conflict of interest
This review assessed the magnitude of reporting bias in trials assessing homeopathic treatments and its impact on evidence syntheses.
A cross-sectional study and meta-analysis. Two persons independently searched Clinicaltrials.gov, the EU Clinical Trials Register and the International Clinical Trials Registry Platform up to April 2019 to identify registered homeopathy trials. To determine whether registered trials were published and to detect published but unregistered trials, two persons independently searched PubMed, Allied and Complementary Medicine Database, Embase and Google Scholar up to April 2021. For meta-analyses, the authors used random effects models to determine the impact of unregistered studies on meta-analytic results.
The investigators reported the proportion of registered but unpublished trials and the proportion of published but unregistered trials. They also assessed whether primary outcomes were consistent between registration and publication
Since 2002, almost 38% of registered homeopathy trials have remained unpublished, and 53% of published randomised controlled trials (RCTs) have not been registered. Retrospective registration was more common than prospective registration. Furthermore, 25% of primary outcomes were altered or changed compared with the registry. Although we could detect a statistically significant trend toward an increase of registrations of homeopathy trials (p=0.001), almost 30% of RCTs published during the past 5 years had not been registered.
A meta-analysis stratified by registration status of RCTs revealed substantially larger treatment effects of unregistered RCTs (SMD: −0.53, 95% CI −0.87 to −0.20) than registered RCTs (SMD: −0.14, 95% CI −0.35 to 0.07).
The authors concluded that registration of published trials was infrequent, many registered trials were not published and primary outcomes were often altered or changed. This likely affects the validity of the body of evidence of homeopathic literature and may overestimate the true treatment effect of homeopathic remedies.
An obvious investigation to do (why did I not have this idea?)!
And a finding that will surprise few (except fans of homeopathy who will, of course, dispute it).
The authors also mention that reporting biases are likely to have a substantial impact on the estimated treatment effect of homeopathy. Using data from a highly cited meta-analysis of homeopathy RCTs, our example showed that unregistered trials yielded substantially larger treatment effects than registered trials. They also caution that, because of the reporting biases identified in their analysis, effect estimates of meta-analyses of homeopathy trials might substantially overestimate the true treatment effect of homeopathic remedies and need to be interpreted cautiously.
In other words, the few reviews suggesting that homeopathy works beyond placebo (and are thus celebrated by homeopaths) are most likely false-positive. And the many reviews showing that homeopathy does not work would demonstrate this fact even clearer if the reporting bias had been accounted for.
Or, to put it bluntly:
The body of evidence on homeopathy is rotten to the core and therefore not reliable.
Vaccine hesitancy is currently recognized by the WHO as a major threat to global health. During the COVID-19 pandemic, there has been a growing interest in the role of social media in the propagation of false information and fringe narratives regarding vaccination. Using a sample of approximately 60 billion tweets, Danish investigators conducted a large-scale analysis of the vaccine discourse on Twitter. They used methods from deep learning and transfer learning to estimate the vaccine sentiments expressed in tweets, then categorize individual-level user attitudes towards vaccines. Drawing on an interaction graph representing mutual interactions between users, They analyzed the interplay between vaccine stances, interaction network, and the information sources shared by users in vaccine-related contexts.
The results show that strongly anti-vaccine users frequently share content from sources of a commercial nature; typically sources that sell alternative health products for profit. An interesting aspect of this finding is that concerns regarding commercial conflicts of interests are often cited as one of the major factors in vaccine hesitancy.
The authors furthermore demonstrate that the debate is highly polarized, in the sense that users with similar stances on vaccination interact preferentially with one another. Extending this insight, the authors provide evidence of an epistemic echo chamber effect, where users are exposed to highly dissimilar sources of vaccine information, enforcing the vaccination stance of their contacts.
The authors concluded that their findings highlight the importance of understanding and addressing vaccine mis- and disinformation in the context in which they are disseminated in social networks.
In the article, the authors comment that their findings paint a picture of the vaccine discourse on Twitter as highly polarized, where users who express similar sentiments regarding vaccinations are more likely to interact with one another, and tend to share contents from similar sources. Focusing on users whose vaccination stances are the positive and negative extremes of the spectrum, we observe relatively disjoint ‘epistemic echo chambers’ which imply that members of the two groups of users rarely interact, and in which users experience highly dissimilar ‘information landscapes’ depending on their stance. Finally, we find that strongly anti-vaccine users much more frequently share information from actors with a vested commercial interest in promoting medical misinformation.
One implication of these findings is that online (medical) misinformation may present an even greater problem than previously thought, because beliefs and behaviors in tightly knit, internally homogeneous communities are more resilient, and provide fertile ground for fringe narratives, while mainstream information is attenuated. Furthermore, such polarization of communities may become self-perpetuating, because individuals avoid those not sharing their views, or because exposure to mainstream information might further entrench fringe viewpoints.
