medical ethics
This article entitled: Keeping Medical Science Trustworthy: The Threat by Predatory Journals caught my attention.
Many scientific journals have started to ask article processes costs from authors. This development has created a new category of journals of which the business model is totally or predominantly based on financial contributions by its authors. Such journals have become known as predatory journals. The financial contributions that they ask are not necessarily lower than those asked by high-quality journals although they offer less:
- there is commonly no real review,
- texts are not edited,
- there are commonly no printed editions.
The lack of serious reviews might make predatory journals attractive particularly to authors of low-quality (or even fraudulent) manuscripts.
The authors of this paper suggest that numerous journals, some of which may predatory, attract manuscripts by approaching authors of articles in high-quality journals. They conclude that publication of articles in such journals contaminates the medical literature and undermines the trustworthiness of science and medicine. Any involvement in such journals (as an author, reviewer or editor) should therefore be discouraged.
The ironic thing here is that the paper was published by a journal that itelf is, in my view, borderline, to say the least. But let me nonetheless contribute a recent, personal experience on this issue.
About 2 weeks ago, I received an invitation to join the editorial board of a general medicine journal that I had never heard of. I looked it up and found that it had a decent impact factor and a long list of international members of the board. But then I found that the journal charged around $ 1 500 for each submission. I was told that this is to cover the cost of the review process.
I then decided to write to the editor thanking her for the kind invitation. I also asked her how much the journal would pay its reviewers for reviewing submissions. I received a polite answer explaining that the amount was $ 00.00. My response was to politely decline the invitation to join the editorial board and to urge the journal editor to make it clear from the outset that the fees charged to authors did NOT go to the reviewers.For many years now, I have taken a very dim view on predatory journals. Sadly, in the realm of so-called alternative medicine (SCAM), there currently are dozens of such publications. I believe their danger in polluting the medical literature is hard to over-estimate. I think they ought to be stopped. One way of doing this is refusing to co-operate with them in any way.
The increasing demand for fertility treatments has led to the rise of private clinics offering so-called alternative medicine (SCAM) treatments. Even King Charles has recently joined in with this situalion. One of the most frequently offered SCAM infertility treatment is acupuncture. However, there is no good evidence to support the effectiveness of acupuncture in treating infertility.
This study evaluated the scope of information provided by SCAM fertility clinics in the UK. A content analysis was conducted on 200 websites of SCAM fertility clinics in the UK that offer acupuncture as a treatment for infertility. Of the 48 clinics that met the eligibility criteria, the majority of the websites did not provide sufficient information on:
- the efficacy,
- the risks,
- the success rates
of acupuncture for infertility.
The authors concluded that this situation has the potential to infringe on patient autonomy, provide false hope and reduce the chances of pregnancy ever being achieved as fertility declines during the time course of ineffective acupuncture treatment.
The authors are keen to point out that their investigation has certain limitations. The study only analysed the information provided on the clinics’ websites and did not assess the quality of the treatment provided by the clinics.
Therefore, the study’s fndings cannot be generalized to the quality of the acupuncture treatment provided by the clinics.
Nonetheless the paper touches on very important issues: far too many health clinics that offer SCAM for this or that indication operate way outside the ethically (and legally) acceptable norm. They advertise their services without making it clear that they are neither effective nor safe. Desperate consumers thus fall for their promises. In the case of infertility, this might result merely in frustration and loss of (often substantial amounts of) money. In the case of serious disease, such as cancer, this often results in premature death.
It is time, I think, that this entire sector is regualted in a way that it does not endanger the well-being, health, or life of consumers.
Spiritual healing has been defined as the direct interaction between one individual (the healer) and a patient, with the intention of improving the patient’s condition or curing the illness. Treatment can occur through personal, direct contact between healer and patient or at a (sometimes large) distance. Spiritual healers, who are usually not medically qualified, believe that the therapeutic effect results from the channelling of ‘energy’ from an undefined source via the healer to the patient. The main problem with this concept is that there is no evidence that this energy actually exists. Therefore, the assumptions on which spiritual healing is based lack plausibility.
