Monthly Archives: July 2022
I recently looked at the list of best-sellers in homeopathy on Amazon. To my surprise, there were several books that were specifically focused on the homeopathic treatment of children. Since we had, several years ago, published a systematic review of this subject, these books interested me. Here is what Amazon tells us about them:
Homeopathic remedies are increasingly being used to treat common childhood ailments. They are safe, have no side effects or allergic reactions, are inexpensive and, above all, effective. In this guide, Dana Ullman explains what homeopathy is, how it works and how you can use it correctly to enhance your child’s health. He recommends remedies for more than 75 physical and emotional conditions, including: allergies, grief, anxiety, headaches, asthma, measles, bedwetting, nappy rash, bites and stings, shock, burns, sunburn, colic, teething, coughs and colds and travel sickness
Without doubt, this is the most comprehensive book on homeopathic pediatrics. Included is a complete guide to the correct use of homeopathy, recommended remedies for the treatment of more than seventy-five common physical, emotional, and behavioral conditions, and valuable information on the essential medicines that all parents should have in their home medicine kits
Tricia Allen, a qualified homeopath, offers a host of practical advice on how to treat illness using natural, homeopathic remedies. Homeopathy differs from conventional medicine in that it does not only alleviate the individual symptoms of an illness, but treats the underlying state to ensure that the disease does not return, something which rarely occurs when using traditional remedies. This guide gives you advice on; what homeopathy is and how to use it; each stage of childhood and how to deal with the complaints that occur at that time of a child’s development; the most common childhood illnesses, how to take your own steps to treating them, which homeopathic remedies to use and when to seek medical help and first aid.
The Homeopathic Treatment of Children is indispensible at giving both a clear overall impression of the various major constitutional types, and also a detailed outline for reference at the end of each chapter. Not only does Paul Herscu draw from various sources (repertories and materia medica), he also adds indispensable original information from his successful practice.
______________________________
The fact that such books exist is perhaps not all that surprising. Yet, I do find the fact that they are among the best-selling books on homeopathy surprising – or to be more precise, I find it concerning.
Why?
Simple: children cannot give informed consent to the treatments they receive. Thus, consent is given for them by their parents or (I suspect often) not at all. This renders homeopathic treatment of children more problematic than that of fully competent adults.
Homeopathy has not been shown to be effective for any pediatric condition. I know Dana Ullman disagrees and claims it works for children’s allergies, grief, anxiety, headaches, asthma, measles, bedwetting, nappy rash, bites and stings, shock, burns, sunburn, colic, teething, coughs and colds, and travel sickness. Yet, these claims are not based on anything faintly resembling sound evidence! Our above-mentioned systematic review reached the following conclusion: “The evidence from rigorous clinical trials of any type of therapeutic or preventive intervention testing homeopathy for childhood and adolescence ailments is not convincing enough for recommendations in any condition.”
And what follows from this state of affairs?
I am afraid it is this:
Treating sick children with homeopathy amounts to child abuse.
Yes, it is hot! Very hot. Where I live – Cambridge, UK – we expect records to be broken today and tomorrow, and we are predicted to reach as much as 40 degrees Celsius.
But do not despair – there is help!
As so often, homeopathy comes to our rescue.
I found this source giving us advice about “BEST HOMEOPATHY MEDICINE FOR SUMMER HEAT“:
Homeopathic remedies are non-toxic and a safe way to help the body to replenish its store of the cell salts and nutrients it needs in warmer periods and help to relieve cramps, aches, and fatigue. Some of the most common homeopathic medicines to deal with summer heat are:
-
- Calendula: This is an all-purpose medicine for many kinds of skin damage that many of us face during the summer season. When the skin gets damaged due to wounds, infection, prolonged sun exposure, and even excessive pollution and dirt, one can try using calendula.
- Arnica: All that running around on the beach can easily give you sore muscles, while the heat can sap up your energy and leave you fatigued. In such cases, Arnica is the perfect homeopathic answer to your maladies. This homeopathic remedy can be used for topical application if bought in its cream or gel form.
