bias
The UK Chiropractic Council is inviting you to help them re-formulate their educational standards. It is an occasion, some of my readers might find interesting. I, therefore, copy the relevant part of their announcement:
… Following a scoping review in 2021, which determined that the existing Education Standards, published in 2017, required development and updating, the GCC began revising the Education Standards in January 2022.
The revision will ensure that the Education Standards:
- Provide a realistic and comprehensive set of outcomes to be met by graduates on approved qualifications, demonstrating an ability to practise in accordance with the GCC Code.
- Take into account developments within the profession, increase focus on multi-disciplinary learning and different professions working more closely together across the UK, ensuring that graduates are well placed to meet the opportunities to care for patients in different contexts.
- Remain consistent, as appropriate, with the outcomes set by other UK healthcare frameworks and standards.
Purpose: why we are consulting
This consultation sets out our draft Education Standards for providers and Learning Outcomes for students, which reflect and build on the evidence and feedback we have obtained through our scoping review.
We seek stakeholders’ views on these draft Education Standards to ensure our final proposals are future-proof and fit for purpose.
We welcome all responses to the consultation.
Documents
The draft Education Standards on which we invite comments.
The equality impact assessment of the Education Standards, with comments invited within the consultation.
The GCC Education Standards consultation document in Word format.
Ways to respond
Submissions to this consultation can be made online (see below) or by email at [email protected] (click here to download the consultation document).
It is advisable to make a copy of your submission to prevent the loss of information due to internet, portal or connectivity issues. This should be done before pressing the submit button.
Information in responses, including personal information, may need to be published or disclosed under the access to information regimes (mainly the Freedom of Information Act 2000, the General Data Protection Regulation, the Data Protection Act 2018, and the Environmental Information Regulations 2004).
The GCC is a data controller registered with the Information Commissioner’s Office. We use personal data to support our work as the regulatory body for chiropractors. We may share data with third parties to meet our statutory aims and objectives, and when using our powers and meeting our responsibilities.
Closing date
The deadline for responses to this consultation on the draft Education Standards is 16 September 2022 at noon. The consultation will be publicised and stakeholders will be invited to comment…
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Personally, I think the GCC desperately needs to improve its educational (and other) standards. They claim that, “as the regulator for chiropractors, our role is to protect the public”. The case of the late John Lawler is one of many examples to show how unfit for this purpose the GCC truly is.
So, perhaps you might want to contribute to the consultation with a view to making UK chiropractors less of a danger to the public?
I have been warning the public about the indirect dangers of so-called alternative medicine (SCAM) for a very long time. It is now 25 years ago, for instance, that I published an article in the ‘European Journal of Pediatrics’ entitled “The attitude against immunisation within some branches of complementary medicine“. Here is the discussion section of this paper:
… certain groupings within COMPLEMENTARY MEDICINE (CM) may advise their patients against immunisation. Within these groupings, there is, of course, a considerable diversity of attitudes towards immunisation. Therefore
generalisations are difficult and more detailed investigations are required to clarify the issue.
The question arises whether the level of advice against immunisation as it exists today represents a real or only a potential risk. One study from the U.K. demonstrates homoeopathy to be the most prevalent reason for non-compliance with immunisation [30]. The problem may not be confined to naturopathy, chiropractic and homoeopathy. Books relating to CM in general [e.g. 19] also strongly advise against immunisation: “Vaccination may provoke the illness which it is supposed to prevent. People who are vaccinated can transmit the illness, even if they are not ill themselves. The vaccine can make the person more susceptible to the illness … The vaccinated child is a contaminated child”.
At present, our data is insufficient to de®ne which proportion of which complementary practitioners share this
attitude. The origin of this stance against vaccination is largely unknown. For instance, there is nothing in Hahnemann’s writings against immunisation [14]. It may therefore stem from a general antipathy toward modern medicine which seems to be prevalent within CM [7, 19, 23]. A more specific reason is that immunisation is viewed as detrimental, burdened with long-term side effects. It is also felt that it is not fully effective and unnecessary because
better methods of protection exist within CM [16].
Anti-immunisation activists are often unable to argue their case rationally, yet they place advertisements in the daily press warning about immunisation. In Britain, one tragic case has recently been publicised. A physician advised parents against measles vaccination for their child who was suspected of suffering from convulsions. Five years later, the child suffered severe brain damage after contracting measles. The doctor was sued by the parents and found guilty of negligence and ordered to pay £825,000 in damages [1].