The central claim of healers is that they promote or facilitate self-healing and wellbeing, both of which could be relevant to patients with any type of condition. An article by enthusiasts of spiritual healing explains: “All conditions can be treated by spiritual healing—but not all people. Some people are more receptive than others to this treatment, due to a number of factors such as karma and mental outlook. As such the results of healing can vary a great deal. If the patient has faith in the technique and the healer, this will of course aid the healing process, but is not necessary; this is not faith healing as practiced in some religions—it is based instead on spiritual energy. This being the case, it is possible for a skeptic to receive healing and benefit from it.”
The evidence from clinical trials of spiritual healing is contradictory. Many studies have serious flaws, and the most reliable trials fail to show effects beyond placebo. Research papers often fail to differentiate between different types of paranormal healing. One Cochrane, for instance, review “found inconclusive evidence that interventions with spiritual or religious components for adults in the terminal phase of a disease may or may not enhance well-being. Such interventions are under-evaluated. All five studies identified were undertaken in the same country, and in the multi-disciplinary palliative care interventions it is unclear if all participants received support from a chaplain or a spiritual counsellor. Moreover, it is unclear in all the studies whether the participants in the comparative groups received spiritual or religious support, or both, as part of routine care or from elsewhere. The paucity of quality research indicates a need for more rigorous studies.”
Many people believe that spiritual healing is harmless. Sadly, this is not the case. The BBC’s ‘Women’s Hour’ reported on 9 August this year about serious abuses of spiritual healers. Here you can find the published test of the broadcast:
Spiritual healing is extremely popular in many countries in the Middle East and North Africa. But the practice is unregulated and that means women are vulnerable to sexual exploitation. An investigation by BBC News Arabic has uncovered allegations of widespread sexual abuse by healers in Sudan and Morocco. Clare McDonnell is joined by the BBC’s Hanan Razek and Senior Women’s Rights Researcher at Human Rights Watch, Rothna Begum, to discuss.
And here you can listen to the actual broadcast. Briefly, what it reveales is deeply shocking:
- Spiritual healing is extremely popular in Sudan and Morocco.
- Healers charge hefty sums and healing is big business.
- Anyone regardless of background or training can call themselves a healer.
- There is no regulation whatsoever.
- Healers claim to cure illnesses, expell evil spirits, help with emotional problems, etc.
- For the programme, the BBC asked 80 women who had received healing.
- They accused 60 different healers of sexual transgression, including rape.
- Undercover recording revealed a healer placing his hand on a woman’s abdomen and then putting a finger “all the way down”.
- The police refuses to investigate if a women complains.
- The authorities refuse to take notice of the problem.
- A minister was quoted stating that there is no need for regulation.
- Another one said that the political athmosphere is not allowing to investigate the issue.
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The references for the evidence cited above can be found here.
This short news report appeared on X [formerly Twitter]:
The Ohio State Medical Board just approved the indefinite suspension Dr. Sherri Tenpenny’s medical license, an osteopathic physician and longtime figure in the anti-vaccine movement. The board got around 350 complaints into her behavior, but that’s not why she’s being suspended.
As this could easily be unreliable, I looked for confirmations … and found several, for instance, this one:
An Ohio physician who sparked widespread ridicule in 2021 after spreading bizarre COVID-19 vaccine conspiracies to the House Health Committee by claiming the jabs magnetize their hosts and “interface” with cell towers had her medical license indefinitely suspended Wednesday. Anti-vaccine spreader Sherri Tenpenny sparked a firestorm in June, 2021 after making the comments, which saw 350 complaints sent to the State Medical Board. According to Cleveland.com, the board’s decision was not based on the comments, rather on procedural grounds, citing Tenpenny’s refusal to cooperate with investigators during the inquiry. “Dr. Tenpenny, neither you nor any doctor licensed by this board is above the law, and you must comply with the investigation,” said Dr. Jonathan Feibel, an orthopedic surgeon and medical board member, according to the outlet. “You have not done so, and therefore, until you do, your license will be suspended.” A lawyer for Tenpenny, Tom Renz, described the investigation as a form of “harassment” on her “free speech rights.” Tenpenny did not speak after the announcement, however Renz declared, “This appears very much like a lynch mob.”
