Edzard Ernst

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

Dr Julian Kenyon is no stranger to this blog:

I met him once or twice in the mid 1990s. Then he was the GP partner of the late George Lewith. It took me not long to find that I thought of the former even less than the latter.

Now it has been reported that Julian Kenyon was struck off the UK medical register. Apparently, he put pressure on a patient with advanced cancer to pay £13,000 for so-called alternative medicine (SCAM), including sound and light therapy. He ran the former Dove Clinic, a private health centre at Twyford, Hampshire and wrongly told his patient: “You have had all the standard treatments and you are running out of treatment options”. Kenyon’s prescription in May 2022 included sonodynamic/photodynamic therapy as well as the supplements cannabidiol, claricell and similase. The patient was asked to pay a further £20,000 if the initial course of treatment was unsuccessful, the tribunal heard.

The Medical Practitioners Tribunal Service (MPTS) ruled that the doctor’s conduct was “wholly unacceptable, morally culpable and disgraceful”. Kenyon told his patient that there was a 10% chance of his stage 4 prostate cancer being cured. This was a “total fabrication”, the MTPS found. The patient “was vulnerable and… made to feel under pressure to have expensive treatment that was not in his best interests”, it added.

Kenyon has form:

  • In 2003, an undercover investigation by the BBC Inside Out programme accused Dr Kenyon of using spurious tests for allergies.
  • In 2013, a tribunal found he failed to give good care.
  • The following year, it said he made a misleading cancer cure claim.

The latest MTPS ruling bars Dr Kenyon from practising medicine in the UK. His former clinic went into liquidation in March 2023 and has debts of more than £154,000, according to Companies House. Despite all this, it was deemed to be “safe” and “effective”, according to its latest Care Quality Commission report, external in 2019.

Yesterday, I received the email below. I almost deleted it because, at first glance, it looked like spam. Then I started reading it – perhaps you should do so too.

Dear Edzard Ernst,

We’d like to inform you that Research.com, a leading academic platform for researchers, has just released the 2024 Edition of our Ranking of Best Scientists in the field of Medicine.

We are sure you will be very happy to learn that you have ranked #819 in the world ranking and #86 in United Kingdom. You have also been recognized with our Medicine Leader Award for 2024. Congratulations!

The ranking is based on D-index (Discipline H-index) metric, which only includes papers and citation values for an examined discipline. The ranking includes only leading scientists with D-index of at least 70 for academic publications made in the area of Medicine.

The full world ranking is available here: https://www.research.com/scientists-rankings/medicine
The full ranking for United Kingdom is available here: https://www.research.com/scientists-rankings/medicine/gb

Feel free to also read an article summarizing the statistics and trends from our ranking here: https://research.com/careers/world-online-ranking-of-best-medicine-scientists-2024-report

Please accept our sincere congratulations. Being present in our ranking is definitely a great achievement for you and your university or research institution. Feel free to share and publicize your accomplishment in any way you see fit.

With Best Regards…

________________________

I am not sure how significant this all is. Nonetheless, I thought I share the email with my small fan club from my blog.

This prospective cohort study examined the effects of fish oil supplements on the clinical course of cardiovascular disease, from a healthy state to atrial fibrillation, major adverse cardiovascular events, and subsequently death.

The analysis is based on the UK Biobank study (1 January 2006 to 31 December 2010, with follow-up to 31 March 2021 (median follow-up 11.9 years)) including 415 737 participants, aged 40-69 years. Incident cases of atrial fibrillation, major adverse cardiovascular events, and death, identified by linkage to hospital inpatient records and death registries. Role of fish oil supplements in different progressive stages of cardiovascular diseases, from healthy status (primary stage), to atrial fibrillation (secondary stage), major adverse cardiovascular events (tertiary stage), and death (end stage).

