MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

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‘Chiropractic is safe’ is a statement by Dr Arleen Scholten (see below) and thousands of other chiropractors like her. This sentence seems to be a nice marketing slogan – but sadly it is far removed from reality:

How many such serious events have occurred is anyone’s guess. The reason for this uncertainty is that there is no monitoring system that would give us this information. About 500 serious complications have been published in the medical literature. But these published cases are just the tip of a much bigger iceberg. We have shown that under-reporting is close to 100%.

This means that the vast majority of these cases remain completely undocumented. Some appear in the popular press, like the one recently published in the DAILY MAIL:

A chiropractor has been arrested on suspicion of manslaughter after a retired bank manager died following treatment for backache.

John Lawler, 80, was undergoing routine treatment at a private clinic when he lost consciousness and appeared to have become paralysed from the shoulders down. He was taken straight to hospital but died the next day as a result of a ‘traumatic spinal cord injury.’

His wife of 55 years, Joan Lawler, 81, was in the chiropractor’s clinic with her husband and witnessed the incident. Police are investigating to establish whether or not criminal negligence was a factor in his death.

Dr Arleen Scholten, 40, the chiropractor who treated Mr Lawler, was arrested by police on suspicion of manslaughter and released pending further inquiries.

Mr Lawler, a former Barclays Bank manager, was an active and healthy grandfather who lived in York. It is understood he was taken ill on his third visit in a week to Chiropractic 1st – a clinic within walking distance of the family home. He was seen by Dr Scholten, a chiropractor and director of the company, on Friday, August 11 and was undergoing treatment on his back when the unexpected and fatal problem occurred.

Mr Lawler was taken to York District Hospital by ambulance before being transferred to Leeds General Infirmary when the seriousness of his condition became clear.

END OF QUOTE

DOCTOR Scholten tells us on her website that we get to help people who suffer from a variety of health issues. Naturally, chiropractic helps traditional neck and back problems, but chiropractic has also produced wonderful results with a variety of organic and systemic problems. Chiropractic is safe.*** Chiropractic is natural. And Chiropractic works!

Doctor Scholten also informs us that our children were all adjusted the day they were born, 2 were homebirths and I continue to check their spines regularly. There is a saying in Chiropractic ‘If the twig is bent so grows the tree’.

Say no more!

(*** my emphasis)

 

 

Researchers from Texas have recently shown that the administration of hdc Lactobacillus reuteri in the gut resulted in luminal hdc gene expression and histamine production in the intestines of Hdc mice.

Would you conclude from this result that human colon cancer can be reversed or prevented by consuming probiotics?

Probably not!

You would need to be a moron to do so, in my view.

But this did not stop my favourite source of misinformation, WDDTY, to publish an article about this very study entitled “Probiotics could reverse colon cancer”. Here it is:

Colon cancer could be reversed just with probiotics that change the gut’s bacteria—and the disease can be prevented in the first place by eating whole grains, such as brown rice and whole-wheat bread, every day, two new research studies have found. In a breakthrough study that could herald in a new drugs-free approach to treating colon cancer, researchers have discovered that sufferers lack certain enzymes known as metabolites, simple ‘building-block’ compounds, in their gut, and this can cause inflammation and cancer…

Amazed?

Shocked?

I am not! By now, I know what to expect from my favourite source of misinformation, WDDTY.

The authors of a recent paper stated that cerebellar and spinal cord injuries related to cervical chiropractic manipulation were first reported in 1947. By 1974, there were 12 reported cases. Non-invasive imaging has since greatly improved the diagnosis of cervical artery dissection and of stroke, and cervical artery dissection is now recognized as pathogenic of strokes occurring in association with chiropractic manipulation. 

The purpose of their study was to determine the frequency of patients seen at a single institution who were diagnosed with a cervical vessel dissection related to chiropractic neck manipulation.

The authors identified cases through a retrospective chart review of patients seen between April 2008 and March 2012 who had a diagnosis of cervical artery dissection following a recent chiropractic manipulation. Relevant imaging studies were reviewed by a board-certified neuro-radiologist to confirm the findings of a cervical artery dissection and stroke. The authors also conducted telephone interviews with each patient to ascertain the presence of residual symptoms in the affected patients.

Of the 141 patients with cervical artery dissection, 12 had documented chiropractic neck manipulation prior to the onset of the symptoms that led to medical presentation. The 12 patients had a total of 16 cervical artery dissections. All 12 patients developed symptoms of acute stroke. All strokes were confirmed with magnetic resonance imaging or computerized tomography. Follow-up information could be obtained from 9 patients, 8 of whom had residual symptoms and one of whom died as a result of their injury. The tables below give the full details. [Click to enlarge.]

The authors concluded that in this case series, 12 patients with newly diagnosed cervical artery dissection(s) had recent chiropractic neck manipulation. Patients who are considering chiropractic cervical manipulation should be informed of the potential risk and be advised to seek immediate medical attention should they develop symptoms.