The present study investigated the impact of a purposefully designed Islamic religion-based intervention on reducing depression and anxiety disorders among Muslim patients using a randomised controlled trial design. A total of 62 Muslim patients (30 women and 32 men) were divided by gender into two groups, with each group assigned randomly to either treatment or control groups. The participants who received the Islamic-based intervention were compared to participants who received the control intervention.
The Islamic-Based Intervention that was applied to the two experimental groups (i.e. one male, one female) has several components. These components were based on moral and religious concepts and methods, including moral confession, repentance, insight, learning, supplication, seeking Allah’s mercy, seeking forgiveness, remembrance of Allah, patience, trust in Allah, self-consciousness, piety, spiritual values, and moral principles. The techniques implemented in the intervention included the art of asking questions, clarifying, listening, interacting, summarising, persuading, feedback, empathy, training practice, reflecting feelings, discussion, and dialogue, lecturing, brainstorming, reinforcement, modeling, positive self-talk, evaluation, homework, practical applications, activation games (play through activities), emotional venting, stories, presentation, correction of thoughts, and relaxation. The two control groups (i.e. one male, one female) received the energy path program provided by the Al-Nour Centre. This program aimed to enhance self-confidence and modify people’s behavior with anxiety disorders, depression, and obsessive-compulsive disorder. Both interventions comprised 30 sessions over 30 h; two sessions were conducted per week, and each session lasted for 60 min (one hour). The duration of the intervention was 15 weeks.
Taylor’s manifest anxiety scale and Steer and Beck’s depression scale were used for examining the effects on depression and anxiety levels. The results revealed that the Islamic intervention significantly reduced anxiety levels in women and depression levels in men compared to the typical care control groups.
The authors concluded that religious intervention played a vital role in lowering the patients’ level of anxiety among women and depression among men. In general, religious practices prevent individuals from becoming subject to mental disorders, i.e. anxiety and depression.
The authors comment that the Islamic religion-based intervention (RSAFI) significantly reduced the levels of depression and anxiety among the participants. Also, there was a substantial improvement in the patients’ general health after the intervention. They were satisfied and believed that everything happening to them was destined by Allah. These results could be attributed to the different intervention practices that relied on the guidance of the Holy Quran and Sunnah. For instance, Saged et al. (2020) confirmed that the Holy Quran significantly impacts healing patients who suffer from physical, psychological, and mental disorders. In this respect, Moodley et al. (2018) concluded that having faith in Allah offers a relatively quick approach to healing patients suffering from heartache and depression. This goes hand in hand because the recitation of the Quran and remembrance of Allah help patients feel relaxed and peaceful. Muslims believe that the Quran is the word of Allah and that Allah’s words exert a significant impact on the healing of mental health patients, as, ultimately, Almighty Allah is the one who cures illnesses.
When discussing the limitations of their study, the authors state that the sample of this study was limited to the patients with anxiety and depression disorders at the Al-Nour Centre in Kuala Lumpur, so the results cannot be generalized to other samples. Furthermore, the treatment of anxiety was restricted to females, whereas the treatment of depression was restricted to males. Additionally, the selection of females and males as samples for the study was based on their pre-measurement of anxiety and depression, which serve as self-report measures.
The authors seem to be unconcerned about the fact that the 2 interventions (verum and control) were clearly distinguishable and their patients thus were not blinded (and neither were the evaluators). This obviously means that the observed effect might have nothing at all to do with the Islamic-Based Intervention but could be entirely due to expectation and persuasion.
Why might the authors not even bother to discuss such an obvious possibility?
A look at their affiliations might provide the answer:
- 1Academy of Islamic Studies, University of Malaya, 50603, Kuala Lumpur, Malaysia. [email protected].
- 2Academy of Islamic Studies, University of Malaya, 50603, Kuala Lumpur, Malaysia.
- 3Faculty of Education, Universiti Teknologi Malaysia, Johor, Malaysia.
- 4Faculty of Education, University of Malaya, 50603, Kuala Lumpur, Malaysia.
- 5Islamic Banking and Finance, International Islamic University Malaysia, Selangor, Malaysia.
- 6Department of Hadith and Associated Sciences, Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.
I rarely follow up announcements of new studies of so-called alternative medicine (SCAM). But this one is different. It was so spectacular that almost precisely two years ago I reported about it. Here is what I wrote:
Dr. Dhanunjaya Lakkireddy, a cardiologist at the Kansas City Heart Rhythm Institute in the US, has started a trial of prayer for corona-virus infection. The study will involve 1000 patients with COVID-19 infections severe enough to require intensive care. The four-month study will investigate “the role of remote intercessory multi-denominational prayer on clinical outcomes in COVID-19 patients,” according to a description provided to the National Institutes of Health.
Inclusion Criteria:
- Male or female greater than 18 years of age
- Confirmed positive for COVID-19
- Patient admitted to Intensive Care Unit
Exclusion Criteria:
- Patients admitted to ICU for diagnosis that is not COVID-19 positive
(Not giving informed consent is not listed as an exclusion criterion!)