Among 415 737 participants free of cardiovascular diseases, 18 367 patients with incident atrial fibrillation, 22 636 with major adverse cardiovascular events, and 22 140 deaths during follow-up were identified. Regular use of fish oil supplements had different roles in the transitions from healthy status to atrial fibrillation, to major adverse cardiovascular events, and then to death:

  • For people without cardiovascular disease, hazard ratios were 1.13 (95% confidence interval 1.10 to 1.17) for the transition from healthy status to atrial fibrillation and 1.05 (1.00 to 1.11) from healthy status to stroke.
  • For participants with a diagnosis of a known cardiovascular disease, regular use of fish oil supplements was beneficial for transitions from atrial fibrillation to major adverse cardiovascular events (hazard ratio 0.92, 0.87 to 0.98), atrial fibrillation to myocardial infarction (0.85, 0.76 to 0.96), and heart failure to death (0.91, 0.84 to 0.99).

The authors concluded that regular use of fish oil supplements might be a risk factor for atrial fibrillation and stroke among the general population but could be beneficial for progression of cardiovascular disease from atrial fibrillation to major adverse cardiovascular events, and from atrial fibrillation to death. Further studies are needed to determine the precise mechanisms for the development and prognosis of cardiovascular disease events with regular use of fish oil supplements.

I must admit that I am slightly puzzled by this study and its findings. The authors clearly speak of the ‘role’ regular use of fish oil supplements has. This language implies a casual impact. Yet, what we have here are associations, and every 1st year medical student knows that

correlation is not causation.

Other things to note are that:

  • the associations are only very weak;
  • they go in opposite directions depending on the subpopulation that is examined,
  • there is no plausible mechanism of action to explain all this.

Collectively, these facts suggest to me that we are indeed more likely dealing here with a non-causal association and not a causal link. All the more surprising then that the (UK) press took up this paper in a major and occasionally alarmist fashion (the headline in THE TELEGRAPH was Revealed: How cod liver oil could be bad for your health). I learned of it by listening to the BBC headline news.

 

We have discussed the LIGHTNING PROCESS before:

Now, the BBC reports that it is promoted as a treatment of Long-COVID. Oonagh Cousins was offered a free place on a course run by the Lightning Process, which teaches people they can rewire their brains to stop or improve long Covid symptoms quickly. Ms Cousins, who contracted Covid in March 2020, said it “exploits” people.

Ms Cousins had reached a career goal many athletes can only dream of – being selected for the Olympics – when she developed long Covid. By the time the cancelled 2020 Olympic Games in Tokyo were rescheduled for 2021, Ms Cousins was too ill to take part. When she went public with her struggles, she was approached by the Lightning Process. It offered her a free place on a three-day course, which usually costs around £1,000.

“They were trying to suggest that I could think my way out of the symptoms, basically. And I disputed that entirely,” the former rower said. “I had a very clearly physical illness. And I felt that they were blaming my negative thought processes for why I was ill.” She added: “They tried to point out that I had depression or anxiety. And I said ‘I’m not, I’m just very sick’.

In secret recordings by the BBC, coaches can be heard telling patients that almost anyone can recover from long Covid by changing their thoughts, language and actions. Over three days on Zoom, the course taught the ritual that forms the basis of the programme. Every time you experience a symptom or negative thought, you say the word “stop”, make a choice to avoid these symptoms and then do a positive visualisation of a time you felt well. You do this while walking around a piece of paper printed with symbols – a ritual the BBC was told to do as many as 50 times a day.

In some cases the Lightning Process has encouraged participants to increase their activity levels without medical supervision, against official advice – which could make some more unwell, according to NHS guidelines. Lightning Process founder, Dr Phil Parker, who’s not a medical doctor but has a PhD in psychology of health, told us his course was “not a mindset or positive thinking approach,” but one that uses “the brain to influence physiological changes”, backed by peer-reviewed evidence. The coach on the course the BBC attended said “thoughts about your symptoms, your worry about whether it’s ever going to go – that’s what keeps the neurology going. Being in those kind of thoughts is what’s maintaining your symptoms. They’re not caused by a physical thing any more.”

___________________

As I pointed out previously, The Lightning Process  (LP) is a therapy based on ideas from osteopathy, life coaching, and neuro-linguistic programming. LP is claimed to work by teaching people to use their brains to “stimulate health-promoting neural pathways”.

LP teaches individuals to recognize when they are stimulating or triggering unhelpful physiological responses and to avoid these, using a set of standardized questions, new language patterns, and physical movements with the aim of improving a more appropriate response to situations.

Proponents of the ‘LP’ in Norway claim that 90% of all ME patients get better after trying it. However, such claims seem to be more than questionable.

