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

bias

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A long article on chiropractic casts doubt that chiropractic is useful. Here is an abbreviated version of it:

The chemistry and biology graduate from the University of Georgia, 28-year-old Caitlin Jensen, visited a chiropractor to sort out her lower back pain. During the session, the therapist performed an adjustment.  It severed four arteries in her neck. She collapsed shortly after, unable to speak or move. The injury had caused her to suffer a series of strokes. Today, she has regained some movement in her head, legs and arms but she is still unable to speak, is partially blind and relies on a wheelchair.

While shocking and extreme, experts say Caitlin’s story is evidence of the risks of chiropractic. And although such cases are rare, they are not unheard of. Yet despite these risks, the treatment has only become more popular recently. Currently it is being driven by a social media craze for videos of chiropractors manipulating spines to make terrifying cracking sounds. The more brutal the crack, the higher the views.
And now chiropractors in the UK are pushing for their services, which are largely private, to be rolled out on the NHS. According to a report commissioned by the British Chiropractic Association, employing chiropractors in the health service could save £1.5 billion and cut physiotherapist waiting lists. Last week The Mail on Sunday’s GP columnist Dr Ellie Cannon expressed concerns over the safety of the scheme, writing that she was worried that the forceful manipulation of the body involved can be dangerous, causing serious injuries. Dr Cannon asked readers for their own experiences – and was flooded with responses. Scores claimed they’d found relief from joint pain and other issues thanks to a chiropractor, when nothing else worked. Yet, disturbingly, among these were accounts from those who’d suffered horrific injuries.
  • One 66-year-old grandmother said a visit to a chiropractor to treat her sore shoulder left her covered in bruises, hearing ringing in her ears and with a splitting pain in her jaw. She was later diagnosed by doctors with trigeminal neuralgia – a chronic pain disorder caused by a trapped or irritated nerve in the neck that causes sudden, electric shock-like pain in the face. She believes the condition – which, three years later, still sometimes leaves her unable to open her mouth wide enough to speak to her grandchildren – was triggered by a chiropractic adjustment of her neck.
  • A 55-year-old woman was left with chronic neck and shoulder pain after visiting a chiropractor for a sore back. The pain was so bad she once spent 72 hours immobile and unable to sleep despite taking a concoction of painkillers.
  • And a 66-year-old man says his back went into spasm as he was leaving his first chiropractor appointment – which left him hospitalised and bedbound for weeks. The intense treatment, he later learned, had pushed one of the discs of his spine out of place, causing him to lose feeling in his right leg for ever.
In the UK, several film and TV shows – including Love Island – have bragged of having a resident chiropractor on set. And the number of British chiropractors has risen by more than 60 per cent in the past four years, according to regulatory board the General Chiropractic Council.
Orthopaedic surgeon Dr Simon Fleming worries that vulnerable patients are turning to chiropractors without knowing its risks. He says: ‘It’s not that there aren’t safe chiropractors, it’s that there’s such a high risk of potentially doing harm. Adults can make their own choices – but if they want to go down that route, we need to ensure they do it with their eyes open.’
The NHS currently lists neck, back, shoulder and elbow pain as issues that can be treated with chiropractic – adding that there’s little evidence it can help with more serious conditions, or problems that don’t affect the muscles or joints. It warns: ‘There is a risk of more serious problems, such as stroke, from spinal manipulation.’
Chiropractic is not widely available on the health service, other than in exceptional circumstances where no other options, such as physiotherapy, are available. But a report released by the University of York last week called for the practice to be brought under the NHS in order to cut the number of patients with musculoskeletal issues waiting for physiotherapy. And according to Mark Gurden, president of the Royal College of Chiropractors, it will help the NHS more generally by offering up a skilled and competent workforce during a national staffing crisis. ‘It’s a profession just like physiotherapy is a profession, and can offer a range of interventions that include both soft tissue techniques and spinal manipulation,’ he says. ‘Chiropractors are regulated healthcare professionals who undergo four-years training and must be registered with the General Chiropractic Council. It’s an entirely safe procedure when done by competent professionals.’
Edzard Ernst, emeritus professor of complementary medicine at the University of Exeter and author of ‘Chiropractic: Not All That It’s Cracked Up To Be‘, says hundreds of patients have suffered a stroke after getting their necks manipulated – with some dying from the damage. Recent instances include the tragic case of 29-year-old Joanna Kowalczyk, who suffered a fatal tear of her blood vessels after having her neck adjusted by a chiropractor, as well as Playboy model Katie May, 34, who died after getting the treatment for a pinched nerve in her neck sustained during a photoshoot. And Professor Ernst believes even more patients may have sustained injuries than we know of.
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You might be interested in what I actually wrote in response to the questions posed by the journalist from the ‘Mail-online’. Here are his questions (Q) and my replies (R), both unabbreviated:
Q: Should chiropractic treatment be available on the NHS?
R: The NHS cannot even pay for all effective therapies; as chiropractic is of at best doubtful effectiveness, it should, in my view, not be reimbursed by the public purse.
Q: Are chiropractic therapies dangerous? If so, why?
R: Chiropractors manipulate the spine of virtually every patient. These manipulations often move the spine beyond its physiological range of motion and can thus cause severe structural damage.
Q: Are all chiropratic adjustments risky? Or just those that involve certain areas of the body (ie, neck)?
R: The neck is, of course, particularly vulnerable; but damage can occur along the entire spine.
Q: Equally, is it a case of some chiropractors just not being very good at their jobs?
R: Some chiropractors are surely more dangerous than others. Yet none are risk-free.
Q: I’ve seen stories of awful injuries / deaths at the hands of a chiropractor. But if the practice is so risky why don’t we see more injuries than we do?
R: There is no reporting system of side effects of chiropractic – so, if we don’t look, we don’t see.
Q: Lots of our readers have written in to say it’s helped massively with their pain or other ailment. Can it have any positive effect on our health and wellbeing?
R: True some people swear by chiropractic. But let’s not forget that having your bones cracked is bound to have a considerable placebo response.
Q: Should babies be getting chiropractic adjustments?
R: Most definitely no!
Q: Are some people more prone to injury from these treatments than others?
R: Yes, some people may, for instance, have fragile arteries that then might burst when the neck is being forcefully manipulated.
Q: What do you think needs to happen to reform the chiropractic industry?
R: If it wants to be called a valuable form of healthcare, chiropractic needs to abide by the principles of evidence-based medicine. In other words, it needs to demonstrate through rigorous research that it does more good than harm and for which condition. At present, chiropractic is very far from having achieved this. And that means, I fear, that it should not be part of rational healthcare.
_______________________
I am glad that, these days, I usually insist on doing interviews with journalists via email

