bias
This open-label, randomized, controlled trial was aimed to assess the effectiveness and safety of Vuong Hoat (VH) natural health supplement for reducing the negative impact of low back pain, improving the quality of life, and enhancing functional activities in patients with lumbar degenerative disc disease (LDD).
The study involved 60 patients suffering from low back pain caused by LDD. The participants were randomly assigned to:
- a study group (SG) comprising 30 subjects who received VH in conjunction with the same electro-acupuncture,
- a control group (CG) comprising 30 subjects who received treatment with electro-acupuncture.
These treatments lasted for 28 days.
The clinical progression and tolerability of both groups were compared based on seven objective measurements:
- visual analog scale index,
- Schober test,
- fingertip-to-floor distance,
- spinal flexion,
- spinal extension,
- spinal tilt,
- spinal rotation.
Already after 14 days of treatment, the SG showed a significant improvement in overall outcomes compared to the CG. Specifically, 43.3% of SG patients achieved very good results, 53.3% had good results, and 3.4% had moderate results, whereas corresponding figures for the CG were 6.7%, 76.7%, and 16.6%, respectively (P < .05).
After 28 days of treatment, both groups demonstrated a shift toward very good results, with the SG continuing to show better outcomes than the CG (P < .05). In the SG, the very good results increased to 76.7%, good results decreased to 20%, and moderate results were 3.3%. On the other hand, the CG had 46.7% very good results, 43.3% good results, and 10% moderate results. Notably, no side effects were reported from the VH treatments during the study.
The authors concluded that their findings of this study indicate that VH health supplement is a safe and effective approach for managing low back pain and limited spinal movement in patients with LDD.
I have several concerns and questions, some are trivial others are not:
- What does VH contain? I have no free access to the actual paper but even the abstract should mention this information.
- How do the investigators know that low back pain was caused by LDD? Lots of people have LDD without pain and vice versa.
- The A+B vs B design is known to produce false positive results due to its failure to control for placebo effects; why not use a placebo (which would have been very easy in this case)?
- Contrary to the authors statement, the outcome measures are NOT objective.
- It seems highly implausible that no side effects of VH occurred. Even placebos cause side-effects in ~6% of all cases.
- Conclusions about safety are NEVER warranted based on just 30 patients.
- Why does an allegedly respectable journal publish such rubbish?
Chronic back pain is a prevalent and debilitating condition, significantly impacting quality of life and functional independence. While conventional interventions, including physical therapy and pharmacological treatments, are commonly utilized, complementary practices like yoga are increasingly explored for their potential benefits in pain management and functional improvement.
This scoping review aimed to assess the existing evidence on the effectiveness of yoga compared to conventional interventions in reducing pain and back-related disability in older adults, highlighting key findings and identifying gaps for future research. The review followed the Arksey and O’Malley scoping review framework, systematically searching databases including PubMed, Scopus, and Web of Science. Studies were included if they:
- (1) involved older adults (aged 60 and above),
- (2) compared yoga with conventional back pain interventions,
- (3) measured outcomes related to pain intensity and back-related disability,
- (4) were published in peer reviewed journals.
A thematic analysis was performed to identify common findings, trends, and research gaps in the literature.
Twenty-four studies met the inclusion criteria, including randomized controlled trials, cohort studies, and observational research. Findings generally support the efficacy of yoga in reducing pain and disability among older adults, with many studies demonstrating comparable or superior results to conventional physical therapy interventions. Yoga was associated with additional benefits in psychological well-being, flexibility, and balance, which were less frequently addressed by conventional treatments. However, the studies varied in intervention types, duration, and measurement tools, limiting cross-study comparisons. Few studies examined long-term outcomes, highlighting a need for further longitudinal research.
The authors concluded that this evidence suggests that yoga is a viable alternative or adjunct to conventional back pain interventions in older adults, offering potential benefits for pain reduction, functional mobility, and quality of life. Despite these promising findings, the heterogeneity of studies and lack of long-term data indicate a need for further high-quality research to establish standardized protocols and evaluate sustained effects. Future studies should focus on randomized controlled designs with consistent measures to better inform clinical guidelines on integrating yoga into back pain management for older adults.