In medicine we must, of course, always be vigilant about the risks of our interventions. Each form of immunisation should therefore be continuously scrutinised for its possible risks and benefits. Most forms of immunisation are clearly not entirely free of risk [e.g. 22] – in fact, no effective intervention will ever be entirely risk-free. Therefore the risks have to be discounted against the benefits. It follows that any blanket rejection of immunisation, in general, must be misleading. It endangers not only the individual patient but (if prevalent) also the herd immunity of the community at large. Such unreflected rejection of immunisation, in general, will inevitably do more harm than good.
It is concluded that the advice of some, by no means all complementary practitioners in relation to immunisation represents an area for concern, which requires further research. Complementary practitioners and patients alike should be educated about the risks and benefits of immunisation. Paediatricians should be informed about the present negative attitude of some complementary practitioners and discuss the issue openly with their patients.
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I suspect that, had we heeded my caution, researched the subject more thoroughly, and taken appropriate action, the current pandemic might have produced fewer and less vocal anti-vaxxers, and fewer patients might have died.
On 18/7/2022 the ‘WORLD FEDERATION OF CHIROPRACTIC’ published a statement on cervical artery dissection (CAD). Below are a few excerpts to which I have added a few numbers [in brackets] which refer to my comments below:
… On rare occasions, CAD has been reported to have occurred after a patient visited a chiropractor or other provider of manual therapy [1]. However, the best evidence available to date indicates that spinal manipulation does not stress the arteries enough to cause tearing of the arteries leading to dissection-related strokes [2]. Additional studies have concluded that patients are as likely to have consulted a primary care physician as receive spinal manipulation from a chiropractor prior to experiencing a CAD-related stroke [3]…
The provision of safe, high-quality, evidence-based, patient-centered care for these and other conditions is a priority for the chiropractic profession [4]. Rigorous research is core to the pursuit of that objective [5]. We urge caution in making claims that are in conflict with the current state of the evidence.
About the WFC
The World Federation of Chiropractic is an international, non-governmental organization whose members are the national associations of over 90 countries in seven world regions. It is a non-state actor in official relations with the World Health Organization and is the global authority for matters related to the chiropractic profession [6]…
References
Cassidy JD, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ. Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study. Eur Spine J. 2008 Apr;17(Suppl 1):176–83. Open access here.#
Chaibi A, Russell MB. A risk-benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: a comprehensive review. Ann Med. 2019 Mar;51(2):118-127. Open access here.
Church EW, Sieg EP, Zalatimo O, Hussain NS, Glantz M, Harbaugh RE. Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation. Cureus. 2016 Feb 16;8(2):e498. Open access here.
Kosloff TM, Elton D, Tao J, Bannister WM. Chiropractic care and the risk of vertebrobasilar stroke: results of a case-control study in U.S. commercial and Medicare Advantage populations. Chiropr Man Therap. 2015 Jun 16;23:19. Open access here.
Rubinstein SM, Peerdeman SM, van Tulder MW, Riphagen I, Haldeman S. A systematic review of the risk factors for cervical artery dissection. Stroke. 2005 Jul;36(7):1575-80. Open access here.
Whedon JM, Mackenzie TA, Phillips RB, Lurie JD. Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66 to 99 years. Spine (Phila Pa 1976). 2015 Feb 15;40(4):264-70. Open access here
Here are my brief comments based on the evidence discussed in dozens of posts previously published on this blog:
- As there is no post-marketing surveillance, nobody can say with any degree of confidence that CADs after chiropractic are rare.
- This is not the ‘best’ evidence. In fact, it has been refuted repeatedly.
- This study has also been refuted.
- Chiropractic is very far from being evidence-based.
- Rigorous research fails to show that chiropractic neck manipulations generate more good than harm.
- The WFC is a lobby group for chiropractic; its mission is ” to advance awareness, utilization, and integration of chiropractic internationally”. Its current director is Richard Brown who spear-headed the disaster when the BCA sued Simon Singh, lost, and caused immense reputational damage to chiropractic worldwide.