  • In the Norwegian ME association’s user survey from 2012 with 1,096 participants, 164 ME patients stated that they had tried LP. 21% of these patients experienced improvement or great improvement and 48% got worse or much worse.
  • In Norway’s National Research Center in Complementary and Alternative Medicine, NAFKAM’s survey from 2015 amongst 76 patients 8 had a positive effect and 5 got worse or much worse.
  • A survey by the Norwegian research foundation, published in the journal Psykologisk, with 660 participants, showed that 62 patients had tried LP, and 5 were very or fairly satisfied with the results.

Such figures reflect the natural history of the condition and are no evidence that the LP works.

Is there any evidence supporting the LP specifically for long COVID?

My Medline search retrieved just one single paper. Here is the abstract:

As a result of the COVID-19 pandemic, Long COVID (LC) is now prevalent in many countries. Little evidence exists regarding how this chronic condition should be treated, but guidelines suggest for most people it can be managed symptomatically in primary care. The Lightning Process is a trademarked positive psychology focused self-management programme which has shown to be effective in reducing fatigue and accompanying symptoms in other chronic conditions including Chronic Fatigue Syndrome/Myalgic Encephalomyelitis. Here we outline its novel application to two patients with LC who both reported improvements in fatigue and a range of physical and emotional symptoms post-treatment and at 3 months follow-up.

Well, that surely convinced everyone! Except me and, of course, anyone else who can think critically.

So, I look further and find this on the company’s website:

Do you know how it feels to…

  • …be exhausted and tired no matter how much rest you get?
  • …be stuck with re-occurring pain, health symptoms and issues?
  • …get so stressed by almost everything?
  • …feel low and upset much of the time?
  • …want a better life and health but just can’t find anything that works?

If any, or all, of these sound familiar then the Lightning Process, designed by Phil Parker, PhD, could be the answer that you’re looking for.  There are lots of ways you can find out more about the suitability of the Lightning Process for you, have a look through below…

___________________________

Let me try to summarise:

  • The LP is promoted as a cure for long-Covid.
  • There is no evidence that LP is effective for it.
  • The claim is that it has been shown to work for ME.
  • There is no evidence that LP is effective for it.
  • A 3-day course costs £1 000.
  • Their website claims it is good for practically everyone.

Does anyone think that LP or its promoters are remotely serious?

I am glad to hear that the Vatican is issueing  new guidelines on supernatural phenomena. The document, compiled by the Vatican’s Dicastery for the Doctrine of the Faith, will lay out rules to assess the truthfulness of supernatural claims. Reports of such phenomena are said to have soared in recent years in an era of social media – sometimes spread through disinformation and rumour. The guidelines are likely to tighten criteria for the screening, analysis, and possible rejection of cases.

Apparitions have been reported across the centuries. Those recognised by the Church have prompted pilgrims, and popes, to visit spots where they are said to have taken place. Millions flock to Lourdes in France, for example, or Fatima in Portugal, where the Virgin Mary is alleged to have appeared to children, promising a miracle – after which crowds are said to have witnessed the sun zig-zagging through the sky. The visitation was officially recognised by the Church in 1930.

But other reports are found by church officials to be baloney. In 2016, an Italian woman began claiming regular apparitions of Jesus and Mary in a small town north of Rome after she brought back a statue from Medjugorje in Bosnia, where the Virgin Mary is also said to have appeared. Crowds prayed before the statue and received messages including warnings against same-sex marriage and abortion. It took eight years for the local bishop to debunk the story.

_________________________

 

Perhaps the Vatican should also have a look at faith healing*, the attempt to bring about healing through divine intervention. The Bible and other religious texts provide numerous examples of divine healing, and believers see this as a proof that faith healing is possible. There are also numerous reports of people suffering from severe diseases, including cancer and AIDS, who were allegedly healed by divine intervention.

Faith healing has no basis in science, is biologically not plausible. Some methodologically flawed studies have suggested positive effects, however, this is not confirmed by sound clinical trials. Several plausible explanations exist for the cases that have allegedly been healed by divine intervention, for instance, spontaneous remission or placebo response. Another explanation is fraud. For instance, the famous German faith healer, Peter Popoff, was exposed in 1986 for using an earpiece to receive radio messages from his wife giving him the home addresses and ailments of audience members which he purported had come from God during his faith healing rallies.

