Edzard Ernst

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

Open-label placebos (OLPs) are placebos without deception in the sense that patients know that they are receiving an inert sugar pill with no activity of its own. Intuitively, we think that such treatments must be ineffective. Yet, there have been several studies that seemed to show otherwise.

The objective of this paper was to systematically review and analyze the effect of OLPs in comparison to no treatment in clinical trials. A systematic literature search was carried out in February 2020. Randomized controlled trials of any medical condition or mental disorder comparing OLPs to no treatment were included. Data extraction and risk of bias rating were independently assessed. 1246 records were screened and 13 studies were included in the systematic review. Eleven trials were eligible for meta-analysis.

These trials assessed the effects of OLPs on

  • back pain,
  • cancer-related fatigue,
  • attention deficit hyperactivity disorder,
  • allergic rhinitis,
  • major depression,
  • irritable bowel syndrome,
  • menopausal hot flushes.

The risk of bias was moderate among all studies.

figure4

A significant overall effect (standardized mean difference = 0.72, 95% Cl 0.39–1.05, p < 0.0001, I2 = 76%) of OLP. Thus, OLPs appear to be a promising treatment in different conditions. Yet, the researchers spotted several caveats and discuss them in some detail.

First, we detected hints of a publication bias in the study sample, but the respective test was not significant. The quantitative basis of the meta-analysis is based on a small number of studies, reflecting the early state of research in this field. Moreover, the set of studies showed some heterogeneity. Finally, four studies were rated to have a high risk of bias, and nine to have some concerns.

In order to assess the impact of these high-risk studies we performed an exploratory best-evidence synthesis. We excluded the four studies with a high risk of bias. In this analysis, the heterogeneity could be reduced to a non-critical value and almost all variance in the set of studies could be explained by a sampling error (I2 = 4%). With the exclusion of these four studies the mean effect size was reduced to a more conservative SMD = 0.49.

Regardless of this reduction of the overall effect, the same conclusions about the treatment-effect of OLPs can be drawn, although the lack of robustness means that interpretations require some caution. The decrease of heterogeneity shows that methodological impairments might be responsible for the considerable unexplained variance in our results. We abstained from carrying out a further sensitivity analysis for explaining heterogeneity because of the small number of studies.

This is certainly an interesting subject. And the above findings are certainly counter-intuitive.

My impression is that the effect of OLPs is small and of doubtful value in clinical practice. My prediction is that, as more and better research emerges, it will diminish further, if not vanish totally. I think that there are several reasons for this:

  • The number of trials is still quite small.
  • The studies obviously lack patient blinding.
  • Positive messages can be included alongside open-label placebos.
  • The “time lag bias” is high.

This type of bias means that, due to initial enthusiasm in a new subject, negative results are published with some delay. I have observed this bias repeatedly in the past. A new treatment initially tends to generate nothing but positive results, and only after a while, when the researchers’ euphoria has subsided, more realistic findings emerge.

Ovariohysterectomy (OH) is one of the most frequent elective surgical procedures in routine veterinary practice. The aim of this study was to evaluate analgesia with Arnica montana 30cH during the postoperative period after elective OH.

Thirty healthy female dogs, aged 1 to 3 years, weighing 7 to 14 kg, were selected at the Veterinary Hospital in Campo Mourão, Paraná, Brazil. The dogs underwent the surgical procedure with an anaesthetic protocol and analgesia that had the aim of maintaining the patient’s wellbeing. After the procedure, they were randomly divided into three groups of 10. One group received Arnica montana 30cH; another received 5% hydroalcoholic solution; and the third group, 0.9% NaCl saline solution. All animals received four drops of the respective solution sublingually and under blinded conditions, every 10 minutes for 1 hour, after the inhalational anaesthetic had been withdrawn. The Glasgow Composite Measure Pain Scale was used to analyse the effect of therapy. Analysis of variance (ANOVA) followed by the Tukey test was used to evaluate the test data. Statistical differences were deemed significant when p ≤0.05.