Half of the patients, randomly chosen, will receive a “universal” prayer offered in five denominational forms, via:
- Buddhism,
- Christianity,
- Hinduism,
- Islam,
- Judaism.
The other 500 patients in the control group will not be prayed for by the prayer group. All the patients will receive the standard care prescribed by their medical providers. “We all believe in science, and we also believe in faith,” Lakkireddy claims. “If there is a supernatural power, which a lot of us believe, would that power of prayer and divine intervention change the outcomes in a concerted fashion? That was our question.”
The outcome measures in the trial are
- the time patients remain on ventilators,
- the number of patients who suffer from organ failure,
- the time patients have to stay in intensive care,
- the mortality rate.
________________________________________
For months, I have now been looking out for the results of this study. It must long be finished now. The results cannot be difficult to analyze. The publication of such a sensational trial should not be a problem. If the findings are positive, even top journals would be keen to publish them. If they are negative, they would still be worth reporting.
So, where are they?
I could not find a trace of them!
Why not?
I was puzzled and became more and more frustrated.
Until I had the obvious idea of looking at the website that reported the above details two years ago. There was the answer to my questions:
“Recruitment Status: Terminated (Due to the low enrollment, this study is closed. Analysis of data is not performed.)”
But how can this be?
What can possibly be the reason for an enrollment that was too low to properly conclude this trial?
- There were certainly enough COVID patients (contrary to what was claimed earlier, the sample size is now given at merely 200).
- Many of these US patients would, of course, be religious and thus welcome some divine intervention.
So, why might such a trial fail? I can only think of two reasons:
- The execution of the trial was sloppy and half-hearted.
- The research question was too daft for participants to consent.
Whatever the reason, I find it sad, possibly even unethical that research funds are being wasted on such nonsense.
PS
The sponsor of this study was the Kansas City Heart Rhythm Institute. The director of the Kansas City Heart Rhythm Institute is Dhanunjaya Lakkireddy, the principal investigator of this trial.
PPS
When the study was first announced in 2020, it received huge publicity. I, therefore, think that the investigators should have had the decency to also publicly announce that they failed to conclude it.
The Nobel Prize laureate Luc Montagnier has died at the age of 89.
Montagnier became the hero of the realm of homeopathy when he published findings suggesting that ultra-molecular dilutions are not just pure water but might have some activity. In this context, he has been mentioned repeatedly on this blog. During the years that followed his support for homeopathy, things got from bad to worse, and Montagnier managed to alienate most of the scientific community.
Amongst other things, he became a champion of the anti-vax movement, supported the view that vaccination causes autism, and argued that viral infections including HIV could be cured by diet. During the pandemic, he then claimed that Sars-CoV-2 had originated from a laboratory experiment attempting to combine coronavirus and HIV. On French television, he claimed that vaccination was an “enormous mistake” that would only promote the spread of new variants.
Before Montagnier became a victim of ‘Nobelitis‘, he had a brilliant career as a virologist in his world-famous Paris lab. A co-worker of Montagnier, Barré-Sinoussi, managed to isolate a retrovirus from an AIDS patient in 1983. They called it ‘lymphadenopathy-associated virus’, and concluded that it may be involved in several pathological syndromes, including AIDS.
Meanwhile, in the US, Gallo had identified a family of immunodeficiency retroviruses that he called human T-lymphotropic virus (HTLV). In 1984, Gallo announced that one of these viruses was the cause of AIDS. The US government swiftly patented a blood test for detecting antibodies to it. Thus it became possible to screen for the virus in the blood.
When it became clear that material used in Gallo’s studies included samples that Montagnier had supplied in 1983, one of the fiercest rows in the history of science ensued. Eventually, negotiations between the two governments settled it by resolving that the two scientists should be equally credited. In 2002, Gallo and Montagnier published a joint paper acknowledging each other’s role: Montagnier’s team discovered HIV, and Gallo’s proved it caused AIDS. When Gallo was excluded from the Nobel prize given in 2008 to Montagnier and Barré-Sinoussi, the world of science was stunned. The spectacular dispute between Galo and Montagnier became the subject of a movie and several books.
Montagnier died on 8/2/2022 leaving behind his wife Dorothea and their three children, Anne-Marie, Francine, and Jean-Luc.
The new issue of the BMJ carries an article on acupuncture that cries out for a response. Here, I show you the original article followed by my short comments. For clarity, I have omitted the references from the article and added references that refer to my comments.
_________________________________________
Conventional allopathic medicine [1]—medications and surgery [2] used in conventional systems of medicine to treat or prevent disease [3]—is often expensive, can cause side effects and harm, and is not always the optimal treatment for long term conditions such as chronic pain [4]. Where conventional treatments have not been successful, acupuncture and other traditional and complementary medicines have potential to play a role in optimal patient care [5].