Qi-gong is a branch of Traditional Chinese Medicine that employs meditation, exercise, deep breathing and other techniques with a view of strengthening the assumed life force ‘qi’ and thus improving health and prolong life. Qi-gong has ancient roots in China and has recently also become popular in other countries. There are several distinct forms of qi-gong which can be categorized into two main groups, internal qi-gong and external qi-gong. Internal qi-gong refers to a physical and mental training method for the cultivation of oneself to achieve optimal health in both mind and body. Internal qi-gong is not dissimilar to tai chi but it also employs the coordination of different breathing patterns and meditation. External qi-gong refers to a treatment where qi-gong practitioners direct their qi-energy to the patient with the intention to clear qi-blockages or balance the flow of qi within that patient. According to Taoist and Buddhist beliefs, qi-gong allows access to higher realms of awareness.

The assumptions of qi-gong are not scientifically plausible. But this does not stop enthusiasts to submit it to clinical trials.

A quasi-experimental pretest-posttest study was conducted with 231 adolescent girls aged 13-17 years suffering from premenstrual syndrome (PMS). Participants underwent a 4-week Qi Gong therapy program, with five 45-minute sessions weekly. Data were collected using a demographic questionnaire and Modified PMS Scale, analysing pre- and post-intervention symptoms through descriptive statistics, paired t-tests and chi-square tests.

The intervention significantly reduced PMS severity, with mild PMS cases increasing from 48 (20.78%) to 166 (71.86%) post-intervention. Paired t-tests revealed a highly significant mean difference in PMS scores (T = 12.251, p < 0.001).

The authors concluded that Qi Gong therapy offers a holistic, non-invasive approach for managing PMS by addressing both physiological and emotional dimensions to the condition. Its ability to balance hormones, alleviate stress and improve overall quality of life makes it a valuable addition to PMS care. 

