A new survey from the Frazer Institute, an independent, non-partisan Canadian public policy think-tank, suggests that more and more Canadians are using alternative therapies. In 2016, massage was the most common type of therapy that Canadians used over their lifetime with 44 percent having tried it, followed by chiropractic care (42%), yoga (27%), relaxation techniques (25%), and acupuncture (22%). Nationally, the most rapidly expanding therapies over the past two decades or so (rate of change between 1997 and 2016) were massage, yoga, acupuncture, chiropractic care, osteopathy, and naturopathy. High dose/mega vitamins, herbal therapies, and folk remedies appear to be in declining use over that same time period.
“Alternative treatments are playing an increasingly important role in Canadians’ overall health care, and understanding how all the parts of the health-care system fit together is vital if policymakers are going to find ways to improve it,” said Nadeem Esmail, Fraser Institute senior fellow and co-author of Complementary and Alternative Medicine: Use and Public Attitudes, 1997, 2006 and 2016.
The updated survey of 2,000 Canadians finds more than three-quarters of Canadians — 79 per cent — have used at least one complementary or alternative medicine (CAM) or therapy sometime in their lives. That’s an increase from 74 per cent in 2006 and 73 per cent in 1997, when two previous similar surveys were conducted. In fact, more than one in two Canadians (56 per cent) used at least one complementary or alternative medicine or therapy in the previous 12 months, an increase from 54 per cent in 2006 and 50 per cent in 1997.
And Canadians are using those services more often, averaging 11.1 visits in 2016, compared to fewer than nine visits a year in both 2006 and 1997. In total, Canadians spent $8.8 billion on complementary and alternative medicines and therapies last year, up from $8 billion (inflation adjusted) in 2006.
The majority of respondents — 58 per cent — support paying for alternative treatments privately and don’t want them included in provincial health plans. Support for private payment is even highest (at 69 per cent) among 35- to 44-year-olds. “Complementary and alternative therapies play an increasingly important role in Canadians’ overall health care, but policy makers should not see this as an invitation to expand government coverage — the majority of Canadians believe alternative therapies should be paid for privately,” Esmail said.
This seems to be a good survey, and it offers a host of interesting information. Yet, it also leaves many pertinent questions unanswered. The most important one might be WHY?
Why are so many people trying treatments which clearly are unproven or disproven?
Enthusiasts would obviously say this is because they are useful in some way. I would, however, point out that the true reason might well be that consumers are systematically mislead about the value of alternative therapies, as I have shown on this blog so many times.
Nevertheless, this seems to be a good survey – there are hundreds, if not thousands of surveys in the realm of alternative medicine which are of such deplorable quality that they do not deserve to be published at all – but even with a relatively good survey, we need to be cautious. For instance, I have no difficulty designing a questionnaire that would guarantee a result of 100% prevalence of alternative medicine usage. All I would need to do is to include the following two questions:
- Have you ever used plant-based products for your well-being or comfort?
- Have you ever prayed while being ill?
Drinking a cup of tea would already have to prompt a positive reply to the 1st question. And if you answer yes to the 2nd question, it would be interpreted as using prayer as a therapy.
I think, I rest my case.
The aim of this paper was to systematically review surveys of 12-month prevalence of homeopathy use by the general population worldwide. Studies were identified via database searches to October 2015. Study quality was assessed using a six-item tool. All estimates were in the context of a survey which also reported prevalence of any complementary and alternative medicine use. A total of 36 surveys were included. Of these, 67% met four of six quality criteria.
Twelve-month prevalence of treatment by a homeopath was reported in 24 surveys of adults (median 1.5%, range 0.2–8.2%). Estimates for children were similar to those for adults. Rates in the USA, UK, Australia and Canada all ranged from 0.2% to 2.9% and remained stable over the years surveyed (1986–2012). Twelve-month prevalence of all use of homeopathy (purchase of over-the-counter homeopathic medicines and treatment by a homeopath) was reported in 10 surveys of adults (median 3.9%, range 0.7–9.8%) while a further 11 surveys which did not define the type of homeopathy use reported similar data. Rates in the USA and Australia ranged from 1.7% to 4.4% and remained stable over the years surveyed. The highest use was reported by a survey in Switzerland where homeopathy is covered by mandatory health insurance.
The authors concluded that each year a small but significant percentage of these general populations use homeopathy. This includes visits to homeopaths as well as purchase of over-the-counter homeopathic medicines.