“Yoga is a viable alternative or adjunct to conventional back pain interventions”?
Really?
Based on what precisely?
We cannot know, because the paper does not even reference the primary studies. Nor does it provide essential details about them. Nor does it reveal what the ‘conventional interventions’ were. Nor does it address the problem of bias or methodological quality of the primary studies.
What we do know is that some (but not how many) uncontrolled studies were included. This means that the evidence is likely to be flimsy indeed.
It is, of course, possible that some form of yoga is an effective therapy for back pain but the above paper does not come anywhere near proving this hypothesis. Personally, I suspect that most treatments that include an element of exercise might be marginally helpful, but somehow doubt that one is dramatically better than the next.
The Internet is increasingly used as a primary source of information for patients. Many private physiotherapy practices provide informative content on low back pain (LBP) and neck pain (NP) on their websites, but the extent to which this information is biopsychosocial, guidelines-consistent, and fear-inducing is unknown. The aim of this study was to analyse the information on websites of private physiotherapy practices in the Netherlands about LBP and NP regarding consistency with the guidelines and the biopsychosocial model and to explore the use of fear-inducing language.
The content of all existing Dutch private physiotherapy practice websites was examined in a cross sectional study design. Content analysis was based on predetermined criteria of the biopsychosocial model and evidence-based guidelines. Descriptive statistics were applied.
After removing duplicates and sites without information, 834 (10%) of 8707 websites remained. Information about LBP was found on 449 (54%) websites and 295 (35%) websites informed about NP. A majority of websites (LBP: n = 287, 64%; NP: n = 174, 59%) were biomedically oriented. Treatment advice was given 1855 times on n = 560 (67%) websites. Most of the recommended interventions were inconsistent with or not mentioned in the guidelines. Fear-inducing language was provided n = 1624 (69%) times.
The interventions that were inconsistent with the guidelines included several so-called alternative medicine (SCAM) options, including:
- dry needling (for LBP),
- medical tape (for LBP),
- trigger point therapy (for LBP),
- dry needling (for NP),
- trigger point therapy (for NP).
The authors concluded that their study shows that most Dutch private physiotherapy practice website are not a reliable source of information for patients with LPB and NP. The Dutch physiotherapy community needs to take action to comprehensively review and update the information on their websites to align with high‐quality best practice recommendations and guidelines for LBP and NP. It is important to strive for better information for patients to reduce fear, to support them in making better recovery choices, to achieve less disability, and to improve their quality of life.
To be honest, I would never have expected Dutch private physiotherapy practice website to be a reliable source of information for patients with LPB and NP. In general, private websites from healthcare practitioners are not reliable sources for anything, as we have so often seen on this blog. They are promotional by nature and have the purpose of boosting business.
I fear that the only thing positive I can say about the private physiotherapy practice websites is that they are not nearly as bad as those of:
- acupuncturists,
- aromatherapists,
- chiropractors,
- energy healers,
- herbalists,
- homeopaths,
- naturopaths,
- osteopath,
- reflexologists,
- etc, etc.
(If you need evidence for these bold statements, please look through the last 3 000 posts of this blog.)
As misinformation can cause untold harm, we need to ask: what is the solution to this problem? I think it’s disarmingly simple: for health-related information, stay away from websites that are evidently promotional by nature!
This blog is now almost 13 years old. In well over 3 000 (!) posts, I have been trying to alert consumers to the things that are wrong with much of so-called alternative medicine (SCAM). In this new series of posts entitled ‘WHAT HAPPENED NEXT? …’ I intend to re-visit some of my early posts and ask: WHAT HAPPENED NEXT?
This might show us
- what has changed,
- what has remained the same
- and what needs to change.
Here we go:
In my blog post of 17/12/2012 about Craniosacral Therapy (CST) I concluded that:
1) ineffective therapies, such as CST, may seem harmless but, through their ineffectiveness, they constitute a serious threat to our health;
2) bogus treatments become bogus through the false claims which are being made for them;
3) seriously flawed studies can be worse than none at all: they generate false positive results and send us straight up the garden path.