This study originated from the Department of Obstetrics and Gynecological Nursing, Nootan college of Nursing, Sankalchand Patel university, Visnagar, Gujarat, India; the Department of Pediatric Nursing of the same institution and the Department of Psychiatric Nursing of the same institution. One would have hoped that its authors know better than to draw such conclusions from such a study. Here are some points of concern:

  • There is no reason why the treatment should be holistic.
  • The study did not have a control group; causal inferences are thus not waarranted.
  • The study did not produce any evidence to show that the treatment addressed either physiological or emotional dimensions.
  • The study did not produce any evidence to show that the treatment did anything to hormones.
  • The study did not produce any evidence to show that the treatment alleviated stress.
  • The study did not produce any evidence to show that the treatment improved quality of life.
  • I see no resason why the treatment should be promoted as a valuable addition to PMS care.
  • The PMS severity changed after the treatment and not necessarily because of it.
  • The true reasons it changed might be multifold, e.g.: placebo, regression towards the mean, social desirability.
  • Misleading the public by drawing far-reaching conclusions has the potential to do untold harm.

I have said it often, and it saddens me to have to say it again:

If the quality of research into so-called alternative medicine (SCAM) does not improve dramatically, nobody can blame the public to not take SCAM seriously any more.

Robert F. Kennedy Jr. (RFK Jr.), America’s anti-vaxer in-chief, famously claimed his brain has been eaten by a worm. While this assumption is as ridiculous as the man himself, the actions and delusions of RFK Jr. seem almost to confirm that something fundamental must be wrong with his intellectual abilities.

Recently he said that he will be working to get cell phones out of schools. “Cell phones produce electric magnetic radiation, which has been shown to do neurological damage to kids when it’s around them all day … It’s also been shown to cause cellular damage and even cancer … Cell phone use and social media use on the cell phone has been directly connected with depression, poor performance in schools, suicidal ideation, and substance abuse … The states that are doing this have found that it is a much healthier environment when kids are not using cell phones in schools.”

There are two separate issues here:

  • Limiting children’s use of cell phones might be – for several (not health-related) reasons –  a reasonable idea.
  • The assumption that cell phones cause the type of damage that RFK Jr. claimed is nonsense.

There is plenty of evidence on the subject, some more reliable than others. The most reliable data do not support what RFK Jr. claims. Here are a few systematic reviews on the subject:

A recent systematic review included 63 aetiological articles, published between 1994 and 2022, with participants from 22 countries, reporting on 119 different E-O pairs. RF-EMF exposure from mobile phones (ever or regular use vs no or non-regular use) was not associated with an increased risk of glioma [meta-estimate of the relative risk (mRR) = 1.01, 95 % CI = 0.89-1.13), meningioma (mRR = 0.92, 95 % CI = 0.82-1.02), acoustic neuroma (mRR = 1.03, 95 % CI = 0.85-1.24), pituitary tumours (mRR = 0.81, 95 % CI = 0.61-1.06), salivary gland tumours (mRR = 0.91, 95 % CI = 0.78-1.06), or paediatric (children, adolescents and young adults) brain tumours (mRR = 1.06, 95 % CI = 0.74-1.51), with variable degree of across-study heterogeneity (I2 = 0 %-62 %). There was no observable increase in mRRs for the most investigated neoplasms (glioma, meningioma, and acoustic neuroma) with increasing time since start (TSS) use of mobile phones, cumulative call time (CCT), or cumulative number of calls (CNC). Cordless phone use was not significantly associated with risks of glioma [mRR = 1.04, 95 % CI = 0.74-1.46; I2 = 74 %) meningioma, (mRR = 0.91, 95 % CI = 0.70-1.18; I2 = 59 %), or acoustic neuroma (mRR = 1.16; 95 % CI = 0.83-1.61; I2 = 63 %). Exposure from fixed-site transmitters (broadcasting antennas or base stations) was not associated with childhood leukaemia or paediatric brain tumour risks, independently of the level of the modelled RF exposure. Glioma risk was not significantly increased following occupational RF exposure (ever vs never), and no differences were detected between increasing categories of modelled cumulative exposure levels.