How many times have we on this blog issued similar warnings?

And how many times have chiropractors countered with denial?

This time will be no different, I am sure.

They will cite the Cassidy study and assure us that neck manipulations are entirely safe.

But sadly, repeating a lie many times does not turn it in to a truth.

Dear edzard

I am sending you Richard Eaton’s excellent update on developments around complementary medicine. As you will know, the College is supportive of an integrated approach that offers each patient the best of both worlds – conventional and complementary. In both worlds it is important that treatment and advice offered is safe, appropriate and evidence based…

Thank you for your continued support of the College of Medicine.

With best wishes,

Dr Michael Dixon
Chairman
College of Medicine

I received this via email today, and of course I was interested. The ‘excellent update’ turned out to be truly amazing. For reasons that will become clear when you read on, I will abstain from any criticism – but I urge you to read it in full and perhaps let me know what you think by posting a comment:

START OF QUOTE

The Charity Commission’s Consultation: The use and promotion of complementary and alternative medicine – Making decisions about charitable status, (13.03.17):

The deadline for responses to the Charity Commission’s Consultation about the charitable status of CAM expired on 19th May (see the May edition of this blog). Many responses were filed, including by The Complementary & Natural Healthcare Council (CNHC) and by The College of Medicine.

Confusingly, the Commission’s Consultation Document expressly provided (in the section What the Commission is not consulting on at page 5) that:

‘…This consultation is not about…whether or not CAM therapies in general, or any particular CAM therapies, are effective…’

Yet logic dictates that the effectiveness of CAM and, therefore, the reliability of the evidence for it, will clearly feature significantly in the Commission’s deliberations as it assesses the extent to which CAM is of benefit to the public for charitable purposes.

The submission by The College of Medicine included the following:

‘…the continuing appetite of the public for access to CAM both in the private sector and through NHS organisations, should offer the Commission at least some reassurance that CAM has overall, a beneficial impact for those who use it…’

and further that:

‘…Whilst an RCT can be regarded as the highest level evidence, this type of study is not always the most suitable for assessing the benefits (efficacy/effectiveness) of CAM. Other research designs such as observational studies, surveys and qualitative methods can provide high quality information. In addition, RCTs invariably require very large budgets to underpin their delivery and CAM has not on the whole been the recipient of sufficient grant funding to enable large RCTs to be performed…’

The outcome of this important Charity Commission Consultation is awaited. It will be of huge significance to charitable organisations using or promoting CAM and to CAM practitioners and patients.

The Exclusivity of the Randomised Controlled Trial – the debate:

There is a continuing debate about the exclusivity of the Randomised Controlled Trial (RCT). Research articles about the RCT may be found here [Getting off the “Gold Standard”: Randomised Controlled Trials and Education Research: PMCID-PMC3179209] and here [Fool’s gold, lost treasures, and the randomised controlled trial-PMID: 23587187].
Further observations on the efficacy of the RCT may be found in the (free) April 2017 Newsletter published online by the Alliance for Natural Health International.

The Human effect and its desirability:

Also relevant to the debate about the evidence-base for CAM is the desirability of the Human effect. The Smallwood Report (The Role of Complementary and Alternative Medicine in the NHS: 2005), at page 23, makes the following observation:

‘…While some critics have derided the use of CAM treatments, claiming the success of some therapies to be purely based on a placebo effect, CAM proponents see what Dr Michael Dixon calls the “human effect” as desirable in itself…’
(Dixon & Sweeny, 2000 and see the BMJ book review here)

National Institute for Health & Care Excellence: CAM Updates

Practitioners of complementary and alternative medicine (CAM) may recall my November 2016 blog which referred to confirmation by the National Institute for Health and Care Excellence (NICE) that it had decided to retain its guideline on improving supportive care for adults with cancer, thereby ensuring that, for the time being at least, selected CAM therapies will continue to be available within the NHS in England & Wales. This guideline has been given the new title of End of life care for adults in the last year of life: service delivery and is currently “in development” with a publication date of January 2018 when it is hoped that CAM therapies will continue to be retained.

In the meantime, Further NICE guidelines have been published covering the planning and management of end of life and palliative care for infants, children and young people (aged 0 – 17 years) with life-limiting conditions. These aim to involve children, young people and their families in decisions about their care, and improve the support that is available to them throughout their lives. Recommendations include (paragraph 1.3.25) consideration of non-pharmacological interventions for pain management including music and physical contact such as touch, holding or massage. These Guidelines will next be reviewed in December 2018.