According to the World Health Organisation (WHO) 2019 global report, acupuncture is widely used across the world. [6] In some countries acupuncture is covered by health insurance and established regulations. [7] In the US, practitioners administer over 10 million acupuncture treatments annually. [6] In the UK, clinicians administer over 4 million acupuncture treatments annually, and it is provided on the NHS. [6]
Given the widespread use of acupuncture as a complementary therapy alongside conventional medicine, there has been an increase in global research interest and funding support over recent decades. In 2009, the European Commission launched a Good Practice in Traditional Chinese Medicine Research (GP-TCM) funding initiative in 19 countries. [7] The GP-TCM grant aimed to investigate the safety and efficacy of acupuncture as well as other traditional Chinese medicine interventions.
In China, acupuncture is an important focus of the national research agenda and receives substantial research funding. [8] In 2016, the state council published a national strategy supporting universal access to acupuncture by 2020. China has established more than 79 evidence-based traditional Chinese medicine or integrative medicine research centers. [9]
Given the broad clinical application and rapid increase in funding support for acupuncture research, researchers now have additional opportunities to produce high-quality studies. However, for this to be successful, acupuncture research must address both methodological limitations and unique research challenges.
This new collection of articles, published in The BMJ, analyses the progress of developing high quality research studies on acupuncture, summarises the current status, and provides critical methodological guidance regarding the production of clinical evidence on randomised controlled trials, clinical practice guidelines and health economic evidence. It also assesses the number and quality of systematic reviews of acupuncture. [10] We hope that the collection will help inform the development of clinical practice guidelines, health policy, and reimbursement decisions. [11]
The articles document the progress of acupuncture research. In our view, the emerging evidence base on the use of acupuncture warrants further integration and application of acupuncture into conventional medicine. [12] National, regional, and international organisations and health systems should facilitate this process and support further rigorous acupuncture research.
Footnotes
This article is part of a collection funded by the special purpose funds for the belt and road, China Academy of Chinese Medical Sciences, National Natural Science Foundation of China, the National Center for Complementary and Integrative Health, the Innovation Team and Talents Cultivation Program of the National Administration of Traditional Chinese Medicine, the Special Project of “Lingnan Modernization of Traditional Chinese Medicine” of the 2019 Guangdong Key Research and Development Program, and the Project of First Class Universities and High-level Dual Discipline for Guangzhou University of Chinese Medicine. The BMJ commissioned, peer reviewed, edited, and made the decision to publish. Kamran Abbasi was the lead editor for The BMJ. Yu-Qing Zhang advised on commissioning for the collection, designed the topic of the series, and coordinated the author teams. Gordon Guyatt provided valuable advice and guidance. [13]
1. Allopathic medicine is the term Samuel Hahnemann coined for defaming conventional medicine. Using it in the first sentence of the article sets the scene very well.
2. Medicine is much more than ‘medications and surgery’. To imply otherwise is a strawman fallacy.
3. What about rehabilitation medicine?
4. ‘Conventional medicine is not always the optimal treatment’? This statement is very confusing and wrong. It is true that conventional medicine is not always effective. However, it is by definition the best we currently have and therefore it IS optimal.
5. Another fallacy: non sequitur
6. Another fallacy: appeal to popularity.
7. Yet another fallacy: appeal to authority.
8. TCM is heavily promoted by China not least because it is a most lucrative source of income.
9. Several research groups have shown that 100% of acupuncture research coming out of China report positive results. This casts serious doubt on the reliability of these studies (see, for instance, here, here, and here).
10. It has been noted that more than 80 percent of clinical data from China is fabricated.
11. Based on the points raised above, it seems to me that the collection’s aim is not to provide objective information but uncritical promotion.
12. I find it telling that the authors do not even consider the possibility that rigorous research might demonstrate that acupuncture cannot generate more good than harm.
13. This statement essentially admits that the series of articles constitutes paid advertising for TCM. The BMJ’s peer-review process must have been less than rigorous in this case.
Bioresonance is an alternative therapeutic and diagnostic method employing a device developed in Germany by Scientology member Franz Morell in 1977. The bioresonance machine was further developed and marketed by Morell’s son-in-law Erich Rasche and is also known as ‘MORA’ therapy (MOrell + RAsche). Bioresonance is based on the notion that one can diagnose and treat illness with electromagnetic waves and that, via resonance, such waves can influence disease on a cellular level.
On this blog, we have discussed the idiocy bioresonance several times (for instance, here and here). My favorite study of bioresonance is the one where German investigators showed that the device cannot even differentiate between living and non-living materials. Despite the lack of plausibility and proof of efficacy, research into bioresonance continues.
The aim of this study was to evaluate if bioresonance therapy can offer quantifiable results in patients with recurrent major depressive disorder and with mild, moderate, or severe depressive episodes.
The study included 140 patients suffering from depression, divided into three groups.