These data thus indicate that the percentage of the adult general population using homeopathy over the previous 12 months was in the range of 0.7–9.8%, with a median estimate of 3.9%, and the percentage accessing treatment by a homeopath over the previous 12 months was in the range of 0.2–8.2%, with a median estimate of 1.5%. The data also suggest that, over the last few decades, use of homeopathy has remained fairly stable. These facts are in sharp contrast to the claims by homeopaths that:
- Homeopathy is hugely popular.
- Homeopathy is being used by more and more people across the globe.
- Homeopathy is the medicine of the future.
The well-documented and undeniable unpopularity of homeopathy begs the question, I think, why so many people seem to get so excited about homeopathy. The level of usage is nothing to write home about! Therefore, why don’t we just put it down to an aberration like believing the earth is flat? Why don’t we just concede that some minor, harmless stupidity will always exist in some people’s minds?
Here are some reasons why:
- It is not about the amount of people using homeopathy, but about the principle that any of the increasingly scarce public funds for healthcare are wasted on something as irrational and useless as homeopathy.
- Homeopathy makes a mockery of EBM.
- Homeopathy and homeopaths are by no means harmless.
- Homeopaths tell too many lies to be allowed to get away with them.
- Homeopathy and its followers systematically undermine rational thought.
The British Chiropractic Association (BCA) has lost all credibility after suing Simon Singh for drawing the public’s attention to the fact that they were ‘happily promoting bogus treatments’. Now, it seems, they are trying to re-establish themselves with regular, often bogus or dubious pronouncements about back pain. It looks as though they have learnt nothing. A recent article in THE INDEPENDENT is a good example of this ambition, I think:
START OF QUOTE
Skinny jeans and coats with big fluffy hoods can contribute to painful back problems, chiropractors have warned.
Nearly three-quarters of women have experienced back pain, according to a survey by the British Chiropractic Association (BCA), who said fashionable clothing including backless shoes, oversized bags and heavy statement jewellery were partly to blame.
Wearing very tight jeans can restrict mobility and force other muscles to strain as they try to compensate for the resulting change in posture, chiropractor Rishi Loatey told The Independent.
“If they’re incredibly tight, you won’t be able to walk as you normally would,” he said.
“You’ve got a natural gait, or stride, that you would take, and the knee, hip and lower back all move to minimise the pressure coming up through the joints.
“However, if one of those areas isn’t moving as it should be, it’s going to cause more pressure elsewhere.”
While 73 per cent of women from a sample of more than 2,000 said they have had back pain, more than a quarter – 28 per cent – said they were aware their clothing affects their posture and back and neck pain, but did not take this into account when choosing what to wear.
Lower back pain is the most common cause of disability worldwide, with 9.4 per cent of people suffering from it, according to a previous study.
High heels, which cause muscles in the back of the leg and the calf to tighten and pull on the pelvis differently, have long been culprits of back pain.
A number of high-profile campaigns against “sexist” dress codes requiring women to wear high heels at work have made reference to this fact.
But backless shoes, flimsy ballet pumps and some soft boots can also damage your back if they are worn too often, said Mr Loatey.
“If you imagine the back of a shoe, the bit that goes round the back is supposed to be quite firm, so it grips the rear foot,” he said. “If you don’t have that, then your foot is more mobile in the shoe.”
“If they’re not the right size, they’re a bit loose or they don’t have the bit at the back, you’re almost gripping the shoe as you walk, which again changes the way you walk,” said Mr Loatey, adding that ideally shoes should be laced up at the front to make sure the foot is held firmly.
A third of women surveyed by the BCA were unaware that their clothing choices could harm their backs and necks.
Mr Loatey said people should try and wear clothes that allow them to move more freely. Heavy hoods and over-shoulder bags can both restrict movement.
They should also consider limiting the amount of time they spent wearing high heels or backless shoes and consider travelling to work or social events in trainers or other well-supported shoes instead, he said.
END OF QUOTE
This piece strikes me as pure promotion of chiropractic – health journalism at its worse, I’d say. What is more objectionable than the promotion, it is full of half truths, ‘alternative facts’ and pure invention. Let me list a few statements that I find particularly doggy:
- “Skinny jeans and coats with big fluffy hoods can contribute to painful back problems.” Do they have any evidence for this? I don’t know of any!
- “…fashionable clothing including backless shoes, oversized bags and heavy statement jewellery were partly to blame [for back problems].” Idem!
- “Wearing very tight jeans can restrict mobility and force other muscles to strain…” Idem!
- “…it’s going to cause more pressure elsewhere.” Idem!
- 28% of women said “they were aware their clothing affects their posture and back and neck pain, but did not take this into account when choosing what to wear.” To make the findings from a survey look like scientific evidence for cause and effect is at best misleading, at worst dishonest.
