions. We know that studies of SMT often do not even mention AEs. If such studies are then pooled in a review, they inevitably generate an impression of safety. But this would, of course, be a false-positive result!
The authors of the overview are aware of this problem and address it in the following paragraph: “When only considering the subset of reviews, where the objective was to investigate AEs (37 reviews), then 8 reviews (22%) expressed that SMT is safe, 13 reviews (35%) expressed that SMT is harmful and 16 reviews (43%) were neutral or unclear regarding the safety of SMT. Hence, there is a tendency that a bigger proportion of these reviews are expressing that SMT is harmful compared to the full sample of reviews…”
To my surprise, I found several of my own reviews in the ‘neutral or unclear’ category. Here are the verbatim conclusions of three of them:
- It is concluded that serious cerebrovascular complications of spinal manipulation continue to be reported.
- The most common serious adverse events are vertebrobasilar accidents, disk herniation, and cauda equina syndrome.
- These data indicate that mild and transient adverse events seem to be frequent. Serious adverse events are probably rare but their incidence can only be estimated at present.
I find it puzzling how this could be classified as neutral or unclear. The solution of the puzzle might lie in the methodology used: “we appraised the communicated opinions of each review concerning the safety of SMT based on their conclusions regarding the AEs and SAEs. This was done by two reviewers independently (SMN, LK), who judged the communicated opinions as either ‘safe’, ‘neutral/unclear’ or ‘harmful’, based on the qualitative impression the reviewers had when reading the conclusions. The reviewers had no opinion about the safety/harmfulness of SMT before commencing the judgements. Cohen’s weighted Kappa was calculated for the agreement between the reviewers, with a value of 0.40–0.59 indicating ‘fair agreement’, 0.60–0.74 indicating ‘good agreement’ and ≥0.75 indicating ‘excellent agreement’. Disagreements were resolved by a third reviewer (MH).”
In other words, the categorisation was done on the basis of subjective judgements of two researchers. It seems obvious that, if their attitude was favourable towards SMT, their judgements would be influenced. The three examples from my own work cited above indicates to me that their verdicts were indeed far from objective.
So what is the main message here? In my view, it can be summarized in the following quote from the overview: “a bigger proportion of these reviews are expressing that SMT is harmful …”
Yes, yes, yes – I know that, if you are a chiropractor (or other practitioner using mostly SMT), you are unlikely to agree with this!
Perhaps you can agree with this statement then:
As long as there is reasonable doubt about the safety of SMT, and as long as we cannot be sure that SMT generates more good than harm, we should be very cautious using it for routine healthcare and do rigorous research to determine the truth (it’s called the precautionary principle and applies to all types of healthcare).
THE CHRONICLE OF CHIROPRACTIC is not a publication I usually read, I have to admit. But perhaps I should, because this article from its latest edition is truly fascinating. Here are the crucial excerpts:
“A so called “debate” on vertebral subluxation was held at the recent chiropractic educational conference held by the controlling factions of the Chiropractic Cartel: The World Federation of Chiropractic, the Association of Chiropractic Colleges and the American Chiropractic Association. Every few years this faction of the profession makes an attempt to disparage vertebral subluxation and those who practice in a subluxation model by trotting out its long list of Subluxation Deniers.
This year was no different.
David Newell, who is a Senior Lecturer at the Anglo European College of Chiropractic, made a number of unsubstantiated claims and engaged in logical fallacies that would shock even the casual observer. As an example, Newell made the statement:
“The subluxation as vitalistic concept, an impediment in and of itself to health and well being, impeding the expression of higher intelligence is not only entirely bereft of any evidence whatsoever but is a complete non starter even as a scientific question.”
…Newell claimed that what is dangerous about the use of vertebral subluxation are concepts and behavior associated with its use. Newell stated that subluxations are used by some in the profession to “scare or misinform patients” and gave the following examples of claims he has issues with:
- You cannot be healthy with them
- They will lead to serious disease
- Chiropractors are the only ones that can help
- A chiropractic manipulation is unique
- You need to come back for the rest of your life
- You need to bring your children otherwise they will not develop properly
Newell claimed that such statements are “confusing, un-evidenced and detrimental to our standing as a profession in the outside world” and that “at worse, sometimes used to justify approaches to care and practice models that are unacceptable both inside and outside of the profession.”
