MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

risk

About a century ago, Royal Raymond Rife developed special microscopes and claimed he could visualize living microorganisms, including viruses too small to be seen with any other existing technology, via the color of auras emitted as they vibrated. In 1961, he explained this as follows: “A special risley prism which works on a counter rotation principle selects a portion of the light frequency which illuminates these viruses in their own characteristic chemical colors by emission of coordinative light frequency and the viruses become readily identifiable by the colors revealed on observation.”. The principles and alleged function of these microscopes have never been validated, and they have never been adopted for use.

Rife went on to postulate that the microorganisms he was seeing were involved in human diseases, including cancer . He also invented a machine that he claimed could transmit radio frequency energy into a person and vibrate these microorganisms at a “mortal oscillatory rate”, thereby killing them and improving the disease they were causing. The concept that diseases can be cured by radio frequency energy, originally proposed by Albert Abrams and referred to as ‘radionics’, was later investigated and disproven. Nonetheless, there remain enthusiasts who believe in Rife’s work, claim it was suppressed as part of an elaborate conspiracy. and continue to sell energy-transmitting devices and cures.

Rife machines (also called a Rife frequency generator.) produce low electromagnetic energy waves. These waves are similar to radio waves. Supporters of the treatment claim that the Rife machine can treat different conditions including cancer. There is no reliable evidence that the Rife machine works as a cure for cancer.

The Rife machine produces low-energy waves, also called radiofrequency electromagnetic fields. They have low energy compared to x-rays or radiotherapy.

Here is what proponents of the Rife therapy say:

… Although no official health claims are made for Rife therapy, testimonials from many countries point to its efficacy in the support of the body in maintaining or regaining good, natural health. A good Rife machine normally contains all of the original Royal Rife frequencies plus others that have been researched and utilised over the years.

WHAT IS THE PROCEDURE?

In most Rife sessions the client is seated. They have their feet on footplate electrodes and in their lap they hold in their hands plasma tubes. Thus they get the frequencies in normal form through the feet and in radio wave form through their hands. There are variations on this but this is the basic set up.

Some practitioners will occasionally employ something called a Beam Ray Tube. This is essentially a large plasma tube on a stand that plugs into the machine. The client just sits in front of it, about 3 feet away, while the frequencies are generated. In this instance the client does not have to hold anything or have their feet on footplates.

HOW LONG DO SESSIONS LAST?

The length of a session varies, depending on what is being addressed. Any session would be a minimum of 30 minutes but in serious or chronic conditions can last over 2 hours, occasionally more. However, clients can take breaks during the therapy.

HOW FREQUENT ARE TREATMENTS?

Once a week or once a fortnight is a common pattern of treatments. But in the case of more frequent sessions a minimum of 48 hours should be left between therapy. The duration of treatments varies on the condition being addressed. Sometimes it’s just a few visits…for conditions like Lyme Disease the treatments are ongoing for well over a year. The practitioner will answer your specific questions on this.

There are also frequencies to support regeneration and boost functions such as the immune system, the adrenals and several others.

ARE THERE ANY CONTRAINDICATIONS?

Rife therapy is not suitable for people with pacemakers or similar devices. It should not be given to children under 4 years of age. If a client is undergoing radiotherapy or frequency therapy for kidney stones etc there should should be no Rife sessions administered during these periods.

The day after some sessions a client may occasionally get a Herxheimer’s reaction. This is a feeling of tiredness, almost as if one is about to go down with flu. It was named after Dr Herxheimer who, along with one other doctor, discovered that when the liver and kidneys etc get overworked in disposing of waste products, this phenomena happens. The answer is just to drink lots of fluid to help the body dispose of the cells or toxins that have been eliminated by the Rife session. The day after that, the client is back to normal and usually feeling better than before the session.

I think that such promotional texts could and should be much shorter, more truthful, and hugely more informative, e.g.:

Rife therapy is not biologically plausible, has never been shown to be effective for any condition, might have adverse effects, and is not cheap. Therefore, we have a responsibility to warn consumers and patients not to use it.

