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

Monthly Archives: July 2022

The interest in the medicinal properties of honey is lively. A recent review, for instance, concluded that honey is a safe natural substance, effective in the inhibition of bacterial growth and the treatment of a broad range of wound types, including burns, scratches, diabetic boils (Skin abscesses associated with diabetic), malignancies, leprosy, fistulas, leg ulcers, traumatic boils, cervical and varicose ulcers, amputation, burst abdominal wounds, septic and surgical wounds, cracked nipples, and wounds in the abdominal wall. Honey comprises a wide variety of active compounds, including flavonoids, phenolic acid, organic acids, enzymes, and vitamins, that may act to improve the wound healing process. Tissue-engineered scaffolds have recently attracted a great deal of attention, and various scaffold fabrication techniques are being researched.

But there is also reason to be cautious. The U.S. Food and Drug Administration (FDA) posted warning letters to four companies for illegally selling honey-based products that may pose a significant health risk to consumers. The FDA’s laboratory testing found that product samples contained active drug ingredients not listed on the product labels, including the active drug ingredients found in Cialis (tadalafil) and Viagra (sildenafil), which are FDA approved drugs used to treat men with erectile dysfunction. Sildenafil and tadalafil are restricted to use under the supervision of a licensed health care professional. These undeclared ingredients may interact with nitrates found in some prescription drugs, such as nitroglycerin, and may lower blood pressure to dangerous levels. People with diabetes, high blood pressure, high cholesterol, or heart disease often take nitrates.

“Tainted honey-based products like these are dangerous because consumers are likely unaware of the risks associated with the hidden prescription drug ingredients in these products and how they may interact with other drugs and supplements they may take,” said FDA Associate Commissioner for Regulatory Affairs Judy McMeekin, Pharm.D., “Products marketed with unidentified ingredients may be dangerous and, in some cases, deadly to consumers. We encourage consumers to remain vigilant when shopping online or in stores to avoid purchasing products that put their health at risk, and instead seek effective, FDA-approved treatments.”

Today’s warning letters outline how companies violated federal law by selling active drug ingredients in products marketed as foods, like honey, and by making unauthorized claims that their products treat disease or improve health. These products are promoted and sold for sexual enhancement on various websites and online marketplaces, and possibly in some retail stores.

The warning letters were issued to:

Companies marketing food products containing tadalafil and/or sildenafil violate federal law. Some of the products cited in the warning letters are also unapproved new drugs because they are intended for use in the cure, mitigation, treatment, or prevention of disease and they lack FDA approval. In some cases, product claims reference diseases that can only be diagnosed or treated under medical supervision. Additionally, some products cited in the warning letters are represented as dietary supplements even though tadalafil and sildenafil products are excluded from the dietary supplement definition.
The FDA has requested responses from the companies within 15 working days stating how they will address these issues or providing their reasoning and supporting information as to why they think the products are not in violation of the law. Failure to promptly address the violations may result in legal action, including product seizure and/or injunction.

Consumers using or considering using any over-the-counter product marketed for sexual enhancement should talk to a health care professional first, as some ingredients may interact with medications or dietary supplements. The FDA’s health fraud products database can help consumers identify nearly 1,000 of these potentially dangerous products.

The FDA previously warned consumers about more than 10 honey-based products containing hidden drug ingredients. The FDA’s laboratory testing found that product samples contained undeclared active ingredients, including sildenafil and tadalafil. The agency also previously warned consumers to avoid products with hidden drug ingredients sold through Amazon, eBay, Walmart and other retailers. The FDA is committed to protecting consumers by identifying and removing these potentially dangerous products from the market and urges stores, websites, and online marketplaces to stop selling these products.

If a consumer thinks that a product might have caused a reaction or an illness, they should immediately stop using the product and contact their health care provider. The FDA also encourages health care providers and consumers to report adverse reactions associated with FDA-regulated products to the agency using MedWatch or the Safety Reporting Portal.

Look what I found on Facebook:

Learn how to offer the healing energy of Reiki to yourself, people, and animals while enhancing your animal connection skills!

From daily support for health or challenges during times of crisis, Reiki helps restore balance on physical, emotional, spiritual, and mental levels for all living beings, enabling the body to do what it does best—heal itself. These benefits extend to other people, animals, trees/plants, and self-healing.

Reiki offers so many benefits for animals and for their human caregivers that I call it the gift that keeps on giving!

Reiki also enables students to connect and communicate more deeply with animals. If you think animals like you now, wait until they discover you’ve got Reiki—you’ll become an animal magnet!