Who is Sherry Tenpenny? Here is what Wiki tells us about her:
Sherri J. Tenpenny is an American anti-vaccination activist and conspiracy theorist who promulgates the disproven hypothesis that vaccines cause autism.[1] An osteopathic physician, she is the author of four books opposing vaccination. A 2015 lecture tour of Australia was canceled due to a public outcry over her views on vaccination, which oppose established scientific consensus. A 2021 Center for Countering Digital Hate analysis concluded that Tenpenny is among the top twelve people spreading COVID-19 misinformation and pseudoscientific anti-vaccine misinformation on social media platforms. She has falsely asserted that the vaccines magnetize people and connect them with cellphone towers…
The story is puzzling, in my view. The biggest question for me is this:
Why only now?
She should have been suspended years ago!
Online misinformation is disproportionality created and spread by people with extreme political attitudes, especially among the far-right. There is a debate in the literature about why people spread misinformation and what should be done about it. According to the purely cognitive account, people largely spread misinformation because they are lazy, not biased. According to a motivational account, people are also motivated to believe and spread misinformation for ideological and partisan reasons. To better understand the psychological and neurocognitive processes that underlie misinformation sharing among the far-right, an international team of researchers conducted a cross-cultural experiment with conservatives and far-right partisans in the Unites States and Spain (N = 1,609) and a neuroimaging study with far-right partisans in Spain (N = 36).
Far-right partisans in Spain and U.S. Republicans who highly identify with Trump were more likely to share misinformation than center-right voters and other Republicans, especially when the misinformation was related to sacred values (e.g., immigration). Sacred values predicted misinformation sharing above and beyond familiarity, attitude strength, and salience of the issue. Moreover, far-right partisans were unresponsive to fact-checking and accuracy nudges. At a neural level, this group showed increased activity in brain regions implicated in mentalizing and norm compliance in response to posts with sacred values.
The authors concluded that these results suggest that the two components of political devotion – identity fusion and sacred values – play a key role in misinformation sharing, highlighting the identity-affirming dimension of misinformation sharing. We discuss the need for motivational and identity-based interventions to help curb misinformation for high-risk partisan groups.
People who have followed the discussions on this blog closely could be forgiven in assuming that right-wing political devotion also plays an important role in spreading misinformation about healthcare (e.g. vaccination) and so-called alternative medicine (SCAM). It would be good, if someone could test this hypothesis more directly.
PS
Just as I had finished writing this post, I came across a quote given yesterday by Ben Habib on GBN:
“I’m very reluctant to put my destiny in the hands of scientists. You know, unbridled authority given to faux knowledge.”
QED
We discussed the 2015 Australian NHMRC report on homeopathy many times before, e.g.:
- Homeopathy: the 2015 NHMRC report and its criticism re-analysed
- HOMEOPATHY: the NHMRC report revisited
- Ombudsman investigates ‘flawed’ homeopathic study
- The final verdict on homeopathy: it’s a placebo
In a nutshell, the report was an hugely influential analysis of the effectiveness of homeopathy which came to squarely negative conclusions. Thus it was celebrated as a thorough and conclusive piece evidence demonstrating the madness of homeopathy. Unsurprisingly, homeopaths did not like it at all and produced various criticisms claiming that it was neither thorough nor conclusive.
Now the final evaluation of what has been going on was finally published (ISSUED BY THE COMMONWEALTH OMBUDSMAN, IAIN ANDERSON, ON 4 AUGUST 2023):
The Office of the Commonwealth Ombudsman (the Office) has finalised an investigation relating to the National Health and Medical Research Council’s (NHMRC) review of the evidence for the effectiveness of homeopathy, conducted between 2010 and 2015. We commenced this investigation in September 2017 in response to concerns raised with us about how the NHMRC review had proceeded.