Another recent systematic review included 5 studies that reported analyses of data from 4 cohorts with 4639 participants consisting of 2808 adults and 1831 children across three countries (Australia, Singapore and Switzerland) conducted between 2006 and 2017. The main source of RF-EMF exposure was mobile (cell) phone use measured as calls per week or minutes per day. For mobile phone use in children, two studies (615 participants) that compared an increase in mobile phone use to a decrease or no change were included in meta-analyses. Learning and memory. There was little effect on accuracy (mean difference, MD -0.03; 95% CI -0.07 to 0.02) or response time (MD -0.01; 95% CI -0.04 to 0.02) on the one-back memory task; and accuracy (MD -0.02; 95%CI -0.04 to 0.00) or response time (MD -0.01; 95%CI -0.04 to 0.03) on the one card learning task (low certainty evidence for all outcomes). Executive function. There was little to no effect on the Stroop test for the time ratio ((B-A)/A) response (MD 0.02; 95% CI -0.01 to 0.04, very low certainty) or the time ratio ((D-C)/C) response (MD 0.00; 95% CI -0.06 to 0.05, very low certainty), with both tests measuring susceptibility to interference effects. Complex attention. There was little to no effect on detection task accuracy (MD 0.02; 95% CI -0.04 to 0.08), or response time (MD 0.02;95% CI 0.01 to 0.03), and little to no effect on identification task accuracy (MD 0.00; 95% CI -0.04 to 0.05) or response time (MD 0.00;95% CI -0.01 to 0.02) (low certainty evidence for all outcomes). No other cognitive domains were investigated in children. A single study among elderly people provided very low certainty evidence that more frequent mobile phone use may have little to no effect on the odds of a decline in global cognitive function (odds ratio, OR 0.81; 95% CI 0.42 to 1.58, 649 participants) or a decline in executive function (OR 1.07; 95% CI 0.37 to 3.05, 146 participants), and may lead to a small, probably unimportant, reduction in the odds of a decline in complex attention (OR 0.67;95%CI 0.27 to 1.68, 159 participants) and a decline in learning and memory (OR 0.75; 95% CI 0.29 to 1.99, 159 participants). An exposure-response relationship was not identified for any of the cognitive outcomes.

A 2022 systematic review concluded that the body of evidence allows no final conclusion on the question whether exposure to RF EMF from mobile communication devices poses a particular risk to children and adolescents.

That RFK Jr. spouts BS almost every time he opens his mouth should be an embarrassment to all US citizens. For the rest of the world, it is more than that. In fact, it is fast becoming a serious concern: sooner or later, his insane delusions will affect public health on a global scale!

The primary aim of this ‘mixed-methods, feasibility pilot study’ was to evaluate the feasibility of providing Reiki at a behavioral health clinic serving a low-income population. The secondary aim was to evaluate outcomes in terms of patients’ symptoms, emotions, and feelings before and after Reiki.
The study followed a pre-post experimental design. Reiki was offered to adult outpatients at a community behavioral health center in Rochester, Minnesota. Patients with a stable mental health diagnosis completed surveys before and after the Reiki intervention and provided qualitative feedback. Patients were asked to report their ratings of:
  • pain,
  • anxiety,
  • fatigue,
  • feelings (eg, happy, calm)

on 0- to 10-point numeric rating scales. Data were analyzed with Wilcoxon signed rank tests.

Among 91 patients who completed a Reiki session during the study period, 74 (81%) were women. Major depressive disorder (71%), posttraumatic stress disorder (47%), and generalized anxiety disorder (43%) were the most common diagnoses. The study was feasible in terms of recruitment, retention, data quality, acceptability, and fidelity of the intervention. Patient ratings of pain, fatigue, anxiety, stress, sadness, and agitation were significantly lower, and ratings of happiness, energy levels, relaxation, and calmness were significantly higher after a single Reiki session.
The authors concluded that the results of this study suggest that Reiki is feasible and could be fit into the flow of clinical care in an outpatient behavioral health clinic. It improved positive emotions and feelings and decreased negative measures. Implementing Reiki in clinical practice should be further explored to improve mental health and well-being.
One might have expected better science from the Mayo Clinic, Rochester; in fact, this is not science at all; it’s pure pseudo-science! Here are some critical remarks:
  • What on earth is a ‘mixed-method, feasibility, pilot study’? A hallmark of pseudo-researchers seems to be that they think they can invent their own terminology.
  • There is no objective, validated outcome measure.
  • The conclusion that ‘Reiki is feasible‘ has been known and does not need to be tested any longer.
  • The conclusion that ‘Reiki improved positive emotions and feelings and decreased negative measures’ is false. As there was no control group, these improvements might have been caused by a whole lot of other things than Reiki – for instance, the extra attention, placebo effects, regression towards the mean or social desirability.
  • The conclusion that ‘implementing Reiki in clinical practice should be further explored to improve mental health and well-being’ is therefore not based on the data provided. In fact, as Reiki is an implausible esoteric nonsense, it is a promotion of wasting resources on utter BS.