As mentioned in my blogs posted in September 2016 and February 2017, NICE Guidelines regarding the assessment and management of low back pain and sciatica in people aged 16 or over (published in November 2016) have stopped recommending acupuncture. The removal of acupuncture from the guidelines conflicts with research published (in January 2017) by MacPherson H, Vickers A (and others) in The National Institute for Health Research Journals Library: Programme Grants for Applied Research, Volume 5, issue 3 (“Acupuncture for chronic pain and depression in primary care: a programme of research”), which concludes as follows:

‘…We have provided the most robust evidence from high-quality trials on acupuncture for chronic pain. The synthesis of high-quality IPD found that acupuncture was more effective than both usual care and sham acupuncture. Acupuncture is one of the more clinically effective physical therapies for osteoarthritis and is also cost-effective if only high-quality trials are analysed. When all trials are analysed, TENS is cost-effective. Promising clinical and economic evidence on acupuncture for depression needs to be extended to other contexts and settings. For the conditions we have investigated, the drawing together of evidence on acupuncture from this programme of research has substantially reduced levels of uncertainty. We have identified directions for further research. Our research also provides a valuable basis for considering the potential role of acupuncture as a referral option in health care and enabling providers and policy-makers to make decisions based on robust sources of evidence…’

These Guidelines will next be reviewed in November 2018 when, again it is hoped, acupuncture will be reinstated and that Alexander Technique together with other beneficial CAM therapies will be included.

Professional Standards Authority: Accredited Registers Programme

Practitioners will already be aware of the Accredited Registers Programme which is overseen by the Professional Standards Authority for Health and Social Care (PSAHSC). This programme aims to provide assurance to the public, care commissioners and patients who are seeking health practitioners (including complementary therapists) who are not regulated by statute. The President of the Federation of Holistic Therapists (FHT), Jennifer Wayte, has suggested that:

‘…By signposting the Accredited Registers programme in relevant Guidelines, NICE would help to ensure better safety and standards of care…’ (International Therapist Journal, Issue 117 at page 17: Summer 2016).

Commissioning cost-saving CAM: The future for Integrated Medicine

In March 2016, The Kings Fund published its report Bringing together physical and mental health: A new frontier for integrated health about which a discussion can be viewed here and a blog by the FHT may be read here. In the News & Analysis section of its Health and Wellbeing Board Bulletin (06.06.17), The Kings Fund also highlighted the article published in The Lancet on 23.05.17 titled Forecasted trends in disability and life expectancy in England & Wales up to 2025: a modelling study which concludes:

‘…The rising burden of age-related disability accompanying population ageing poses a substantial societal challenge and emphasises the urgent need for policy development that includes effective prevention interventions…’

In the light of this and having regard to research such as that relating to the worsening mental well-being of year 10 school children, practitioners and their patients could lobby relevant Government departments, NICE and the PSAHSC regarding the potential of CAM as a cost-saving contributor to preventative and integrated medicine. In his Economic Outlook published in The Sunday Times on 23.04.17 (Business Section, page 4), Economist David Smith predicted frightening health spending as doubling from (roughly) 7% of gross domestic product to over 12.5% over the next 40-50 years and that social care costs will also double to 2% of GDP. Health spending policy makers and Clinical Commissioning Groups would do well to keep these (long-term) numbers in mind when assessing the potential of CAM and integrated medicine.

Further information about integrated and complementary medicine may be found in the Elsevier publications Advances in Integrative Medicine and the European Journal of Integrative Medicine and by accessing British Medical Journal (BMJ) articles such as Complementary therapies for labour and birth study: a randomised controlled trial of antenatal integrative medicine for pain management in labour (as amended), which concludes:

‘…The Complementary Therapies for Labour and Birth study protocol significantly reduced epidural use and caesarean section. This study provides evidence for integrative medicine as an effective adjunct to antenatal education, and contributes to the body of best practice evidence…’

For further research and debate about the cost-effective integration of CAM into the NHS, please refer to the February 2017 issue of this blog.

Adopting a business approach to practising CAM

Turning to a very different topic, my message to Practitioners and especially to those who are in the process of starting or establishing their CAM practice, is that adopting a business approach to practice management is crucial. By doing so and without compromising their professionalism, practitioners can help to defend their freedom to practice.

The past year has been challenging for practitioners. It looks like next few years will be even more so as those working in the health and social care sectors continue to assess the implications of ‘Brexit’ and how these may affect their freedom to practise and their patient’s right to receive a CAM treatment of their choice.

As ever, much of the popular press continues to present an unbalanced and misrepresentative view of CAM. For instance, I have yet to see popular print or broadcast journalism properly cover The World Health organisation Traditional Medicine Strategy 2014 to 2023: Strategy Document which states (at page 19; note: italics added by me):

‘…As the uptake of T&CM (Traditional and Complementary medicine) increases, there is a need for its closer integration into health systems…’

(refer to my November 2016 blog for more information).

Contrast this with the column in the Times Newspaper (by a Times leader writer and columnist) on Tuesday 13th December last year, captioned:

‘…Prince Charles’s homeopathy fad is joke medicine…’

I suggest there has never been greater need for practitioners to ‘fight their corner’, including by effectively organising the management of their practice and promoting the health benefits of their treatments.