The Office conducts its investigations in private, and the Ombudsman generally does not make a public statement in the absence of a formal report. In the circumstances of this matter, including that the then-Ombudsman released a public statement on 4 June 2021 which acknowledged the Office was investigating, we believe it is important to share publicly the information we can, now that the investigation is complete.
Our investigation was finalised in July 2023. We acknowledge the length of time the investigation has taken. This is in part due to the extensive efforts the Office made to source independent scientific expertise to advise us on some detailed and specific questions of scientific methodology that were raised with our Office, including some that were only brought to our attention as our investigation progressed. Despite our best efforts, it was not possible to engage an expert (or experts) to provide independent advice to our Office on this subject. In the absence of independent, expert scientific expertise we have not been able to conclusively determine those matters of scientific methodology. This did not prevent our Office from forming a view on other aspects of the matter.
Our investigation did not result in any adverse findings about the review or the NHMRC. When finalising investigations, we may offer comments and suggestions to an agency about areas for future improvement. In this instance, we offered comments and suggestions to the NHMRC about how it records and publicly explains decisions about its activities. The NHMRC also independently made several improvements to its processes during the course of our investigation.
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In essence, this means that the conclusions of the report stand:
Homeopathy should not be used to treat health conditions that are chronic, serious, or could become serious. People who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness. People who are considering whether to use homeopathy should first get advice from a registered health practitioner. Those who use homeopathy should tell their health practitioner and should keep taking any prescribed treatments.
Thus the matter is closed – that is closed for rational thinkers. For irrationalists, the matter will no doubt continue to be a stone of contention. No, homeopath will be able to accept these conclusions simply because a member of a cult ceases to be a cultist once he/she accepts the criticism agaist the cult.
There is evidence that, in the US, Republican-leaning counties have had higher COVID-19 death rates than Democratic-leaning counties and similar evidence of an association between political party affiliation and attitudes regarding COVID-19 vaccination. This investigation assessed political party affiliation and mortality rates for individuals during the initial 22 months of the COVID-19 pandemic.
A cross-sectional comparison of excess mortality between registered Republican and Democratic voters between March 2020 and December 2021 adjusted for age and state of voter registration was conducted. Voter and mortality data from Florida and Ohio in 2017 linked to mortality records for January 1, 2018, to December 31, 2021, were used in data analysis. The main outcome measure was the excess weekly death rates during the COVID-19 pandemic adjusted for age, county, party affiliation, and seasonality.
Between January 1, 2018, and December 31, 2021, there were 538 159 individuals in Ohio and Florida who died at the age of 25 years or older in the study sample. The median age at death was 78 years (IQR, 71-89 years). Overall, the excess death rate for Republican voters was 2.8 percentage points, or 15%, higher than the excess death rate for Democratic voters (95% prediction interval [PI], 1.6-3.7 percentage points). After May 1, 2021, when vaccines were available to all adults, the excess death rate gap between Republican and Democratic voters widened from −0.9 percentage points (95% PI, −2.5 to 0.3 percentage points) to 7.7 percentage points (95% PI, 6.0-9.3 percentage points) in the adjusted analysis; the excess death rate among Republican voters was 43% higher than the excess death rate among Democratic voters. The gap in excess death rates between Republican and Democratic voters was larger in counties with lower vaccination rates and was primarily noted in voters residing in Ohio.
The authors concluded that, in this cross-sectional study, an association was observed between political party affiliation and excess deaths in Ohio and Florida after COVID-19 vaccines were available to all adults. These findings suggest that differences in vaccination attitudes and reported uptake between Republican and Democratic voters may have been factors in the severity and trajectory of the pandemic in the US.