The results show that the Arnica montana 30cH group maintained analgesia on average for 17.8 ± 3.6 hours, whilst the hydroalcoholic solution group did so for 5.1 ± 1.2 hours and the saline solution group for 4.1 ± 0.9 hours (p ≤0.05).

The authors concluded that these data demonstrate that Arnica montana 30cH presented a more significant analgesic effect than the control groups, thus indicating its potential for postoperative analgesia in dogs undergoing OH.

I do not have access to the full article (I was fired by the late Peter Fisher from the editorial board of the journal ‘HOMEOPATHY’) which puts me in a somewhat difficult position:

  • not reporting this study could be construed as an anti-homeopathy bias,
  • and reporting it handicaps me as I cannot assess essential details.

So, if anyone has access, please send the full paper to me and I will then study it and revise this post accordingly.

Judging from the abstract, I have to say that the results seem far too good to be true. I doubt that any oral remedy can have the effect that is being described here – let alone one that has been diluted (sorry, potentised) at a rate of 1: 1000000000000000000000000000000000000000000000000000000000000. That fact alone reduces the plausibility of the finding to zero.

At this stage, I do wonder who peer-reviewed the study and ask myself whether the rough data have been checked for reliability.

Yesterday, it was reported that one of Austria’s best-known opponents of vaccination has died as a result of coronavirus infection. He vehemently refused treatment in hospital. Instead, he insisted on treating himself – and tragically, he is not an isolated case.

Miracle Mineral Solution” (MMS) is being promoted as a treatment for all kinds of diseases – including, of course, the coronavirus. But MMS is nothing more than the bleach and disinfectant chlorine dioxide, or CDL for short. It made headlines when Donald Trump suggested it as a remedy against Covid-19. Subsequently, CDL became highly popular amongst the anti-vax brigade.

Johann Biacsics was one of the leading figures of the anti-vaccination scene in Austria. On 11 November, he was seen in a Vienna hospital with an acute corona infection. At this stage, he had already taken chlorine dioxide because of fever complaints. Biacsics was, of course, not vaccinated and refused treatment. He was firmly convinced that he had already overcome the infection thanks to his treatment with chlorine dioxide.

The senior physician at the Vienna hospital saw things differently. His condition was “life-threatening”, she said. But instead of accepting treatment in hospital, Biacsics discharged himself and said he would rather treat himself. Once home, Biacsics put in an IV line with chlorine dioxide and sodium chloride. Two days later he was dead.

Only two weeks before his death, Biacsics had demonstrated in Vienna against the Austrian Corona measures. In a television interview from September, he can be seen in front of the parliament. “There are mainly vaccinated people in the intensive care units. 67 percent of them are vaccinated,” he said on camera at the time. When the reporter corrected him, he only replied that he had “inside information”.

His followers are now suggesting that he was poisoned. And for once they are, of course, correct. He basically poisoned himself with MMS. His family, meanwhile, blames the hospital and claim that he did not die of COVID, nor that Biacsics’ death is the result of treatment with chlorine dioxide.

Biacsics is not the first Austrian Covid patient who has refused treatment or used “alternative remedies”. And he is not the first who has died as a result. Self-treatment is booming among vaccination opponents and Corona deniers. It was even propagated in the Austrian parliament. For weeks, FPÖ leader Herbert Kickl (who also is COVID-positive) and his party colleagues have been promoting the deworming drug ivermectin – despite warnings from doctors, scientists, and the manufacturer.

All too often, the consequences are fatal: In Styria, two patients died from poisoning with ivermectin, in the district of Rohrbach in Upper Austria, a Corona patient left the intensive care unit in critical condition and died. He had also relied on ivermectin and refused other treatments.

 

Conspiracy beliefs are associated with detrimental health attitudes during the coronavirus pandemic. Prior research on these issues was mostly cross-sectional, however, and restricted to attitudes or behavioral intentions. This investigation was designed to examine to what extent conspiracy beliefs predict health behavior and well-being over a longer period of time.