To this end, I suggest that practitioners need to accept that running a CAM practice is, in essence, the same as trading in any (small) business. The knowledge, experience, professionalism and ethical standards of a qualified, insured and properly regulated CAM practitioner are acknowledged and to be congratulated. Nevertheless, now more than ever, practitioners need to embrace business processes.

The following are some straightforward business processes that could assist your business and thereby enhance the health and care of your patients.

Business planning will help you to prepare for most eventualities, including when, like most businesses, your practice encounters financial losses or failures. Don’t delay taking good business advice and realise that it is sometimes what you don’t want to hear that constitutes the most valuable advice.

Remember, “people buy from people” so you need to build good rapport with your patients. Listen to what they have to say about you and how you provide your practice specialism(s). If appropriate, adapt the structure and delivery of your business to their needs and requirements. Give them the opportunity to provide feedback [maybe use: surveymonkey]

While established practitioners may have the well-deserved and hard-earned luxury of relying on ‘word of mouth’ recommendations to find them new clients, this will rarely be an option for a new practitioner. So, whether you are practising alone or in association with other practitioners, for instance at a Health Centre, do not wait for patients to find you. You need to go out and find them. Recruit them by actively promoting yourself and your expertise.

Join local and national business support organisations such as the Federation of Small Businesses and the Chamber of Commerce. Always attend their meetings, networking events and, if appropriate, Trade Shows. As the contacts you make get to know and to trust you, they are likely to seek your professional help for themselves and their family and possibly for their colleagues and employees, too. Encourage this by offering to give a presentation [maybe use: presentme] about your practice to local businesses, to community groups and to the employees and students of local colleges and universities. Introduce them to your practice.

Sign-up to (often free) supportive online business newsletters and memberships like enterprisenation.

Using, among other things, the feedback from your patients (see above), prepare a patient database and create a Marketing Plan and a Business Plan, including a cash-flow forecast. You will have a much better chance of achieving your business goals if you first write them down.

Ask yourself: when and why did my patients seek my services and how can I keep in touch with them? Distribute print or e-newsletters [maybe use constantcontact]. Write articles about your practice and its treatments for professional journals and general healthcare-focused magazines. Produce a well-designed, good quality brochure and publicity material, both in print [see, for instance, moo.com] and also online.

Make use of social media platforms. Although new practitioners are likely to be familiar with how this is done, it’s possible this may not be the case with established practitioners. Record a video about you and your business and post it on YouTube. Link this to your Twitter and Facebook accounts. Your “followers” might then “comment”, “like” or “re-tweet” to their “followers”, thereby promoting your professional status and practice. Create, or, if you already have one, keep updated a (free) LinkedIn business account profile.

A website that is well designed and informative is a vital marketing tool. It is a worldwide ‘shop window’ as it informs your patients (existing and prospective) about you, where you are located, what you do and when you do it. If, when starting your business, you cannot afford a professionally built site, then build you own (maybe try wordpress].

Keep your cyber security under constant review and seek advice and support from websites like cyberware and getsafeonline. Your business will be processing your patients personal and health information/patient records, so ensure that you comply with data protection legislation including the new General Data Protection Regulation.

There are other business processes that could assist your practice, especially if you decided to diversify into the manufacture and sale of CAM-based products (e.g. first-aid kits, aromatherapy oils/preparations, books/course material, meditation audio-packs, therapy tools and devices) or to associate your business with other health professionals (e.g. at a veterinary practice, NHS Practice or Hospital, as appropriate for your specialism).

I hope that you have found this focus on the business aspects of practising CAM useful and thought provoking. My further thoughts can be found as either a paperback or as an e-book (the latter including hyperlinks to business and CAM websites) and at the amazon.co.uk bookstore. Information about business guides for complementary medicine may be found online.

I anticipate that, in the coming years, the freedom to practise CAM (whether or not independently of the conventional medicine sector or as a contribution to the provision of integrated healthcare and medicine) will depend upon the adoption of a business-focused approach by practitioners.
Established practitioners might be prepared to mentor new members to help them to adopt this approach.

Veterinary CAM Practitioners: Review of guidance by the RCVS

The Royal College of Veterinary Surgeons has announced a review of its position statement and guidance regarding the prescribing of CAM by its members (see my November 2016 blog). A campaign by is underway by www.vets4informedchoice.org to:

‘…raise the awareness of the Evidence Base (or lack of) for many current Veterinary Practices, enabling animal owners and guardians to make considered responsible choices without pressure from the Veterinary Industry…concerns over frequent and unnecessary Vaccination, Corporatisation of Veterinary Clinics, Pressure Selling of products and services, etc, are widespread and growing…’

A facility is available on the campaign website to sign-up to join the campaign and to get regular updates.

Therapy Expo 2017 and RCCM Membership

Therapy Expo returns to Birmingham’s NEC on 22nd – 23rd November. Conference information and booking details can be found here. Have you thought of becoming a member of the Research Council for Complementary Medicine? CAMRN membership ‘is free and provides members with access to the CAMRN research network, which provides regular email messages about conferences, events, projects, funding, new research and dissemination of members queries and requests’.