In light of what has been discussed repeatedly, these findings are in my view most impressive and seem to speak for themselves. The authors are nevertheless prudent and stress that their study has several limitations which mean that we ought to interpret their results with caution.
- First, there are plausible alternative explanations for the difference in excess death rates by political party affiliation beyond the explanatory role of vaccines discussed herein.
- Second, the mortality data, although detailed and recent, only included approximately 83.5% of deaths in the US and did not include the cause of death. Although overall excess death patterns in our data are similar to those in other reliable sources, such as the Centers for Disease Control and Prevention National Center for Health Statistics data, it is possible that the deaths that our study data did not include may disproportionately occur among individuals registered with a particular political party, potentially biasing our results. In addition, the completeness of the mortality data may vary across states or time, potentially biasing our estimates of excess death rates.
- Third, all excess death models rely on fundamentally untestable assumptions to construct the baseline number of deaths one would expect in the absence of the COVID-19 pandemic.
- Fourth, because no information on individual vaccination status was available, analyses of the association between vaccination rates and excess deaths relied on county-level vaccination rates.
- Fifth, the study was based on data from 2 states with readily obtainable historical voter registration information (Florida and Ohio); hence, the results may not generalize to other states.
We have discussed the Miracle Mineral Solution (MMS) before. Now it has been making headlines again. It has been reported that a Miami federal jury convicted a father and his three sons of selling a toxic bleach solution as a “miracle” medical cure out of a fake Florida church’s website to thousands of consumers across the US. Mark Grenon, 65, and sons Jonathan, 37, Joseph, 35, and Jordan, 29, chose to represent themselves in their two-day trial in Miami federal court. But they said nothing during the trial as if they were silently protesting the proceeding. Only after the 12-person jury hit them with a quick verdict did one of the Grenons speak up. “We will be appealing,” Joseph Grenon said.
During the trial and closing arguments, prosecutors portrayed the four defendants as con men who used a phony religious front on a website, the Genesis II Church of Health and Healing, to sell $1 million worth of their “Miracle Mineral Solution” a cure for 95% of the world’s known diseases, from AIDS to the coronavirus. “This whole Miracle Mineral Solution scheme was built on deception and dishonesty,” the prosecutor said during his closing argument, telling jurors that the Grenons “created a fake church to make it harder for the Food and Drug Administration and government to stop them from selling snake oil.” But, “this was no church,” he argued. “This was a scam for money — an old-fashioned scam.” The jury found the four defendants — all wearing beige inmate uniforms, ponytails, and flowing beards — guilty of conspiring to defraud the U.S. government and FDA, which regulates the food and drug industry, by distributing an unapproved and misbranded drug, Miracle Mineral Solution (MMS). That conviction carries up to five years in prison.
During the trial, the prosecutor said the Grenons called themselves “bishops” and peddled MMS as “sacraments” to consumers in South Florida and other parts of the US in exchange for a “donation” to the Genesis church, before the FDA cracked down on the family in 2020.
The Grenons were charged that April with conspiring to defraud the U.S. government after the outbreak of the COVID-19 pandemic when they defied FDA and court orders to stop distributing the toxic MMS substance. Their criminal case was the first pandemic-related enforcement action in Florida. In public warnings, FDA said it received several reports of hospitalizations and life-threatening conditions as people drank the dangerous substance.
MMS is a chemical solution containing sodium chlorite that, when mixed with water and a citric acid “activator,” turns into chlorine dioxide, a powerful bleach typically used for industrial water treatment or bleaching textiles, pulp, and paper. During the trial, a FDA agent testified about three Grenon-produced videos that pitched the solution as a cure for cancer, lung cancer, and COVID-19, among other deadly diseases. “We are trying to create a world without disease,” Mark Grenon said in one video, pitching the MMS substance. “It’s been proven to be tremendously effective in curing cancer.” Another video, dated March 8, 2020, was titled: “The coronavirus is curable. Do you believe it? You better!”