Newell … continued his tirade against his perceived threat to public health stating vertebral subluxation and the concepts attached to it are: “. . . used to generate dependancy through fear or coercion. Here, use of such words and concepts essentially as smoke screens for a model of care dominated by a coercive business ethic are strongly reputationally damaging and are not OK.” …Newell further claimed that the concept of ” . . . subluxation as an impediment to innate intelligence is bereft of science and evidence” and that “. . . this approach will be inadmissible to characterise a modern healthcare profession. Describing the profession in such language will further isolate and marginalise.”…”The irony” he states “. . . is of course that there are much better explanations, concepts and terms. Much of what is seen in practice can be explained by sound science and scientific language and so a subluxation model isn’t even needed.”
He went on to engage in further expressions of logical fallacies by stating: “Even on a simple level, science has yet to answer questions as to what a subluxation is as a defined entity, can it be validly and reliably identified, can it be validly and reliably shown to have gone post manipulation and is such disappearance associated with meaningful clinical change in patients.”
In reality, there is a rich evidence base that demonstrates the validity and reliability of numerous methods of measurements focused on the various components of vertebral subluxation as well as evidence demonstrating reduction or correction of it with resulting positive health outcomes.
Unfortunately, most simply go along with statements such as Newell’s either out of ignorance, simple aquiesence or collegiality.
Imagine the plight of students in a chiropractic program being exposed to Newell’s dogma, scientism and denial of even the existence of vertebral subluxation. That he is even given a stage and an audience is a failure of leadership within the ranks of those who purport to embrace the vitalistic concept of vertebral subluxation.
We laugh and mock those who contend the Earth is flat, yet Subluxation Deniers are given voice by schools and political organizations along with a role in determining the subluxation research agenda. And its the leadership on the traditional, conservative side of the profession that does this – as evidenced by his even being entertained at an educational conference billed as the largest and most important gathering of chiropractic educators and researchers.
Not a single objection to his, or any other Deniers, participation by the leadership in the vitalistic faction. In fact, quite the opposite – he was given the opportunity to spew his Flat Earth nonsense to a wide audience who educate the future of this profession.
Imagine a meeting at NASA where a Flat Earther is given a voice and a vote on the Mars Mission.
This was and is a failure of leadership within the vitalistic, conservative, traditional faction of the chiropractic profession.”
END OF EXCERTS
On this blog, we have heard again and again that the chiropractic profession is in the middle of a fundamental reform, that it has given up the idiotic concepts of its founders, that it has joined the 21st century, that it is becoming evidence-based, that progress is being made etc. etc. However, sceptics have always doubted these claims and pointed out that chiropractic minus its traditional concepts would merely become a limited type of physiotherapy.
From the above article, I get the impression that the notion of reform might be a bit optimistic. The old guard seems to be as alive and powerful as ever, fighting as fiercely as always to preserve chiropractic’s nonsensical cult.
Some will, of course, claim that the above article shows exactly the opposite of what I just stated. They will try to persuade us that it is evidence for the struggle of the new generation of chiropractors instilling reason into their brain-dead peers. It is evidence, they will claim, for the fact that there is a healthy discussion within the profession.
Yet this is simply not true: The maligned Mr Newell is NOT a chiropractor!
To me, the above article suggests that, for the foreseeable future, chiropractic will remain where it always has been: firmly anchored in the realm of quackery.
On their website, ‘CBC News’ just published an article that is relevant to much what we have been discussing here. I therefore take the liberty of showing you a few excerpts:
START OF QUOTES
…A CBC News analysis of company websites and Facebook pages of every registered chiropractor in Manitoba found several dozen examples of statements, claims and social media content at odds with many public health policies or medical research.
- Offers of treatments for autism, Tourette’s syndrome, Alzheimer’s disease, colic, infections and cancer.
- Anti-vaccination literature and recently published letters to the editor from chiropractors that discourage vaccination.