- Belladonna: Sun strokes, dehydration, and over-exposure to the sun, in general, can give you a host of problems and conditions including heat headaches. In order to treat such conditions, one can use homeopathic medicine Belladonna used for sun-stroke related ailments and symptoms.
- Rhus Toxicodendron: This Homeopathy remedy used for Hot Weather Symptom is also known as Rhus Tox. It is made from poison ivy extracts and is an effective drug when it comes to dealing with itchy rashes. These rashes may be caused because of exposure to oak, sumac, and even poison ivy.
- Ledum: Ledum or Ledum Palustre is one of the best homeopathic drugs when it comes to treating insect bites during summers.
- Euphrasia Officinalis: This homeopathic medicine is most commonly used for eye-related problems that may come about due to sun exposure or excessive sweating in prickly heat and other heat-related factors.
_____________________________
So, now we know. All you need to do is go to a homeopathic pharmacy and buy the remedies (please do not run, this might aggravate your symptoms!).
Which potency?
Good question!
The author of the advice – Dr. Bela Chaudhry, BHMS, MD – Homeopathy, Homeopathy Doctor, Delhi, India – does not disclose this important information. As some of these ingredients are toxic, I would urge you to buy an ultra-molecular dilution – a C30, for instance – this way, you are sure that not a single molecule of what is printed on the package is contained in the actual remedy.
Alternatively, you could save quite a bit of money by staying where you are, taking a cool drink of water (put a pinch of salt in it, if you think you are getting dehydrated), and considering the evidence. It clearly shows that homeopathic remedies are pure placebos. They do not work against the symptoms of overheating nor against anything else.
PS
I suspect, there will be some who disagree with me. To them, I say: please show me the evidence that any of the above-listed homeopathic remedies are effective against the named conditions. If you do that, I promise that I will change my post accordingly. Thank you.
Few people would dispute that a politician who promotes homeopathy as a treatment paid for by the public purse is irresponsible and disregards the scientific evidence. Few people would dispute that such a person is not best-suited for the top job in politics.
THE GUARDIAN reported yesterday that Penny Mordaunt, a leading contender to win the Conservative party leadership contest and become the UK prime minister, has repeatedly advocated the use of homeopathy on the National Health Service (NHS). 
Mordaunt, is currently the bookmakers’ favorite to replace Boris Johnson. In June 2010 she was one of 16 supporters of an early day motion in the House of Commons sharply criticizing the British Medical Association for voting to withdraw NHS support for homeopathy. The motion claimed there was “overwhelming anecdotal evidence that homeopathy is effective, frequently in cases when patients have not found relief through conventional medical treatments”. The statement signed by Mordaunt called on the government to allow health commissioners to refer patients to “homeopathic doctors and approved homeopaths”.
Four years later Mordaunt again intervened on behalf of homeopathy. She declared in a tweet that GPs “should have freedom to decide” if they wished to prescribe homeopathic treatments to NHS patients. In July 2014, Peter Stokes, a data director at the Office for National Statistics, wrote on Twitter that Mordaunt was a “supporter of homeopathy on NHS”, adding: “Hard to vote for people who don’t believe in evidence-based decisions.” In response, Mordaunt wrote: “Hi, I support drinking cranberry juice for UTIs & campaigned for better access to osteopathy. Do pl email me for more info.” Stokes wrote back: “Both reasonable, but you also signed [the 2010 early day motion]. “Homeopathy is the worst kind of bunkum medicine.” Mordaunt replied: “I don’t think GPs referring 2 homeopathy 2 cure cancer. Do think they should have freedom to decide. Pl email for more info.”
Her renewed support for homeopathy came five months after Dame Sally Davies, then the government’s chief medical officer, had dismissed homeopathy as a waste of time and money. “There is no evidence that homeopathy extends life for cancer patients – or indeed for patients with any other condition,” Davies said in February 2014.
Daisy Cooper, the Liberal Democrats’ health spokesperson, said: “It’s alarming that someone who could be appointed prime minister in a few weeks’ time has repeatedly supported homeopathy being provided by the NHS, despite concerns about the practice among health experts. “Penny Mordaunt should make clear that she will focus on fixing the real issues facing the NHS like soaring ambulance waiting times, not on imposing homeopathic treatments.”