Prosecutors said the Grenon family’s religious front, the Genesis II Church of Health and Healing, sold tens of thousands of MMS orders in violation of federal law since 2010. It was in that year that Mark Grenon claims to have founded the organization with a man named Jim Humble in a plan to avoid governmental regulation and arrest as they promoted MMS as a miracle cure. Humble, a man who has dabbled in Scientology and professed to be a billion-year-old god, began promoting the substance as early as 2006 in self-published works after he claimed to have discovered its medical properties while on a gold-mining expedition in South America. After Humble supposedly stepped away from the organization in 2017, Grenon continued to manufacture, promote and sell MMS with his three sons.
The Grenons’ open defiance of a court order ultimately led to criminal charges and a federal raid on the family’s Bradenton home, where federal investigators say they found loaded guns, nearly 10,000 pounds of sodium chlorite powder, and thousands of bottles of MMS.
The World Federation of Chiropractic (WFC) has recently launched a new Global Patient Safety (GPS) initiative:
Unanimously approved by the WFC Board at its May meeting, the project will be overseen by the Research Committee and involve the establishment of an expert task force. Planned projects will include a scoping review, identification of best practices in incident reporting and learning, risk management in chiropractic practice and knowledge translation activities.
In recent years, patient safety has increasingly been in the spotlight as health systems strive to reduce unnecessary incidents and iatrogenic injury.
“With adverse events having the potential to impact trust and confidence in the chiropractic profession, it is important that we do as much as possible to inform ourselves in relation to the risks and benefits of chiropractic treatments and related activities,” said Prof. Richard Brown DC, LL.M, WFC Secretary- General.
“While we know that serious adverse events are rare, patients with multiple co-morbidities and known risk factors require special attention. The WFC GPS Task Force will highlight key areas of patient safety to support chiropractors, build and strengthen the existing safety culture and help to meet the expectations of patients and the public.”
Chiropractors use a package of interventions in their treatment of patients, including hands-on care, adjunct therapies, health promotion, advice and exercise prescription. The process of shared decision-making involves consideration by the chiropractor of the suitability and safety of each intervention. In addition to direct patient care, chiropractors also have a duty to consider the safety of their offices and clinics.
A WHO resolution on patient safety, passed in 2019 at the World Health Assembly, made a commitment to take global action in tackling avoidable harm.
Its subsequent publication, Global Action on Patient Safety, set out goals and targets to reduce morbidity from healthcare related incidents.
Chair of the Task Force and Research Committee vice-chair, Dr Katie Pohlman DC, PhD, said: “With the current global focus on patient safety, I’m proud to be leading this WFC Task Force, which will support the chiropractic profession but, most importantly, work to minimize adverse events and protect patients.
“The creation of an open, transparent culture of patient safety is key to maintaining trust and credibility. The Task Force is looking forward to adding to the body of knowledge and advancing safe, evidence-based, people-centered practice.”
The WFC GPS Task Force will report to Research Committee Chair, Assoc. Prof Sidney Rubinstein. It will include members of the existing Research Committee as well as external experts.
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At first, most people will think: WHAT A GOOD IDEA!
After a bit of reflection, however, some might ponder: WHY ONLY NOW AND NOT DECADES AGO?
And after reading the above text carefully, skeptics might feel that the exercise can already be classified as a PR gimmick that will not generate the needed information:
- The WFC has yet again failed to establish a monitoring system of adverse effects; without it ‘patient safety’ is not achievable.
- They claim that “we know that serious adverse events are rare”. How do they know this? And if they already are convinced of this, the new task force is bound to be a pure ‘white wash’.
- They think an “existing safety culture” exists in chiropractic. This is wishful thinking and far from reality.
- They speak of the “expectations of patients and the public” but ignore the need for a monitoring system accessible to the public.