I recently looked at the list of best-sellers in homeopathy on Amazon. To my surprise, there were several books that were specifically focused on the homeopathic treatment of children. Since we had, several years ago, published a systematic review of this subject, these books interested me. Here is what Amazon tells us about them:
Homeopathic remedies are increasingly being used to treat common childhood ailments. They are safe, have no side effects or allergic reactions, are inexpensive and, above all, effective. In this guide, Dana Ullman explains what homeopathy is, how it works and how you can use it correctly to enhance your child’s health. He recommends remedies for more than 75 physical and emotional conditions, including: allergies, grief, anxiety, headaches, asthma, measles, bedwetting, nappy rash, bites and stings, shock, burns, sunburn, colic, teething, coughs and colds and travel sickness
Without doubt, this is the most comprehensive book on homeopathic pediatrics. Included is a complete guide to the correct use of homeopathy, recommended remedies for the treatment of more than seventy-five common physical, emotional, and behavioral conditions, and valuable information on the essential medicines that all parents should have in their home medicine kits
Tricia Allen, a qualified homeopath, offers a host of practical advice on how to treat illness using natural, homeopathic remedies. Homeopathy differs from conventional medicine in that it does not only alleviate the individual symptoms of an illness, but treats the underlying state to ensure that the disease does not return, something which rarely occurs when using traditional remedies. This guide gives you advice on; what homeopathy is and how to use it; each stage of childhood and how to deal with the complaints that occur at that time of a child’s development; the most common childhood illnesses, how to take your own steps to treating them, which homeopathic remedies to use and when to seek medical help and first aid.
The Homeopathic Treatment of Children is indispensible at giving both a clear overall impression of the various major constitutional types, and also a detailed outline for reference at the end of each chapter. Not only does Paul Herscu draw from various sources (repertories and materia medica), he also adds indispensable original information from his successful practice.
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The fact that such books exist is perhaps not all that surprising. Yet, I do find the fact that they are among the best-selling books on homeopathy surprising – or to be more precise, I find it concerning.
Why?
Simple: children cannot give informed consent to the treatments they receive. Thus, consent is given for them by their parents or (I suspect often) not at all. This renders homeopathic treatment of children more problematic than that of fully competent adults.
Homeopathy has not been shown to be effective for any pediatric condition. I know Dana Ullman disagrees and claims it works for children’s allergies, grief, anxiety, headaches, asthma, measles, bedwetting, nappy rash, bites and stings, shock, burns, sunburn, colic, teething, coughs and colds, and travel sickness. Yet, these claims are not based on anything faintly resembling sound evidence! Our above-mentioned systematic review reached the following conclusion: “The evidence from rigorous clinical trials of any type of therapeutic or preventive intervention testing homeopathy for childhood and adolescence ailments is not convincing enough for recommendations in any condition.”
And what follows from this state of affairs?
I am afraid it is this:
Treating sick children with homeopathy amounts to child abuse.
Few people would dispute that a politician who promotes homeopathy as a treatment paid for by the public purse is irresponsible and disregards the scientific evidence. Few people would dispute that such a person is not best-suited for the top job in politics.
THE GUARDIAN reported yesterday that Penny Mordaunt, a leading contender to win the Conservative party leadership contest and become the UK prime minister, has repeatedly advocated the use of homeopathy on the National Health Service (NHS). 
Mordaunt, is currently the bookmakers’ favorite to replace Boris Johnson. In June 2010 she was one of 16 supporters of an early day motion in the House of Commons sharply criticizing the British Medical Association for voting to withdraw NHS support for homeopathy. The motion claimed there was “overwhelming anecdotal evidence that homeopathy is effective, frequently in cases when patients have not found relief through conventional medical treatments”. The statement signed by Mordaunt called on the government to allow health commissioners to refer patients to “homeopathic doctors and approved homeopaths”.
Four years later Mordaunt again intervened on behalf of homeopathy. She declared in a tweet that GPs “should have freedom to decide” if they wished to prescribe homeopathic treatments to NHS patients. In July 2014, Peter Stokes, a data director at the Office for National Statistics, wrote on Twitter that Mordaunt was a “supporter of homeopathy on NHS”, adding: “Hard to vote for people who don’t believe in evidence-based decisions.” In response, Mordaunt wrote: “Hi, I support drinking cranberry juice for UTIs & campaigned for better access to osteopathy. Do pl email me for more info.” Stokes wrote back: “Both reasonable, but you also signed [the 2010 early day motion]. “Homeopathy is the worst kind of bunkum medicine.” Mordaunt replied: “I don’t think GPs referring 2 homeopathy 2 cure cancer. Do think they should have freedom to decide. Pl email for more info.”