Almost 13 years after writing this, I fear that the notion ‘SCAM MAY BE INEFFECTIVE BUT IT CANNOT DO ANY HARM!’ is still as popular as it was before. Equally, the dismal quality of research into SCAM is still a problem. And, of course, CST is still around with unsupported, often dangerous claims.
So, has anything changed at all?
I am not sure.
If nothing much has changed, what does that mean for me, my motivation and this blog?
When I started my blog I already had ~20 years experience in full-time SCAM research. If that experience had taught me anything at all, it was not to expect too much. SCAM is a most resistant phenomenon. I don’t see my blog as an instrument for abolishing SCAM (an outright impossibility, in my view). I prefer to think of it as a means of damage limitation.
Having said all this, I must admit that the often dismal quality of research and the tolerance of pseudoscience by journal editors and consumers do disappoint me. But my conclusion is not to give up and resign but to work a bit harder trying my best to prevent harm!
Removing the chest tube in cardiac patients after surgery is one of the worst experiences of hospitalization in the intensive care units. Various pharmacological and non-pharmacological methods are available to control pain in these patients. This study aimed to investigate the combined effect of reflexology massage and respiratory relaxation on pain following chest tube removal in cardiac surgery patients of Shahid Beheshti Hospital in Shiraz, Iran, in 2023.
The study was a double-blind randomized clinical trial performed on 140 patients who underwent heart surgery and had a chest tube in Shiraz, Iran. The samples were randomly divided into four groups:
1- control group,
2- respiratory relaxation group,
3- foot reflex massage group,
4- a combination of respiratory relaxation and reflexology massage.
To collect data, two demographic questionnaires, and a visual analog scale were used.
The participants of the 4 groups were not meaningfully different in terms of age, BMI, duration of surgical operation, gender, job, education, place of residency, number of chest tubes, history of operation (P = 0.99, 0.31, 0.06, 0.81, 0.97, 0.96, 0.17, 0.10, 0.89 respectively).
The mean scores of pain intensity during chest tube removal, and 15 min after chest tube removal were not statistically different among the 4 groups. However, just after chest tube removal, the mean scores of pain intensity differed meaningfully among four groups (P = 0.008).
The authors concluded that the results showed that reflexology massage and respiratory relaxation both reduce pain immediately after chest tube removal in heart surgery patients. Also, the combination of these two techniques was more effective in reducing patients’ average pain.
Double blind?
Really?
How did they do that?
Here is their description:
“For the blinding purpose of the study, a nurse who worked at the ICU had to record the pain intensity and the data, so the possible researcher bias did not impact the results. Also, the patients knew the concept of the study but did not know that there were whether in single relaxation groups or mixed methods groups and did not know that other patients had different methods used for them. Also, the pain intensity data for the control group was routinely checked by the nurses, and along with the fact that they had no information that some of the patients were in the intervention groups and received complementary and alternative therapies, therefore, their data were also considered blinded. Therefore, the study could have their initial aim to use the double-blinded design.”
Double blind usually means that the therapist and the patient were masked as to the group alloca. Blinding the nurse is fine, but the therapists were not blind and could therefore have influenced the patients via verbal and non-verbal communications.
According to the authors, patients did not know whether they were “in single relaxation groups or mixed methods groups”. I think that cannot be true. Even if it were, what about the control group? Surely every patient knows whether or not he/she receives a reflexology massage!
It follows, I think, that the study was NOT double-blind, not even single-blind!
Does that matter?
Yes!
Firstly, I don’t want to be misled in this way.
Secondly, as blinding did not happern, the findings can be explaind by the effects of patient expectation and might therefore NOT be the result of the therapies. In other words, the conclusions drawn by the authors are not warranted.
This study evaluated the recurrence of acute upper respiratory tract infections (aURTI) and the number of antibiotic prescriptions within 12-month follow-up in patients prescribed with either homeopathic medicines or medicines from one of four conventional medication classes for aURTI therapy.