Department of Health Policy Research Programme Project – The effectiveness and cost effectiveness of complementary and alternative medicine (CAM) for multimorbid patients with mental health and musculoskeletal problems in primary care in the UK: a scoping study (The University of Bristol):

On 13th July this year, I received a circulated email from the Senior Research Associate at The School of Social and Community Medicine (University of Bristol) advising as follows:

‘…We are pleased to be able to let you know that our project ‘SCIM’ – “The effectiveness and cost effectiveness of complementary and alternative medicine (CAM) for multimorbid patients with mental health and musculoskeletal problems in primary care in the UK: a scoping study” has now finally been approved by the funders and the final report is available on their website. I have also attached our Executive Summary. I hope you find it interesting and please do get in touch with any feedback…We may well be in touch again over the summer as we progress with this piece of work and look for collaborators and input from the wider CAM, primary care and research communities…’

(The Executive Summary may be found here).

This is great news. Many congratulations to Professor Deborah Sharp and to her colleagues. There will, of course, be more about this project in my next blog (November 2017). In the meantime, CAM practitioners and others will no doubt welcome the opportunity to provide feedback and to respond to a request for further input to this project.

Professor George Lewith

Finally and most importantly, I add my belated (following its inexcusable omission from my blog in May) expressions of sadness and shock to those of countless others at the untimely and sudden death of Professor George Lewith for whom numerous obituaries have been recorded, including by the College of Medicine, the University of Southampton and The Research Council for Complementary Medicine. All practitioners, patients, students and researchers of CAM and orthodox medicine owe him so much. Along with those of many, my thoughts are with his family.

RICHARD EATON

1st August 2017

END OF QUOTE

Who is Richard Eaton?, I asked myself after reading this. The answer is here:

Richard Eaton LL.B (Hons) whose professional background is as a barrister (Bar Council – Academic Division) – now retired – and as a lecturer in law, believes that the future for practitioners of complementary and alternative medicine in private practice lies within well-managed Health Centres. He formerly owned and managed, together with his wife Marion Eaton LLB (Hons) Reiki Master Teacher, the Professional Centre for Holistic Health in Hastings, East Sussex. He now provides consultancy services through his company, Touchworks Ltd, including in relation to the practice management of CAM.

SAY NO MORE!!!

 

I have been collecting pictures posted by homeopaths on Twitter. When I say collection, I am exaggerating: it takes only about 10 minutes to find what I posted below.

Let’s hope that my collection cures some people from the desire to try homeopathy.

For those who, after having had a look at the pictures, still believe that there might be something in it, I have this challenge:

SHOW ME GOOD EVIDENCE FOR THE CLAIMS MADE BELOW, AND I WILL SEND YOU A FREE COPY OF MY  RECENT BOOK ON THE SUBJECT.

[please click to see them full size]

It is bad enough to mislead adult patients into believing that chiropractic is effective for conditions for which it is clearly not. However, it is far worse, in my view, to do that for paediatric conditions.

There is no doubt that chiropractors continue to treat children and advertise their services for childhood conditions. I am not aware of good evidence to show that chiropractic is effective for any childhood condition at all. Yet, whenever I or anyone else says so, we get ignored. Chiropractors do not accept this sort of criticism. This blog provides more than ample evidence for that, I believe.

Perhaps chiropractors are not good at reading?

Perhaps they only understand pictures?

As for my previous post, I have assembled here a few pictures posted by chiropractors on Twitter. They all relate to chiropractic treatments for children.

Why did I do that?

Because I hope that the many chiropractors who read my blog could now point us to the evidence that support the claims made in these advertisements. If they cannot do that, it would be an ethical imperative for them to clearly state that these posts are deceitful. If they fail to do this, they are tolerating quackery in their own ranks without objection – and that would render them unethical!

Or have I got this wrong???

[please click to see them full size]

 

In her article “Chiropractors are Bullshit” SciBabe discussed her views on the chiropractic profession. Now the chiro ‘Dr’ Michael Braccio has published a rebuttal (excerpts from it are below). Here I will provide a rebuttal of his rebuttal. For clarity, the bold quotes are by SciBabe (as quoted by the ‘Dr’), what follows is the rebuttal by the ‘Dr‘ himself and my re-rebuttal is in italics.

“There is scant medical evidence that a chiropractor is your best treatment option for…anything”

Since most people initially seek care from a chiropractor for low back pain, it seems appropriate to focus there. The most recent clinical practice guidelines recommend heat, exercise, spinal manipulation, acupuncture, and massage as first-line therapies for low back pain. All of these services (with the exception of acupuncture) are services commonly provided by chiropractors for low back pain.

The current low back pain guidelines used to advise healthcare providers on the  can be found here: American College of Physicians (ACP), National Institute of Health and Care Excellence (NICE), Towards Optimized Practice (TOP), and Journal of Orthopedic and Sports Physical Therapy (JOSPT).