Mordaunt has also voted against smoking bans, and consistently voted against restricting the provision of services to private patients by the NHS, according to the website TheyWorkForYou, which monitors the voting records of MPs.
__________________________________
To me, this looks as though Penny Mordaunt disregards scientific evidence at the cost of public health. Call me old-fashioned, but I do not think that such an attitude is an ideal qualification for becoming our next prime minister.
PS
I was unable to find any evidence related to the other Tory contenders’ attitude towards so-called alternative medicine (SCAM). If any of my readers have such information, please let me know.
Crystal healing is the treatment of all types of illnesses via the ‘healing energy’ of gemstones. It is as implausible as so-called alternative medicine (SCAM) gets. In my recent analysis of 150 SCAMs, I concluded that “there are no rigorous trials testing the therapeutic value of crystal healing”. This assumption is further confirmed by published papers like this one: 
Recently, crystal healing and gemstone therapy, also known as litho- or gemmotherapy, is extensively promoted in the media, newspapers and the internet. There is also a growing interest of cancer patients in this unconventional treatment, resulting in the need for oncologists to give informed advice to their patients and to prevent them from wasting hope, time and money in an ineffective treatment, and at worst to postpone the necessary treatment of this life threatening disease. In the context of the currently ever-growing New-Age wave, believing in crystal healing has spread widely in the population. It is a historical belief similar to that of charmstones, rather than one based on modern scientific practices and advances. Pleasant feelings or seeming successes of crystal healing can be attributed to the strong placebo effect, or the believers wanting it to be true and seeing only things that back that up: cognitive bias. A scientific proof of any positive effect beyond a placebo effect does not exist. Even though this treatment can be generally regarded as harmless and without toxicity, it should not be recommended to cancer patients. Thereby we will help prevent our patients from wasting hope, time and money in an ineffective treatment, and at worst to postpone the necessary treatment of this life threatening disease, resulting in a worsened prognosis.
Yet, it seems that we were not entirely correct. Recently, I came across an article that mentions such a study:
A study conducted in 2001 by British psychologist Christopher French challenged 80 volunteers to differentiate between real and fake crystals after holding them in their hands for five minutes and meditating. Six people felt nothing at all, and the rest reported feeling some energy, whether in the form of tingling in the body or an improved sense of wellbeing. Both groups, though—whether holding the fake crystals or the real ones—reported similar impressions, suggesting the placebo effect could be at play.
“When scientists conduct robust clinical trials, they want to strip the intervention of these placebo effects to figure out if it has a specific benefit,” Jarry explains. “Alternative medicine’s reputation benefits strongly from these non-specific placebo effects. Enough people will start to feel better after using crystals (because of regression to the mean, self-limiting illness, misremembering, etc.), and they will publicly testify to their improvement, giving the illusion that crystals work. What they don’t know is what would have happened had they not used the crystals.”
So, if you want to keep a hunk of amethyst at your desk to alleviate your grief, or a Tiger’s Eye stone to clear the mind, go ahead: they may not be manipulating a sacred energy field around your body to heal you, but they can certainly manipulate your mind.
Unfortunately, the link provided does not lead directly to the study but to the publication list of Chris French. This in turn leads us to the reference in question:
French, C. C., O’Donnell, H., & Williams, L. (2001). Hypnotic susceptibility, paranormal belief and reports of ‘crystal power’. British Psychological Society Centenary Annual Conference, Glasgow, 28-31 March 2001. (Abstract published in Proceedings of the British Psychological Society, 9(2), 186).
Sadly, I cannot find the paper online and I suspect it exists only as an abstract in a conference book (I have emailed Chris and asked him). In any case, his study did not test the therapeutic value; so, my above statement is not entirely false.