Her renewed support for homeopathy came five months after Dame Sally Davies, then the government’s chief medical officer, had dismissed homeopathy as a waste of time and money. “There is no evidence that homeopathy extends life for cancer patients – or indeed for patients with any other condition,” Davies said in February 2014.
Daisy Cooper, the Liberal Democrats’ health spokesperson, said: “It’s alarming that someone who could be appointed prime minister in a few weeks’ time has repeatedly supported homeopathy being provided by the NHS, despite concerns about the practice among health experts. “Penny Mordaunt should make clear that she will focus on fixing the real issues facing the NHS like soaring ambulance waiting times, not on imposing homeopathic treatments.”
Mordaunt has also voted against smoking bans, and consistently voted against restricting the provision of services to private patients by the NHS, according to the website TheyWorkForYou, which monitors the voting records of MPs.
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To me, this looks as though Penny Mordaunt disregards scientific evidence at the cost of public health. Call me old-fashioned, but I do not think that such an attitude is an ideal qualification for becoming our next prime minister.
PS
I was unable to find any evidence related to the other Tory contenders’ attitude towards so-called alternative medicine (SCAM). If any of my readers have such information, please let me know.
A recent report provided a sales prognosis of the future development of the worldwide market of homeopathic products.
… Homeopathic remedies are derived from substances that come from Plant Homeopathics, minerals, or animals, such as red onion, arnica (mountain herb), crushed whole bees, white arsenic, poison ivy, belladonna (deadly nightshade), and stinging nettle. Homeopathic remedies are often formulated as sugar pellets to be placed under the tongue; they may also be in other forms, such as ointments, gels, drops, creams, and tablets. Treatments are “individualized” or tailored to each person—it is not uncommon for different people with the same condition to receive different treatments.
Due to the COVID-19 pandemic, the global Homeopathic Products market size is estimated to be worth US$ 854.4 million in 2021 and is forecast to a readjusted size of US$ 1388.8 million by 2028 with a CAGR of 7.1% during the forecast period 2022-2028…
Currently, the companies in the world that produce homeopathic products mainly concentrate in Europe, USA and India. The main market players are DHU, Nelson & Co Ltd, Hyland’s, Homeopathic, SBL and Apotheca etc, with about 14% market shares.
Europe homeopathic products is the world’s most flourishing area, homeopathic treatment sales in Europe accounted for 24%, North America area is about 16% of market share…
I feel that the agencies that publish such reports could do with a bit of proper research. This might result in fewer errors and less egg on their faces. Here are a few points that I think might need corrections:
- Homeopathics can also be produced from a complete absence of material, for instance, X-rays or vacuum.
- Some can also be injected.
- I fear that the sales predictions are far too optimistic; they fail to account for the almost worldwide realization that homeopathy is an obsolete placebo therapy.
- The market share of South American nations seems to have been forgotten.
- The worldwide main player is Boiron.
Of course, none of this is important; after all, it’s only one of those meaningless market predictions that seem to be made by looking at tea leaves rather than facts.
Am I too harsh?
I don’t think so, – not least because it is easy to find predictions that differ substantially, e.g.:
- The homeopathy market is expected to grow at a CAGR of 14.3% from 2020 to 2028
- The global homeopathy market is expected to grow at a CAGR of 6.5% during the forecast period, from 2021 to 2030.
- Goldstein Research analyst forecast the Homeopathy Product Market to grow at a CAGR of 16.8% during the forecast period 2016-2024 and attain the revenue of USD 16.2 billion by 2024.
Unimportant? Yes, except that homeopaths and their advocates (like Prince Charles, for instance) are bound to use such documents for claiming that, if millions continue to use homeopathy, it must be effective and science must be wrong. Readers of this blog got used to and can by now see through homeopaths’ fallacies – but far too many consumers still fall for them.