For 25+ years Reiki has blessed me, my animal companions, students, and as a teacher I love sharing those benefits with as many people and animals as possible.

AVAILABLE WORLDWIDE

For many years I’ve taught a LIVE personally-mentored 6-week audio class where students learn all the basic skills needed by a beginning Reiki practitioner in addition to foundational principles of energy healing. And you don’t even need to leave the comfort of your home!

TAKEN REIKI BEFORE but don’t feel confident? Students who have retaken Reiki with me share that the weekly calls, opportunities to practice, online community, and opportunity to ask questions and receive guidance have helped them make Reiki a part of their daily lives and feel confident in offering it to loved ones.

REIKI LEVEL 1 CLASS SERIES

August 3 – September 7, 2022

LIVE WEEKLY CALLS and PERSONAL MENTORING

Every Wednesday at 6:00 p.m. Pacific for six weeks. Each call will be recorded and available for replay for students, including those in other time zones/countries. You do not have to attend live to take this class.

In addition to the 60-90 minute weekly calls, each student receives handouts and personal guidance for practice sessions.

When the class concludes, and all requirements have been fulfilled, each student receives a Reiki Level 1 certificate.

To learn more or register:

AND NOW FOR THE IMPORTANT BIT:

Choose one payment for all six classes. Payment is available with Visa, MC, or PayPal (choose PayPal credit card option for payment with Amex or Discover). PayPal also offers a payment plan option. Confirmation will be sent after registration along with instructions on how to join the first call. If you were unable to register in time to attend the first class live you can very easily catch up with the replay. Final deadline for registration is the day of the second class.

Single Pay Plan: $249.00

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This seems like a good little earner to me!

Congratulations to whoever invented it.

Yet I do feel that something has been forgotten:

the evidence.

If you search for Reiki on Pubmed, you find a baffling array of papers many of which arrive at positive conclusions. If you then check out the primary studies, you realize that most of them are of extremely poor quality, published by members of the Reiki cult (often in 3rd class journals for the nursing professions). If you search for independent systematic reviews that adequately account for the quality of the primary studies, you discover that, in fact, the evidence does not support the notion that Reiki is effective for anything. Here are a few examples:

And what about Reiki for animals?

As far as I can see, there is no good evidence at all.

So, does this render the above and similar courses fraudulent?

I let you answer this question for yourselves.

The UK Chiropractic Council is inviting you to help them re-formulate their educational standards. It is an occasion, some of my readers might find interesting. I, therefore, copy the relevant part of their announcement:

… Following a scoping review in 2021, which determined that the existing Education Standards, published in 2017, required development and updating, the GCC began revising the Education Standards in January 2022.

The revision will ensure that the Education Standards:

  • Provide a realistic and comprehensive set of outcomes to be met by graduates on approved qualifications, demonstrating an ability to practise in accordance with the GCC Code.
  • Take into account developments within the profession, increase focus on multi-disciplinary learning and different professions working more closely together across the UK, ensuring that graduates are well placed to meet the opportunities to care for patients in different contexts.
  • Remain consistent, as appropriate, with the outcomes set by other UK healthcare frameworks and standards.

Purpose: why we are consulting

This consultation sets out our draft Education Standards for providers and Learning Outcomes for students, which reflect and build on the evidence and feedback we have obtained through our scoping review.

We seek stakeholders’ views on these draft Education Standards to ensure our final proposals are future-proof and fit for purpose.

We welcome all responses to the consultation.


Documents

The draft Education Standards on which we invite comments.

The equality impact assessment of the Education Standards, with comments invited within the consultation.

The GCC Education Standards consultation document in Word format.


Ways to respond

Submissions to this consultation can be made online (see below) or by email at enquiries@gcc-uk.org (click here to download the consultation document).

It is advisable to make a copy of your submission to prevent the loss of information due to internet, portal or connectivity issues. This should be done before pressing the submit button.

Information in responses, including personal information, may need to be published or disclosed under the access to information regimes (mainly the Freedom of Information Act 2000, the General Data Protection Regulation, the Data Protection Act 2018, and the Environmental Information Regulations 2004).

The GCC is a data controller registered with the Information Commissioner’s Office. We use personal data to support our work as the regulatory body for chiropractors. We may share data with third parties to meet our statutory aims and objectives, and when using our powers and meeting our responsibilities.


