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

I just stumbled over a paper we published way back in 1997. It reports a questionnaire survey of all primary care physicians working in the health service in Devon and Cornwall. Here is an excerpt:

Replies were received from 461 GPs, a response rate of 47%. A total of 314 GPs (68%, range 32-85%) had been involved in complementary medicine in some way during the previous week. One or other form of complementary medicine was practised by 74 of the respondents (16%), the two most common being homoeopathy (5.9%) and acupuncture (4.3%). In addition, 115 of the respondents (25%) had referred at least one patient to a complementary therapist in the previous week, and 253 (55%) had endorsed or recommended treatment with complementary medicine. Chiropractic, acupuncture and osteopathy were rated as the three most effective therapies, and the majority of respondents believed that these three therapies should be funded by the health service. A total of 176 (38%) respondents reported adverse effects, most commonly after manipulation.

What I found particularly interesting (and had totally forgotten about) were the details of these adverse effects: Serious adverse effects of spinal manipulation included the following:

  • paraplegia,
  • spinal cord transection,
  • fractured vertebra,
  • unspecified bone fractures,
  • fractured neck of femur,
  • severe pain for years after manipulation.

Adverse effects not related to manipulation included:

  • death after a coffee enema,
  • liver toxicity,
  • anaphylaxis,
  • 17 cases of delay of adequate medical attention,
  • 11 cases of adverse psychological effects,
  • 14 cases of feeling to have wasted money.

If I remember correctly, none of the adverse effects had been reported anywhere which would make the incidence of underreporting 100% (exactly the same as in a survey we published in 2001 of adverse effects after spinal manipulations).

3 Responses to Adverse effects after so-called alternative medicine (SCAM): underreporting is huge

  • EE: Serious adverse effects of spinal manipulation included the following”

    Of? You were able to determine causation in each case?

    Also interesting is that in one study 88% couldn’t recall even one case within the prior year that met the criteria. Not even one case?

    As far as under reporting, as a comparison:

    “The median under-reporting rate across the 37 studies was 94% (interquartile range 82-98%).”

    And that’s a reporting system.

    https://link.springer.com/article/10.2165/00002018-200629050-00003

    I do support an AE reporting system regarding SMT but to achieve any relevance and insight it has to be very detailed and a collaborative effort between several parties.

  • Alt-med in general has a big reporting bias in its favor, just because it’s something out of the mainstream – it’s more of a conscious choice, not the default choice. It’s part of the user’s self-determination.
    So if someone tries some kind of alt-med, and they get better, it seems like information worth propagating, more newsworthy than “I have a good doctor”. More so to some extent, the more exotic and implausible a treatment is. And it may feel flattering to the person, that they found out something not generally recognized.
    But if someone tries something and it doesn’t work, or they actually get worse, they’re likely to feel embarrassed. And it’s boring – just one more thing on a huge heap of things that were dubious to begin with. So they just go on to something else without telling people.

  • An archived news report resonates with this very concerning piece.

    It demonstrates very well how alternative medicine, even when practiced by well meaning practitioners, can ruin lives and empower criminals.

    The report also includes important information about the gullibility of doctors.

    The piece is behind a paywall, however it is archived here

    https://archive.ph/cw9VH

    The investigative journalist who wrote the piece, Tim Rayment, is deserving of the highest praise. He put his life at risk to investigate the story and he was doing the work that the police should have done but failed to do.

    When the police did eventually get round to dealing with this, largely due to the courage and hard work of Tim Rayment, they did very well and one of the most notorious criminals in UK history (by then going by the name Juliette D’Souza) was jailed for 11 years a string of dreaful crimes against vulnerable people.

    Unfortunately the crimes D’Souza was convicted of were only the tip of the iceberg, she was involved in a many more crimes in the UK and other territories. There are many other disgusting criminals, exactly like her, like her operating today and her strategy of manipulating naive SCAM practitioners to access vulnerable people is not unusual.

    Thank you for your excellent article Edzard. Your work in protecting the vulnerable is incredibly important and I appreciate it very much.

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