The US Food and Drug Administration created the Tainted Dietary Supplement Database in 2007 to identify dietary supplements adulterated with active pharmaceutical ingredients (APIs). This article compared API adulterations in dietary supplements from the 10-year time period of 2007 through 2016 to the most recent 5-year period of 2017 through 2021. Its findings are alarming:
- From 2007 through 2021, 1068 unique products were found to be adulterated with APIs.
- Sexual enhancement and weight-loss dietary supplements are the most common products adulterated with APIs.
- Phosphodiesterase-5 inhibitors are commonly included in sexual enhancement dietary supplements.
- A single product can include up to 5 APIs.
- Sibutramine, a drug removed from the market due to cardiovascular adverse events, is the most included adulterant API in weight loss products.
- Sibutramine analogues, phenolphthalein (which was removed from the US market because of cancer risk), and fluoxetine were also included.
- Muscle-building dietary supplements were commonly adulterated before 2016, but since 2017 no additional adulterated products have been identified.
The authors concluded that the lack of disclosure of APIs in dietary supplements, circumventing the normal procedure with clinician oversight of prescription drug use, and the use of APIs that are banned by the Food and Drug Administration or used in combinations that were never studied are important health risks for consumers.
The problem of adulterated supplements is by no means new. A similar review published 4 years ago already warned that “active pharmaceuticals continue to be identified in dietary supplements, especially those marketed for sexual enhancement or weight loss, even after FDA warnings. The drug ingredients in these dietary supplements have the potential to cause serious adverse health effects owing to accidental misuse, overuse, or interaction with other medications, underlying health conditions, or other pharmaceuticals within the supplement.”
These papers relate to the US where supplement use is highly prevalent. The harm done by adulterated products is thus huge. If we focus on Chinese or Ayurvedic supplements, the problem might even be more serious. In 2002, my own review concluded that adulteration of Chinese herbal medicines with synthetic drugs is a potentially serious problem which needs to be addressed by adequate regulatory measures. Twenty years later, we seem to be still waiting for effective regulations that protect the consumer.
Progress in medicine, they say, is made funeral by funeral!
A recent report provided a sales prognosis of the future development of the worldwide market of homeopathic products.
… Homeopathic remedies are derived from substances that come from Plant Homeopathics, minerals, or animals, such as red onion, arnica (mountain herb), crushed whole bees, white arsenic, poison ivy, belladonna (deadly nightshade), and stinging nettle. Homeopathic remedies are often formulated as sugar pellets to be placed under the tongue; they may also be in other forms, such as ointments, gels, drops, creams, and tablets. Treatments are “individualized” or tailored to each person—it is not uncommon for different people with the same condition to receive different treatments.
Due to the COVID-19 pandemic, the global Homeopathic Products market size is estimated to be worth US$ 854.4 million in 2021 and is forecast to a readjusted size of US$ 1388.8 million by 2028 with a CAGR of 7.1% during the forecast period 2022-2028…
Currently, the companies in the world that produce homeopathic products mainly concentrate in Europe, USA and India. The main market players are DHU, Nelson & Co Ltd, Hyland’s, Homeopathic, SBL and Apotheca etc, with about 14% market shares.
Europe homeopathic products is the world’s most flourishing area, homeopathic treatment sales in Europe accounted for 24%, North America area is about 16% of market share…
I feel that the agencies that publish such reports could do with a bit of proper research. This might result in fewer errors and less egg on their faces. Here are a few points that I think might need corrections:
- Homeopathics can also be produced from a complete absence of material, for instance, X-rays or vacuum.
- Some can also be injected.
- I fear that the sales predictions are far too optimistic; they fail to account for the almost worldwide realization that homeopathy is an obsolete placebo therapy.
- The market share of South American nations seems to have been forgotten.
- The worldwide main player is Boiron.
Of course, none of this is important; after all, it’s only one of those meaningless market predictions that seem to be made by looking at tea leaves rather than facts.
Am I too harsh?
I don’t think so, – not least because it is easy to find predictions that differ substantially, e.g.:
- The homeopathy market is expected to grow at a CAGR of 14.3% from 2020 to 2028
- The global homeopathy market is expected to grow at a CAGR of 6.5% during the forecast period, from 2021 to 2030.