The impact of drug-induced liver injury (DILI) on patients with chronic liver disease (CLD) is unclear. There are few reports comparing DILI in CLD and non-CLD patients. In this study, the researchers aimed to determine the incidence and outcomes of DILI in patients with and without CLD.

They collected data on eligible individuals with suspected DILI between 2018 and 2020 who were evaluated systematically for other etiologies, causes, and the severity of DILI. They compared the causative agents, clinical features, and outcomes of DILI among subjects with and without CLD who were enrolled in the Thai Association for the Study of the Liver DILI registry. Subjects with definite, or highly likely DILI were included in the analysis.

The researchers evaluated the causal relationship between the clinical pattern of liver injury and the suspected drugs or SCAM products with the Roussel Uclaf Causality Assessment Method (RUCAM) system. RUCAM is a validated and established tool to quantitatively assess causality in cases of suspected DILI and/or SCAM product-induced liver injury. They also used the Clinical Assessment of Causality Scale to assess the association as definite (>95% likelihood), highly likely (75–95%), probable (50–74%), possible (25–49%) or unlikely (<25%).

A total of 200 subjects diagnosed with DILI were found in the registry. Of those, 41 had CLD and 159 had no evidence of CLD. So-called alternative medicine (SCAM) products were identified as the most common class of DILI agents. Approximately 59% of DILI in the CLD and 40% in non-CLD group were associated with SCAM use. Individuals with pre-existing CLD had similar severity including mortality. Twelve patients (6%) developed adverse outcomes related to DILI including seven (3.5%) deaths and five (2.5%) with liver failure. Mortality was 4.88% in CLD and 3.14% in non-CLD subjects over median periods of 58 (8-106) days and 22 (1-65) days, respectively.

The authors concluded that, in this liver disease registry, the causes, clinical presentation, and outcomes of DILI in subjects with CLD and without CLD patients were not different. Further study is required to confirm our findings.

Consumers often prefer SCAM to conventional medicine because SCAM is viewed as gentle and safe. The notions are that they

  • are natural and therefore harmless;
  • have been in use for ages and thus have stood the test of time.

Readers of this blog will appreciate that both notions are, in fact, fallacies:

  • appeal to nature;
  • appeal to tradition.

This new paper is an impressive reminder that SCAM’s reputation as a safe option is not justified, and that SCAM relies more on fallacies than on facts.

Yesterday, Harriet’s many friends received the sad news of her unexpected death on 11 January. Harriet was not just a good and loyal friend, she was a tirelessly working, determined, and effective skeptic. Her work focussed on so-called alternative medicine (SCAM), and thus the two of us were on the same wavelength.

Harriet’s husband, Kirk, posted this short note about her death on social media:

I know Harriet’s work was followed and admired by many of you. It is with great sadness that I must tell you my beloved wife passed away quietly and unexpectedly in her sleep last night. At this moment, she would probably simply ask you to have a kind thought for her, be kind to each other and continue to support her belief in the truth.

I feel that, without intending to, Kirk described Harriet’s character very well. She was a quiet and kind person. Yet she inspired many, and her influence was considerable. Harriet Hall had been the founding member of skeptic organizations, author of books and countless articles, recipient of awards, author of many brilliant lectures, and much more.

Harriet and I have met in person only 2 or 3 times. But we did keep in contact and exchanged many emails. Most generously, she published reviews of most of my books and was often immeasurably supportive of my work.

Harriet Hall will be remembered by skeptics around the world for her quiet enthusiasm, her kindness, and her honesty. I will always remember her for coining an absolutely perfect term for the pseudo-research that plagues the field of SCAM:

TOOTH FAIRY SCIENCE

I lost a friend; the world lost a great skeptic.

We will all miss you, Harriet!

We have discussed the UK conservative MP and arch-Brexiteer, Andrew Bridgen, and his anti-vax stance before. Yesterday, it has been reported that he lost the Tory whip, i.e. he was expelled from the Tory party. The reason for this step is that he had taken to social media and claimed the Covid vaccine to be the “biggest crime against humanity since the holocaust”.