- “…according to a previous study“. It turns out that this previous study was of occupational back pain which has nothing to do with tight jeans etc.
- “High heels, which cause muscles in the back of the leg and the calf to tighten and pull on the pelvis differently, have long been culprits of back pain.” A link to the evidence would be nice – if there is any.
- “But backless shoes, flimsy ballet pumps and some soft boots can also damage your back – if they are worn too often…” Evidence needed – if there is any.
- “Mr Loatey said people should try and wear clothes that allow them to move more freely. Heavy hoods and over-shoulder bags can both restrict movement.” Concrete recommendations require concrete evidence or a link to it.
- Women “should also consider limiting the amount of time they spent wearing high heels or backless shoes and consider travelling to work or social events in trainers or other well-supported shoes instead.” Idem.
At this point congratulations are in order, I feel.
Firstly to THE INDEPENDENT for publishing one of the most inadequate health-related article which I have seen in recent months.
Secondly to the BCA for their stubborn determination to ‘happily promoting bogus’ notions. Instead of getting their act together when found out to advertise quackery in 2008, they sued Simon Singh (unsuccessfully, I hasten to add). Instead of cutting out the nonsense once and for all, they now promote populist ‘alternative facts’ about the causes of back pain. Instead of behaving like a professional organisation that promotes high standards and solid evidence, they continue to do the opposite.
One cannot but be impressed with so much intransigence.
The notorious tendency of pharmacist to behave like shop-keepers when it comes to the sale of bogus remedies has been the subject of this blog many times before. In my view, this is an important subject, and I will therefore continue to report about it.
On the website of the AUSTRALIAN JOURNAL OF PHARMACY (AJP), we find interesting new data on Australian pharmacists’ love affair with bogus alternative medicine. The AJP recently ran a poll asking readers: “Do you stock Complementary Medicines (CMs) in your pharmacy?” The results of this little survey so far show that 54% of all participating pharmacists say they stock CMs, including homeopathic products. About a quarter (28%) of respondents stock CMs but not homeopathic products. And 9% said they “only stock evidence-based CMs”. Three percent completely refuse to stock CMs, while 2% stock them but with clear in-store labels saying that they may not work. One person stated they stock CMs but have recently decided to no longer do so.
The President of the Pharmaceutical Society of Australia (PSA) Joe Demarte commented on these findings: “The latest survey results, showing over 40% of pharmacists are adhering to PSA’s Code of Ethics on complementary medicines, are very encouraging… However it’s disappointing that some pharmacists are still stocking homeopathy products, which are not supported by PSA’s Code of Ethics or our Position Statement on Complementary Medicines… Irrespective of the products stocked in a pharmacy, the important thing is when discussing the use of complementary medicines with consumers, pharmacists must ensure that consumers are provided with the best available information about the current evidence for efficacy, as well as information on any potential side effects, drug interactions and risks of harm… It’s important for pharmacists to provide a fair, honest and balanced view of the current evidence available on all complementary medicines,” Demarte added.
NSW pharmacist Ian Carr, who is a member of the Friends of Science in Medicine group, commented that many pharmacists may not have much choice when it comes to stocking complementary and alternative medicines. “CMs policy is not being filtered through the professional assessment of the pharmacist… It’s basically a business deal with the franchise, and as a pharmacist taking on a franchise you’ve basically got to sign those rights away about what you get to sell. Some of the chains offer basically everything that is available, no questions asked. As an independent pharmacist I am able to make my own decisions about what to stock… We’ve got a ‘de-facto’ corporatisation happening with marketing groups and franchises, and I’m concerned the government will look at this trend and ask, why are we not deregulating the industry to reflect the apparent reality of pharmacy today? We’re only playing into the hands of people who want deregulation… We should be telling people in no uncertain terms that if something is on the shelf it doesn’t mean it’s been assessed or approved by the TGA… There is no doubt that there has been a long-term relationship between the supplement industry and pharmacy. But it was also a few decades ago that researchers started applying the concept of evidence-based medicine to healthcare generally. That should have been the point where we said, ‘we’re not just going to be a conduit for your products without questioning their basis in evidence’. That’s where we lost the plot. The question now is: where do we draw that line? I’m really trying to say to my fellow pharmacists: Please let us reassess the unquestioning support of the CM industry, or we’ll all be tarred with the same brush. I and many others are concerned about – and fighting for – the reputation of the pharmacy profession.”