- Goldstein Research analyst forecast the Homeopathy Product Market to grow at a CAGR of 16.8% during the forecast period 2016-2024 and attain the revenue of USD 16.2 billion by 2024.
Unimportant? Yes, except that homeopaths and their advocates (like Prince Charles, for instance) are bound to use such documents for claiming that, if millions continue to use homeopathy, it must be effective and science must be wrong. Readers of this blog got used to and can by now see through homeopaths’ fallacies – but far too many consumers still fall for them.
Novak Djokovic not only is against getting COVID vaccinations, he is also deeply into so-called alternative medicine (SCAM). Many of us have seen him winning this year’s Wimbledon final and drinking from a mysterious white bottle during Wimbledon 2022. Consequently, people are wondering: what does the white bottle contain?
‘Magic potion, that is all I can say,’ Djokovic said about the contents of the bottle ahead of the Wimbledon final after a clip went viral on Twitter. Now The Telegraph is suggesting that the ‘magic potion’ is, in fact, merely isotonic powder.
This, of course, begs the question: what is isotonic powder?
It is the powder used for making an isotonic drink that typically contains 40-80g of carbohydrate per liter. The drink then has the same osmolarity as body fluids and is therefore the most effective way to rehydrate during and following exercise. There are plenty of such products for sale. They are designed to provide the carbs and electrolytes needed to fuel exercise and replace the salts lost during sweating and maintain hydration.
It is suggested that Djokovic and some other tennis players take the powder pure without dissolving it in water. This must be jolly unpleasant, and I would not recommend it. If you want to save money, you can make an isotonic drink yourself:
- take 200ml of pineapple or other fruit juice,
- add it to 400ml of water,
- add a pinch of salt.
The pinch of salt might also come in handy if, one day, we hear that the powder Djokovic takes also contains this or that SCAM such as “peptides with specific functionality” developed by the pharmaceutical firm that Djokovic partly owns.
Today, I received an email advertising a book – nothing unusual, of course. But the book and its author are both quite unusual. Here is the text:
Dr. Farokh J. Master’s birth into homeopathy was in the year 1976, when he joined Bombay homeopathic medical college, after giving up his studies at the orthodox school of medicine. Dr Master was instrumental in starting homeopathic out-patient dept in many allopathic hospitals viz. Bombay Hospital, KEM Hospital & Ruby Hall, Pune. Besides his work as a senior Homeopath of the HHC, Dr. Farokh Master is teaching homeopathy (advanced level) at the Mumbai Homeopathic Medical College, part of Mumbai university. He is also teaching at other homeopathic colleges in India and abroad. He has given seminars in various countries like Austria, Australia, India, Japan etc…
Healing Cancer: A Homoeopathic Approach
As a homeopath one should not deter oneself in dealing with any type of cases, be it cancer. But for executing that an ultimate guidance is needed. Cancer is so much prevalent and challenging medical problem of today that a trustworthy source of accurate information becomes pertinent and this work of Dr. Farokh Master immediately propels at the top of quality books for cancer. Based on Master’s 40 years of experience this book was written for students to understand the basis of oncology and for practitioners for brushing-up of their knowledge in this growing discipline. Author says that to get a grasp on cancer cases we should believe in the potential of the homeopathic treatment, that healing from cancer refers to internal process of becoming whole and feeling harmonious with yourself and your environment.To even start with handling the cases of cancer one should be aware of understanding of cancer, its cause, pathophysiology, different types, conventional treatment and their side effects, integrative medicines, social problems in the treatment, such topics are well casted by Volume 1 of the book…• A whole chapter on Cadmium salts and cancer.• 51 “lesser known remedies” are briefly quoted and their usefulness in different situations and types of cancer exposed.• A long chapter deals with the “Indian drugs”, it is important that these remedies are used mostly in tincture or low potencies, as herbal or Ayurvedic remedies or food supplements relieving the patients. • The choice and differentiation between the remedies is then helped by the “Repertory of Cancer”, very well compiled and a highly useful section. “Clinical tips from my practice” given as a sub-chapter. • It ends with recommendations on how to deal with radiation illness and the side-effects of conventional treatment, as well as the treatment of pain and help with palliative care. For fighting and curing cancer and improving the quality and quantity of life of people, knowledge of Homeopathy, both philosophically and scientifically is needed which this work of art portrays delightfully.