The North West Leicestershire MP has been vocal in remarks questioning the coronavirus vaccine.

On Wednesday he shared an article on vaccines on Twitter, adding: “As one consultant cardiologist said to me, this is the biggest crime against humanity since the Holocaust.”

Renouncing Bridgen’s right to sit as a Tory MP in Parliament, Conservative chief whip Simon Hart said: “Andrew Bridgen has crossed a line, causing great offence in the process. “As a nation, we should be very proud of what has been achieved through the vaccine programme. The vaccine is the best defence against Covid that we have. “Misinformation about the vaccine causes harm and costs lives. I am therefore removing the whip from Andrew Bridgen with immediate effect, pending a formal investigation.”

Earlier, former Cabinet minister Simon Clarke had condemned his colleague’s tweet referencing the Holocaust, calling it “disgraceful”.

Bridgen is currently already suspended from the Commons after he was found to have displayed a “very cavalier” attitude to the rules in a series of lobbying breaches. MPs agreed on Monday to suspend the North West Leicestershire MP for five sitting days from Tuesday.

Comments from different sources are not flattering for Bridgen:

  • Karen Pollock, the chief executive of the Holocaust Educational Trust, said Bridgen’s tweet was “highly irresponsible, wholly inappropriate and an elected politician should know better”.
  • Anneliese Dodds, the Labour chair, said: “Andrew Bridgen has been spreading dangerous misinformation on Covid vaccines for some time now. He could have been disciplined weeks ago. “To invoke the Holocaust, as he did today, is utterly shameful, but it should never have reached this point.”
  • Andrew Percy, the Conservative MP who is vice-chair of the all-party group against antisemitism, called the comment “disgusting”. Asked by Times Radio if Bridgen should be allowed to stand again, Percy said: “I don’t think anybody who believes this kind of crap should, but that’s a matter for the whips not for me.”
  • John Mann, the former Labour MP who is now a non-affiliated peer and the government’s independent adviser on antisemitism, said Bridgen should not be allowed to stand again as a Tory. “There is no possibility that Bridgen can be allowed to stand at the next election,” he said. “He cannot claim that he didn’t realise the level of offence that his remarks cause.”

____________________________

To the best of my knowledge, this is the first time that a UK politician has been punished in this way. But it may well be also the first time that a sitting UK politician has uttered such insane stupidity. Bridgen’s chronic ineptitude is all the more significant as he really should know better. He studied genetics and behaviour at the University of Nottingham and graduated with a degree in biological sciences!

Here are some reactions from people commenting on Twitter about the twit:

  • Tory MP, Andrew Bridgen highlights… – Lies in court over family dispute and ordered by judge to pay £800k – Suspended for breaching MP lobbying rules – Thought all Brits entitled to Irish passport after Brexit – Likens vaccines to holocaust What a guy.
  • Spreads a dangerous, baseless smear his party colluded in a vaccine Holocaust and at the same time manages to insults victims of a grotesque wartime Holocaust. Conspiracy theorist Andrew Bridgen’s lost the plot. See no way back for the Tory MP now.
  • Grubby and despicable: Tory MP Andrew Bridgen loses whip over ‘dangerous’ Covid vaccine claims
  • To be fair, Bridgen kept the whip after saying the MI5 knew about the pandemic six months early, then colluded with shadowy elites to impose needless restrictions for their own nefarious ends. So the bar is high.
  • Politicians like Andrew Bridgen have succeeded in bringing conspiracy theories into the mainstream. They need to be called out, their arguments dismantled and their political influence cast out to the fringes where it belongs.
  • A Holocaust survivor has condemned a Tory MP’s “mind-boggling ignorance” after he compared the mass genocide of Jewish people during World War II to the COVID vaccine rollout
  • Many congratulations to Andrew Bridgen on his imminent selection as the Reform Party candidate for North West Leicestershire in the 2024 election
  • Andrew Bridgen. Perjury, bullying, misuse of money, months of anti-vaccine garbage, finally loses whip after comparing vaccination to the Holocaust. Scum.
  • Six million Jews were murdered in the Holocaust. COVID vaccines have saved millions. The false and outrageous comparisons must end.
  • Andrew Bridgen suspended as Tory MP he said: “As one consultant cardiologist said to me, this is the biggest crime against humanity since the Holocaust.” Crucially a cardiologist saying this too. Who are they? Should GMC act in same way as Whips Office?