Faith healing may per se be safe, but it can nevertheless do untold indirect harm, and even fatalities are on record: “Faith healing, when added as an adjuvant or alternative aid to medical science, will not necessarily be confined to mere arguments and debates but may also give rise to series of complications, medical emergencies and even result in death.”

Alternatively, the Vatican might look at the healing potential of pilgrimages*, journeys to places considered to be sacred. The pilgrims often do this in the hope to be cured of a disease. The purpose of Christian pilgrimage was summarized by Pope Benedict XVI as follows:

To go on pilgrimage is not simply to visit a place to admire its treasures of nature, art or history. To go on pilgrimage really means to step out of ourselves in order to encounter God where he has revealed himself, where his grace has shone with particular splendour and produced rich fruits of conversion and holiness among those who believe.

There are only few scientific studies of pilgrimages. The purpose of this qualitative research was to explore whether pilgrims visiting Lourdes, France had transcendent experiences. The authors concluded that visiting Lourdes can have a powerful effect on a pilgrim and may include an “out of the ordinary” transcendent experience, involving a sense of relationship with the divine, or experiences of something otherworldly and intangible. There is a growing focus on Lourdes as a place with therapeutic benefits rather that cures: our analysis suggests that transcendent experiences can be central to this therapeutic effect. Such experiences can result in powerful emotional responses, which themselves may contribute to long term well-being. Our participants described a range of transcendent experiences, from the prosaic and mildly pleasant, to intense experiences that affected pilgrims’ lives. The place itself is crucially important, above all the Grotto, as a space where pilgrims perceive that the divine can break through into normal life, enabling closer connections with the divine, with nature and with the self.

Other researchers tested the effects of tap water labelled as Lourdes water versus tap water labelled as tap water found that placebos in the context of religious beliefs and practices can change the experience of emotional salience and cognitive control which is accompanied by connectivity changes in the associated brain networks. They concluded that this type of placebo can enhance emotional-somatic well-being, and can lead to changes in cognitive control/emotional salience networks of the brain.

The risks involved in pilgrimages is their often considerable costs. It is true, as the text above points out that “millions flock to Lourdes in France”. In other words, pilgrimiges are an important source of income, not least for the catholoc church.

A more important risk can be that they are used as an alternative to effective treatments. This, as we all know, can be fatal. As there is no good evidence that pilgrimiges cure diseases, their risk/benefit balance as a treatment of disease cannot be positive.

So, will the new rules of the Vatican curtail the risks on supernatural healing practises? I would not hold my breath!

_________________

* for references see my book from where this text has been borrowed and modified.

Anyone who writes a lively blog like this one is bound to receive all sorts of attacks, accusations, insults, innuendo, etc. I certainly have been claimed or implied to be many things that I am simply and objectively not. Many of them are quite hilarious in their stupidity, in my view. Perhaps it might be fun to list (some of) them.

Here we go (in no particular order).

I am not:

  • woke
  • anti-woke
  • someone who thinks that woke is a useful concept
  • against restricting discussions on certain topics (but I may not be interested in some subjects)
  • an expert on any subject other than so-called alternative medicine (SCAM)
  • like Trump (I think it was D Ullmann who stated that I was like Trump)
  • young (recently, I was repeatedly criticised for being an ‘old white man’)
  • a woman (recently, I was repeatedly criticised for being an ‘old white man’)
  • black (recently, I was repeatedly criticised for being an ‘old white man’)
  • an anti-semite
  • a racist
  • right-wing (I have not even once voted conservative in my life)
  • devoid of experience in SCAM as a patient
  • a researcher who has never practised SCAM
  • someone who has never done any original research
  • someone who does not know what he is talking about
  • unqualified
  • someone who was fired from an academic appointment
  • a pseudoscientist
  • a man who has falsified his research
  • on the payroll of BIG PHARMA
  • receiving any money for running this blog
  • relying on any finacial support other than my pensions
  • a liar
  • a fraud
  • someone who took the Exeter appointment in order to ditch homeopathy
  • out to defame SCAM (I am advocating solid evidence and criticising claims that are not evidence-based)
  • running an evil empire
  • devoid of self-confidence
  • someone who despises women
  • suffering from digestive problems
  • unable to process feelings
  • someone who manipulates data
  • the head of a lobby group
  • perfect (sadly, that’s the only claim nobody ever made).