Guidelines are often not up-to date. NICE no longer recommends chiropractic for back pain. All the hundreds of non-back pain claims made by chiros are even less well supported by evidence.

“Medical doctors often refer patients to the proper experts, and outside of a narrow scope of experts, this rarely includes someone who is a ‘duly-licensed non-M.D.,” because that person’s views on medicine would not be aligned with their standards of care.” 

Clinical practice guidelines are intended to provide healthcare professionals with information on the most effective treatment options for various conditions based on the current research. As stated above, the current standards of care for low back pain include spinal manipulation and other therapies commonly provided by chiropractors.

Guidelines are often not up-to date. It is true that proper doctors rarely refer to chiros.

“We didn’t have proper scanning equipment to identify issues in the spine” 

Imaging technique has definitely improved since the 19th century, however, this statement reflects an inadequate understanding of low back pain (and pain in general). Abnormal radiographic findings in the spine are common in asymptomatic individuals and are more closely associated with age than they are pain severity. In fact, the current practice guidelines for low back pain discourages routine imaging due to the high false positive rates.

Yet far too many chiros do use imaging – not for diagnostic but for financial reasons, I suspect.

“It appears there is a link between chiropractic manipulation and risk of stroke due to potential artery dissection.”

The American Heart Association and American Stroke Association (also endorsed by the American Association of Neurological Surgeons and Congress of Neurological Surgeons) released a scientific statement stating that the association between stroke and chiropractic manipulation was not well established and probably low. These patients are likely already presenting with a stroke that is in progress, regardless of treatment provided.

I am not sure what a ‘low association’ is. The risk of stroke is, however, real. To deny it is a violation of the precautionary principle that governs all healthcare.

“Chiropractic beliefs are dangerously far removed from mainstream medicine, and the vocation’s practices have been linked to strokes, herniated discs, and even death.”

This statement is made without context. All medical interventions have an associated risk when performed, but their occurrence rates vary. The risk of death from cervical manipulation has been estimated to be 1 in greater than 3,330,000 to 3,730,000 manipulations while the risk of death from gastrointestinal bleeding from NSAIDs is estimated to be 1 in 1,200 patients.

Medical error has also been reported as the third leading cause of death in the United States and many of the commonly used medications have also been linked to adverse events such as stroke and death (ibuprofen, tramadol, and duloxetine).

Even if all of this were true (which it isn’t), it would not be a good reason to tolerate unnecessary harm by chiros (look up ‘tu quoque fallacy).

“Chiropractors can also cause damage by being used for primary care or emergency medical needs, as their training is not appropriate for such care…The chiropractor somehow missed that her son’s arm was broken, and the injury was not detected until many days later when they visited an emergency room.”

I am not privy to the case referred to above to specifically comment on it, but it is inappropriate to condemn an entire profession based on a single case. In SciBabe’s interview on the Joe Rogan Experience, she describes her experience with spinal manipulation performed by her Doctor of Osteopathy (D.O.) for an episode of low back pain. It turned out that her lower back pain was caused by a fractured rib (fractures are a contraindication for spinal manipulation) which was also somehow missed. It is biased to berate the entire chiropractic profession based on a single case and not hold other healthcare professions to a similar standard.

Yes, that would be biased! But the case was a mere example, one of many. It is undeniable that chiros want to be upgraded to primary care physicians, a role for which they are not sufficiently educated or trained.

And finally, “don’t let a chiropractor fool you by reciting the warning label from a vaccine that they’re not qualified to administer.” 

Similarly, please do not take medial advice from someone who is not licensed to administer it.

I am not sure I understand the rebuttal here. Yet, avoiding chiros is sound advice, particularly when it comes to vaccination advice.

MY CONCLUSION + ADVICE:

Dr’ Braccio is using very tired pseudo-arguments which have all been addressed and invalidated hundreds of times.

My advice to him: book yourself urgently on a course of critical thinking.

My advice to consumers: ask yourself who has an axe to grind; perhaps ‘Dr’ Braccio is worried about his and his colleagues cash-flow? Neither SciBabe nor I have such reasons to misguide you.

The current Cochrane review of acupuncture for polycystic ovary syndrome (PCOS) included 5 RCTs and concluded that thus far, only a limited number of RCTs have been reported. At present, there is insufficient evidence to support the use of acupuncture for treatment of ovulation disorders in women with PCOS.

A new study was aimed at assessing whether active acupuncture, either alone or combined with clomiphene, increases the likelihood of live births among women with PCOS.  A double-blind (clomiphene vs placebo), single-blind (active vs control acupuncture) factorial trial was conducted at 27 hospitals in mainland China between July 6, 2012, and November 18, 2014, with 10 months of pregnancy follow-up until October 7, 2015. Chinese women with polycystic ovary syndrome were randomized in a 1:1:1:1 ratio to 4 groups. Active or control acupuncture administered twice a week for 30 minutes per treatment and clomiphene or placebo administered for 5 days per cycle, for up to 4 cycles. The active acupuncture group received deep needle insertion with combined manual and low-frequency electrical stimulation; the control acupuncture group received superficial needle insertion, no manual stimulation, and mock electricity. The primary outcome was live birth.