- An article claiming vaccines have caused a 200 to 600 per cent increase in autism rates.
- A statement that claims the education and training of a chiropractor is “virtually identical” to that of a medical doctor.
- Discouraging people from getting diagnostic tests such as CT scans, colonoscopies and mammograms.
- An informational video discouraging the use of sunscreen.
The Manitoba Chiropractors Association declined an interview request but did say it would review the content.
…The Manitoba Chiropractors Association has previously addressed certain issues with its membership through an internal communication. “In Manitoba, the administration of ‘vaccination and immunization’ currently falls outside the scope of chiropractic practice,” the communication said. It also cautioned members that:
- “Chiropractors may be liable for opinions they provide to patients/public in circumstances where it would be reasonably foreseeable that the individual receiving the opinion would rely on it.
- “Providing professional opinions on the issue of vaccination and immunization would likely be found by a court to be outside the scope of practice of a chiropractor.”
The association also said, “The degree to which a chiropractor can or cannot discuss ‘vaccination and immunization’ or other health-care procedures that are outside the scope of practice with a patient is currently being reviewed by the board of directors.”…
The fact that members of a regulated health profession are actively disseminating questionable medical information while benefiting from public funds is cause for concern, Katz said. “Should we as a society be paying for the services of professionals, and I use that word loosely, that are advocating care that is contrary to the official public policy?”
Marcoux wrote that he does not recommend flu vaccines, calling them “toxic.” He further stated that the flu virus actually “purifies our systems” and said that he believes flu vaccines are “driven by a vast operation orchestrated by pharmaceutical companies.” People should instead focus on general wellness — which includes chiropractic treatment — to stave off the flu, he wrote.
- Chiropractic neck procedures cause strokes, say survivors
- Manitoba clinic avoiding opioids in chronic pain management
Letters then poured in from members of the community, including a resident and two physicians who took exception to these statements. Marcoux told the CBC’s French service, Radio-Canada, that he does not believe his views are at odds with public health. He stands by his letter, he said, adding if society as a whole took health and wellness more seriously — rather than trying to treat symptoms — the need for vaccines would dissipate or never would have existed in the first place…
END OF QUOTES
Some chiropractors will respond that this is Canada and that elsewhere the situation is much better. I fear that this is not necessarily true – and if it is better in the UK, it is not because of the efforts of chiropractors or their professional organisations. In the UK, the situation has improved because of the work of organisations such as the Nightingale Collaboration and The Good Thinking Society. Likewise, in other countries, progress is being generated not by chiropractors but by critical thinkers and critics of quackery.
The British Chiropractic Association (BCA) has lost all credibility after suing Simon Singh for drawing the public’s attention to the fact that they were ‘happily promoting bogus treatments’. Now, it seems, they are trying to re-establish themselves with regular, often bogus or dubious pronouncements about back pain. It looks as though they have learnt nothing. A recent article in THE INDEPENDENT is a good example of this ambition, I think:
START OF QUOTE
Skinny jeans and coats with big fluffy hoods can contribute to painful back problems, chiropractors have warned.
Nearly three-quarters of women have experienced back pain, according to a survey by the British Chiropractic Association (BCA), who said fashionable clothing including backless shoes, oversized bags and heavy statement jewellery were partly to blame.
Wearing very tight jeans can restrict mobility and force other muscles to strain as they try to compensate for the resulting change in posture, chiropractor Rishi Loatey told The Independent.
“If they’re incredibly tight, you won’t be able to walk as you normally would,” he said.
“You’ve got a natural gait, or stride, that you would take, and the knee, hip and lower back all move to minimise the pressure coming up through the joints.
“However, if one of those areas isn’t moving as it should be, it’s going to cause more pressure elsewhere.”
While 73 per cent of women from a sample of more than 2,000 said they have had back pain, more than a quarter – 28 per cent – said they were aware their clothing affects their posture and back and neck pain, but did not take this into account when choosing what to wear.
Lower back pain is the most common cause of disability worldwide, with 9.4 per cent of people suffering from it, according to a previous study.