We have discussed the currently fashionable herbal remedy, ‘kratom‘, before:
Inadequate regulation of Kratom supplements put consumers at risk
News about Kratom: the herb was recently (semi-)legalized in Thailand
Kratom: a ‘herbal drug’ with the potental to do more harm than good
A quick recap:
Kratom is made of the leaves of Mitragyna speciosa, a tree endogenous to parts of Southeast Asia. It has been used traditionally for its stimulant, mood-elevating, and analgesic effects. The plant’s active constituents, mitragynine and 7-hydroxymitragynine, have been shown to modulate opioid receptors, acting as partial agonists at mu-opioid receptors and competitive antagonists at kappa- and delta-opioid receptors. Both alkaloids are G protein-biased agonists of the mu-opioid receptor and therefore, may induce less respiratory depression than classical opioid agonists. The Mitragyna alkaloids also appear to exert diverse activities at other brain receptors (including adrenergic, serotonergic, and dopaminergic receptors), which may explain the complex pharmacological profile of raw kratom extracts. By the early 2000s, kratom was increasingly used in the US as a substitute for prescription and illicit opioids for managing pain and opioid withdrawal by people seeking abstinence from opioids. There are numerous assessments where people have been unable to stop using kratom and withdrawal signs and symptoms are problematic. Kratom does not appear in normal drug screens and, when taken with other substances of abuse, may not be recognized.
Now it has been reported that the family of a Florida woman who died in 2021 after ingesting kratom has been awarded more than $11m from a distributor of the herbal extract. “There is of course no amount of money that will make up for the pain and suffering that Ms Talavera’s children are enduring because of their mother’s death,” Middlebrooks wrote in court records addressing the sanction against Kratom Distro. “The law nonetheless recognizes that the defendant must pay something, however inadequate.”
The US Drug Enforcement Agency in 2016 had imposed its strictest restrictions on kratom, which is made from the leaves of an evergreen tree and is often used by people to self-treat pain, anxiety, depression, and opioid addiction as well as withdrawal. There was an intense, immediate public backlash to that approach, however, and it prompted the DEA to rescind its prohibition of kratom, which is sold in stores and online.
The US Food and Drug Administration nonetheless has warned consumers over possible safety and addiction risks associated with kratom, and it has spoken in favor of more research aimed at gaining a better understanding of “the substance and its components”.
Friends of Talavera, a resident of the Florida community of Boynton Beach, introduced her to kratom years before her death. Her family said she regarded it as a safe, natural supplement and had taken some after buying it online from the Kratom Distro when her partner and the father of her youngest child – Biagio Vultaggio – found her unconscious in the living room on 20 June 2021. The 39-year-old Talavera was face down on the ground next to an open bag of a kratom derivative marketed as a “space dust”, her family has said. Vultaggio called paramedics, and they took Talavera to a hospital where she was pronounced dead. An autopsy later listed Talavera’s cause of death as acute intoxication from mitragynine, the main kratom component. The local coroner wrote in a report that “at high concentrations, mitragynine produces opioid-like effects, such as respiratory failure”.
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Kratom Disro claims that 
Product Consistency
- Our kratom powder is sourced directly from Indonesia monthly. Your order was literally on a farm in Indonesia two months ago. No old powder.
- Our kratom extracts are produced in the US by a licensed chemist and a professionally trained staff.
- We only use delicious flavors and quality ingredients.
Complete Transparency
- Every batch of products we receive is lab tested and will not ship out without meeting our meticulous quality standards.
- Current labs – We will never show you an out-of-date lab with our products.
- Guaranteed purity levels and free of all toxins.
Get It When You Want It
- Many orders shipped same day.
- USPS shipping on all orders under 6 pounds.
- Larger orders can ship USPS Priority for a small additional charge.
_________________________________
Back to the above lawsuit:
One of the attorneys for Talavera’s family, Tamara Williams, said in a statement that the judgment won by her clients “should be a wakeup call to the kratom industry”. Williams’s law firm had also recently won a $2.5m jury verdict against a kratom manufacturer in Washington state after a separate lawsuit alleging wrongful death. A colleague of Williams called on government officials to take steps “to protect other families from having to deal with unnecessary kratom overdose deaths”.