Have I promised too much?

The list is long and the claims are as funny as they are unfounded. Evidence that (some of) these allegations have indeed been made can be found here, here, here, and here or, if you are really keen and gifted at doing searches, on X [formerly Twitter].

Many forms of so-called alternative medicine (SCAM) involve touch, and touch is of critical importance: many studies have shown that it promotes mental and physical well-being.

A team of researchers conducted a pre-registered (PROSPERO: CRD42022304281) systematic review and multilevel meta-analysis encompassing 137 studies in the meta-analysis and 75 additional studies in the systematic review (n = 12,966 individuals, search via Google Scholar, PubMed and Web of Science until 1 October 2022) to identify critical factors moderating touch intervention efficacy.

Included studies always featured a touch versus no touch control intervention with diverse health outcomes as dependent variables. Risk of bias was assessed via small study, randomization, sequencing, performance and attrition bias.

The results show that touch interventions were especially effective in:

  • regulating cortisol levels (Hedges’ g = 0.78, 95% confidence interval (CI) 0.24 to 1.31),
  • increasing weight (0.65, 95% CI 0.37 to 0.94) in newborns,
  • reducing pain (0.69, 95% CI 0.48 to 0.89),
  • reducing feelings of depression (0.59, 95% CI 0.40 to 0.78),
  • reducing state (0.64, 95% CI 0.44 to 0.84) or trait anxiety (0.59, 95% CI 0.40 to 0.77) for adults.

Comparing touch interventions involving objects or robots resulted in similar physical (0.56, 95% CI 0.24 to 0.88 versus 0.51, 95% CI 0.38 to 0.64) but lower mental health benefits (0.34, 95% CI 0.19 to 0.49 versus 0.58, 95% CI 0.43 to 0.73). Adult clinical cohorts profited more strongly in mental health domains compared with healthy individuals (0.63, 95% CI 0.46 to 0.80 versus 0.37, 95% CI 0.20 to 0.55).

The authors found no difference in health benefits in adults when comparing touch applied by a familiar person or a health care professional (0.51, 95% CI 0.29 to 0.73 versus 0.50, 95% CI 0.38 to 0.61), but parental touch was more beneficial in newborns (0.69, 95% CI 0.50 to 0.88 versus 0.39, 95% CI 0.18 to 0.61). Small but significant small study bias and the impossibility to blind experimental conditions need to be considered.

The authors concluded that leveraging factors that influence touch intervention efficacy will help maximize the benefits of future interventions and focus research in this field.

It seems obvious to me that these findings are relevant to several SCAMs, e.g.:

  • acupuncture,
  • Alexander technique,
  • applied kinesiology,
  • aromatherapy,
  • Bowen technique,
  • chiropractic,
  • craniosacral therapy,
  • cupping,
  • Dorn method,
  • Feldenkrais method,
  • gua sha,
  • kinesiology taping,
  • lymph drainage,
  • massage in all its variations,
  • naprapathy,
  • osteopathy,
  • rebirthing,
  • reflexology,
  • Rolfing,
  • shiatsu,
  • slapping therapy,
  • therapeutic touch.

This also means that the effects of these SCAMs will be at least to some extend non-specific, i.e. not related to the treatment per se but to touch. Finally, it means that clinical trials testing these SCAMs need to be designed such that the touch element is adequately accounted for.

EuroConsum‘ is an organisation that aims “to focus on areas that otherwise receive too little attention. Together with our approximately 6,000 members, member and partner organisations, we find these areas and work on them in numerous projects. We have been entered in the list of qualified organisations for this purpose since 2012 and, as a public body, carry out market inspections with a focus on the retail sector and have maintained the market watchdog Psychomarkt since 2015. We are particularly committed to the principle of scientific rigour and evidence.” (my translation)

‘EuroConsum’ recently published a bizarre statement:

For more than a decade, EuroConsum has worked closely with the Gesellschaft zur wissenschaftlichen Untersuchung von Parawissenschaften (GWUP e.V.). Under the leadership of Amardeo Sarma and Dr Holm Hümmler, we experienced a fruitful and always respectful cooperation that contributed significantly to the improvement of consumer advice and information. This cooperation was in line with shared values, which manifested themselves in a commitment to an informed public and against quackery and evidence-free advertising promises.