A BMC Complementary and Alternative Medicine survey by researchers from Alfred Hospital in Melbourne found that 92% thought pharmacists should provide safety information about CMs, while 93% thought it important for pharmacists to be knowledgeable about CMs. This shows a huge divide between what is happening in Australian pharmacy on the one side and ethical demands or public opinion on the other side. What is more, there is little reason to believe that the situation in other countries is fundamentally different.
And did you notice this little gem in the comments above? “…over 40% of pharmacists are adhering to PSA’s Code of Ethics…” – the PSA president finds this ‘VERY ENCOURAGING’.
When I saw this, I almost fell off my chair!
Does the president know that this means that 60% of his members are violating their own code of ethics?
Is that truly VERY ENCOURAGING, I ask myself.
My answer is no, this is VERY WORRYING.
Yes, to a large extend, quacks make a living by advertising lies. A paper just published confirms our worst fears.
This survey was aimed at identifying the frequency and qualitative characteristics of marketing claims made by Canadian chiropractors, naturopaths, homeopaths and acupuncturists relating to the diagnosis and treatment of allergy and asthma.
A total of 392 chiropractic, naturopathic, homeopathic and acupuncture clinic websites were located in 10 of the largest metropolitan areas in Canada. The main outcome measures were: mention of allergy, sensitivity or asthma, claim of ability to diagnose allergy, sensitivity or asthma, claim of ability to treat allergy, sensitivity or asthma, and claim of allergy, sensitivity or asthma treatment efficacy. Tests and treatments promoted were noted as qualitative examples.
The results show that naturopath clinic websites had the highest rates of advertising at least one of diagnosis, treatment or efficacy for allergy or sensitivity (85%) and asthma (64%), followed by acupuncturists (68% and 53%, respectively), homeopaths (60% and 54%) and chiropractors (33% and 38%). Search results from Vancouver were most likely to advertise at least one of diagnosis, treatment or efficacy for allergy or sensitivity (72.5%) and asthma (62.5%), and results from London, Ontario were least likely (50% and 40%, respectively). Of the interventions advertised, few are scientifically supported; the majority lack evidence of efficacy, and some are potentially harmful.
The authors concluded that the majority of alternative healthcare clinics studied advertised interventions for allergy and asthma. Many offerings are unproven. A policy response may be warranted in order to safeguard the public interest.
In the discussion section, the authors state: “These claims raise ethical issues, because evidence in support of many of the tests and treatments identified on the websites studied is lacking. For example, food-specific IgG testing was commonly advertised, despite the fact that the Canadian Society of Allergy and Clinical Immunology has recommended not to use this test due to the absence of a body of research supporting it. Live blood analysis, vega/electrodiagnostic testing, intravenous vitamin C, probiotics, homeopathic allergy remedies and several other tests and treatments offered all lack substantial scientific evidence of efficacy. Some of the proposed treatments are so absurd that they lack even the most basic scientific plausibility, such as ionic foot bath detoxification…
Perhaps most concerning is the fact that several proposed treatments for allergy, sensitivity or asthma are potentially harmful. These include intravenous hydrogen peroxide, spinal manipulation and possibly others. Furthermore, a negative effect of the use of invalid and inaccurate allergy testing is the likelihood that such testing will lead to alterations and exclusions in diets, which can subsequently result in malnutrition and other physiological problems…”
This survey originates from Canada, and one might argue that elsewhere the situation is not quite as bad. However, I would doubt it; on the contrary, I would not be surprised to learn that, in some other countries, it is even worse.
Several national regulators have, at long last, become aware of the dangers of advertising of outright quackery. Consequently, some measures are now beginning to be taken against it. I would nevertheless argue that these actions are far too slow and by no means sufficiently effective.
We easily forget that asthma, for instance, is a potentially life-threatening disease. Advertising of bogus claims is therefore much more than a forgivable exaggeration aimed at maximising the income of alternative practitioners – it is a serious threat to public health.
We must insist that regulators protect us from such quackery and prevent the serious harm it can do.
Alternative medicine suffers from what might be called ‘survey overload’: there are far too much such investigations and most of them are of deplorably poor quality producing nothing of value except some promotion for alternative medicine. Yet, every now and then, one finds a paper that is worth reading, and I am happy to say that this survey (even though it has several methodological shortcomings) belongs in this category.
This cross-sectional assessment of the views of general practitioners towards chiropractors and osteopaths was funded by the Department of Chiropractic at Macquarie University. It was designed as a quantitative descriptive study using an anonymous online survey that included closed and open-ended questions with opportunities provided for free text. The target population was Australian general practitioners. Inclusion criteria included current medical registration, membership of the Royal Australian College of General Practitioners and currently practicing as a general practitioner in Australia. The data being reported here were collected between May and December, 2014.