Does it matter?

Why not let pseudo-scientists do what they do best: PSEUDO-SCIENCE?

I think it matters because:

  • Respectable institutions like the Mayo Clinic should not allow its reputation being destroyed by quackery.
  • The public should not be misled by charlatans.
  • Patients suffering from mental health problems deserve better.
  • Resources should not be wasted on pseudo-research.
  • ‘Academic journals like ‘Glob Adv Integr Med Health’ have a responsibility for what they publish.
  • ‘The ‘Academic Consortium for Integrative Medicine & Health‘ that seems to be behind this particular journal claim to be “the world’s most comprehensive community for advancing the practice of whole health, with leading expertise in research, clinical care, and education. By consolidating the top institutions in the integrative medicine space, all working in unison with a common goal, the Academic Consortium is the premier organizational home for champions of whole health. Together with over 86 highly esteemed member institutions from the U.S., Australia, Brazil, Canada and Mexico, our collective vision is to transform the healthcare system by promoting integrative medicine and health for all.” In view of the above, such statements are a mockery of the truth.

 

On this blog, we have discussed all sorts of so-called alternative medicine (SCAM) but only rarely we scrutinize any of the many gadets and devices that are being promoted under the SCAM umbrella. Therefore, I will in future try to fill this gap.

This study investigated the effects of a magnetic pain relief patch (MPRP) on gait variability in adults. In 10 young men and women, MPRP was attached to 18 bilateral lower limb muscle areas (biceps femoris, gastrocnemius medialis, gastrocnemius lateralis, rectus femoris, soleus, semitendinosus, tibialis anterior, vastus medialis, and vastus lateralis) for 24 hours. Gait parameters collected from the accelerometer sensor were ground contact time, cadence, stance phase, swing phase, double support, stride length, and swing width, and were analyzed as gait variability. Data analysis was performed using the Wilcoxon signed-rank test.
Significant differences were found in the left and right gait cycle time coefficient of variation (CV) (p=0.047 in left, p=0.028 in right), cadence CV (p=0.047 in left and right), and double support CV (p=0.028 in left and right) before and after attachment of the MPRP.

The author concluded that MPRP enhances gait variability and can be utilized as a potential tool to complement noninvasive pain management and rehabilitation strategies. However, further studies are required to prove the long-term benefits and optimal application protocol of MPRP use.

My interpretation is very different!

The author of the paper, Do-Youn Lee from the College of General Education, Kookmin University, Seoul, Republic of Korea, urgently needs some general education. He claims that “several studies have demonstrated the potential benefits of magnetotherapy to relieve pain”. As he quotes our systematic review on the subject, he must know that this statement is not quite true:

Background: Static magnets are marketed with claims of effectiveness for reducing pain, although evidence of scientific principles or biological mechanisms to support such claims is limited. We performed a systematic review and meta-analysis to assess the clinical evidence from randomized trials of static magnets for treating pain.

Methods: Systematic literature searches were conducted from inception to March 2007 for the following data sources: MEDLINE, EMBASE, AMED (Allied and Complementary Medicine Database), CINAHL, Scopus, the Cochrane Library and the UK National Research Register. All randomized clinical trials of static magnets for treating pain from any cause were considered. Trials were included only if they involved a placebo control or a weak magnet as the control, with pain as an outcome measure. The mean change in pain, as measured on a 100-mm visual analogue scale, was defined as the primary outcome and was used to assess the difference between static magnets and placebo.

Results: Twenty-nine potentially relevant trials were identified. Nine randomized placebo-controlled trials assessing pain with a visual analogue scale were included in the main meta-analysis; analysis of these trials suggested no significant difference in pain reduction (weighted mean difference [on a 100-mm visual analogue scale] 2.1 mm, 95% confidence interval -1.8 to 5.9 mm, p = 0.29). This result was corroborated by sensitivity analyses excluding trials of acute effects and conditions other than musculoskeletal conditions. Analysis of trials that assessed pain with different scales suggested significant heterogeneity among the trials, which means that pooling these data is unreliable.