The prime candidate for the cardiologist in question must, of course, be Aseem Malhotra who also appeared on September 27, 2022, in a press conference with the World Council for Health — a group that has previously spread vaccine misinformation — to call for the “immediate and complete suspension of Covid-19 vaccine.”

Who was it that coined the bon mot: We were all born ignorant but to remain so requires hard work

I have tried!

Honestly!

But at present, it is simply not possible to escape the revelations and accusations by Harry Windsor.

So, eventually, I gave in and had a look at the therapy he often refers to. He claims that he is deeply traumatized by what he had to go through and, to help him survive the ordeal, Harry has been reported to use EMDR.

Eye Movement Desensitization and Reprocessing (EMDR) is a fringe psychotherapy that was developed to alleviate the distress associated with traumatic memories. It is supposed to facilitate the accessing and processing of traumatic memories and other adverse life experiences with a view of bringing these to an adaptive resolution. The claim is that, after successful treatment with EMDR therapy, affective distress is relieved, negative beliefs are reformulated, and physiological arousal is reduced.

During EMDR therapy the patient must attend to emotionally disturbing material in brief sequential doses while simultaneously focusing on an external stimulus. Therapist-directed lateral eye movements are commonly used as external stimulus but a variety of other stimuli including hand-tapping and audio stimulation can also be employed.

Francine Shapiro, the psychologist who invented EMDR claims to have serendipitously discovered this technique by experiencing spontaneous saccadic eye movements in response to disturbing thoughts during a walk in the woods. Yet, as GM Rosen explains, this explanation is difficult to accept because normal saccadic eye movements appear to be physiologically undetectable and are typically triggered by external stimuli.

Shapiro hypothesizes that EMDR therapy facilitates the access to the traumatic memory network, so that information processing is enhanced, with new associations forged between the traumatic memory and more adaptive memories or information. These new associations are alleged to result in complete information processing, new learning, elimination of emotional distress, and development of cognitive insights.

EMDR therapy uses a three-pronged protocol:

  • (1) the past events that have laid the groundwork for dysfunction are processed, forging new associative links with adaptive information;
  • (2) the current circumstances that elicit distress are targeted, and internal and external triggers are desensitized;
  • (3) imaginal templates of future events are incorporated, to assist the client in acquiring the skills needed for adaptive functioning.

The question I ask myself is, of course: Does EMDR work?

The evidence is mixed and generally flimsy. A systematic review showed that “limitations to the current evidence exist, and much current evidence relies on small sample sizes and provides limited follow-up data”.

What might be particularly interesting in relation to Harry Windsor is that EMDR techniques have been associated with memory-undermining effects and may undermine the accuracy of memory, which can be risky if patients, later on, serve as witnesses in legal proceedings.

Personally, I think that Harry’s outbursts lend support to the hypothesis that EMDR is not effective. In the interest of the royal family, we should perhaps see whether so-called alternative medicine (SCAM) does offer an effective treatment against navel gazing?

It has been reported that a German consumer association, the ‘Verbraucherzentrale NRW’, has first cautioned the manufacturer MEDICE Arzneimittel Pütter GmbH & Co. and then sued them for misleading advertising statements. The advertisement in question gave the wrong impression that their homeopathic remedy MEDITONSIN would:

  1. for certain generate a health improvement,
  2. have no side effects,
  3. be superior to “chemical-synthetic drugs”.

The study used by the manufacturer in support of such claims was not convincing according to the Regional Court of Dortmund. The results of a “large-scale study with more than 1,000 patients” presented a pie chart indicating that 90% of the patients were satisfied or very satisfied with the effect of Meditonsin. However, this was only based on a “pharmacy-based observational study” with little scientific validity, as pointed out by the consumer association. Despite the lack of evidence, the manufacturer claimed that their study “once again impressively confirms the good efficacy and tolerability of Meditonsin® Drops”. The Regional Court of Dortmund disagreed with the manufacturer and agreed with the reasoning of the consumer association.