There were 630 respondents to the online survey during this period representing a response rate of 2.6 %. Results were not uniform for the two professions. More general practitioners believed chiropractic education was not evidence-based compared to osteopathic education (70 % and 50 % respectively), while the scope of practice was viewed as similar for both professions. A majority of general practitioners had never referred a patient to either profession (chiropractic: 60 %; osteopathy: 66 %) and indicated that they would not want to co-manage patients with either profession. Approximately two-thirds of general practitioners were not interested in learning more about their education (chiropractors: 68 %; osteopaths: 63 %).
The authors concluded that this study provides an indication of the current views of Australian general practitioners towards chiropractors and osteopaths. The findings suggest that attitudes may have become less favourable with a growing intolerance towards both professions. If confirmed, this has the potential to impact health service provision. The results from this cross-sectional study suggest that obtaining representative general practitioner views using online surveys is difficult and another approach is needed to supplement or replace the current recruitment strategy.
The authors do not speculate on the reasons why the attitudes of general practitioners towards chiropractic and osteopathy might have become more critical. Therefore I decided to offer a few possibilities here. The more negative views could be due to:
- better education of general practitioners,
- tightening of healthcare budgets,
- recent ‘bad press’ and loss of reputation (for instance, the BCA’s libel action against Simon Singh),
- the work of sceptics in informing the public about the numerous bogus claims made by osteopaths and chiropractors,
- the plethora of overtly bogus claims which nevertheless continue to be made by these practitioners on a daily basis,
- a more general realisation that these therapies can cause very serious harm,
- a mixture of the above factors.
Whatever the reasons are, the finding that there now seems to be a growing scepticism (in Australia, but hopefully elsewhere as well) about the value of chiropractic and osteopathy is something that cheers me up no end.
Chiropractors may not be good at treating diseases or symptoms, but they are certainly good at promoting their trade. As this trade hardly does more good than harm, one could argue that chiropractors are promoting bogus and potentially harmful treatments to fill their own pockets.
Does that sound too harsh? If you think so, please read what Canadian researchers have just published:
This study aimed to investigate the presence of critiques and debates surrounding efficacy and risk of Spinal Manipulative Therapy (SMT) on the social media platform Twitter. Specifically, it examined whether there is presence of debate and whether critical information is being widely disseminated.
An initial corpus of 31,339 tweets was compiled through Twitter’s Search Application Programming Interface using the query terms “chiropractic,” “chiropractor,” and “spinal manipulation therapy.” Tweets were collected for the month of December 2015. Post removal of tweets made by bots and spam, the corpus totalled 20,695 tweets, of which a sample (n=1267) was analysed for sceptical or critical tweets.
The results showed that there were 34 tweets explicitly containing scepticism or critique of SMT, representing 2.68% of the sample (n=1267). As such, there is a presence of 2.68% of tweets in the total corpus, 95% CI 0-6.58% displaying explicitly sceptical or critical perspectives of SMT. In addition, there are numerous tweets highlighting the health benefits of SMT for health issues such as attention deficit hyperactivity disorder (ADHD), immune system, and blood pressure that receive scant critical attention. The presence of tweets in the corpus highlighting the risks of “stroke” and “vertebral artery dissection” is also minute (0.1%).
The authors drew the following conclusions: In the abundance of tweets substantiating and promoting chiropractic and SMT as sound health practices and valuable business endeavors, the debates surrounding the efficacy and risks of SMT on Twitter are almost completely absent. Although there are some critical voices of SMT proving to be influential, issues persist regarding how widely this information is being disseminated.
I have no doubt that this paper will be sharply criticised by chiropractors, other manipulators and lobbyists of quackery. Yet I think it is an interesting and innovative approach to describe what is and is not being said on public media. The fact that chiropractors hardly ever publicly criticise or challenge each other on Twitter or elsewhere for even the most idiotic claims is, in my view, most telling.
Few people would doubt that such platforms have become hugely important in forming public opinions, and it seems safe to assume that consumers views about SMT are strongly influenced by what they read on Twitter. If we accept this position, we also have to concede that Twitter et al. are a potential danger to public health.
The survey is, however, not flawless, and the authors are the first to point that out: Given the nature of Twitter discussions and the somewhat limited access provided by Twitter’s API, it can be challenging to capture a comprehensive collection of tweets on any topic. In addition, other potential terms such as “chiro” and “spinal adjustment” are present on Twitter, which may produce datasets with somewhat different results. Finally, although December 2015 was chosen at random, there is nothing to suggest that other time frames would be significantly similar or different. Despite these limitations, this study highlights the degree to which discussions of risk and critical views on efficacy are almost completely absent from Twitter. To this I would add that a comparison subject like nursing or physiotherapy might have been informative, and that somehow osteopaths have been forgotten in the discussion.