High heels, which cause muscles in the back of the leg and the calf to tighten and pull on the pelvis differently, have long been culprits of back pain.
A number of high-profile campaigns against “sexist” dress codes requiring women to wear high heels at work have made reference to this fact.
But backless shoes, flimsy ballet pumps and some soft boots can also damage your back if they are worn too often, said Mr Loatey.
“If you imagine the back of a shoe, the bit that goes round the back is supposed to be quite firm, so it grips the rear foot,” he said. “If you don’t have that, then your foot is more mobile in the shoe.”
“If they’re not the right size, they’re a bit loose or they don’t have the bit at the back, you’re almost gripping the shoe as you walk, which again changes the way you walk,” said Mr Loatey, adding that ideally shoes should be laced up at the front to make sure the foot is held firmly.
A third of women surveyed by the BCA were unaware that their clothing choices could harm their backs and necks.
Mr Loatey said people should try and wear clothes that allow them to move more freely. Heavy hoods and over-shoulder bags can both restrict movement.
They should also consider limiting the amount of time they spent wearing high heels or backless shoes and consider travelling to work or social events in trainers or other well-supported shoes instead, he said.
END OF QUOTE
This piece strikes me as pure promotion of chiropractic – health journalism at its worse, I’d say. What is more objectionable than the promotion, it is full of half truths, ‘alternative facts’ and pure invention. Let me list a few statements that I find particularly doggy:
- “Skinny jeans and coats with big fluffy hoods can contribute to painful back problems.” Do they have any evidence for this? I don’t know of any!
- “…fashionable clothing including backless shoes, oversized bags and heavy statement jewellery were partly to blame [for back problems].” Idem!
- “Wearing very tight jeans can restrict mobility and force other muscles to strain…” Idem!
- “…it’s going to cause more pressure elsewhere.” Idem!
- 28% of women said “they were aware their clothing affects their posture and back and neck pain, but did not take this into account when choosing what to wear.” To make the findings from a survey look like scientific evidence for cause and effect is at best misleading, at worst dishonest.
- “…according to a previous study“. It turns out that this previous study was of occupational back pain which has nothing to do with tight jeans etc.
- “High heels, which cause muscles in the back of the leg and the calf to tighten and pull on the pelvis differently, have long been culprits of back pain.” A link to the evidence would be nice – if there is any.
- “But backless shoes, flimsy ballet pumps and some soft boots can also damage your back – if they are worn too often…” Evidence needed – if there is any.
- “Mr Loatey said people should try and wear clothes that allow them to move more freely. Heavy hoods and over-shoulder bags can both restrict movement.” Concrete recommendations require concrete evidence or a link to it.
- Women “should also consider limiting the amount of time they spent wearing high heels or backless shoes and consider travelling to work or social events in trainers or other well-supported shoes instead.” Idem.
At this point congratulations are in order, I feel.
Firstly to THE INDEPENDENT for publishing one of the most inadequate health-related article which I have seen in recent months.
Secondly to the BCA for their stubborn determination to ‘happily promoting bogus’ notions. Instead of getting their act together when found out to advertise quackery in 2008, they sued Simon Singh (unsuccessfully, I hasten to add). Instead of cutting out the nonsense once and for all, they now promote populist ‘alternative facts’ about the causes of back pain. Instead of behaving like a professional organisation that promotes high standards and solid evidence, they continue to do the opposite.
One cannot but be impressed with so much intransigence.
Dana Ullman is an indefatigable promotor of bogus claims and an unwitting contributor of hilarity. Therefore he has become a regular feature of this blog (see for instance here, here and here). His latest laughable assertion is that lead and other poisonings can be successfully treated with homeopathy.
Just to make sure: lead poisoning is no joke. The greatest risk is to brain development in babies, where irreversible damage can occur. Higher levels can damage the kidneys and nervous system in both children and adults. Very high lead levels may cause seizures, unconsciousness and death.
In view of this, Ullman’s claim is surprising, to say the least. In order to persuade the unsuspecting public of his notion, Ullman first cites a review of basic research on homeopathy and toxins published in Human and Experimental Toxicology. “Of forty high-quality studies, 27 showed positive results from homeopathic treatment”, Ullman states.