This explorative cohort study used real-world electronic healthcare data from the Disease Analyzer database (IQVIA). Included were patients of all ages from Germany with an index diagnosis of a URTI between 2010 and 2018, who had prescriptions for either homeopathic, conventional cough & cold, nasal, or throat medicines, or nonopioid analgesics on the day of diagnosis or within six days afterwards. URTI recurrences were assessed by multivariable logistic regression, the number of antibiotic prescriptions by multivariable negative binomial regression.
From 3,628,295 patients with aURTI diagnosis initially identified in the database in the relevant time interval, a total of 610,118 patients, fulfilling the in- and not violating the exclusion criteria, were retained for analysis. In the multivariate analyses on all patients, prescriptions of nasal medicines were associated with a significant, slightly higher (OR: 1.18, CI: 1.10-1.26, p<0.001) risk of aURTI recurrence compared to homeopathic medicines within 12 months. Prescriptions of cough & cold (OR: 0.92, CI: 0.86-0.97, statistically significant, p=0.005) as well as throat medicines (OR: 0.93, CI: 0.86-1.01, p=0.086), and nonopioid analgesics (OR: 0.95, CI: 0.89-1.02, p=0.181) were associated with slightly lower risk of aURTI recurrence compared to homeopathic medicines. In the analysis of the age-dependent subgroups, there were some deviations from the overall population in terms of statistical significance; however, the directions of the effect estimates were unchanged. Almost all results of negative binomial regression analyses assessing differences in the frequency of antibiotic prescriptions during follow-up, both in all patients and in the age-dependent subgroups were statistically significant in favor of homeopathic medicines.
The authors concluded that the study demonstrated that follow-up recurrence and antibiotic prescriptions in patients with uncomplicated aURTI are at least comparable between patients treated with homeopathic and conventional medicines in real-world practice. Despite some methodological limitations inherent to the used database, the results of this study indicate that homeopathic medicines present a valuable therapeutic option for managing aURTI.
This study has a long list of fatal or near-fatal flaws:
- The patients who received homeopathic prescriptions surely differed in many ways from those who had conventional prescriptions.
- Information on medicines used without prescription were not accounted for.
- There is no way of telling who took the prescibed medicines and who did not.
- The database does not contain information on the severity or duration of the URTIs.
- The database does not contain information on socioeconomic status and lifestyle-related
risk factors such as smoking, alcohol consumption or physical activity. - URTI recurrences were not verified, and the primary outcome measure is thus not reliable.
- The observation of patients is limited to a single practice each. Patients who initially consulted a homeopaths and suffered a recurrence might have gone to consult a conventional doctor. In this case, their recurrence was not registered.
- Most patients self-prescribe medicines for URTIs; this phenomenon was not accounted for.
- The lower use of antibiotics and other conventional drugs in one group merely shows that 1) homeopaths tend to avoid these medications, 2) patients who consult homeopaths often reject conventional drugs.
So, does the study provide any useful information?
No!
Why was it conceived, conducted and published then?
The conflict of interest and funding statements give us a clue:
- NB has received a fee from Deutsche Homöopathie-Union for providing advice during preparation of the manuscript. SDJ and SN are employees of Deutsche Homöopathie-Union, TR is employee of Dr. Willmar Schwabe GmbH & Co.KG.
- The analysis of the available data from Disease Analyzer Database by IQVIA was commissioned and funded by Deutsche Homöopathie-Union (DHU-Arzneimittel GmbH & Co. KG. 76227 Karlsruhe, Germany).
So, what does all this amount to:
- A flawed study?
- Pseudoscience?
- Scientific misconduct?
- Fraud?
Please let me know.
Do you remember the case of Katie May who died “as the result of visiting a chiropractor for an adjustment, which ultimately left her with a fatal tear to an artery in her neck”?
Here is the abstract:
A 34-year-old female suffered a fatal stroke 7.5 h after cervical spine manipulation (CSM) performed by a chiropractic physician. Imaging noted vertebral artery dissection (VAD), basilar artery occlusion, and thromboembolic stroke. The medical examiner opined that CSM caused the VAD which embolized to cause the fatal stroke. However, causation of VAD by CSM is not supported by the research.