Interpretation: The evidence does not support the use of static magnets for pain relief, and therefore magnets cannot be recommended as an effective treatment. For osteoarthritis, the evidence is insufficient to exclude a clinically important benefit, which creates an opportunity for further investigation.

Our systematic review did evidently not stop the author to do his own study – good for him!

But what a study it is!!!

Alert readers will have noticed that the study has no control group. Others might have remarked that the notion of static magnets of this kind doing anything meaningful to our bodies lacks plausibility. Thus the observed effects cannot possibly attributed to the magnet therapy. Most likely they are due to the considerable attention the volunteers received.

Some might argue that such gadgets do no harm – so, why not use them? I would disagree with this notion. Firstly, they cost money and thus harm the finances of gullible consumers. Secondly, they distract people from effective treatments and thus have the potential to prolong the suffering of patients.

In view of all this, I feel I should rewrite the conclusions as follows:

Attention can improve pain and enhance gait variability. MPRP is neither biologically plausibe nor has it been shown to be clinically effective. Responsible clinicians should stop using MPRP and employ effective treatments instead. Future research on MPRP must be categorized as a waste of resources.

Thanks to Trump and his administration, US science is descending into chaos. Federal grants are being frozen, Scientists are getting fired and are leaving the US in droves, the NIH is under threat, crucial meetings are being postponed indefinitely and anti-science increasingly dominates the agenda of the White House.

US Universities are forced to cut back offers of admission for graduate students. Many have stopped hiring as the Trump administration threatens to take away federal money over their handling of a wide range of issues. Meanwhile, JD Vance does not miss an occasion to insult Europeans and to lecture us about free speach. The whole scenario is so utterly bizarre that it seems to originate from a 3rd class science fiction film.

Back in July 2024, when JD Vance first launched his attack on universities, I pointed out that fascist movements are known to be notoriously anti-intellectual and anti-science. Adolf Hitler said he regretted that his regime still had some need for its “intellectual classes,” otherwise, “one day we could, I don’t know, exterminate them or something.” And the ‘bon mot’, “when I hear the word culture, I reach for my gun”, is attributed even to several of the top Nazis of the Third Reich.

At the time, my comparison to fascist regimes may have seemed exaggerated to some. Now it is fairly obvious to all but the most deluded that it was spot on. Those who are not afraid of what Trump and his sycophants are doing to science are simply not listening!

In response to the multiple threats to science, ‘Stand Up for Science‘ organized demonstrations of scientific communities throughout the US. The central event took place in Washington, D.C. on March 7, 2025, with approximately 2,000 participants in attendance. Parallel demonstrations occurred in more than 30 additional U.S. cities, with international solidarity events reported in several countries, including over 30 locations in France.

Several universities in Europe and elsewhere have also reacted; they are busy putting programmes in place to receive scientists who are fleeing the US. The consequence will inevitably be a significant ‘brain drain’ that will haunt the US for decades to come.

This study investigated the impact of spirituality and SCAM (so-called alternative medicine) use on perceptions of vaccine harmfulness, with a focus on COVID-19 and mandatory childhood vaccinations. Additionally, it examined whether spirituality indirectly influences vaccine hesitancy through SCAM use and beliefs in conspiracies.

A cross-sectional probability-based survey was conducted with over 1300 participants from South Tyrol, Italy, in 2023, using the GrAw-7 (Gratitude/Awe) scale as a measure of the experiential aspect of non-religious spirituality. Statistical analysis encompassed Spearman’s correlation and linear regression to assess the associations between spirituality and vaccine perceptions. A mediation model was applied to evaluate the role of spirituality in shaping attitudes towards vaccination.

The results show that higher experiential spirituality was associated with increased perceived harmfulness of COVID-19 and mandatory childhood vaccinations. Spirituality as well as perceived harmfulness of COVID-19 vaccination and mandatory childhood vaccination were correlated with age, increased SCAM utilisation and conspiracy ideation, while institutional distrust was solely associated with vaccine scepticism but not with spirituality; well-being and altruism were only associated with spirituality. Mediation analysis revealed that experiential spirituality accounted for a modest but significant portion of the influence of SCAM use and conspiracy thinking on vaccine perceptions.