The big question, of course, is: what can be done about creating more balance on Twitter and elsewhere? I wish I had a practical answer. In the absence of such a solution, all I can offer is a plea to everyone who is able of critical thinking to become as active as they can in busting myths, disclosing nonsense and preventing the excesses of harmful quackery.
Let’s all work tirelessly and effectively for a better and healthier future!
An analysis of the 2012 National Health Interview Survey Data examined the associations between self-reported use of various forms of complementary and alternative medicine (CAM) therapies (dietary supplements, mind-body practices) and the number of days missed from job or business in the past 12 months due to illness or injury. Multivariable Poisson regression was used to determine the association between CAM use and absence from work among individuals with one or more chronic disease (n = 10,196).
Over half (54 %) of the study population reported having one chronic disease, while 19 % had three or more conditions. The three most common chronic diseases were high cholesterol (48 %), arthritis (35 %) and hypertension (31 %). More participants used dietary supplements (72 %) while fewer individuals reported using mind-body practices (17 %) in the past twelve months. Over half of individuals reported missing any number of days from job or business due to illness or injury (53 %). Of those who had missed any days from work, 42 % missed one or two days, 36 % missed three to five days, and 23 % missed six days or more.
In multivariable Poisson regression adjusting for demographic variables (race, age, gender, income, education) and potential confounders (BMI, general health, and use of CAM to improve energy), the rate of missing days from job or business in the past 12 months among those who used mind-body therapy was significantly greater than those who did not use these practices (IRR = 1.55, 95 % CI: 1.09, 2.21) (Table 4). Similar association was observed for dietary supplements use (IRR = 1.13, 95 % CI: 0.85, 1.51) (Table 4), although the result was not significant.
The authors concluded: Although nearly all individuals who practiced mind-body therapies reported being in good to excellent health, these individuals had a higher rate of absenteeism compared to non-users. Previous studies have shown that many individuals with chronic illness use CAM with the intent of alleviating the symptoms associated with chronic illness but this body of evidence is limited. Further studies are needed to examine the potential effects of these self-managed CAM therapies on the symptoms associated with chronic disease. Additionally, future studies should explore how managing these symptoms through the integration CAM therapies chronic disease management and employee programs could have a positive effect on absence from work, school, and other responsibilities.
How can these finding be interpreted?
The authors offer two possible explanations: Self-administered CAM practices may be more accessible to individuals with chronic disease regardless of socioeconomic status and other demographic factors. Alternatively, CAM use without the advisement of a practitioner may be harmful due to lack of knowledge on proper technique or dosage.
I am sure there are other ways to make sense of these data. How about this interpretation, for instance: CAM-use and absenteeism have in common that they are the things that the ‘worried well’ tend to do. Thus the two phenomena correlate because they are a characteristic of a certain type of consumer.
Yes, I am just guessing, because the data certainly does not give us anything like a conclusive explanation.
Nonetheless, one thing seems to be fairly clear: CAM-use in this population is not a thing that motivates consumers to go to work.
Yes, I admit it: over the years, I had formed a vague impression that homeopaths lack humour. Certainly, many comments on this blog seemed to confirm the notion. But now I changed my mind: some homeopaths are intensely funny.
Yesterday, I found a tweet which read: “NCH and homeopathy to be highlighted at the 2016 American Public Health Association’s conference in Denver”. The tweet provided a link which took me to an abstract authored by Alison Teitelbaum from the US National Center for Homeopathy (on their website, this organization tell us that they “inform legislators and work to secure homeopathy’s place in the U.S health care system while working to ensure that homeopathy is accurately represented in the media”).
The abstract in question summarized a presentation for the up-coming APHA-meeting in Denver. It is so hilariously comical that I simply have to share it with you (for those readers are homeopaths, I have added [in square brackets] a few footnotes explaining the humorous side of it):
Background: Over the last 25 years there has been a marked increase in consumer demand for information about complimentary  and alternative medicine, including homeopathy. Anecdotal data  suggest that homeopathic consumers are very satisfied with homeopathic medicines, and use them to treat acute, self-limiting conditions, however very little data exists in the published literature examining either topic . Therefore, the purpose of this project was to evaluate homeopathic consumers’ use and satisfaction with homeopathic medicines.