In this multi-wave study on a large (N = 5745) Dutch research panel (weighted to provide nationally representative population estimates), the researchers examined if conspiracy beliefs early in the pandemic (April 2020) would predict a range of concrete health and well-being outcomes eight months later (December 2020).

The results revealed that Covid-19 conspiracy beliefs prospectively predicted a decreased likelihood of getting tested for corona; if tested, an increased likelihood of the test coming out positive; and, an increased likelihood of having violated corona regulations, deteriorated economic outcomes (job loss; reduced income), experiences of social rejection, and decreased overall well-being. Most of these effects generalized to a broader susceptibility to conspiracy theories (i.e. conspiracy mentality).

The authors concluded that conspiracy beliefs are associated with a myriad of negative life outcomes in the long run. Conspiracy beliefs predict how well people have coped with the pandemic over a period of eight months, as reflected in their health behavior, and their economic and social well-being.

These findings tie in with another recent study that investigated whether individual beliefs and personal characteristics differences affect people’s likelihood of contracting COVID-19. In the early months of the pandemic, U.S. participants responded to a variety of individual difference measures as well as questions specific to the pandemic itself. Four months later, 2120 of these participants were asked whether they had contracted COVID-19. Nearly all of the included individual difference measures significantly predicted whether a person reported testing positive for the virus in this four-month period. Additional analyses revealed that all of these relationships were primarily mediated by whether participants held accurate knowledge about COVID-19.

I find it hard not to despair vis a vis such results. Not that they were not to be expected – if you ignore the existence of risk factors exist for heart attacks, it seems plausible that your likelihood of dying of myocardial infarction is increased. What is particularly desolating are two facts:

  • This pandemic seems to have rendered the voices of stupidity and ignorance loud and popular, even fashionable.
  • Those lunatics who adhere to conspiracy beliefs harm not merely themselves but endanger all of us.

I ask myself how we will ever get past this new age of unreason.

Psychosocial distress, depression, or anxiety are frequent problems of women after a breast cancer diagnosis and treatment. Many try so-called alternative medicine (SCAM) in an attempt to deal with them. But is this effective?

The purpose of this study was to assess the potential benefit of lavender oil as a perioperative adjunct to improve anxiety, depression, pain, and sleep in women undergoing microvascular breast reconstruction.

This was a prospective, single-blinded, randomized, controlled trial of 49 patients undergoing microvascular breast reconstruction. Patients were randomized to receive lavender oil or a placebo (coconut oil) throughout their period of hospitalization. The effect of lavender oil on perioperative stress, anxiety, depression, sleep, and pain was measured using the hospital anxiety and depression scale, Richards-Campbell Sleep Questionnaire, and the visual analogue scale.

Twenty-seven patients were assigned to the lavender group and 22 patients were assigned to the control group. No significant differences were seen in the perioperative setting between the groups with regard to anxiety (p = 0.82), depression, sleep, or pain scores. No adverse events were noted, and no significant differences in surgery-related complications were observed. When evaluating the entire cohort, postoperative anxiety scores were significantly lower than preoperative scores, while depression scores were significantly higher postoperatively as compared with preoperatively.

The authors concluded that, in the setting of microvascular breast reconstruction, lavender oil and aromatherapy had no significant adverse events or complications; however, there were no measurable advantages pertaining to metrics of depression, anxiety, sleep, or pain as compared with the control group.

One could argue that the sample size of the trial was too low to pick up small differences in the outcome measures. Yet, even then, the findings do not suggest that the treatment did make a large enough difference to justify the effort and expense of the treatment.

One could also argue that – who cares? – if a patient wants aromatherapy (or another SCAM that is harmless), why not? The answer to this is the fact that researchers have the ethical duty to identify the most effective treatment, and clinicians have the ethical duty to employ not just any odd therapy but the one that works demonstrably best. Seen from this perspective, the place of SCAM in cancer care seems far less certain than many enthusiasts try to make us believe.