Now, now, now Dana!
Has your mom not taught you that telling porkies is forbidden?
Or did you perhaps miss this line in the article’s abstract? “The quality of evidence in these studies was low with only 43% achieving one half of the maximum possible quality score and only 31% reported in a fashion that permitted re-evaluation of the data. Very few studies were independently replicated using comparable models.”
Hardly ‘high quality studies’, wouldn’t you agree?
But this review was of pre-clinical studies; what about the much more important clinical evidence?
Here Ullman cites one trial where a potentized homeopathic remedy, Arsenicum Album 30C, was administered to 55 people who were entered into a double-blind, placebo-controlled trial. According to Ullman, the homeopathically treated group “experienced higher excretion of arsenic in their urine for the first eleven days, compared to those given a placebo.”
Na, na, na, Dana, this is getting serious!!!
Another porky – and not even a little one.
The authors of this study clearly stated that, at the end of the 11-day RCT, there was no significant difference between the homeopathy and the placebo group: “The differences in the concentration between the two groups (drug versus placebo) were generally a little higher during the first week, but subsequently the differences were not so palpable, particularly at the 11th day.” And for those who are a bit slow on the uptake, they even included a graph that makes it abundantly clear.
The only other clinical study cited by Ullman in support of his surprising claim is a double-blind randomized trial which was conducted with 131 workers who suffered lead poisoning at the Ajax battery plant in Bauru, São Paulo State, Brazil. Subjects were prescribed homeopathic doses of lead (Plumbum metallicum 15C) or placebo which they took orally for 35 days. The results of this RCT show that homeopathy is not better than placebo.
So, we seem to have all of two RCTs on the subject (I did a quick Medline-search and also found no further RCTs), and both are negative.
Anyone who is not given to compulsive porky-telling would, I guess, conclude from this evidence that people suffering from lead poisoning should urgently see conventional experts and avoid homeopaths at all costs – not so Dana Ullman who boldly concludes his article with these words:
“As an adjunct to conventional medical treatment, professional homeopathic care is recommended for people who have been exposed (or think they have been exposed) to toxic substances… Even if you do not have a professional homeopath in your town, many homeopathic practitioners “see” their patients via Skype or do consultations over the telephone. Unlike acupuncturists, who put needles in you, or chiropractors, who adjust your spine, homeopaths are not “hands-on”: they simply need to conduct a detailed interview… If your symptoms are serious or potentially serious, it is important to see a professional homeopath and/or physician. While a homeopath will commonly prescribe a safe homeopathic dose of the toxic substance to which one was exposed, the homeopath may instead decide that a different substance more closely matches the patient’s unique symptoms…”
It takes a lot these days to make me speechless but there, Dana, you almost succeeded!
The British Homeopathic Association (BHA) is a registered charity founded in 1902. Their objectives are “to promote and develop the study and practice of homeopathy and to advance education and research in the theory and practice of homeopathy…” and their priority is “to ensure that homeopathy is available to all…” The BHA believes that “homeopathy should be fully integrated into the healthcare system and available as a treatment choice for everyone…”
This does not bode well, in my view. Specifically, it does not seem as though we can expect unbiased information from the BHA. Yet, from a charity we certainly do not expect a packet of outright lies – so, let’s have a look.
The BHA have a website (thank you Greg for reminding me of this source; I have long known about it and used it often for lectures when wanting to highlight the state of homeopathic thinking) where they provide “THE EVIDENCE FOR HOMEOPATHY“. I find the data presented there truly remarkable, so much so that I present a crucial section from it below:
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The widely accepted method of proving whether or not a medical intervention works is called a randomised controlled trial (RCT). One group of patients, the control group, receive placebo (a “dummy” pill) or standard treatment, and another group of patients receive the medicine being tested. The trial becomes double-blinded when neither the patient nor the practitioner knows which treatment the patient is getting. RCTs are often referred to as the “gold standard” of clinical research.