The murder of Halit Yozgat by right-wing terrorists of the so-called “National Socialist Underground” (NSU) and the assassination of the Kassel district president Dr Walter Lübcke, also by a right-wing terrorist, took place during the same period. The racist murders in Hanau, which could have been prevented and in which a right-wing terrorist took the lives of Gökhan Gültekin, Sedat Gürbüz, Said Nesar Hashemi, Mercedes Kierpacz, Hamza Kurtović, Vili Viorel Păun, Fatih Saraçoğlu, Ferhat Unvar, Kaloyan Velkov and Gabriele Rathjen, also took place during this time. Not only these murders, but also the involvement of state authorities in these events have increased pain and caused suffering. Many of our members know the victims or their surviving relatives personally. These events are fundamental and guiding for us and our work.They remind us every day.

For us, one of the lessons of this terror is that we must clearly distance ourselves from right-wing extremist and neo-right-wing movements. We must also fight to improve social conditions alongside those who share our values; in particular, these are groups in which people who are themselves affected by discrimination and marginalisation organise themselves. Work that does not take into account the perspectives of these people does not meet our own standards; work that is directed against the legitimate concerns of marginalised people and groups is inconceivable for us.

At the GWUP’s general meeting on 11 May 2024, a new election of the GWUP Board was held, which was previously presented as a “directional election”. The decision was close, as ultimately only around 20 votes made the difference. We perceive the result of the election as a decision on the future positioning of the GWUP in terms of content and as a commitment to a new direction for the GWUP and recognise it in this respect.

With this election, the GWUP has declared that it is taking a new course, which we do not want to follow against the background of our own association identity and cannot follow for personal reasons. EuroConsum will therefore terminate its cooperation with the GWUP immediately and finalise joint projects promptly. A statement to this effect was sent by post today.

This decision was not taken lightly, particularly in view of the long-standing good relationship and the considerable overlap within the groups and circles supporting our two associations. However, after an intensive discussion, there is no alternative for us.

EuroConsum would like to continue to engage in dialogue and cooperation with all sceptical people who share our values and want to work towards a fair and inclusive society.

(my translation)

_________________

WHAT?

ARE THEY SERIOUS?

‘EuroConsum’ seems to be disappointed with the result of the recent election of the GWUP-Board – I did previously mention the contest between ‘TEAM HUEMMLER’ and ‘TEAM SEBASTIANI’. The latter group won, and several Huemmler fans, including ‘EuroConsum’, have since left the GWUP. Nothing wrong about that! Everyone is free to do what they think is right, of course.

To associate the new GWUP leadership with a series of right-wing murders, is however an entirely different matter. In my view, this is not just extremely bad taste and utterly unjustifiable; it is slanderous and potentially actionable.

PS

What is perhaps also worth mentioning in this context an exchange that occurred on ‘X’ when ‘EuroConsum’ made the announcement. Here is the part of it that I could retrieve (my translation):

  • Holm Gero Hümmler: Surprised. Not.
  • Jörg Wipplinger: Wow, listing the right-wing extremist murders creates a context that, in my view, borders on character assassination. It doesn’t imply any affinity with right-wing ideas, but puts you in the neighbourhood of right-wing extremist murderers. Don’t you realise that or do you think it’s okay anyway?
  • Holm Gero Hümmler: If that is your only worry…
  • Jörg Wipplinger: What kind of answer is that? I find it extremely disturbing when a club, a board that has never worked a day, is portrayed in this way. I’m not with the club, but if that happened to me, I’d be pretty upset.
  • Jörg Wipplinger: It’s not about all the gwup stories at all, zero. It’s about Euroconsum’s explanation, which provides no real explanation, but a list of murderers as ‘context. Holm shared this and I want to know if he thinks it’s good. I find it shocking.
  • Holm Gero Hümmler: Euroconsum has always clearly positioned itself against anti-democratic tendencies.
    So I think it’s only natural that we don’t want to have anything to do with people who are in favour of the GWUP spreading the narratives of enemies of democracy and using their rhetoric.