Among the 1000 randomized women, 250 were randomized to each group, and 926 women completed the trial. Live births occurred in

  • 69 of 235 women (29.4%) in the active acupuncture plus clomiphene group,
  • 66 of 236 (28.0%) in the control acupuncture plus clomiphene group,
  • 31 of 223 (13.9%) in the active acupuncture plus placebo group,
  • 39 of 232 (16.8%) in the control acupuncture plus placebo group.

There was no significant interaction between active acupuncture and clomiphene, so main effects were evaluated. The live birth rate was significantly higher in the women treated with clomiphene than with placebo and not significantly different between women treated with active vs control acupuncture.

The authors concluded that among Chinese women with polycystic ovary syndrome, the use of acupuncture with or without clomiphene, compared with control acupuncture and placebo, did not increase live births. This finding does not support acupuncture as an infertility treatment in such women.

There is much evidence to show that nearly 100% of all acupuncture trials originating from China report positive findings regardless of the condition treated. This led to the assumption by myself and several other experts that such studies are best ignored.

This study is from China and does not report positive results. What is more, it is well-designed and well-reported. This trial therefore is a most laudable exception, and I applaud the authors for their courage and good science.

Does this mean that in future we can trust all Chinese acupuncture trials?

One swallow does not make a summer. And I will remain very sceptical. But perhaps this new study is a sign indicating that things are beginning to change. Perhaps Chinese acupuncture researchers are starting to join the 21st century?

The last time I reported about Kate Birch, I ended my post stating that I became so angry that I was about to write something that I might later regret. Let’s see whether I can restrain myself again.

Kate published another book: The Solution  Homeoprophylaxis: The Vaccine Alternative. Here is the press release for her new rant:

Modern parents and even medical practitioners often pose the question of whether the benefits of reducing the incidence of acute diseases through vaccinations is worth the risks of the increased incidence of immune system imbalanceas a result of those same vaccines. This often leads many into questioning if vaccinations for children are indeed safe.

Despite the fact that most medical practitioners refute the possibility that vaccines can cause harm to the immune system, and that their purpose and efficacy have been instilled in people’s minds for the last 200 years, many parents still are looking for possible alternative ways of preventing and treating infants from the so many forms of infectious, contagious acute diseases.

Certified classical homeopaths and authors Kate Birch and Cilla Whatcott want the world to know that there is an alternative path to the use of vaccination which is a more effective and less expensive method of helping to build immunity towards infectious disease. The Solution ~ Homeoprophylaxis: The Vaccine Alternative offers parents a wealth of useful information on the effective prevention of infectious diseases through homeoprophylaxis. The book introduces the basic principles of HP, and an overview of the immune system and how it iacs intended to work with infectious disease, what vaccines actually do in the immune system and a clinical overview of the homeopathic treatment of childhood eruptive diseases, febrile illnesses, and tropical diseases.

This book is written in simple language to help parents navigate the question of immune system development, infectious disease prevention with homeoprophylaxis and if vaccines are really doing what they are intended to do. The authors clearly explain and differentiate important terminology such as immunology, vaccination, and immunization. What is amazing with this book is that Birch and Whatcott offer the world a different view on disease prevention and the use of HP as an immune system educator, and cite multiple references to clinical research and real time applications of the use of HP for disease prevention.

The Solution is a must-read for every parent, health care provider, and any concerned citizen who has questions about the current day vaccine paradigm. As adverse reactions and associated health problems are becoming more and more prevalent in children after receiving vaccinations The Solution offers another way.

END OF QUOTE

We have discussed homeoprophylaxis (HP) many times before on this blog (see here, here, here, and here, for instance) It seems to be a subject that does not go away. HP-fans tend to claim that:

  • conventional vaccinations are dangerous
  • conventional vaccinations are ineffective
  • the public is being conned by BIG PHARMA
  • homeopathy works like vaccination
  • highly diluted homeopathic nosodes stimulate the immune system
  • highly diluted homeopathic nosodes are effective for the prevention of infectious diseases
  • they are much safer than conventional vaccinations

None of this is true!

The concept of HP lives off the herd immunity we have via conventional vaccinations and, at the same time, endangers this very immunity. It is a danger for both the public and the individual who might believe in it. In my view, promoting HP is unethical, irresponsible and possibly even criminal.

The claim that Cannabis can cure cancer is all over the Internet. Such promotion is regularly enhanced by announcements of VIPs that they intend to try Cannabis when affected by cancer.