Up to the end of 2014, a total of 104 papers reporting good-quality placebo-controlled RCTs in homeopathy (on 61 different medical conditions) have been published in peer-reviewed journals. 41% of these RCTs have reported a balance of positive evidence, 5% a balance of negative evidence, and 54% have not been conclusively positive or negative. For full details of all these RCTs and more in-depth information on the research in general, visit the research section of the Faculty of Homeopathy’s website. Also, see 2-page evidence summary with full references.
END OF QUOTE
But is it true?
Let’s have a closer look at the percentage figures: according to the BHA
- 41% of all RCT are positive,
- 5% are negative,
- 54% are inconclusive.
These numbers are hugely important because they are being cited regularly across the globe as one of the most convincing bit of evidence to date in support of homeopathy. If they were true, many more RCT would be positive than negative. They would, in fact, constitute a strong indicator suggesting that homeopathic remedies are more than placebos.
One does not need to look far to find that these figures are clearly not correct! To disclose the ‘mistake’, we do not even need to study any of the 104 RCTs in question, we only need to straighten out the BHA’s ‘accounting error’ and ask: what on earth is an ‘inconclusive’ RCT?
A positive RCT obviously is one where homeopathy generated better outcomes than the placebo; similarly a negative RCT is one where the opposite was the case; in other words, where the placebo generated better outcomes than homeopathy. But what is an ‘inconclusive’ RCT? It turns out that, according to the BHA, it is one where there was no significant difference between the results obtained with placebo and homeopathy.
Yes, you understood correctly!
Outside homeopathy such RCTs are categorised as negative studies – they fail to show that homeopathy out-performs placebo and therefore confirm the null-hypothesis. An RCT is a test of the null-hypothesis (the experimental treatment is not better than the control) and can only confirm or reject this hypothesis. Certainly finding that the experimental treatment is not better than the control is not inconclusive bit a confirmation of the null-hypothesis. In other words it is a negative result.
So, let’s look at the little BHA – statistic again, and this time let’s do the accounting properly:
- 41% of all RCTs are positive,
- 59% are negative.
This means that, according to this very simplistic method, the majority of RCTs is negative. I say ‘very simplistic’ because, for a proper analysis of the trial evidence, we need to account, of course, for the quality of each trial. If the quality of the positive RCTs is, on average, less rigorous than that of the negative RCTs, the overall result would become yet more clearly negative. Most assessments of homeopathy that consider this essential factor do, in fact, confirm that this is the case.
Once all this has been analysed properly, we still have to account for factors like publication bias. Negative trials get often not published and therefore the overall picture gets easily distorted and generates a false-positive image. At the end of a sound evaluation along these lines, the result would fail to show that homeopathy differs from placebo.
Regardless of all these necessary and important considerations, the BHA website then tells us that the RCT method is problematic when it comes to testing homeopathy: “The RCT model of measuring efficacy of a drug poses some challenges for homeopathic research. In homeopathy, treatment is usually tailored to the individual. A homeopathic prescription is based not only on the symptoms of disease in the patient but also on a host of other factors that are particular to that patient, including lifestyle, emotional health, personality, eating habits and medical history. The “efficacy” of an individualised homeopathic intervention is thus a complex blend of the prescribed medicine together with the other facets of the in-depth consultation and integrated health advice provided by the practitioner; under these circumstances, the specific effect of the homeopathic medicine itself may be difficult to quantify with precision in RCTs.”
What are they trying to say here?
I am not sure.
Are they perhaps claiming that, even if an independent scientist disclosed their ‘accounting error’ and demonstrated that, in fact, the RCT evidence fails to support homeopathy, the BHA would still argue that homeopathy works?
I think so!
It looks to me that the BHA is engaged in the currently popular British past-time: THEY WANT THE CAKE AND EAT IT.
All this is more than a little disturbing, and I think it begs several questions:
- Is this type of behaviour in keeping with the charitable status of the BHA?
- Does it really ‘promote and develop the study and practice of homeopathy and to advance education and research’?
- Is it not rather unethical to mislead the public in such a gross and dishonest fashion?
- Is it not fraudulent to insist on false accounting?
I would be interested to get your views on this.