Closing date

The deadline for responses to this consultation on the draft Education Standards is 16 September 2022 at noon. The consultation will be publicised and stakeholders will be invited to comment…

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Personally, I think the GCC desperately needs to improve its educational (and other) standards. They claim that, “as the regulator for chiropractors, our role is to protect the public”. The case of the late John Lawler is one of many examples to show how unfit for this purpose the GCC truly is.

So, perhaps you might want to contribute to the consultation with a view to making UK chiropractors less of a danger to the public?

 

Third molar extraction is a painful treatment and thus is often used to investigate the effects of analgesics on pain. Hypnotherapy is said to help to reduce pain and to decrease the intake of postoperative systemic analgesics. Therefore, it seems reasonable to study the effects of hypnotherapy on the pain caused by third molar extraction.

In this study, the effectiveness of a brief hypnotic induction for patients undergoing third molar extractions was investigated. Data were collected from 33 patients with third molar extractions on the right and left sides. Patients received two different types of interventions in this monocentric randomized crossover trial. Third molar extraction was conducted on one side with reduced preoperative local anesthetics and an additional brief hypnotic induction (Dave Elman technique). The other side was conducted with regular preoperative local anesthetics without a brief hypnotic induction (standard care). Intake of postoperative systemic analgesics was allowed in both treatments.

Patients’ expectations about hypnosis were assessed at baseline. The primary outcome was the area under the curve with respect to ground of pain intensity after the treatment. Secondary outcomes were the amount of postoperative analgesics consumed and the preferred treatment.

There was no evidence that the area under the curve with respect to ground of pain differed between the two interventions (controlling for gender). There was, however, evidence to show that the patients’ expectations affected the effectiveness of the brief hypnotic induction. This means that patients with high expectations about hypnosis benefit more from treatment with reduced preoperative local anesthetics and additional brief hypnotic induction.

The authors concluded that, in this study, additional a brief hypnotic induction with reduced preoperative local anesthetic use did not generally reduce posttreatment pain after third molar extraction more than regular local anesthetics. The expectation of the patients about the effectiveness of hypnosis affected the effectiveness of the brief hypnotic induction so that patients with high expectations had a larger benefit from a brief hypnotic induction than patients with low expectations.

The most interesting findings here are, in my view, that:

  1. Hypnotherapy is not as effective as many enthusiasts claim.
  2. Expectation influences the outcome of hypnotherapy.

Expectation is, of course, a determinant of the size of the placebo response. Thus, this finding is interesting but far from unexpected. I would go as far as postulating that similar results would be obtained with most treatments regardless of whether they are alternative or conventional. The difference is that, in the case of alternative therapies, the expectation is a major (if not the only) determinant of the outcome, while it merely somewhat improves the outcome of an effective treatment. To put it differently, so-called alternative medicine (SCAM) relies entirely/mostly on expectation, while conventional medicine does not.

Earlier this year, I started the ‘WORST PAPER OF 2022 COMPETITION’. You will ask what is there to win in this competition? I agree: a competition without a prize is no fun. Therefore, I suggest offering the winner (that is the author of the winning paper) one of my books that best fits his/her subject. I am sure this will over-joy him or her. And how do we identify the winner? I suggest that I continue blogging about nominated papers (I hope to identify about 10 in total), and towards the end of the year, I let my readers decide democratically.

In this spirit of democratic voting, let me suggest to you ENTRY No 6:

This study was to ascertain the efficacy of dry cupping therapy (DCT) and optimal cup application time duration for cervical spondylosis (CS). It was designed as a randomized clinical trial involving 45 participants with clinically diagnosed CS. The eligible subjects were randomly allocated into three groups, each having 15 participants. Each of the three groups, i.e., A, B, and C, received DCT daily for 15 days for 8 min, 10 min, and 12 min, respectively. All the participants were evaluated at the baseline, 7th, and 15th day of the trial using the neck disability index (NDI) as well as the visual analog scale (VAS).

The baseline means ± SD of NDI and VAS scores were significantly reduced in all three groups at the end of the trial. Although all three groups were statistically equal in terms of NDI, group C demonstrated greater efficacy in terms of VAS.

The authors concluded that the per-protocol analysis showed that dry cupping effectively alleviated neck pain across all treatment groups. Although this effect on neck disability index was statistically equal in all three groups, the 12-min protocol was more successful in reducing pain.

Who would design such a study and why?