We utilized an intuitive approach to causation analysis to determine the cause of the VAD and the stroke. Causation of the VAD and the stroke by CSM could not be established as more likely than not. The malpractice case was settled by bringing allegations of misdiagnosis and failure to diagnose and refer the VAD to medical emergency.
We conclude that in the absence of convincing evidence that CSM could cause VAD, forensic professionals should consider VAD as a presenting symptom prior to CSM in such cases. Adherence to the standard of care for the chiropractic profession with attention to differential diagnosis could prevent such cases.
The author states that the objectives of this case report were to:
- Perform a forensic analysis to determine the most likely causal mechanism of the VAD.
- Perform a forensic analysis to determine the most likely causal mechanism of the stroke.
- Perform a medicolegal analysis of the standard of care with the aim of determining how this case could have been prevented, and how future such cases could be prevented.
There are, as far as I can see, at least three major problems with these objectives:
- The author is not qualified as a forensic analyst.
- He is merely a chiro (and acupuncturist) with a massive conflict of interest.
- Neither does he seem to be medically nor legally qualified for doing a medicolegal analysis (Dr. Brown received his undergraduate degree in Philosophy and History from Illinois State University in 1989. He went on to attend one semester of Law school at California Western School of Law in San Diego.)
The author even states that his information was taken from publicly available court documents. Background information was taken from publicly available investigative journalism and media coverage of this case. Any information that has not been made public is not reflected in this analysis. Images of the forensic microscopic review of the vertebral arteries were not available for review.
So, how valuable is chiro Brown’s medicolegal second opinion?
Do Chiropractors Break Necks? This is an interesting question. “Dr.” Greg Malakoff (Chiropractor/Neurologist, Board Certified) provided the following answer (never mind that he seems to mean ‘do chiros cause strokes?’):
… The total disinformation that seems to be republished monthly on the news concerning chiropractors and strokes is based on a study performed in the 1950’s, that has been totally discredited. However, students these days are rather lazy and every time a meta analysis is performed on this old study it reaches all the news stations because their main sponsors are drug companies and they don’t want you having the opportunity to get well without their products. A meta analysis is simply someone reading the old study, and writing a book report on it.
If they were to actually study what has been discovered since the 1950’s, which is a tremendous amount of valid scientific research, not one done on a cadaver and deliberately making false conclusions, they would discover a few things, that I feel you should know.
The typical stroke victim if they survive has stroke posture, which consists of the arm being flexed and a lower leg extended. That would be a whole lot of brain damage, but we don’t see the entire motor strip damaged on brain scans. We typically see just a small area with an infarct. That area is the internal capsule. Picture a vase with all it’s stems entering into the narrow portion of it. All the neurons in the brain that leave it from different areas of the motor cortex with long nerves that go to innervate the muscles that you want to move are exiting through this narrow opening called the internal capsule.
Why is that important to know if you ever want a chance at being healthy? The arteries in the back of your neck, called the vertebral arteries do not go there, they do not go to the internal capsule where we see the stroke damage. That part of the brain is being fed by the carotid arteries that are in the front of your neck. That means the chiropractor is not the problem, we are not affecting those arteries. Case closed.
However, there is a type of more severe stroke related to the back of the neck arteries called vertebral artery dissection. These arteries feed the brain stem and the vital centers in there. The vital centers are what keep you breathing and your heart beating. That means, that I have never been sued by a victim of this because they are going to be dead before they get off of the table. That doesn’t happen, well it hasn’t happened to me or just about any other chiropractor. People can get this type of artery damage, but it is proven to be practically impossible to tear those arteries by a chiropractic adjustment. It would require hundreds of pounds of force to tear those arteries with a chiropractic adjustment. So unless your chiropractor is the size of a Polar Bear, there is a good chance you are remaining sick or in pain for no reason at all.