Today, I received an email advertising a book – nothing unusual, of course. But the book and its author are both quite unusual. Here is the text:
Dr. Farokh J. Master’s birth into homeopathy was in the year 1976, when he joined Bombay homeopathic medical college, after giving up his studies at the orthodox school of medicine. Dr Master was instrumental in starting homeopathic out-patient dept in many allopathic hospitals viz. Bombay Hospital, KEM Hospital & Ruby Hall, Pune. Besides his work as a senior Homeopath of the HHC, Dr. Farokh Master is teaching homeopathy (advanced level) at the Mumbai Homeopathic Medical College, part of Mumbai university. He is also teaching at other homeopathic colleges in India and abroad. He has given seminars in various countries like Austria, Australia, India, Japan etc…
Healing Cancer: A Homoeopathic Approach
As a homeopath one should not deter oneself in dealing with any type of cases, be it cancer. But for executing that an ultimate guidance is needed. Cancer is so much prevalent and challenging medical problem of today that a trustworthy source of accurate information becomes pertinent and this work of Dr. Farokh Master immediately propels at the top of quality books for cancer. Based on Master’s 40 years of experience this book was written for students to understand the basis of oncology and for practitioners for brushing-up of their knowledge in this growing discipline. Author says that to get a grasp on cancer cases we should believe in the potential of the homeopathic treatment, that healing from cancer refers to internal process of becoming whole and feeling harmonious with yourself and your environment.To even start with handling the cases of cancer one should be aware of understanding of cancer, its cause, pathophysiology, different types, conventional treatment and their side effects, integrative medicines, social problems in the treatment, such topics are well casted by Volume 1 of the book…• A whole chapter on Cadmium salts and cancer.• 51 “lesser known remedies” are briefly quoted and their usefulness in different situations and types of cancer exposed.• A long chapter deals with the “Indian drugs”, it is important that these remedies are used mostly in tincture or low potencies, as herbal or Ayurvedic remedies or food supplements relieving the patients. • The choice and differentiation between the remedies is then helped by the “Repertory of Cancer”, very well compiled and a highly useful section. “Clinical tips from my practice” given as a sub-chapter. • It ends with recommendations on how to deal with radiation illness and the side-effects of conventional treatment, as well as the treatment of pain and help with palliative care. For fighting and curing cancer and improving the quality and quantity of life of people, knowledge of Homeopathy, both philosophically and scientifically is needed which this work of art portrays delightfully.
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It is clear that Dr. Farokh J. Master does not suggest using homeopathy in addition to conventional cancer therapies. He foremost wants to employ it as an alternative cancer cure. It is also clear that, if his concepts were generally adopted, they could kill millions.
Some defenders of homeopathy might claim that this is not what most homeopaths would advocate; they would merely recommend homeopathy as an adjunct to conventional oncology. Yet, there are many examples to the contrary, and not just from India – after all, Hahnemann, the inventor of homeopathy, insisted that homeopathy must never be combined with ‘allopathic’ medicines.
So, the next time someone claims homeopathy to be harmless, please show them this post.
Ischemic heart disease (IHD) related to cardiovascular or cerebrovascular disease is the leading cause of mortality and an important issue of public health worldwide. The cost of long-term healthcare for IHD patients may result in a huge financial burden. This study analyzed the medical expenditure incurred for and survival of IHD patients treated with Chinese herbal medicine (CHM) and Western medicine.
Subjects were randomly selected from the National Health Insurance Research Database in Taiwan. The Cox proportional hazards regression model, Kaplan–Meier estimator, logrank test, chi-square test, and analysis of variance were applied. Landmark analysis was used to assess the cumulative incidence of death in IHD patients.
A total of 11,527 users were identified as CHM combined with Western medicine and 11,527 non-CHM users. CHM users incurred a higher medical expenditure for outpatient care within 1 (24,529 NTD versus 18,464 NTD, value <0.0001) and 5 years (95,345 NTD versus 60,367 NTD, value <0.0001). However, CHM users had shorter hospitalizations and lower inpatient medical expenditure (7 days/43,394 NTD in 1 year; 11 days/83,141 NTD in 5 years) than non-CHM users (11 days/72,939 NTD in 1 year; 14 days/107,436 NTD in 5 years).
The CHM group’s adjusted hazard ratio for mortality was 0.41 lower than that of the non-CHM group by Cox proportional hazard models with time-dependent exposure covariates. Danshen, Huang qi, Niu xi, Da huang, and Fu zi were the most commonly prescribed Chinese single herbs; Zhi-Gan-Cao-Tang, Xue-Fu-Zhu-Yu-Tang, Tian-Wang-Bu-Xin-Dan, Sheng-Mai-San, and Yang-Xin-Tang were the five most frequently prescribed herbal formulas in Taiwan.
The authors concluded that combining Chinese and Western medicine can reduce hospital expenditure and improve survival for IHD patients.
Why, you will ask, do I think that this study deserves to be in the ‘worst paper cometition’?