“It is not permitted to advertise with statements that give the false impression that a successful treatment can be expected with certainty, as suggested by the advertising for Meditonsin Drops,” emphasizes Gesa Schölgens, head of “Faktencheck Gesundheitswerbung,” a joint project of the consumer centers of North Rhine-Westphalia and Rhineland-Palatinate. According to German law, this is prohibited. In addition, the Regional Court of Dortmund considered consumers to be misled by the advertising because the false impression was created that no harmful side effects are to be expected when Meditonsin Drops are taken. The package insert of the drug lists several side effects, according to which there could even be an initial worsening of symptoms after taking the drug.

The claim of advantages of the “natural remedy” represented by the manufacturer in comparison with “chemical-synthetic medicaments, which merely suppress the symptoms”, was also deemed to be inadmissible. Such comparative advertising is inadmissible.

__________________________________

This ruling is, I think, interesting in several ways. The marketing claims of so-called alternative medicine (SCAM) products seem all too often not within the limits of the laws. One can therefore hope that this case might inspire many more legal cases against the inadmissible advertising of SCAMs.

 

Animals cannot consent to the treatments they are given when ill. This renders the promotion and use of SCAM in animals a tricky issue. This systematic review assessed the evidence for the clinical efficacy of 24 so-called alternative medicines (SCAMs) used in cats, dogs, and horses.

A bibliographic search, restricted to studies in cats, dogs, and horses, was performed on Web of Science Core Collection, CABI, and PubMed. Relevant articles were assessed for scientific quality, and information was extracted on study characteristics, species, type of treatment, indication, and treatment effects.

Of 982 unique publications screened, 42 were eligible for inclusion, representing 9 different SCAM therapies, which were

  • aromatherapy,
  • gold therapy,
  • homeopathy,
  • leeches (hirudotherapy),
  • mesotherapy,
  • mud,
  • neural therapy,
  • sound (music) therapy,
  • vibration therapy.

For 15 predefined therapies, no study was identified. The risk of bias was assessed as high in 17 studies, moderate to high in 10, moderate in 10, low to moderate in four, and low in one study. In those studies where the risk of bias was low to moderate, there was considerable heterogeneity in reported treatment effects.

The authors concluded that the present systematic review has revealed significant gaps in scientific knowledge regarding the effects of a number of “miscellaneous” SCAM methods used in cats, dogs, and horses. For the majority of the therapies, no relevant scientific articles were retrieved. For nine therapies, some research documentation was available. However, due to small sample sizes, a lack of control groups, and other methodological limitations, few articles with a low risk of bias were identified. Where beneficial results were reported, they were not replicated in other independent studies. Many of the articles were in the lower levels of the evidence pyramid, emphasising the need for more high-quality research using precise methodologies to evaluate the potential therapeutic effects of these therapies. Of the publications that met the inclusion criteria, the majority did not have any scientific documentation of sufficient quality to draw any conclusion regarding their effect. Several of our observations may be translated into lessons on how to improve the scientific support for SCAM therapies. Crucial efforts include (a) a focus on the evaluation of therapies with an explanatory model for a mechanism of action accepted by the scientific community at large, (b) the use of appropriate control animals and treatments, preferably in randomized controlled trials, (c) high-quality observational studies with emphasis on control for confounding factors, (d) sufficient statistical power; to achieve this, large-scale multicenter trials may be needed, (e) blinded evaluations, and (f) replication studies of therapies that have shown promising results in single studies.

What the authors revealed in relation to homeopathy was particularly interesting, in my view. The included studies, with moderate risk of bias, such as homeopathic hypotensive treatment in dogs with early, stage two heart failure and the study on cats with hyperthyroidism, showed no differences between treated and non-treated animals. An RCT with osteoarthritic dogs showed a difference in three of the six variables (veterinary-assessed mobility, two force plate variables, an owner-assessed chronic pain index, and pain and movement visually analogous scales).