__________________________
It is clear that Dr. Farokh J. Master does not suggest using homeopathy in addition to conventional cancer therapies. He foremost wants to employ it as an alternative cancer cure. It is also clear that, if his concepts were generally adopted, they could kill millions.
Some defenders of homeopathy might claim that this is not what most homeopaths would advocate; they would merely recommend homeopathy as an adjunct to conventional oncology. Yet, there are many examples to the contrary, and not just from India – after all, Hahnemann, the inventor of homeopathy, insisted that homeopathy must never be combined with ‘allopathic’ medicines.
So, the next time someone claims homeopathy to be harmless, please show them this post.
Ischemic heart disease (IHD) related to cardiovascular or cerebrovascular disease is the leading cause of mortality and an important issue of public health worldwide. The cost of long-term healthcare for IHD patients may result in a huge financial burden. This study analyzed the medical expenditure incurred for and survival of IHD patients treated with Chinese herbal medicine (CHM) and Western medicine.
Subjects were randomly selected from the National Health Insurance Research Database in Taiwan. The Cox proportional hazards regression model, Kaplan–Meier estimator, logrank test, chi-square test, and analysis of variance were applied. Landmark analysis was used to assess the cumulative incidence of death in IHD patients.
A total of 11,527 users were identified as CHM combined with Western medicine and 11,527 non-CHM users. CHM users incurred a higher medical expenditure for outpatient care within 1 (24,529 NTD versus 18,464 NTD, value <0.0001) and 5 years (95,345 NTD versus 60,367 NTD, value <0.0001). However, CHM users had shorter hospitalizations and lower inpatient medical expenditure (7 days/43,394 NTD in 1 year; 11 days/83,141 NTD in 5 years) than non-CHM users (11 days/72,939 NTD in 1 year; 14 days/107,436 NTD in 5 years).
The CHM group’s adjusted hazard ratio for mortality was 0.41 lower than that of the non-CHM group by Cox proportional hazard models with time-dependent exposure covariates. Danshen, Huang qi, Niu xi, Da huang, and Fu zi were the most commonly prescribed Chinese single herbs; Zhi-Gan-Cao-Tang, Xue-Fu-Zhu-Yu-Tang, Tian-Wang-Bu-Xin-Dan, Sheng-Mai-San, and Yang-Xin-Tang were the five most frequently prescribed herbal formulas in Taiwan.
The authors concluded that combining Chinese and Western medicine can reduce hospital expenditure and improve survival for IHD patients.
Why, you will ask, do I think that this study deserves to be in the ‘worst paper cometition’?
It is not so bad!
It is an epidemiological case-control study with a large sample size that generates interesting findings.
Agreed!
But, as a case-control study, it cannot establish a causal link between CHM and the outcomes. You might argue that the conclusions avoid doing this – “can … improve survival” is not the same as “does improve survival”. This may be true, yet the title of the article leaves little doubt about the interpretation of the authors:
Chinese Herbal Medicine as an Adjunctive Therapy Improves the Survival Rate of Patients with Ischemic Heart Disease: A Nationwide Population-Based Cohort Study
I find it difficult not to view this as a deliberate attempt of the authors, editors, and reviewers to mislead the public.
Looking at the details of the study, it is easy to see that the two groups were different in a whole range of parameters that were measured. More importantly, they most likely differ in a range of variables that were not measured and had significant influence on IHD survival. It stands to reason, for instance, that patients who elected to use CHM in addition to their standard care were more health conscious. They would thus have followed a healthier diet and lifestyle. It would be foolish to claim that such factors do not influence IHD survival.