 

 

Vertebral artery dissections (VAD) pose a significant risk for strokes, particularly in young adults. This case report details the presentation and management of a 48-year-old patient who was diagnosed with an extracranial VAD following cervical spine manipulation (CSM).

The patient’s symptoms included:

  • acute right-sided ataxia,
  • giddiness,
  • vertigo,
  • nausea,
  • vomiting,
  • persistent pain behind the right ear.

They prompted immediate evaluation. After ruling out acute intracerebral hemorrhages, a computed tomography angiogram (CTA) of the head and neck identified a severe narrowing of the right distal vertebral artery with a string sign at the level of the right C1 loop (V3 segment), indicating an extracranial VAD. This finding was further supported when ultrasound (US) imaging revealed a high resistance flow pattern in the right distal vertebral artery. Furthermore, T2 and diffusion-weighted magnetic resonance imaging (MRI) confirmed a 1.8 cm VAD/hematoma and a 1.4 cm acute/subacute infarct in the right posterior inferior cerebellar artery (PICA) territory.

The authors concluded by stressing the importance of recognizing and addressing that neck pain can be a symptom of musculoskeletal dysfunction or could have neurovascular origins. In this case, the patient’s neck pain may have been musculoskeletal or could have been due to a previous dissection. Thus, differentiation should be considered before cervical spine manipulation.

The link between CSM and arterial dissection is hard to deny. On this blog, we have discussed these issues with depressing regularity, e.g.:

Whether the CSM was the cause of the dissection of a previously intakt artery, or whether the CSM made a pre-existing problem worse, might often be difficult to decide in retrospect. What is crucial in both scenarios, is that CSM carries serious risks. This insight is all the more important, if we consider that the benefits of CSM are minimal or unproven. The inescapable conclusion, therefore, is that the risk/benefit balance of CSM is not positive. In other words, the only sensible advice here is this:

don’t allow chiropractors (who use CSM more often that any other profession), osteopaths, physiotherapists, etc. perform CSMs on your neck.

I have attended numerous ‘Skeptics in the Pub’ (SITP) meetings, either as a member of the audience or as a lecturer. They can be splendid occasions to learn, be entertained, to discuss, and to socialise in a relaxed atmosphere.

The usual format of a SITP meeting includes an invited speaker (often a renouned expert with an international reputation) who gives a talk on a specific topic, followed by a break where people can re-fill their glasses, followed by a long question-and-answer session. Meetings are usually scheduled on a monthly basis. The SITP movement started in 1999 in London. The concept soon spread, and now there are SITP meetings in many countries across the world.

The organisers of the meetings are local enthusiasts who run them on a shoestring. Each attendee pays a small entrance fee or gives a donation. Speakers usually get their expenses paid. As the meetings take place in pubs, there is no expense for room hire.

As I already stated, the concept of SITP is great, no question.

Unfortunately, however, there is also a ‘BUT’.

I have been to SITP meetings that were run perfectly – but I have experienced also the exact opposite, both as a lecturer as well as a attendee. For instance:

  • I have attended meetings where the room was too small and stuffy.
  • I have sat on chairs that seemed like medevial torture instruments.
  • I have suffered through lectures where the technical equipment did not work properly.
  • I have been at meetings that were attended by embarrassingly few people.
  • I have, as an invited speaker, been told retrospectively that my (very modest) expenses could not be paid.

Here is my plea to the organisers of SITP worldwide:

I know you volunteer for this job with enthusiasm and dedication. But PLEASE, do it also with competence. Your speakers are as dedicated as you; often they are top experts. They have a right to be met not just with kindness but also with competence.

So, please advertise each SITP meeting as best as you can; for example, go to your local papers, radio, social media etc. Do not humiliate your speakers by having them lecture in front of a half empty room. Make sure that your technical equipment works and test it thoroughly before your speaker arrives. Do not use locations that are unsuited for such events because they are too small, uncomfortable or poorly ventilated. If you are unable to organise meetings that are good in every respect, it might be better to not run any at all.

Yes, SITP is a great idea in theory. But even a great idea can be destroyed by deficient practice.

 

 

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