“There is a battle raging for humanity”, claims Dr Carrie Madej, a US osteopathic doctor (in the US, osteopaths are [almost] conventional physicians). She thinks she has discovered how Big Tech collaborates with Big Pharma introduced new technologies in the coming vaccines, that will alter our DNA and turn us into hybrids. This, she submits, will end humanity as we know it, and start the process of transhumanism: HUMAN 2.0 They use vaccines to inject nanotechnology into our bodies and connect us to the Cloud and artificial intelligence. This will enable corrupt governments and tech giants to control us, without us being aware of it.Image

Dr. Carrie Madej is from Dearborn, Michigan, and received her medical degree from Kansas City University of Medical Biosciences in 2001. She then completed her traditional internship at The Medical Center in Columbus, Georgia, and internal medicine residency at Mercer University in Macon Georgia. Dr. Madej served as a private clinician and medical director of clinics in Georgia until 2015. Dr. Madej also served as an attending physician for the Pennsylvania College of Osteopathic Medicine. She has served as a public speaker and was featured in the documentary, “The Marketing of Madness” about the overuse of prescription psychotropic medicines. Dr. Madej now dedicates her time educating others on vaccines, nanotechnology, and human rights via multiple platforms and speaking engagements.

IN HER NEWEST SCORCHED EARTH DISCUSSION, Dr. Carrie Madej simply Can NOT stay silent about the ABSOLUTE DANGERS of the Covid-19 “vaccines” any longer! In fact, in this SCATHING PRESENTATION, she literally describes the ‘Killer Concoctions’ as ‘THE FRANKENSTEIN CODE” and HAMMERS the ‘Purveyors of the Poison Jab’ as ‘Murdering Psychopath Witch Doctors’ who are HELL BENT on the TOTAL DESTRUCTION & ANNIHILATION of the ENTIRE HUMAN RACE, as we know it today.

The ‘Kung Flu’ (as it’s been referred to by none other than POTUS Trump), is only ‘KILLING PEOPLE who are already suffering from cancer, diabetes, heart disease and a plethora of other autoimmune problems’ – so now WHY IN THE WORLD IS EVERYBODY being told to get the ‘Killer Jab’ when the risk of DIRE & GROTESQUE INJURY FAR OUTWEIGHS the risk of dying from Covid-19 or the fake Delta Variant, or Beta, or Gamma or WHATEVER ELSE THE DEMONIC FAUCI & GATES CONCOCT NEXT?! Get ready for a BEATING unlike you’ve seen in recent days, as Dr. Madej RIPS THE THROATS straight out of these Deep State Demons in this ‘DO NOT MISS’ Epic Video! Grab the popcorn, and get ready for a trip down the Rabbit Hole and a takedown of Satan’s Army!

This was published by the ‘REPUBLIC BROADCASTING NETWORK’ (RBN) who also published articles such as ‘Who are the Jews behind the coronavirus vaccines?

Dr. Carrie Madej is certainly no fan of COVID vaccines: Doctor Carrie Madej says she personally examined multiple vials of the vaccines that are being forced into people’s arms, and she was horrified by what she saw. She says she cried harder than she ever has before. Elsewhere she explained in detail:

“First it looked just translucent. And then as time went on, over two hours, colors appeared. I had never seen anything like this. There wasn’t a chemical reaction happening. It was a brilliant blue, and royal purple, yellow, and sometimes green,” she said.

She later shared that when she asked nanotech engineers what the emerging brilliant colors might come from, the engineers said the “only thing they knew that could do that” was a white light, over time, causing a reaction on “a super-conducting material.” In this case, Madej noted, white light came from the microscope itself.

She pointed out that an example of a super-conducting substance would be “an injectable computing system.”

Madej went on, “These fibers were appearing more and more. Some of the fibers had a little cube structure on them, I’m not sure what that was. And also metallic fragments were in there. They were not metallic fragments I’m used to seeing. They were exotic. They were very opaque.”

In time, Madej said, “all the particulates, all these colors started moving to the edge” of the cover slide. “There was self-assembling going on, things were growing. They looked synthetic.”