Methods: Survey of nearly 20,000 consumers  who had purchased at least 1 over-the-counter (OTC) homeopathic medicine in the past 2 years.
Results:  More than 95% of respondents indicated they were very or extremely satisfied with the most recent OTC homeopathic medicine they had purchased and used . More than 96% of respondents indicated they were very or extremely satisfied with the results of OTC homeopathic medicines that they had used in general . Over 98% of respondents reported that they were very likely to purchase OTC homeopathic medicines again in the future . More than 97% of respondents indicated that they were very likely to recommend homeopathic medicines to others . Finally, more than 80% of respondents indicated using OTC homeopathic medicines for acute, self-limiting conditions, such as aches and pains; cold and flu symptoms; and digestive upset .
Conclusion: These results support anecdotal evidence  that homeopathic consumers are satisfied with OTC homeopathic medicines , and are using them to treat acute, self-limiting conditions . Additional research is needed to further explore the use of OTC homeopathic medicine in the US for trends, access, and overall awareness about homeopathy . complimentary medicine = healthcare that costs nothing; complementary medicine = healthcare that complements real medicine; homeopathy should belong to the former category because it contains nothing.  please note how ‘anecdotal data’ becomes ‘anecdotal evidence’ by the time we reach the conclusion; little does the author know that THE PLURAL OF ANECDOTE IS NOT ‘DATA’ BUT ‘ANECDOTES’!!!  this statement implies that the author cannot cope with a Medline search, because there are plenty of articles on this subject.  ‘nearly 20 000’ perfectly reflects the scientific rigor of this project (is it really too demanding to provide the exact figure?)  how come we do not learn anything about the response rate of this survey (did ‘nearly’ everyone reply? or did ‘nearly’ everyone not reply?)?  considering that only homeopathy-fans were included, this figure should be 100%!  considering that only homeopathy-fans were included, this figure should be 100%!  considering that only homeopathy-fans were included, this figure should be 100%!  considering that only homeopathy-fans were included, this figure should be 100%!  ‘more than 80%’ of an unknown rate of responders is about as much as a tin of peas. But I am nevertheless relieved that the majority used placebos merely for self-limiting conditions; the 20% who might have used it for life-threatening conditions are probably all dead – sad!  see footnote number 2  this is like doing a survey in a hamburger joint concluding that all consumers love to eat hamburgers.  except, of course, the unknown percentage of non-responders who might all be dead.  I would re-phrase this last sentence as follows: MORE SUCH PRESENTATIONS ARE NEEDED TO PROVIDE COMIC RELIEF TO OTHERWISE DRY AND BORING MEETINGS ON PUBLIC HEALTH.
Yes, yes, yes, I know: we have too few women in our ‘ALT MED HALL OF FAME’. This is not because I have anything against them (quite the contrary) but, in alternative medicine research, the boys by far outnumber the girls, I am afraid.
You do remember, of course, you has previously been admitted to this austere club of excellence; only two women so far. Here is the current list of members to remind you:
David Peters (osteopathy, homeopathy, UK)
Nicola Robinson (TCM, UK)
Peter Fisher (homeopathy, UK)
Simon Mills (herbal medicine, UK)
Gustav Dobos (various, Germany)
Claudia Witt (homeopathy, Germany and Switzerland)
George Lewith (acupuncture, UK)
John Licciardone (osteopathy, US)
If you study the list carefully, you will also notice that, until now, I have totally ignored the chiropractic profession. This is a truly embarrassing omission! When it comes to excellence in research, who could possibly bypass our friends, the chiropractors?
Today we are going to correct these mistakes. Specifically, we are going to increase the number of women by 50% (adding one more to the previous two) and, at the same time, admit a deserving chiropractor to the ALT MED HALL OF FAME.
Cheryl Hawk is currently the Executive Director of Northwest Center for Lifestyle and Functional Medicine, University of Western States, Portland, USA. Previously she worked as Director of Clinical Research at the Logan University College of Chiropractic, Chesterfield, USA, and prior to that she was employed at various other institutions. Since many years she has been a shining light of chiropractic research. She is certainly not ‘small fry’ when it comes to the promotion of chiropractic.
Cheryl seems to prefer surveys as a research tool over clinical trials, and it was therefore not always easy to identify those of her 67 Medline-listed articles that reported some kind of evaluation of the value of chiropractic. Here are, as always, the 10 most recent papers where I could extract something like a data-based conclusion (in bold) from the abstract.
Hawk C, Schneider MJ, Vallone S, Hewitt EG.