- The first group (40 patients) received solely bioresonance therapy.
- The second group (40 patients) received pharmacological treatment with antidepressants combined with bioresonance therapy.
- The third group (60 patients) received solely pharmacological treatment with antidepressants.
The assessment of depression was made using the Hamilton Depression Rating Scale, with 17 items, at the beginning of the bioresonance treatment and the end of the five weeks of treatment.
The results showed a statistically significant difference for the treatment methods applied to the analyzed groups (p=0.0001). The authors also found that the therapy accelerates the healing process in patients with depressive disorders. Improvement was observed for the analyzed groups, with a decrease of the mean values between the initial and final phase of the level of depression, of delta for Hamilton score of 3.1, 3.8 and 2.3, respectively.
The authors concluded that the bioresonance therapy could be useful in the treatment of recurrent major depressive disorder with moderate depressive episodes independently or as a complementary therapy to antidepressants.
One could almost think that this is a reasonably sound study. But why did it generate such a surprising result?
When reading the full paper, the first thing one notices is that it is poorly presented and badly written. Thus there is much confusion and little clarity. The questions keep coming until one comes across this unexpected remark: the study was a retrospective study…
This explains some of the confusion and it certainly explains the surprising results. It remains unclear how the patients were selected/recruited but it is obvious that the groups were not comparable in several ways. It also becomes very clear that with the methodology used, one can make any nonsense look effective.
In the end, I am left with the impression that mutton is being presented as lamb, even worse: I think someone here is misleading us by trying to convince us that an utterly bogus therapy is effective. In my view, this study is as clear an example of scientific misconduct as I have seen for a long time.
Now that the first reviews of, and numerous comments on my new book are in, I thought I bring my readers up to date and perhaps contribute to some fun. My favorite quote comes from a comment on Harriett Hall’s review: “Nothing much new here about Chucky Windsor’s credulity…”
Perhaps I shouldn’t, but I think it is funny and thus I chose it as the title of this post. Apart from being funny, it also has a more serious background. Virtually everyone who contacted me and gave me feedback said that they knew about Charles’ advocacy of alternative medicine. So, the ‘nothing much new’ comment is apt. Yet, they all added that, before reading my book, they had no idea how deeply Charles was involved and how profoundly anti-scientific and irrational his thinking seems to be in this area. Jonathan Stea, for instance, tweeted: “I just finished reading it—review coming soon. Excellent book. I didn’t realize Prince Charles was so stubbornly in love with pseudoscience and trying to promote it for decades under the guise of alternative/integrative medicine.”
Another comment was made on my own blog: “I am an avid consumer of this and other science blogs, books, podcasts and any other media I encounter. One of my earliest exposures was your book Trick or Treat, which I credit with greatly expanding my knowledge of a subject I had dabbled in but had begun to question. I deplore the PoW’s promotion of quackery. I am American and have no dog in the value of Royalty debate. BUT, I don’t see the need to use such a deeply unflattering (and possibly photoshopped) photo of the PoW. I do not think that such a decision is in line with your list of “nots”, and I think it hinders the impact it might otherwise have on fence-sitters. It disappoints me and while I have purchased multiple copies of many of your books to pass on to friends, family, and believers, I will pass on this one.” The photo is perhaps not flattering but there a many out there that are even worse. In any case, it is the publisher who decides on the title page. In the present case, I merely asked them to make my name on the title page a little less prominent than it was on the draft.
And then there were people who emailed me directly, as this medical colleague:
Dear Dr Ernst,
as a GP and ex oral surgeon from a world famous medical school(Edinburgh), also an experienced alternative practitioner,with 51 years in NHS, more than your own clinical exposure, I’m saddened by sponsored? skewed assaults on healing modalities maybe also representing a threat to financial paradigms: I absolved myself of scientific trials “for profit only”, in deference to holistic patient care, & the Hippocratic Oath
In a similar vein, Dr. Larry Malerba, a US homeopath, posted this comment on a Medscape interview with me:
Fortunately, the book reviews were more intelligent. They confirm what I mentioned above: reviewers were amazed at the depth of Charles’ irrationality. Harriett Hall expressed it as follows: “Charles’ efforts to promote alternative medicine have been mentioned many times on SBM, but readers may not appreciate the depth of his folly. I know I didn’t, until I read this book. The full story has never been told until now.” And Paul Benedetti wrote: “In short, readable chapters, Ernst unblinkingly presents how Charles has written books and articles promoting alternative medicine and spearheaded organizations, colleges, and foundations, giving full-throated support to one unproven, often bizarre, alternative health cure after another.”
One of the nicest pieces of praise came from someone who posted this comment on Amazon:
This is a revelatory critique of where vague well-intentioned but ill-informed health ideas promoted by a powerful person do or don’t get us.