Madej noticed something else quite strange: “There was one particular object or organism, I’m not sure what to call it, that had tentacles coming from it. It was able to lift itself up off of the glass slide. It appeared to be self-aware, or to be able to grow or move in space.”

She found it disturbing but said she thought, “Maybe that was a fluke in a way, maybe that was just that one vial.”

Some time later, the same lab obtained more vials from a different batch of Moderna shots, as well as a J&J vial. Madej was concerned to see the same things she had observed in the first vial.

“Another one of those tentacle-like structures appeared,” she said. “This was now completely under the cover slip, so there was no movement because it wasn’t on the edge, but I just couldn’t believe I saw another one. Same thing.” Madej also saw the “same colors” appear over time, as well as the fibers.

In the J&J vial, Madej said, there was “definitely a substance that looked like graphene. They all had graphene-like structures in there. Whether or not they were, I don’t have the capability of testing them in order to know at this lab, but that’s what they appeared to be.”

The vial’s contents also had “fatty substances, a sticky glue-like substance that would be considered a hydrogel in those, both of them.”

The J&J vial “also had colors appear.” “Their colors were different, like a fluorescent pastel kind of color. Again, a lot of synthetic structures in there as well.” Madej also noticed many “spherical ring structures” in the J&J contents.

“I’ve never seen anything like this before. They’re not supposed to be in these injections. What are they going to do to somebody? What are they going to do to a child? I started crying when I saw these the second time under a microscope, because it was confirmation of everything I saw the first time,” Madej said.

Madej again appeared on the Stew Peters show on October 20 to discuss her findings from a Pfizer jab vial as well as another J&J vial. “What I’m seeing in all of these manufacturers are synthetic substances, graphene-like, also these nano-carbon tubes,” Madej said.

“In this particular J&J” vial, Madej saw “round spheres, which were not air bubbles.” She continued, “There’s many of these rings, and as time went on they would get thinner and thinner and expand out and then finally extrude out some gelatinous material — I’m not sure what it was, but different kinds of things were inside these spheres. So they’re almost like a delivery structure, that’s what they were doing.”

On one of these rings, Madej saw what “looked like a translucent organism that went around, and back and forth.” Madej first “thought it was another water parasite,” but after continuing to observe its movements, “thought perhaps it was moving in a more robotic way.”

Madej saw the “same kind of synthetic things” in the Pfizer jab, as well as “something that looks similar to teslaphoresis. That’s when these little graphite-like black, metallic particles start to coalesce into strings, like a spider web. They do that through any external force — it could be light, it could be a magnetic force, it could be an impulse, like a frequency. Anyhow, all these little particles would then coalesce and form their own neural network, or their own fibers, or wires.”

After listening to Madej’s findings and seeing the photo and video documentation she provided, Peters commented, “It’s like I’m watching a seriously bad B-movie, a horror thriller.”

Madej believes the tentacled entity she found in the Moderna jabs has a connection with the organism hydra vulgaris. “It is one of the model organisms that the transhumanists like to study and look at. They feel that this is an amazing organism for humanity,” said Madej, in part because “it’s immortal in the lab setting” and “continuously produces its own stem cells.”

“It never stops. You can chop it up into little bits, put it in a petri dish and it forms itself again and again,” she continued. “They’re thinking, wouldn’t this be great if we could put this inside of a human body’s genome, and then if your hand was chopped off by a trauma, you could grow a new hand.”

My friend Joe Schwarcz recently wrote a brilliant article about Dr. Madej. He concluded by asking:  Is Dr. Madej a maddeningly malicious malfeasant, or does she just have a few loose marbles? I fear that it might be both.

This review summarized the available evidence on so-called alternative medicine (SCAM) used with radiotherapy. Systematic literature searches identified studies on the use of SCAM during radiotherapy. Inclusion required the following criteria: the study was interventional, SCAM was for human patients with cancer, and SCAM was administered concurrently with radiotherapy. Data points of interest were collected from included studies. A subset was identified as high-quality using the Jadad scale. Fisher’s exact test was used to assess the association between study results, outcome measured, and type of SCAM.