  • The authors claim they wanted to ascertain the efficacy of DCT. A trial is for testing, not ascertaining. And this study does certainly not test for efficacy.
  • The groups were too small to generate a meaningful result of what, in fact, was an equivalence study.
  • Intra-group changes in symptoms between baseline and time points during treatment are irrelevant in a controlled trial.
  • The slightly better results of group C are most likely due to chance or non-specific effects (a longer application of a placebo would generate better outcomes that a shorter one).
  • The study participants had cervical spondylosis, yet the conclusion is about neck pain. The two are not identical.
  • The title of the paper promises that we learn something about the safety of DCT. Sadly, a trial with just 45 patients has no chance in hell to pick up adverse effects in a reliable way.
  • As there is no control group, the study cannot tell us anything about possible specific effects of DCT.

The authors of the study have impressive affiliations:

  • Department of Ilaj bil Tadbir, Luqman Unani Medical College Hospital and Research Center, Bijapur, India.
  • Department of Ilaj bil Tadbir, National Institute of Unani Medicine, Bengaluru, India.
  • Department of Moalajat, Luqman Unani Medical College Hospital and Research Center, Bijapur, India.

I would have hoped that researchers from national institutions and medical colleges should be able to design a trial that has at least a small chance to produce a meaningful finding. As it turns out, my hope was badly disappointed.

HISC (HOMEOPATHY IN THE SUSSEX COMMUNITY) was formed in 2011 and has established effective partnerships with organisations that support those in need. Projects include working with domestic and sexual violence charities as well as supporting people recovering from long-term and enduring mental health illness issues. They enable vulnerable and marginalised members of the Sussex community to access low cost treatment with highly experienced homeopaths.

On 22 July, HISC made the following announcement:

Homeopathy in the Sussex Community (HISC) has been awarded a grant from The National Lottery Community Fund to provide homeopathy to survivors of domestic abuse and sexual violence. 

HISC works in partnership with Sussex-based organisations; RISE, and Survivors Network, offering long-term and low-cost homeopathic support to women who have experienced abuse and sexual violence. 

This grant will fund these projects for the next year, allowing HISC to build on the valuable work already being done and reaching even more vulnerable women who want access to homeopathic support.

Society Fellow Caroline Jurdon and Registered members Michael Bird, Therese Eriksen, Tara Lavelle and Jo Magowan have all worked on the project with colleagues from the wider community. HISC received one of the Society of Homeopath’s Community Clinic awards in 2018.

HISC also offer volunteering and sitting in opportunities for students.

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The ‘National Lottery Community Fund’ make the following points on their website:

  • “Our funding is public money. This means that it cannot be used to give organisations an unlawful advantage.”
  • “We fund projects that support people and communities across the UK to thrive.”

I would argue that, for the following reasons, the award is misplaced:

  1. Public money should not be wasted. It must be invested in projects that have a reasonable chance to do more good than harm.
  2. A broad consensus exists today that homeopathy has no effect beyond placebo. In fact, the NHS has stopped funding homeopathy and states that “there’s been extensive investigation of the effectiveness of homeopathy. There’s no good-quality evidence that homeopathy is effective as a treatment for any health condition.”
  3. Homeopathy can endanger lives. If people are misled into believing that it is effective and thus treat serious conditions with homeopathy, they needlessly prolong their suffering or, in the worst case scenario, hasten their death. Awards of the above nature can undoubtedly have this effect.

In my view, this means that the award given to HISC by the  National Lottery Community Fund gives an unlawful advantage to an organisation promoting a bogus therapy. At best, it is a waste of public funds, at worst it causes serious harm.

Surely, women who have experienced abuse and sexual violence deserve better!

 

 

 

I have been warning the public about the indirect dangers of so-called alternative medicine (SCAM) for a very long time. It is now 25 years ago, for instance, that I published an article in the ‘European Journal of Pediatrics’ entitled “The attitude against immunisation within some branches of complementary medicine“. Here is the discussion section of this paper:

… certain groupings within COMPLEMENTARY MEDICINE (CM) may advise their patients against immunisation. Within these groupings, there is, of course, a considerable diversity of attitudes towards immunisation. Therefore
generalisations are difficult and more detailed investigations are required to clarify the issue.

The question arises whether the level of advice against immunisation as it exists today represents a real or only a potential risk. One study from the U.K. demonstrates homoeopathy to be the most prevalent reason for non-compliance with immunisation [30]. The problem may not be confined to naturopathy, chiropractic and homoeopathy. Books relating to CM in general [e.g. 19] also strongly advise against immunisation: “Vaccination may provoke the illness which it is supposed to prevent. People who are vaccinated can transmit the illness, even if they are not ill themselves. The vaccine can make the person more susceptible to the illness … The vaccinated child is a contaminated child”.