Professor Ernst’s explanations are admirably clear – and no-one is more qualified than he to write on this topic. It’s difficult to imagine a more devastating comment on the bad conseqeunces of ill-informed ideas and actions, than that found in the last two paragraphs on Page 88.
There is a great deal of valuable information here on ‘alternative medicine’ approaches, in addition to the explanations of HRH Prince Charles’ involvement with them. A most worthwhile book for anyone wanting to find out more about alternative/complementary treatment modalities.
Yes, publishing a book can be a mixed blessing. The author works tirelessly for many months (for next to no pay) only to get aggressed – not for factual errors (that would be perfectly alright) or unfounded arguments (that would be welcome) but for allegedly being in it for the money or producing ‘prejudicial propaganda’. In the case of the new book, this had to be expected. I hesitated for an entire decade writing it (hoping someone else would tackle the task) because I knew that it would be far from straightforward to criticize the future king of one’s own country.
All the more reason to take this occasion and thank those who stand by me, who find my book relevant, who agree that it is instructive, and who feel that it deserves a wide readership.
THANK YOU
On this blog, I have been regularly discussing the risks of so-called alternative medicine (SCAM). In particular, I have often been writing about the risks of chiropractic spinal manipulations.
Why?
Some claim because I have an ax to grind – and, in a way, they are correct: I do feel strongly that consumers should be warned about the risks of all types of SCAM, and when it comes to direct risks, chiropractic happens to feature prominently.
But it’s all based on case reports which are never conclusive and usually not even well done.
This often-voiced chiropractic defense is, of course, is only partly true. But even if it were entirely correct, it would beg the question: WHY?
Why do we have to refer to case reports when discussing the risks of chiropractic? The answer is simple: Because there is no proper system of monitoring its risks.
And why not?
Chiropractors claim it is because the risks are non-existent or very rare or only minor or negligible compared to the risks of other therapies. This, I fear, is false. But how can I substantiate my fear? Perhaps by listing a few posts I have previously published on the direct risks of chiropractic spinal manipulation. Here is a list (probably not entirely complete):
- Chiropractic manipulations are a risk factor for vertebral artery dissections
- Vertebral artery dissection after chiropractic manipulation: yet another case
- The risks of (chiropractic) spinal manipulative therapy in children under 10 years
- A risk-benefit assessment of (chiropractic) neck manipulation
- The risk of (chiropractic) spinal manipulations: a new article
- New data on the risk of stroke due to chiropractic spinal manipulation
- The risks of manual therapies like chiropractic seem to out-weigh the benefits
- One chiropractic treatment followed by two strokes
- An outstanding article on the subject of harms of chiropractic
- Death by chiropractic neck manipulation? More details on the Lawler case
- Severe adverse effects of chiropractic in children Another serious complication after chiropractic manipulation; best to avoid neck manipulations altogether, I think
- Ophthalmic Adverse Effects after Chiropractic Neck Manipulation
- Is chiropractic treatment safe?
- Cervical artery dissection and stroke related to chiropractic manipulation
- We have an ethical, legal and moral duty to discourage chiropractic neck manipulations
- Cerebral Haemorrhage Following Chiropractic ‘Activator’ Treatment
- Vertebral artery dissection after chiropractic manipulation: yet another case
- Horner Syndrome after chiropractic spinal manipulation
- Phrenic nerve injury: a rare but serious complication of chiropractic neck manipulation
- Chiropractic neck manipulation can cause stroke
- Chiropractic and other manipulative therapies can also harm children
- Complications after chiropractic manipulations: probably rare but certainly serious
- Disc herniation after chiropractic
- Evidence for a causal link between chiropractic treatment and adverse effects
- More on the risks of spinal manipulation
- The risk of neck manipulation
- “As soon as the chiropractor manipulated my neck, everything went black”
- Spinal epidural haematoma after neck manipulation
- New review confirms: neck manipulations are dangerous
- Top model died ‘as a result of visiting a chiropractor’
- Another wheelchair filled with the help of a chiropractor
- Spinal manipulation: a treatment to die for?
Of course, one can argue about the conclusiveness of this or that case report, but I feel that the collective evidence discussed in these posts makes my point abundantly clear:
chiropractic spinal manipulation is not safe.
On 27 January 2022, I conducted a very simple Medline search using the search term ‘Chinese Herbal Medicine, Review, 2022’. Its results were remarkable; here are the 30 reviews I found:
- Zhu, S. J., Wang, R. T., Yu, Z. Y., Zheng, R. X., Liang, C. H., Zheng, Y. Y., Fang, M., Han, M., & Liu, J. P. (2022). Chinese herbal medicine for myasthenia gravis: A systematic review and meta-analysis of randomized clinical trials. Integrative medicine research, 11(2), 100806.
- Lu, J., Li, W., Gao, T., Wang, S., Fu, C., & Wang, S. (2022). The association study of chemical compositions and their pharmacological effects of Cyperi Rhizoma (Xiangfu), a potential traditional Chinese medicine for treating depression. Journal of ethnopharmacology, 287, 114962.