Overall, 163 articles met inclusion. Of these, 68 (41.7%) were considered high-quality trials. Articles published per year increased over time. Frequently identified therapies were biologically based therapies (47.9%), mind-body therapies (23.3%), and alternative medical systems (13.5%). Within the subset of high-quality trials, 60.0% of studies reported a favorable change with SCAM while 40.0% reported no change. No studies reported an unfavorable change. Commonly assessed outcome types were patient-reported (41.1%) and provider-reported (21.5%). The rate of favorable change did not differ based on the type of SCAM or outcome measured.

The authors concluded that concurrent SCAM may reduce radiotherapy-induced toxicities and improve quality of life, suggesting that physicians should discuss SCAM with patients receiving radiotherapy. This review provides a broad overview of investigations on SCAM use during radiotherapy and can inform how radiation oncologists advise their patients about SCAM.

In my recent book, I have reviewed the somewhat broader issue of SCAM for palliative and supportive care. My conclusions are broadly in agreement with the above review:

… some forms of SCAM—by no means all— benefit cancer patients in multiple ways… four important points:
• The volume of the evidence for SCAM in palliative and supportive cancer care is currently by no means large.
• The primary studies are often methodologically weak and their findings are contradictory.
• Several forms of SCAM have the potential to be useful in palliative and supportive cancer care.
• Therefore, generalisations are problematic, and it is wise to go by the current best evidence …

One particular finding of the new review struck me as intriguing: The rate of favorable change did not differ based on the type of SCAM. Combined with the fact that most studies are less than rigorous and fail to control for non-specific effects, this indicates to me that, in cancer palliation (and perhaps in other areas as well), SCAM works mostly via non-specific effects. In other words, patients feel better not because the treatment per se was effective but because they needed the extra care, attention, and empathy.

If this is true, it carries an important reminder for oncology: cancer patients are very vulnerable and need all the empathy and compassion they can get. Seen from this perspective, the popularity of SCAM would be a criticism of conventional medicine for not providing enough of it.

Neck pain affects a vast number of people and leads to reduced quality of life and high costs. Clinically, it is a difficult condition to manage, and the effect sizes of the currently available treatments are moderate at best. Activity and manual therapy are first-line treatment options in several guidelines. But how effective are they really?

This study investigated the combination of home stretching exercises and spinal manipulative therapy in a multicentre randomized controlled clinical trial, carried out in a multidiscipline range of primary care clinics.

The treatment modalities utilized were spinal manipulative therapy combined with home stretching exercises compared to home stretching exercises alone. Both groups received 4 treatments for 2 weeks. The primary outcome was pain, where the subjective pain experience was investigated by assessing pain intensity (NRS – 11) and the quality of pain (McGill Pain Questionnaire). Neck disability and health status were secondary outcomes, measured using the Neck Disability Indexthe EQ-5D, respectively.

One hundred thirty-one adult subjects were randomized to one of the two treatment groups. All subjects had experienced persistent or recurrent neck pain the previous 6 months and were blinded to the other group intervention. The clinicians provided treatment for subjects in both groups and could not be blinded. The researchers collecting data were blinded to treatment allocation, as was the statistician performing data analyses. An intention-to-treat analysis was used.

Sixty-six subjects were randomized to the intervention group, and 65 to the control group. For NRS – 11, a B-coefficient of – 0,01 was seen, indication a 0,01 improvement for the intervention group in relation to the control group at each time point with a p-value of 0,305. There were no statistically significant differences between groups for any of the outcome measures.

Four intense adverse events were reported in the study, three in the intervention group, and one in the control group. More adverse incidents were reported in the intervention group, with a mean pain intensity (NRS-11) of 2,75 compared to 1,22 in the control group. There were no statistically significant differences between the two groups.

The authors concluded that there is no additional treatment effect from adding spinal manipulative therapy to neck stretching exercises over 2 weeks for patients with persistent or recurrent neck pain.

This is a rigorous and well-reported study. It suggests that adjuvant manipulations are not just ineffective for neck pain, but also cause some adverse effects. This seems to confirm many previously discussed investigations concluding that chiropractors do not generate more good than harm for patients suffering from neck pain.