I know, what about that playboy model who died from the chiropractor that she went to? The incompetent medical examiner said that was the cause, but apparently he and all the media don’t read well. She had fallen and hurt the arteries in her neck a month earlier. The E.R. didn’t bother to do an ultrasound Doppler study of her arteries and if they had, they might have realized that she was injured more severely. Instead, she sought help for her neck pain a month later from a chiropractor. Most chiropractors do not have ultrasound Doppler equipment in their office. Neither do most urgent medical care centers. In this case, the adjustment aggravated the severe insult that she had sustained a month earlier. Perhaps he is guilty of taking for granted that the E.R. had done it’s job properly. She should never have been released from the E.R.
While it was all over the news everyday, every hour of every day for weeks, just how often does something like this occur? You are more likely to get blown up out of the sky by a terrorist, and as you are falling to earth still in your seat, get struck by lightning and shot and stabbed by terrorists that have parachuted out of another plane to make sure they had finished their job. However, they too get struck by lightning and you fall to the ground safely where you are now eaten by a land shark.
With that in mind, millions of people are suffering daily for decades because they are afraid of a chiropractic adjustment. This is the safest and most powerful form of treatment known to modern medical science. The number 3 leading cause of death in America is from medicine. Compare that to the one woman that died from a chiropractor in Canada. The case is kind of famous because that was the case that had Chiropractic outlawed in a province. The patient was obese, smoked, was diabetic, and took birth control pills. She had died of a stroke a month after going to the chiropractor. She was the perfect storm of walking disease and as I stated earlier, if the chiropractor was to have caused the stroke, she was not walking out of his office.
There are millions of dollars to be made off of your medical misery. You being sick helps fuel our economy. However, if you want the opportunity to be healthy it can’t be achieved with a lifestyle of drugs. Chiropractors have been labeled back pain doctors, but we are really brain doctors. Our treatment affects your brain and your brain is responsible for creating good health. If you are a drug company, then you would want people to be sick and miserable enough to buy your product. If you are sick and tired of being sick and tired your best chance of not staying that way is to visit a chiropractor. Don’t let all the disinformation keep you miserable and unhealthy.
___________________
I find Malakoff’s answer relevant nnot least because it demonstrates a few points that are important:
- Some chiros call themselves doctors and manage to fool consumers in assuming that they are medically competent.
- Some even call themselves neurologists, it seems.
- They are the exact opposite of competent.
- They understand neither science, nor medicine, nor the methodologies used.
- They have misunderstood so much about [patho)physiology that it’s frightening to think they treat ill people.
- Despite all this they love to use pseudo-scientific language.
- They use it to impress and to white-wash their quackery and the chiropractic profession.
- They have an unrealistic view about the value of chiropractic.
- They are in denial about the risks of spinal manipulation.
- They are consumed by conspiracy theories without even attempting to provide evidence in their support.
On this blog, we have repeatedly noticed that Indian researchers of homeopathy as good as never publish negative findings. A recent paper entitled “Efficacy of homoeopathic therapy in cancer treatment” seems to falsify this hypothesis. Here is its full abstract:
In order to boost their immune system, enhance their mental and physical health, and reduce the discomfort associated with cancer and conventional therapies, many cancer patients turn to homoeopathic methods. Because these very watered-down therapies have no discernible mechanism of action, homoeopathy is quite contentious. The purpose of this study is to provide a concise summary and critical analysis of the effectiveness of homoeopathic medicines in cancer treatment, whether used alone or in conjunction with other therapies. The following databases have been used for literature searches: Amed (beginning in 1985), CINHAL (beginning in 1982), EMBASE (beginning in 1974), Medline (beginning in 1951), and CAMbase (beginning in 1998). This review included data from randomised and non-randomized controlled clinical studies that involved cancer patients or those with a history of cancer who received either a single homoeopathic treatment or a combination of treatments. The trials were evaluated for their methodological quality using the Jadad score. Our inclusion criteria were satisfied by six research, five of which were randomised clinical trials and one of which was not; nevertheless, the methodological quality of these investigations varied, with some exhibiting high standards. There is not enough evidence to establish homoeopathic therapy’s clinical effectiveness in cancer treatment, according to our review of the relevant literature.