At present, our data is insufficient to de®ne which proportion of which complementary practitioners share this
attitude. The origin of this stance against vaccination is largely unknown. For instance, there is nothing in Hahnemann’s writings against immunisation [14]. It may therefore stem from a general antipathy toward modern medicine which seems to be prevalent within CM [7, 19, 23]. A more specific reason is that immunisation is viewed as detrimental, burdened with long-term side effects. It is also felt that it is not fully effective and unnecessary because
better methods of protection exist within CM [16].

Anti-immunisation activists are often unable to argue their case rationally, yet they place advertisements in the daily press warning about immunisation. In Britain, one tragic case has recently been publicised. A physician advised parents against measles vaccination for their child who was suspected of suffering from convulsions. Five years later, the child suffered severe brain damage after contracting measles. The doctor was sued by the parents and found guilty of negligence and ordered to pay £825,000 in damages [1].

In medicine we must, of course, always be vigilant about the risks of our interventions. Each form of immunisation should therefore be continuously scrutinised for its possible risks and benefits. Most forms of immunisation are clearly not entirely free of risk [e.g. 22] – in fact, no effective intervention will ever be entirely risk-free. Therefore the risks have to be discounted against the benefits. It follows that any blanket rejection of immunisation, in general, must be misleading. It endangers not only the individual patient but (if prevalent) also the herd immunity of the community at large. Such unreflected rejection of immunisation, in general, will inevitably do more harm than good.

It is concluded that the advice of some, by no means all complementary practitioners in relation to immunisation represents an area for concern, which requires further research. Complementary practitioners and patients alike should be educated about the risks and benefits of immunisation. Paediatricians should be informed about the present negative attitude of some complementary practitioners and discuss the issue openly with their patients.

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I suspect that, had we heeded my caution, researched the subject more thoroughly, and taken appropriate action, the current pandemic might have produced fewer and less vocal anti-vaxxers, and fewer patients might have died.

It took two years, but now it is done: I am a German again after more than 20 years!

The process started over two years ago when I went to the German embassy in London. When it was my turn, the official asked me what I wanted, and I handed her my lapsed passport and asked to get it renewed. She looked at it, then at me, then at the passport again. What happened next took me by surprise: she confiscated my old passport and told me in no uncertain terms that I was not a German anymore. If I wanted to become a German, I would need to start from scratch and get re-nationalized. Unbeknown to me, I would have had to apply for dual citizenship back in 1999 when I took British nationality. By not doing it, I lost my German nationality.

Now followed a two-year process of application. This meant retrieving and supplying documents over documents over documents. I would have hardly been surprised if they has asked me for the fingerprints of my grandmother. Yes, the Germans are still the world champions of bureaucracy, if you ask me.

But why did you want to become a German again?

Glad you asked!

People who know me well are aware of the fact that I was never really proud of being German. As I grew older, I was often even ashamed. One of my research subjects had long been medicine during the Third Reich, and it was this topic that disenchanted me with Germany. Therefore, it seemed entirely right to become a Brit. In fact, I felt proud – the UK was my chosen home, and the decision was meant to be for life.

Never in my wildest dreams did I think in 1999 that Britain would one day succumb to the collective death wish of leaving the EU. After the deeply dishonest referendum in 2016, I was still convinced that this act of extraordinary self-harm would be prevented. But then it did happen, not least due to the lies of the right-wing of the Tory party and the two-faced incompetence of Jeremy Corbyn and his followers. I remember the morning that I heard it being announced on the radio; I was in tears.

Brexit itself would have been bad enough but the way it changed the atmosphere in Britain was even worse, in my view. With the nationalists in power, every halfwit seemed to feel entitled to let out his xenophobic vomit at will. Lying and corruption in politics became the new norm. The press remained largely silent or even supportive of those who claimed that Brexit would bring back the great British empire. The few who had the courage to object were declared to be ‘enemies of the people’. Britain, I felt, was fast becoming a banana republic.

Most of what had made me once aspire to be British had vanished in a matter of months. It was time to reconsider my position. The first step my wife and I took was to move to Cambridge. We felt it was an enclave of sanity in a country that seemed to destroy itself. The second step was to spend more time in Brittany, my wife’s place of birth. Without exception, our French friends felt that the UK had lost its senses and had become the laughing stock of Europe. The third step was to apply to become a German citizen again.

Now that all this is done, I feel both happy and sad. Happy to be a member of the EU again, and sad to see what has become of the country I so loved.