As her back pain turned out to be caused by metastases from her earlier breast cancer, Olivia Newton-John now intends to complete a course of photon radiation therapy along with alternative therapies for improving her quality of life. “I decided on my direction of therapies after consultation with my doctors and natural therapists and the medical team at my Olivia Newton-John Cancer Wellness and Research Centre in Melbourne”, she said. Newton-John had been diagnosed with breast cancer in 1992. At that time, she initially tried acupuncture and homeopathy and only later underwent chemotherapy. Olivia Newton-John’s daughter, Chloe Lattanzi, has stated that her mother would now use cannabis oil to aid in her fight against cancer. Lattanzi owns a marijuana farm and said that her mother would use natural healing remedies plus modern medicine in addition to cannabis oil to help her battle the deadly disease for the second time.

So, how realistic is the assumption that Cannabis does anything for cancer patients? Cannabis produces a resin containing pharmacologically active compounds called cannabinoids. Some cannabinoids are known for their psychoactive properties. Cannabis has therefore been used for medicinal and recreational purposed since ancient times. Today, the recreational use of Cannabis is illegal in many states, including the UK.

The main active cannabinoids are delta-9-THC and cannabidiol (CBD); the latter compound may relieve pain, lower inflammation, and decrease anxiety without causing the “high” of delta-9-THC. Cannabis and cannabinoids have been studied in the laboratory and the clinic for relief of pain, nausea and vomiting, anxiety, and loss of appetite. There also is some evidence that they can alleviate the side-effects of cancer therapies. Two cannabinoids have even been approved by the regulators in some countries for the prevention and treatment of chemotherapy-related nausea and vomiting. Some test tube results have suggested that Cannabis can kill cancer cells. However, there are no clinical trials yet, and therefore not enough evidence exists to recommend that patients use Cannabis as a treatment for cancer.

The possibility that Cannabis might be useful for cancer patients currently attracts much original research. The most recent review states that “favorable outcomes are demonstrated for chemotherapy-induced nausea and vomiting and cancer-related pain, with evidence of advantageous neurological interactions. Benefit in the treatment of anorexia, insomnia and anxiety is also suggested. Short- and long-term side effects appear to be manageable and to subside after discontinuation of the drug. Finally, cannabinoids have shown anti-neoplastic effects in preclinical studies in a wide range of cancer cells and some animal models. Further research is needed before cannabis can become a part of evidence-based oncology practice.”

Similarly, the conclusions by our ‘CAMcancer’ initiative were cautious: ” The antiemetic efficacy of the cannabinoid dronabinol (THC), when compared to standard antiemetics that were in use before the development of 5-HT3 antagonists for chemotherapy-induced nausea and vomiting, has been established in a meta-analysis. The question of whether cannabis-based medicines have a place in the era of modern antiemetic medication, e.g. for patients with refractory nausea and vomiting despite antiemetic prophylaxis according to current standards, remains uncertain but warrants further research. Limited evidence is available to support the use of cannabis-based medicines in the therapy of radiotherapy-related nausea and multifactorial nausea in advanced cancer patients. The use of cannabis-based medicines for appetite loss and other symptoms associated with cancer cachexia is still unclear at present, since trial results have not only varied widely but also been criticised for the methodology employed (including diversity in stages of cachexia in the patients included and possibly too a low dose of THC/medical cannabis). For cancer pain, several randomised controlled trials of cannabis-based medicines in cancer patients with various pain syndromes have indicated an analgesic effect comparable to weak opioids. The role of cannabinoid medicines as add-on medication for pain that is insufficiently relieved by strong opioids is currently being investigated in several clinical studies and has shown some promising results so far.”

So, the evidence suggests that Cannabis might be helpful in the supportive and palliative treatment of cancer by reducing some of the symptoms from which cancer patients may suffer. But there is no good evidence to show that it can change the natural history of any type of cancer. Even with the symptomatic use of Cannabis, we need to consider at least two caveats.

Firstly, we have no good evidence to suggest that Cannabis is significantly more effective than conventional therapies. A Cochrane review, for instance concluded that ” Cannabinoids can lead to an increase in appetite in patients with HIV wasting syndrome but the therapy with megestrol acetate is superior to treatment with cannabinoids. The included studies were not of sufficient duration to answer questions concerning the long-term efficacy, tolerability and safety of therapy with cannabis or cannabinoids. Due to the sparse amount of data it is not possible to recommend a favoured use of cannabis or cannabinoids at this point.”

Secondly, the Cannabis trials tend to be of low quality. Another Cochrane review concluded that “Cannabis-based medications may be useful for treating refractory chemotherapy-induced nausea and vomiting. However, methodological limitations of the trials limit our conclusions and further research reflecting current chemotherapy regimens and newer anti-emetic drugs is likely to modify these conclusions.”

Back to Olivia Newton-John; her case is, I think, telling. It seems that, by initially using alternative therapies instead of conventional treatments for her breast cancer in 1992, she worsened her prognosis. Now that the cancer has returned, she has learnt her lesson and opts for the best conventional oncology can offer her. Yet, her liking for alternative medicine has not disappeared completely. This confirms what I have observed all too frequently: for many of its fans, alternative medicine is a belief system that is largely untouchable by evidence.

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