The effectiveness of manipulation versus mobilization for the management of spinal conditions, including cervicogenic headache, is conflicting, and a pragmatic approach comparing manipulation to mobilization has not been examined in a patient population with cervicogenic headache.

This study evaluated the effectiveness of manipulation compared to mobilization applied in a pragmatic fashion for patients with cervicogenic headache.

Forty-five (26 females) patients with cervicogenic headache were randomly assigned to receive either pragmatically selected manipulation or mobilization. Outcomes were measured at baseline, the second visit, discharge, and 1-month follow-up. The endpoints of the study included the Neck Disability Index (NDI), Numeric Pain Rating Scale (NPRS), the Headache Impact Test (HIT-6), the Global Rating of Change (GRC), the Patient Acceptable Symptoms Scale (PASS). The primary outcome measures were the effects of treatment on disability and pain. They were examined with a mixed-model analysis of variance (ANOVA), with treatment group (manipulation versus mobilization) as the between-subjects variable and time (baseline, 48 hours, discharge, and follow-up) as the within-subjects variable.

The interaction for the mixed model ANOVA was not statistically significant for NDI (p = 0.91), NPRS (p = 0.81), or HIT (p = 0.89). There was no significant difference between groups for the GRC or PASS.

The authors concluded that manipulation has similar effects on disability, pain, GRC, and cervical range of motion as mobilization when applied in a pragmatic fashion for patients with cervicogenic headaches.

Essentially, this study is an equivalence trial comparing one treatment to another. As such it would need a much larger sample size than the 45 patients enrolled by the investigators. If, however, we ignored this major flaw and assumed the results are valid, they would be consistent with both manipulation and mobilization being pure placebos.

I can imagine that many chiropractors find this conclusion unacceptable. Therefore, let me offer an alternative: both approaches were equally effective. Therefore, mobilization, which is associated with far fewer risks, is preferable. This means that patients suffering from cervicogenic headache should see an osteopath who is less likely to use manipulation than a chiropractor.

And again, I can imagine that many chiropractors find this conclusion unacceptable.

The complex links between so-called alternative medicine (SCAM) and the pandemic have been a regular subject on this blog. Here is more:

This study investigated if people’s response to the official recommendations during the COVID-19 pandemic is associated with conspiracy beliefs related to COVID-19, a distrust in the sources providing information on COVID-19, and an endorsement of SCAM.

The sample consisted of 1325 Finnish adults who filled out an online survey advertised on Facebook. Structural regression analysis was used to investigate whether:

1) conspiracy beliefs, a distrust in information sources, and endorsement of SCAM predict people’s response to the non-pharmaceutical interventions (NPIs) implemented by the government during the COVID-19 pandemic,

2) conspiracy beliefs, a distrust in information sources, and endorsement of CAM are related to people’s willingness to take a COVID-19 vaccine.

The results indicate that individuals with more conspiracy beliefs and lower trust in information sources were less likely to have a positive response to the NPIs. Individuals with less trust in information sources and more endorsement of SCAM were more unwilling to take a COVID-19 vaccine. Distrust in information sources was the strongest and most consistent predictor in all models. In addition, the analyses revealed that some of the people who respond negatively to the NPIs also have a lower likelihood to take the vaccine. This association was partly related to lower trust in information sources.

The authors concluded that distrusting the establishment to provide accurate information, believing in conspiracy theories, and endorsing treatments and substances that are not part of conventional medicine, are all associated with a more negative response to the official guidelines during COVID-19. How people respond to the guidelines, however, is more strongly and consistently related to the degree of trust they feel in the information sources than to their tendency to hold conspiracy beliefs or endorse CAM. These findings highlight the need for governments and health authorities to create communication strategies that build public trust.

I also believe that these findings highlight the urgent need for improvements in education. In my view, it should start at school and continue into adult life. It should focus on a better understanding of science and – crucially – on the ability to differentiate facts from fiction and conspiracies.

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