 

The US Food and Drug Administration (FDA) state that dietary supplements can help people improve or maintain their overall health. But they may also come with health risks. Whether you’re a consumer of dietary supplements or it’s your job to inform and educate, it’s important to know the facts before deciding to take any dietary supplement.

Therefore, they launched the initiative, “Supplement Your Knowledge”. It aims to help inform health care professionals, consumers, and educators about dietary supplements.

“Dietary supplements can be valuable to your health but taking some supplements can also involve health risks,” Douglas Stearn, JD, deputy director for regulatory affairs in the FDA’s Center for Food Safety and Applied Nutrition, said in a statement. “These Supplement Your Knowledge resources will help provide consumers and health care professionals with facts to make informed decisions when determining if they want to use or recommend dietary supplements.”

In collaboration with the American Medical Association, publisher of JAMA, the FDA has developed a free continuing medical education program for physicians and other health care professionals about the regulation of dietary supplements, informing patients about their use, and reporting adverse events to the agency. The program includes 3 videos and accompanying educational materials. It is available on the FDA website and the AMA Ed Hub.

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The objectives of the program are:
1. Define dietary supplements
2. Describe how dietary supplements are regulated
3. Describe how dietary supplements are labelled and the types of claims permitted
4. Review potential interactions of dietary supplements with other supplements, medications, and laboratory tests
5. Identify adverse events and how to report them to FDA

Even though some parts of the program are quite specific to the US, I think that the initiative is most laudable and an excellent resource for physicians, SCAM practitioners, consumers, and decision-makers to learn more about this important subject.

On 18/7/2022 the ‘WORLD FEDERATION OF CHIROPRACTIC’ published a statement on cervical artery dissection (CAD). Below are a few  excerpts to which I have added a few numbers [in brackets] which refer to my comments below:

… On rare occasions, CAD has been reported to have occurred after a patient visited a chiropractor or other provider of manual therapy [1]. However, the best evidence available to date indicates that spinal manipulation does not stress the arteries enough to cause tearing of the arteries leading to dissection-related strokes [2]. Additional studies have concluded that patients are as likely to have consulted a primary care physician as receive spinal manipulation from a chiropractor prior to experiencing a CAD-related stroke [3]…

The provision of safe, high-quality, evidence-based, patient-centered care for these and other conditions is a priority for the chiropractic profession [4]. Rigorous research is core to the pursuit of that objective [5]. We urge caution in making claims that are in conflict with the current state of the evidence.

About the WFC

The World Federation of Chiropractic is an international, non-governmental organization whose members are the national associations of over 90 countries in seven world regions. It is a non-state actor in official relations with the World Health Organization and is the global authority for matters related to the chiropractic profession [6]…

References

Cassidy JD, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ. Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study. Eur Spine J. 2008 Apr;17(Suppl 1):176–83. Open access here.#

Chaibi A, Russell MB. A risk-benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: a comprehensive review. Ann Med. 2019 Mar;51(2):118-127. Open access here.

Church EW, Sieg EP, Zalatimo O, Hussain NS, Glantz M, Harbaugh RE. Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation. Cureus. 2016 Feb 16;8(2):e498. Open access here.

Kosloff TM, Elton D, Tao J, Bannister WM. Chiropractic care and the risk of vertebrobasilar stroke: results of a case-control study in U.S. commercial and Medicare Advantage populations. Chiropr Man Therap. 2015 Jun 16;23:19. Open access here.

Rubinstein SM, Peerdeman SM, van Tulder MW, Riphagen I, Haldeman S. A systematic review of the risk factors for cervical artery dissection. Stroke. 2005 Jul;36(7):1575-80. Open access here.

Whedon JM, Mackenzie TA, Phillips RB, Lurie JD. Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66 to 99 years. Spine (Phila Pa 1976). 2015 Feb 15;40(4):264-70. Open access here

Here are my brief comments based on the evidence discussed in dozens of posts previously published on this blog:

  1. As there is no post-marketing surveillance, nobody can say with any degree of confidence that CADs after chiropractic are rare.
  2. This is not the ‘best’ evidence. In fact, it has been refuted repeatedly.
  3. This study has also been refuted.
  4. Chiropractic is very far from being evidence-based.
  5. Rigorous research fails to show that chiropractic neck manipulations generate more good than harm.
  6. The WFC is a lobby group for chiropractic; its mission is ” to advance awareness, utilization, and integration of chiropractic internationally”. Its current director is Richard Brown who spear-headed the disaster when the BCA sued Simon Singh, lost, and caused immense reputational damage to chiropractic worldwide.
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