The results on homeopathy are supported by another systematic review of 18 RCTs, representing four species (including two dog studies) and 11 indications. The authors excluded generalized conclusions about the effect of certain homeopathic remedies or the effect of individualized homeopathy on a given medical condition in animals. In addition, a meta-analysis of nine homeopathy trials with a high risk of bias, and two studies with a lower risk of bias, concluded that there is very limited evidence that clinical intervention in animals using homeopathic remedies can be distinguished from similar placebo interventions.

In essence, this review confirms what I have been pointing out numerous times: SCAM for animals is not evidence-based, and this includes in particular homeopathy. It follows that its use in animals as an alternative to treatments with proven effectiveness borders on animal abuse.

 

Is so-called alternative medicine (SCAM) compatible with Christian beliefs? This is not a question that often robs me of my sleep, yet it seems an interesting issue to explore during the Christmas holiday. So, I did a few searches and – would you believe it? – found a ‘Christian Checklist’ as applied to SCAM Since it is by no means long, let me present it to you in full:

  1. Taking into consideration the lack of scientific evidence available, can it be recommended with integrity?
  2. What are its roots? Is there an eastern religious basis (Taoism or Hinduism)? Is it based on life force or vitalism?
  3. Are there any specific spiritual dangers involved? Does its method of diagnosis or practice include occult practices, all forms of which are strictly forbidden in Scripture.

Now, let me try to answer the questions that the checklist poses:

  1. No! – particularly not, if the SCAM endangers the health of the person who uses it (which, as we have discussed so often can occur in multiple ways).
  2. Most SCAMs have their roots in eastern religions, life force, or vitalism. Very few are based on Christian ideas or assumptions.
  3. If we define ‘occult’ as anything that is hidden or mysterious, we are bound to see that almost all SCAMs are occult.

What surprises me with the ‘Christian Checklist’ is that it makes no mention of ethics. I would have thought that this might be an important issue for Christians. Am I mistaken? I have often pointed out that the practice of SCAM nearly invariably violates fundamental rules of ethics.

In any case, the checklist makes one thing quite clear: by and large, SCAM is nothing that Christians should ever contemplate employing. This article (which I have quoted before) seems to confirm my point:

The Vatican’s top exorcist has spoken out in condemnation of yoga … , branding [it] as “Satanic” acts that lead[s] to “demonic possession”. Father Cesare Truqui has warned that the Catholic Church has seen a recent spike in worldwide reports of people becoming possessed by demons and that the reason for the sudden uptick is the rise in popularity of pastimes such as watching Harry Potter movies and practicing Vinyasa.

Professor Giuseppe Ferrari … says that … activities such as yoga, “summon satanic spirits” … Monsignor Luigi Negri, the archbishop of Ferrara-Comacchio, who also attended the Vatican crisis meeting, claimed that homosexuality is “another sign” that “Satan is in the Vatican”. The Independent reports: Father Cesare says he’s seen many an individual speaking in tongues and exhibiting unearthly strength, two attributes that his religion says indicate the possibility of evil spirits inhabiting a person’s body. “There are those who try to turn people into vampires and make them drink other people’s blood, or encourage them to have special sexual relations to obtain special powers,” stated Professor Ferrari at the meeting. “These groups are attracted by the so-called beautiful young vampires that we’ve seen so much of in recent years.”

You might take such statements not all that seriously – the scorn of the vatican does not concern you?

Yet, the ‘Christian Checklist’ also raises worries much closer to home. King Charles is the head of the Anglican Church. Undeniably, he also is a long-term, enthusiastic supporter of many of those ‘quasi-satanic’ SCAMs. How are we supposed to reconsile these contradictions, tensions, and conflicts?

Please advise!

It’s again the season for nine lessons, I suppose. So, on the occasion of Christmas Eve, let me rephrase the nine lessons I once gave (with my tongue firmly lodged in my cheek) to those who want to make a pseudo-scientific career in so-called alternative medicine (SCAM) research.