- Su, F., Sun, Y., Zhu, W., Bai, C., Zhang, W., Luo, Y., Yang, B., Kuang, H., & Wang, Q. (2022). A comprehensive review of research progress on the genus Arisaema: Botany, uses, phytochemistry, pharmacology, toxicity and pharmacokinetics. Journal of ethnopharmacology, 285, 114798.
- Nanjala, C., Ren, J., Mutie, F. M., Waswa, E. N., Mutinda, E. S., Odago, W. O., Mutungi, M. M., & Hu, G. W. (2022). Ethnobotany, phytochemistry, pharmacology, and conservation of the genus Calanthe R. Br. (Orchidaceae). Journal of ethnopharmacology, 285, 114822.
- Li, M., Jiang, H., Hao, Y., Du, K., Du, H., Ma, C., Tu, H., & He, Y. (2022). A systematic review on botany, processing, application, phytochemistry and pharmacological action of Radix Rehmnniae. Journal of ethnopharmacology, 285, 114820.
- Mutinda, E. S., Mkala, E. M., Nanjala, C., Waswa, E. N., Odago, W. O., Kimutai, F., Tian, J., Gichua, M. K., Gituru, R. W., & Hu, G. W. (2022). Traditional medicinal uses, pharmacology, phytochemistry, and distribution of the Genus Fagaropsis (Rutaceae). Journal of ethnopharmacology, 284, 114781.
- Xu, Y., Liu, J., Zeng, Y., Jin, S., Liu, W., Li, Z., Qin, X., & Bai, Y. (2022). Traditional uses, phytochemistry, pharmacology, toxicity and quality control of medicinal genus Aralia: A review. Journal of ethnopharmacology, 284, 114671.
- Peng, Y., Chen, Z., Li, Y., Lu, Q., Li, H., Han, Y., Sun, D., & Li, X. (2022). Combined therapy of Xiaoer Feire Kechuan oral liquid and azithromycin for mycoplasma Pneumoniae pneumonia in children: A systematic review & meta-analysis. Phytomedicine : international journal of phytotherapy and phytopharmacology, 96, 153899.
- Xu, W., Li, B., Xu, M., Yang, T., & Hao, X. (2022). Traditional Chinese medicine for precancerous lesions of gastric cancer: A review. Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie, 146, 112542.
- Wang, Y., Greenhalgh, T., Wardle, J., & Oxford TCM Rapid Review Team (2022). Chinese herbal medicine (“3 medicines and 3 formulations”) for COVID-19: rapid systematic review and meta-analysis. Journal of evaluation in clinical practice, 28(1), 13–32.
- Chen, X., Lei, Z., Cao, J., Zhang, W., Wu, R., Cao, F., Guo, Q., & Wang, J. (2022). Traditional uses, phytochemistry, pharmacology and current uses of underutilized Xanthoceras sorbifolium bunge: A review. Journal of ethnopharmacology, 283, 114747.
- Liu, X., Li, Y., Bai, N., Yu, C., Xiao, Y., Li, C., & Liu, Z. (2022). Updated evidence of Dengzhan Shengmai capsule against ischemic stroke: A systematic review and meta-analysis. Journal of ethnopharmacology, 283, 114675.
- Chen, J., Zhu, Z., Gao, T., Chen, Y., Yang, Q., Fu, C., Zhu, Y., Wang, F., & Liao, W. (2022). Isatidis Radix and Isatidis Folium: A systematic review on ethnopharmacology, phytochemistry and pharmacology. Journal of ethnopharmacology, 283, 114648.
- Tian, J., Shasha, Q., Han, J., Meng, J., & Liang, A. (2022). A review of the ethnopharmacology, phytochemistry, pharmacology and toxicology of Fructus Gardeniae (Zhi-zi). Journal of ethnopharmacology, 114984. Advance online publication.
- Wong, A. R., Yang, A., Li, M., Hung, A., Gill, H., & Lenon, G. B. (2022). The Effects and Safety of Chinese Herbal Medicine on Blood Lipid Profiles in Placebo-Controlled Weight-Loss Trials: A Systematic Review and Meta-Analysis. Evidence-based complementary and alternative medicine : eCAM, 2022, 1368576.
- Lu, C., Ke, L., Li, J., Wu, S., Feng, L., Wang, Y., Mentis, A., Xu, P., Zhao, X., & Yang, K. (2022). Chinese Medicine as an Adjunctive Treatment for Gastric Cancer: Methodological Investigation of meta-Analyses and Evidence Map. Frontiers in pharmacology, 12, 797753.
- Niu, L., Xiao, L., Zhang, X., Liu, X., Liu, X., Huang, X., & Zhang, M. (2022). Comparative Efficacy of Chinese Herbal Injections for Treating Severe Pneumonia: A Systematic Review and Bayesian Network Meta-Analysis of Randomized Controlled Trials. Frontiers in pharmacology, 12, 743486.