The fact that the authors fail even to mention this possibility, interpret an association as a causal link, and thus try to mislead us all makes this paper, in my view, a strong contender for my
WORST PAPER OF 2022 COMPETITION
Chiropractors often refer their patients for full-length (three- to four-region) radiographs of the spine as part of their clinical assessment, which are frequently completed by radiographers in medical imaging practices. Overuse of spinal radiography by chiropractors has previously been reported and remains a contentious issue.
The purpose of this scoping review was to explore the issues surrounding the utilization of full-length spinal radiography by chiropractors and examine the alignment of this practice with current evidence.
A search of four databases (AMED, EMBASE, MedLine and Scopus) and a hand search of Google was conducted. Articles were screened against an inclusion/exclusion criterion for relevance. Themes and findings were extracted from eligible articles, and evidence was synthesized using a narrative approach.
In total, 25 articles were identified, five major themes were extracted, and subsequent conclusions drawn by authors were charted to identify confluent findings:
- (1) The historical integration of FLS radiography in chiropractic,
- (2) Clinical indications for FLS radiography in chiropractic,
- (3) Risks associated with FLS radiography,
- (4) Chiropractic techniques which prescribe the use of FLS radiography,
- (5) Current trends in the utilisation of FLS radiography in chiropractic.
This review identified a paucity of literature addressing this issue and an underrepresentation of relevant perspectives from radiographers. Several issues surrounding the use of full-length spinal radiography by chiropractors were identified and examined, including barriers to the adherence to published guidelines for spinal imaging, an absence of a reporting mechanism for the utilization of spinal radiography in chiropractic and the existence of a spectrum of beliefs amongst chiropractors about the clinical utility and limitations of full-length spinal radiography.
The authors concluded that this review has identified a scarcity of literature addressing the completion of chiropractor‐referred FLS X‐rays. Our review has outlined several pressing issues that warrant further investigation including a lack of quantitative measures to assess the utilisation of FLS X‐rays by chiropractors, a lack of consensus of what constitutes appropriate clinical justification for imaging and the existence of a spectrum of beliefs amongst chiropractic authors about the clinical utility and limitations of FLS radiography. This provides radiographers with a definitive opportunity to demonstrate clinical leadership in this space and seek to begin a constructive dialogue with chiropractic referrers about the risks associated with unnecessary or unjustified spinal radiography. In doing this, diagnostic radiographers as evidence‐based health practitioners can actively contribute to the conversation surrounding the issues identified by this study and can be better positioned to advocate for the interests of the discipline and the safety of their patients.
The authors of this review make a number of further relevant points:
- Between 2014 and 2015, approximately 130,000 three‐ to four‐region spinal X‐rays were performed in Australia. Most were requested by chiropractors.
- In Australia, chiropractors often request FLS X‐ray examinations by radiographers.
- A spectrum of beliefs and knowledge exists amongst chiropractic practitioners surrounding the appropriate use of FLS radiography which may not always align with the principles of evidence‐based practice.
- The risks associated with the overutilization of diagnostic imaging are well documented. Aside from the inherent risks of unnecessary exposure to ionizing radiation, increased reliance on diagnostic imaging by any practitioner in the absence of sufficient clinical justification increases economic burdens encumbered upon the health care system. As such, FLS radiography should be used judiciously to ensure risks associated with its use are minimized, thus ensuring that it remains available to chiropractors and other practitioners where its use is clinically justified.
- Imaging that is not clinically indicated also carries a risk of overdiagnosis that being the radiological diagnosis of disease which does not ultimately impact on a patient’s course of treatment.
- The use of FLS radiography by chiropractors for the detection of red flags in the absence of any significant clinical indications for imaging could be considered a practice that carries a high risk of overdiagnosis.
When I first raised the issue of chiropractic overuse of imaging in 1998, I got fiercely attacked by a gang of chiros. Each time hence that I mention the subject, chiros loudly protest, and I do, of course, understand why. Imaging gives chiros the flair of being ‘cutting edge’; more importantly, in most countries, it is an easy source of additional income.
So, I do not expect that things will be different this time. Yet, I feel that, instead of constantly trying to shoot the messenger, chiropractors might be well advised to consider the message.