  1. Throw yourself into qualitative research. For instance, focus groups are a safe bet. They are not difficult to do: you gather 5 -10 people, let them express their opinions, record them, extract from the diversity of views what you recognize as your own opinion and call it a ‘common theme’, and write the whole thing up, and – BINGO! – you have a publication. The beauty of this approach is manifold:
    • you can repeat this exercise ad nauseam until your publication list is of respectable length;
    • there are plenty of SCAM journals that will publish your articles;
    • you can manipulate your findings at will;
    • you will never produce a paper that displeases the likes of King Charles;
    • you might even increase your chances of obtaining funding for future research.
  1. Conduct surveys. They are very popular and highly respected/publishable projects in SCAM. Do not get deterred by the fact that thousands of similar investigations are already available. If, for instance, there already is one describing the SCAM usage by leg-amputated policemen in North Devon, you can conduct a survey of leg-amputated policemen in North Devon with a medical history of diabetes. As long as you conclude that your participants used a lot of SCAMs, were very satisfied with it, did not experience any adverse effects, thought it was value for money, and would recommend it to their neighbour, you have secured another publication in a SCAM journal.
  2. In case this does not appeal to you, how about taking a sociological, anthropological or psychological approach? How about studying, for example, the differences in worldviews, the different belief systems, the different ways of knowing, the different concepts about illness, the different expectations, the unique spiritual dimensions, the amazing views on holism – all in different cultures, settings or countries? Invariably, you must, of course, conclude that one truth is at least as good as the next. This will make you popular with all the post-modernists who use SCAM as a playground for enlarging their publication lists. This approach also has the advantage to allow you to travel extensively and generally have a good time.
  3. If, eventually, your boss demands that you start doing what (in his narrow mind) constitutes ‘real science’, do not despair! There are plenty of possibilities to remain true to your pseudo-scientific principles. Study the safety of your favourite SCAM with a survey of its users. You simply evaluate their experiences and opinions regarding adverse effects. But be careful, you are on thin ice here; you don’t want to upset anyone by generating alarming findings. Make sure your sample is small enough for a false negative result, and that all participants are well-pleased with their SCAM. This might be merely a question of selecting your patients wisely. The main thing is that your conclusions do not reveal any risks.
  4. If your boss insists you tackle the daunting issue of SCAM’s efficacy, you must find patients who happened to have recovered spectacularly well from a life-threatening disease after receiving your favourite form of SCAM. Once you have identified such a person, you detail her experience and publish this as a ‘case report’. It requires a little skill to brush over the fact that the patient also had lots of conventional treatments, or that her diagnosis was never properly verified. As a pseudo-scientist, you will have to learn how to discretely make such details vanish so that, in the final paper, they are no longer recognisable.
  5. Your boss might eventually point out that case reports are not really very conclusive. The antidote to this argument is simple: you do a large case series along the same lines. Here you can even show off your excellent statistical skills by calculating the statistical significance of the difference between the severity of the condition before the treatment and the one after it. As long as this reveals marked improvements, ignores all the many other factors involved in the outcome and concludes that these changes are the result of the treatment, all should be tickety-boo.
  6. Your boss might one day insist you conduct what he narrow-mindedly calls a ‘proper’ study; in other words, you might be forced to bite the bullet and learn how to do an RCT. As your particular SCAM is not really effective, this could lead to serious embarrassment in the form of a negative result, something that must be avoided at all costs. I, therefore, recommend you join for a few months a research group that has a proven track record in doing RCTs of utterly useless treatments without ever failing to conclude that it is highly effective. In other words, join a member of my ALTERNATIVE MEDICINE HALL OF FAME. They will teach you how to incorporate all the right design features into your study without the slightest risk of generating a negative result. A particularly popular solution is to conduct a ‘pragmatic’ trial that never fails to produce anything but cheerfully positive findings.
  7. But even the most cunningly designed study of your SCAM might one day deliver a negative result. In such a case, I recommend taking your data and running as many different statistical tests as you can find; chances are that one of them will produce something vaguely positive. If even this method fails (and it hardly ever does), you can always focus your paper on the fact that, in your study, not a single patient died. Who would be able to dispute that this is a positive outcome?
  8. Now that you have grown into an experienced pseudo-scientist who has published several misleading papers, you may want to publish irrefutable evidence of your SCAM. For this purpose run the same RCT over again, and again, and again. Eventually, you want a meta-analysis of all RCTs ever published (see examples here and here). As you are the only person who conducted studies on the SCAM in question, this should be quite easy: you pool the data of all your dodgy trials and, bob’s your uncle: a nice little summary of the totality of the data that shows beyond doubt that your SCAM works and is safe.