It is not so bad!
It is an epidemiological case-control study with a large sample size that generates interesting findings.
Agreed!
But, as a case-control study, it cannot establish a causal link between CHM and the outcomes. You might argue that the conclusions avoid doing this – “can … improve survival” is not the same as “does improve survival”. This may be true, yet the title of the article leaves little doubt about the interpretation of the authors:
Chinese Herbal Medicine as an Adjunctive Therapy Improves the Survival Rate of Patients with Ischemic Heart Disease: A Nationwide Population-Based Cohort Study
I find it difficult not to view this as a deliberate attempt of the authors, editors, and reviewers to mislead the public.
Looking at the details of the study, it is easy to see that the two groups were different in a whole range of parameters that were measured. More importantly, they most likely differ in a range of variables that were not measured and had significant influence on IHD survival. It stands to reason, for instance, that patients who elected to use CHM in addition to their standard care were more health conscious. They would thus have followed a healthier diet and lifestyle. It would be foolish to claim that such factors do not influence IHD survival.
The fact that the authors fail even to mention this possibility, interpret an association as a causal link, and thus try to mislead us all makes this paper, in my view, a strong contender for my
WORST PAPER OF 2022 COMPETITION
This cohort study was designed as undertaken to evaluate the protective effect of Arsenicum album 30C against COVID-19.
Participants were enrolled in a homeopathy intervention (HI) cohort (who received Arsenicum album) or in a non-intervention (NI) cohort (who received no systematic intervention) from COVID-19 containment areas of Delhi. Individuals of age 5 years or above were given four medicated pills of Arsenicum album 30C, while those from 1 to 5 years old were given two medicated pills in each dose.
The analysis included 10,180 individuals residing in 11 COVID-19 containment areas in Delhi, out of which 6,590 individuals were in the HI cohort and 3,590 individuals were in the NI cohort. The overall protective effect of Arsenicum album 30C was 83% (95% confidence interval [CI], 76.77 to 88.17): 45 cases per 6,590 (8.34 per 10,000 person-weeks) in the Arsenicum album 30C group versus 143 cases per 3,590 (45.01 per 10,000 person-weeks) in the NI cohort. The protective effect of Arsenicum album 30C against laboratory-confirmed COVID-19 was 74% (95% CI, 55.08 to 85.41): 18 cases per 6,590 (3.32 per 10,000 person-weeks) in the Arsenicum album 30C group versus 38 cases per 3,590 (11.85 per 10,000 person-weeks) in the NI cohort.
The authors concluded that the use of Arsenicum album 30C was associated with some protection against probable and laboratory-confirmed COVID-19 in a containment-zone setting. Randomized controlled trials are needed to confirm or refute these results.
It is remarkable, I feel, that the authors conclude Arsenicum album 30C was associated with some protection. All too often enthusiasts of homeopathy claim a causal link where there is none – but not this time, and I wonder why.
Unfortunately, I was unable to read the full text of the paper (it’s behind a paywall and I would be grateful for anyone to make it available). Thus, I cannot comment on one of the most crucial questions related to the study: how were the patients divided into the two groups?
It is clear that it was not by randomization. Yet only randomization would have created two fully comparable groups. The most likely explanation for the findings of this trial is therefore that the two groups differed in terms of one or more prognostic factors. This would explain why a group of patients receiving a placebo (Arsenicum album C30 is a dilution of Arsenic at a ratio of 1: 1000000000000000000000000000000000000000000000000000000000000 and therefore is a pure placebo [unless, of course, one believes in homeopathic magic) experience different outcomes from those receiving nothing.
As I said, the answer can only be found by studying the precise selection criteria used in this study. Until this is cleared up, I can only say three things for sure:
- A causal link between the treatment and the result is highly unlikely.
- It is regrettable that researchers do not use randomization for potentially important trials.
- It seems unethical to encourage placebo use for the prevention of a serious illness.
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UPDATE
I just received the full text from one of the authors. This is what they say about the allocation of the participants:
“Participants were enrolled in two cohorts: the homeopathy intervention (HI) cohort and the non-intervention (NI) cohort. Recruitment to the cohorts was at cluster level (containment area): the clusters were allotted to the HI cohort or the NI cohort as per convenience.”
I am afraid, this tells me very little, and my concerns noted above still apply.
A few other points are of relevance:
- The study was conducted between April and August 2020. This begs the question of why it took 2 years to publish the findings.