- Zhang, L., Huang, J., Zhang, D., Lei, X., Ma, Y., Cao, Y., & Chang, J. (2022). Targeting Reactive Oxygen Species in Atherosclerosis via Chinese Herbal Medicines. Oxidative medicine and cellular longevity, 2022, 1852330.
- Zhou, X., Guo, Y., Yang, K., Liu, P., & Wang, J. (2022). The signaling pathways of traditional Chinese medicine in promoting diabetic wound healing. Journal of ethnopharmacology, 282, 114662.
- Yang, M., Shen, C., Zhu, S. J., Zhang, Y., Jiang, H. L., Bao, Y. D., Yang, G. Y., & Liu, J. P. (2022). Chinese patent medicine Aidi injection for cancer care: An overview of systematic reviews and meta-analyses. Journal of ethnopharmacology, 282, 114656.
- Liu, H., & Wang, C. (2022). The genus Asarum: A review on phytochemistry, ethnopharmacology, toxicology and pharmacokinetics. Journal of ethnopharmacology, 282, 114642.
- Lin, Z., Zheng, J., Chen, M., Chen, J., & Lin, J. (2022). The Efficacy and Safety of Chinese Herbal Medicine in the Treatment of Knee Osteoarthritis: An Updated Systematic Review and Meta-Analysis of 56 Randomized Controlled Trials. Oxidative medicine and cellular longevity, 2022, 6887988.
- Yu, R., Zhang, S., Zhao, D., & Yuan, Z. (2022). A systematic review of outcomes in COVID-19 patients treated with western medicine in combination with traditional Chinese medicine versus western medicine alone. Expert reviews in molecular medicine, 24, e5.
- Mo, X., Guo, D., Jiang, Y., Chen, P., & Huang, L. (2022). Isolation, structures and bioactivities of the polysaccharides from Radix Hedysari: A review. International journal of biological macromolecules, 199, 212–222.
- Yang, L., Chen, X., Li, C., Xu, P., Mao, W., Liang, X., Zuo, Q., Ma, W., Guo, X., & Bao, K. (2022). Real-World Effects of Chinese Herbal Medicine for Idiopathic Membranous Nephropathy (REACH-MN): Protocol of a Registry-Based Cohort Study. Frontiers in pharmacology, 12, 760482.
- Zhang, R., Zhang, Q., Zhu, S., Liu, B., Liu, F., & Xu, Y. (2022). Mulberry leaf (Morus alba L.): A review of its potential influences in mechanisms of action on metabolic diseases. Pharmacological research, 175, 106029.
- Yuan, J. Y., Tong, Z. Y., Dong, Y. C., Zhao, J. Y., & Shang, Y. (2022). Research progress on icariin, a traditional Chinese medicine extract, in the treatment of asthma. Allergologia et immunopathologia, 50(1), 9–16.
- Zeng, B., Wei, A., Zhou, Q., Yuan, M., Lei, K., Liu, Y., Song, J., Guo, L., & Ye, Q. (2022). Andrographolide: A review of its pharmacology, pharmacokinetics, toxicity and clinical trials and pharmaceutical researches. Phytotherapy research : PTR, 36(1), 336–364.
- Zhang, L., Xie, Q., & Li, X. (2022). Esculetin: A review of its pharmacology and pharmacokinetics. Phytotherapy research : PTR, 36(1), 279–298.
- Wang, D. C., Yu, M., Xie, W. X., Huang, L. Y., Wei, J., & Lei, Y. H. (2022). Meta-analysis on the effect of combining Lianhua Qingwen with Western medicine to treat coronavirus disease 2019. Journal of integrative medicine, 20(1), 26–33. https://doi.org/10.1016/j.joim.2021.10.005
The amount of reviews alone is remarkable, I think: more than one review per day! Apart from their multitude, the reviews are noteworthy for other reasons as well.
- Their vast majority arrived at positive or at least encouraging conclusions.
- Most of the primary studies are from China (and we have often discussed how unreliable these trials are).
- Many of the primary studies are not accessible.
- Those that are accessible tend to be of lamentable quality.
I fear that all this is truly dangerous. The medical literature is being swamped with reviews of Chinese herbal medicine and other TCM modalities. Collectively they give the impression that these treatments are supported by sound evidence. Yet, the exact opposite is the case.
The process that is happening in front of our very eyes is akin to that of money laundering. Unreliable and often fraudulent data is being white-washed and presented to us as evidence.
The result:
WE ARE BEING SYSTEMATICALLY MISLED!
Medscape and Ernst deserve each other. What a sad old fellow, desperate to live down his homeopathic past by producing a steady stream of deeply prejudicial anti-homeopathy propaganda. What kind of person dedicates his life to hate speech against the second most popular medical therapy worldwide? No doubt, he’s convinced himself that it’s a noble endeavor. Sad and comical.