The purpose of this review was to

  • identify and map the available evidence regarding the effectiveness and harms of spinal manipulation and mobilisation for infants, children and adolescents with a broad range of conditions;
  • identify and synthesise policies, regulations, position statements and practice guidelines informing their clinical use.

Two reviewers independently screened and selected the studies, extracted key findings and assessed the methodological quality of included papers. A descriptive synthesis of reported findings was undertaken using a level-of-evidence approach.

Eighty-seven articles were included. Their methodological quality varied. Spinal manipulation and mobilisation are being utilised clinically by a variety of health professionals to manage paediatric populations with

  • adolescent idiopathic scoliosis (AIS),
  • asthma,
  • attention deficit hyperactivity disorder (ADHD),
  • autism spectrum disorder (ASD),
  • back/neck pain,
  • breastfeeding difficulties,
  • cerebral palsy (CP),
  • dysfunctional voiding,
  • excessive crying,
  • headaches,
  • infantile colic,
  • kinetic imbalances due to suboccipital strain (KISS),
  • nocturnal enuresis,
  • otitis media,
  • torticollis,
  • plagiocephaly.

The descriptive synthesis revealed: no evidence to explicitly support the effectiveness of spinal manipulation or mobilisation for any condition in paediatric populations. Mild transient symptoms were commonly described in randomised controlled trials and on occasion, moderate-to-severe adverse events were reported in systematic reviews of randomised controlled trials and other lower-quality studies. There was strong to very strong evidence for ‘no significant effect’ of spinal manipulation for managing

  • asthma (pulmonary function),
  • headache,
  • nocturnal enuresis.

There was inconclusive or insufficient evidence for all other conditions explored. There is insufficient evidence to draw conclusions regarding spinal mobilisation to treat paediatric populations with any condition.

The authors concluded that, whilst some individual high-quality studies demonstrate positive results for some conditions, our descriptive synthesis of the collective findings does not provide support for spinal manipulation or mobilisation in paediatric populations for any condition. Increased reporting of adverse events is required to determine true risks. Randomised controlled trials examining effectiveness of spinal manipulation and mobilisation in paediatric populations are warranted.

Perhaps the most important findings of this review relate to safety. They confirm (yet again) that there is only limited reporting of adverse events in this body of research. Six reviews, eight RCTs and five other studies made no mention of adverse events or harms associated with spinal manipulation. This, in my view, amounts to scientific misconduct. Four systematic reviews focused specifically on adverse events and harms. They revealed that adverse events ranged from mild to severe and even death.

In terms of therapeutic benefit, the review confirms the findings from the previous research, e.g.:

  • Green et al (Green S, McDonald S, Murano M, Miyoung C, Brennan S. Systematic review of spinal manipulation in children: review prepared by Cochrane Australia for Safer Care Victoria. Melbourne, Victoria: Victorian Government 2019. p. 1–67.) explored the effectiveness and safety of spinal manipulation and showed that spinal manipulation should – due to a lack of evidence and potential risk of harm – be recommended as a treatment of headache, asthma, otitis media, cerebral palsy, hyperactivity disorders or torticollis.
  • Cote et al showed that evidence is lacking to support the use of spinal manipulation to treat non-musculoskeletal disorders.

In terms of risk/benefit balance, the conclusion could thus not be clearer: no matter whether chiropractors, osteopaths, physiotherapists, or any other healthcare professionals propose to manipulate the spine of your child, DON’T LET THEM DO IT!

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