- The outcomes were verified via telephone. This means that social desirability might have influenced the results.
- The paper also confirms that there were many important differences between the groups that might have prognostic significance.
- The conclusion at the end of the paper does imply causality in stronger terms than the abstract: “The use of Arsenicum album 30C may help protect against COVID-19 infection. Randomized controlled trials are needed
to confirm or refute our findings.
The purpose of this study was to examine the trends in the expenditure and utilization of chiropractic care in a representative sample of children and adolescents in the United States (US) aged <18 years.
The researchers evaluated serial cross-sectional data (2007-2016) from the Medical Expenditure Panel Survey. Weighted descriptive statistics were conducted to derive national estimates of expenditure and utilization, and linear regression was used to determine trends over time. Sociodemographic and clinical characteristics of chiropractic users were also reported.
A statistically significant increasing trend was observed for the number of children receiving chiropractic care (P <.05) and chiropractic utilization rate (P < .05). Increases in chiropractic expenditure and the number of chiropractic visits were also observed over time but were not statistically significant (P > .05). The mean annual number of visits was 6.4 visits, with a mean expenditure of $71.49 US dollars (USD) per visit and $454.08 USD per child. Children and adolescent chiropractic users in the United States were primarily 14 to 17 years old (39.6%-61.6%), White (71.5%-76.9%), male (50.6%-51.3%), and privately insured (56.7%-60.8%). Chiropractic visits in this population primarily involved low back conditions (52.4%), spinal curvature (14.0%), and head and neck complaints (12.8%).
The authors concluded that the number of children visiting a chiropractor and percent utilization showed a statistically significant, increasing trend from 2007 to 2016; however, total expenditure and the number of chiropractic visits did not significantly differ during this period. These findings provide novel insight into the patterns of chiropractic utilization in this understudied age group.
Why are these numbers increasing?
Is it because of increasing and sound evidence showing that chiropractors do more good than harm to kids?
No!
A recent systematic review of the evidence for effectiveness and harms of specific spinal manipulation therapy (SMT) techniques for infants, and children suggests the opposite.
Its authors searched electronic databases up to December 2017. Controlled studies, describing primary SMT treatment in infants (<1 year) and children/adolescents (1–18 years), were included to determine effectiveness. Controlled and observational studies and case reports were included to examine harms. One author screened titles and abstracts and two authors independently screened the full text of potentially eligible studies for inclusion. Two authors assessed the risk of bias in included studies and the quality of the body of evidence using the GRADE methodology. Data were described according to PRISMA guidelines and CONSORT and TIDieR checklists. If appropriate, a random-effects meta-analysis was performed.
Of the 1,236 identified papers, 26 studies were eligible. In all but 3 studies, the therapists were chiropractors. Infants and children/adolescents were treated for various (non-)musculoskeletal indications, hypothesized to be related to spinal joint dysfunction. Studies examining the same population, indication, and treatment comparison were scarce. Due to very low-quality evidence, it is uncertain whether gentle, low-velocity mobilizations reduce complaints in infants with colic or torticollis, and whether high-velocity, low-amplitude manipulations reduce complaints in children/adolescents with autism, asthma, nocturnal enuresis, headache or idiopathic scoliosis. Five case reports described severe harms after HVLA manipulations in 4 infants and one child. Mild, transient harms were reported after gentle spinal mobilizations in infants and children and could be interpreted as a side effect of treatment.
The authors concluded that, based on GRADE methodology, we found the evidence was of very low quality; this prevented us from drawing conclusions about the effectiveness of specific SMT techniques in infants, children and adolescents. Outcomes in the included studies were mostly parent or patient-reported; studies did not report on intermediate outcomes to assess the effectiveness of SMT techniques in relation to the hypothesized spinal dysfunction. Severe harms were relatively scarce, poorly described and likely to be associated with underlying missed pathology. Gentle, low-velocity spinal mobilizations seem to be a safe treatment technique in infants, children and adolescents. We encourage future research to describe effectiveness and safety of specific SMT techniques instead of SMT as a general treatment approach.
But chiros do more than just SMT, I hear some say.
Yes, they do!
But they nevertheless manipulate virtually every patient, and the additional treatments they use are merely borrowed from other disciplines.
So, why are the numbers increasing then?
I suggest this as a main reason:
chiropractors are systematically misleading the public about the value of their trade.