Yes, there are a few things that one might criticize here. For instance efficacy is not the same as effectiveness and the conclusion could be clearer, in my view, e.g. stating “there is no reliable evidence to suggest that homeopathy is an effective cancer treatment.” Yet, on the whole, this paper is remarkable considering its country of origin.
It comes from the “Department of homeopathic, Kakatiya University Warangal” in India. I tried to find the department but only found the university. In the realm of healthcare, this institution seems to have an emphasis on pharmacy. Perhaps that explains a lot?
In any case, I am delighted that some progress seems to be emerging now even in India regarding its research on homeopathy.
PROGRESS AT LAST?
A new paper with the promising title “Chiropractic Care in Children: A Review of Evidence and Safety” caught my attention. Here is its full abstract:
Complementary therapies are used to treat many pediatric symptoms and health conditions, and chiropractic care is one of the most commonly used forms of complementary therapies by children and adolescents. Research studies have investigated the evidence behind and safety of chiropractic care in pediatrics with various musculoskeletal and non-musculoskeletal conditions. There are limited data with a range of findings and often no definite conclusion. Despite the paucity of evidence of benefits of chiropractic care in children, the considerations around safety, and the differing opinions regarding pediatric chiropractic practice inside and outside the field, many pediatric patients visit chiropractors, and chiropractors often care for pediatric patients. Pediatric health care providers should discuss the use of all complementary therapies with patients, so guidance can be optimal with a focus on promoting health and safety.
Specifically on safety the authors state this:
Many pediatricians are concerned about the safety of chiropractic care in their patients. There are little data on adverse events from chiropractic care, but serious adverse events are rare. Unlike the high-velocity, low-amplitude thrust manipulations used with adults, most techniques used in pediatric patients are gentle, low-force, and appear to be safe. According to a 2015 review study of 31 articles, serious adverse events in infants and children receiving chiropractic care are rare, and no deaths had been reported. However, significant adverse events have been documented with chiropractic care in pediatric patients such as subarachnoid hemorrhage, recurrent stroke, paraplegia, severe headache, and midback soreness as well as delays of diagnosis and inappropriate use of chiropractic care for severe illness.
I find it regrettable that the authors fail to mention the lack of a monitoring system and instead make the categorical claim: “serious adverse events are rare”. How do they know?
Regarding another important issue, ethics, the authors state this:
The ethics of using chiropractic care in children is complex, particularly due to the lack of robust scientific evidence regarding its safety and efficacy. Ethical considerations must prioritize every child’s well-being, ensuring that care is based on the best available evidence. However, since there is very limited funding for chiropractic care research, robust studies are rarely performed. Informed consent is crucial. Parents need clear communication of potential risks, benefits, and alternatives. Using unproven treatments in children may risk harm, whether physical or by diverting resources away from more effective interventions. In addition, the fact that some chiropractors hold anti-vaccine views adds another ethical layer, as it can undermine public health efforts and influence parents away from proven, life-saving interventions. However, respecting parents’ autonomy in making health care decisions for their children is important, provided that they are fully informed of the evidence and possible outcomes. Pediatric health care professionals must weigh all these factors carefully as they guide their patients and families.
I find this passage also slightly odd:
- The authors confirm that there is a lack of robust scientific evidence regarding its safety and efficacy. And in the nexy sentence they state that care must be based on the best available evidence. Would it not be more ethical to be blunt and suggest that employing chiropractic care for kids is ethically questionable in the absence of sound data?
- The authors also say that very only limited funding for chiropractic care research is available and therefore robust studies are rarely performed. To me, this looks like an excuse and an attempt to white-wash this situation. Would it not be more ethical to be blunt and suggest that the burden for funding and conducting the research is on the chiros and failing this challange amounts to unethical behavior?
My most important criticism of this new “Review of Evidence and Safety” is that its title implies a broad and laudable aim that its methodology cannot even nearly fulfill. The paper contains no methods section at all. Thus the authors are at liberty to pick and choose the evidence for review that they like – and this is precisely what they did. The review is based on carefully cherry-picked evidence. It thus is an apt example of what is wrong with the entire field of chiropractic: it is an area that is based on wishful thinking, very poor science and a denial of the most obvious facts.