Homeopathy is never far from my mind, it seems. and this is reflected by the many posts on the subject that I continue to publish. Homeopaths get more than a little irritated by what they see as my ‘obsession’ with their beloved therapy. They thus try anything – yes, I mean anything – to undermine my credibility. One very popular way of doing this is to claim that I am sitting in the ‘ivory tower’ of academia and have no real inkling of the life on the ‘coal face’ of healthcare.
Because this is an argument that I find difficult to counter – I have indeed not routinely seen patients for over 20 years! – I was immensely pleased to read this article by an Australian GP. I take the liberty of quoting a section from it below:
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…An intricate web of lies protects the pernicious practice of homeopathy in Australia. Homeopathy is one of the most widespread disciplines of alternative medicines, with an estimated one million Australian consumers. It’s very popular. It also doesn’t work. At all. No better than a sugar pill, anyway. Turns out, vials of homeopathic remedies are chemically indistinguishable from water. Numerous international investigations and a scientific review of over 1800 studies by the National Medical Health Research Council could not be clearer: there is zero evidence that homeopathy is an effective treatment for medical conditions.
And yet the practice of homeopathy in Australia goes largely unchecked. The industry is overwhelmingly self-regulated by its own board, lending it an undue air of legitimacy. Meanwhile homeopaths advertise their ability to treat everything from autism to haemorrhoids with near impunity. Most obscenely, homeopathic therapies attract rebates under private health insurance policies that are funded by public taxes.
The justifications for allowing homeopathy are convoluted. One of the most common defences is that if the remedies truly are ineffective vials of water, then they are harmless. This is perhaps the most toxic myth about these therapies. Giving people a false cure for real symptoms is dangerous, because it delays correct diagnosis and treatment.
As a general practitioner I have observed the consequences of this in practice, seeing patients of homeopaths with conditions ranging from undiagnosed autoimmune disorders to mistreated blood pressure. These experiences mirror more notorious incidents – one West Australian coronial inquest in 2005 revealed a case where a homeopath treated rectal cancer, leading to the patient’s death. In 2009, a nine-month-old child with severe eczema was treated by her homeopath father who was later found guilty of manslaughter by denying her conventional medical care.
These are the kind of horror stories that prompt bureaucracies into symbolic action. Enter the Victorian Health Complaints Commission: a brand new watchdog unveiled last week to reign in, as Premier Daniel Andrews called them, “dodgy health providers”. The idea is that “health service providers” in Victoria, whether officially registered or not, will have to follow a general code of conduct. Included in this category are all homeopaths, and practitioners of other completely debunked practices such as reiki and iridology. The idea seems good on paper. The new code demands practitioners are truthful about their treatments, and act in the patient’s best interest. But here’s the catch – the commission will only take action on complaints lodged against individual practitioners.
This system is clearly geared towards only chasing a handful of rogue practitioners. But the problem isn’t a few rogue practitioners – it’s entirely rogue industries. The discipline of homeopathy, by its very nature, is untruthful.
Perhaps we can begin by following the lead of the United States, where the Federal Trade Council has ruled that homeopathic medicine labels must state that there is no scientific evidence backing homeopathic health claims. You have to admit, it’s bold stuff. It leaves our ACCC looking quite impotent. Real change requires the kind of courage that is in short supply.
That’s what it comes down to – cowardice. Homeopathy, along with an array of debunked complementary and alternative health disciplines, are tolerated by authorities to avoid an inconvenient confrontation. They let it slide to avoid upsetting delusional practitioners, misinformed customers, and anyone profiting from the practice. The presence of disproved medicines has insidiously embedded itself so deeply into our culture that curtailing a false cure is a huge political risk. So the status quo prevails, lest we rock the boat. Never mind that it’s heading straight down a waterfall.
END OF QUOTE
This clearly is a deeply felt and well-expressed article. It reiterates what we have regularly been trying to get across on this blog. But it is much better than anything I could ever contribute to the subject; it comes from someone who encounters the ‘pernicious practice of homeopathy’ on a regular basis and who knows about the harm it can do.
All I need to add is this: WELL DONE DOCTOR VYOM SHARMA!