J Manipulative Physiol Ther. 2016 Mar-Apr;39(3):158-68
All of the seed statements in this best practices document achieved a high level of consensus and thus represent a general framework for what constitutes an evidence-based and reasonable approach to the chiropractic management of infants, children, and adolescents.
Clinical Practice Guideline: Chiropractic Care for Low Back Pain.
Globe G, Farabaugh RJ, Hawk C, Morris CE, Baker G, Whalen WM, Walters S, Kaeser M, Dehen M, Augat T.
J Manipulative Physiol Ther. 2016 Jan;39(1):1-22
The evidence supports that doctors of chiropractic are well suited to diagnose, treat, co-manage, and manage the treatment of patients with low back pain disorders.
Ndetan H, Hawk C, Sekhon VK, Chiusano M.
J Evid Based Complementary Altern Med. 2016 Apr;21(2):138-42.
The odds ratio for perceiving being helped by a chiropractor was 4.36 (95% CI, 1.17-16.31) for respondents aged 65 years or older; 9.5 (95% CI, 7.92-11.40) for respondents reporting head or neck trauma; and 13.78 (95% CI, 5.59-33.99) for those reporting neurological or muscular conditions as the cause of their balance or dizziness.
Schneider MJ, Evans R, Haas M, Leach M, Hawk C, Long C, Cramer GD, Walters O, Vihstadt C, Terhorst L.
Chiropr Man Therap. 2015 May 4;23:16.
American chiropractors appear similar to chiropractors in other countries, and other health professionals regarding their favorable attitudes towards EBP, while expressing barriers related to EBP skills such as research relevance and lack of time. This suggests that the design of future EBP educational interventions should capitalize on the growing body of EBP implementation research developing in other health disciplines. This will likely include broadening the approach beyond a sole focus on EBP education, and taking a multilevel approach that also targets professional, organizational and health policy domains.
Chiropractic identity, role and future: a survey of North American chiropractic students.
Gliedt JA, Hawk C, Anderson M, Ahmad K, Bunn D, Cambron J, Gleberzon B, Hart J, Kizhakkeveettil A, Perle SM, Ramcharan M, Sullivan S, Zhang L.
Chiropr Man Therap. 2015 Feb 2;23(1):4
The chiropractic students in this study showed a preference for participating in mainstream health care, report an exposure to evidence-based practice, and desire to hold to traditional chiropractic theories and practices. The majority of students would like to see an emphasis on correction of vertebral subluxation, while a larger percent found it is important to learn about evidence-based practice. These two key points may seem contradictory, suggesting cognitive dissonance. Or perhaps some students want to hold on to traditional theory (e.g., subluxation-centered practice) while recognizing the need for further research to fully explore these theories. Further research on this topic is needed.
Twist E, Lawrence DJ, Salsbury SA, Hawk C.
Chiropr Man Therap. 2014 Dec 10;22(1):40
These results strongly suggest that chiropractic clinical researchers are not developing ICDs at a readability level congruent with the national average acceptable level. The low number of elements in some of the informed consent documents raises concern that not all research participants were fully informed when given the informed consent, and it may suggest that some documents may not be in compliance with federal requirements. Risk varies among institutions and even within institutions for the same intervention.
Hawk C, Kaeser MA, Beavers DV.
J Chiropr Educ. 2013 Fall;27(2):135-40.
This active learning exercise appeared to be a feasible way to introduce tobacco counseling into the curriculum.
Hawk C, Schneider M, Evans MW Jr, Redwood D.
J Manipulative Physiol Ther. 2012 Sep;35(7):556-67
This living document provides a general framework for an evidence-based approach to chiropractic wellness care.
Ndetan H, Evans MW Jr, Hawk C, Walker C.
J Altern Complement Med. 2012 Apr;18(4):347-53.
C/OM is primarily used for back and neck pain, which is increasing in prevalence in children. Teens are more likely to use it than are younger children.
Dougherty PE, Hawk C, Weiner DK, Gleberzon B, Andrew K, Killinger L.
Chiropr Man Therap. 2012 Feb 21;20(1):3.
Given the utilization of chiropractic services by the older adult, it is imperative that providers be familiar with the evidence for and the prudent use of different management strategies for older adults.
I am pleased to say that Prof Hawk gave me no problems at all; her case is clear: she is a champion of using research as a means for promoting chiropractic, has published many papers in this vein, clearly prefers the journals of chiropractic that nobody other than chiropractors ever access, and has an impeccable track record when it comes to avoiding negative conclusions which could harm chiropractic in any way.
Very well done indeed!
WELCOME, PROF HAWK, TO THE ‘ALT MED HALL OF FAME’.