The authors concluded that their study underscores the association between experiential spirituality and vaccine perceptions, particularly among individuals with a predisposition towards SCAM and those who exhibit conspiracy-related beliefs, highlighting the intricate relationships without implying causation. While spirituality does not appear to directly hinder vaccine uptake, it correlates with heightened perceptions of vaccine risks, particularly within contexts where alternative health practices and distrust in mainstream medical authorities are prevalent. This relationship emphasises that people who score high on spiritual awareness may be indirectly influenced to differ from others with respect to vaccination attitudes by promoting scepticism towards vaccine safety and efficacy. Even if we cannot change the spirituality of people, we know now that we can address information campaigns not only by attempting to build trust but also by addressing information to people preferring SCAM use and being spiritual at once. We think that this result is an important insight when focusing vaccine campaigns on vaccine-hesitant persons. These findings emphasise the importance of incorporating spiritual awareness, convictions, and beliefs into public health communication strategies. To address vaccine hesitancy within spiritually inclined populations, public health campaigns could explore framing vaccination in ways that resonate with values such as community care, personal responsibility, or altruism while ensuring that these messages are tailored to the diverse beliefs and perspectives of these groups. Moreover, collaboration with spiritual and community leaders could serve as a strategy to strengthen vaccine acceptance in populations that perceive health through a spiritual perspective. Future research should further explore the interactions between spirituality, SCAM use, and beliefs in conspiracies, with an emphasis on understanding how spirituality mediates health behaviours in culturally and religiously diverse contexts. Longitudinal studies and analyses across broader demographic groups are necessary to generalise these findings and refine public health interventions aimed at addressing spirituality-linked vaccine hesitancy.

My interpretation of these findings is that they confirm what we have repeatedly discussed here: There is a link between SCAM use and vaccination hesitance. It most likely is due to a cross-correlation: a certain mindset (that includes spirituality and several other phenomena) influences the distrust in vaccinations as well as the use of SCAM (and other things like, for instance, the belief in conspiracy theories).

Measles had been declared eliminated from the US in 2000. Now the disease is back with a vengeance. In February, an unvaccinated Texan child became the first person in a decade to die from measles in the US. Another death occurred in New Mexico.

The reason for the outbreak is simple: the uptake of the measles vaccine dropped below the 95% rate that is necessary for herd immunity. In the region where the current outbreak began, only 82% of the kids were vaccinated. This triggered the outbreak and, in turn, might mean that the US will lose its ‘measles elimination status’.

Only days after his appointment, Trump pledged to withdraw the United States from the World Health Organization and to drastically cut the US Agency for International Development. Both moves are likely to cause more cases of measles and similarly vaccine-preventable diseases in the US and around the world. To make matters worse, Trump administration has fired hundreds of workers from the US Centers for Disease Control and Prevention (CDC).

And to make matters even worse, Trump appointed Robert F. Kennedy Jr., one of the US most deluded antivaxer. Since being appointed, Kennedy has downplayed the importance of the current measles outbreak, postponed a meeting of the CDC vaccine advisers, made statements like “vaccinations are over-rated” and claimed that good nutrition and treatment with vitamin A as ways to reduce measles severity. He even praised the benefits of cod liver oil as a measure against measles. “There are adverse events from the vaccine,” Kennedy said in a March 11 interview. “It does cause deaths every year. It causes all the illnesses that measles itself causes, encephalitis and blindness, et cetera. And so people ought to be able to make that choice for themselves.” Further confirming his cluelessness Kennedy also stated: “When you and I were kids, everybody got measles, and measles gave you … lifetime protection against measles infection. The vaccine doesn’t do that… The vaccine wanes 4.5% per year.”

But Kennedy does not just propagate BS in interviews, he also plans to investigate whether vaccines cause autism — an assumption that has been discredited ad nauseam. A spokesperson for the US Department of Health and Human Services (DHHS) said: “The rate of autism in American children has skyrocketed. CDC will leave no stone unturned in its mission to figure out what exactly is happening.”

Meanwhile in Texas, some parents, who evidently believe Kennedy’s deluded nonsense, are giving unvaccinated children vitamin A, which, of course, is toxic at high doses.

This systematic review was aimed at assessing whether spinal manipulative therapy (SMT) procedures (i.e., target, thrust, and region) impacted on pain and disability for adults with spine pain.

The investigators searched PubMed and Epistemonikos for systematic reviews indexed up to February 2022 and conducted a systematic search of 5 databases (MEDLINE, EMBASE, CENTRAL [Cochrane Central Register of Controlled Trials], PEDro [Physiotherapy Evidence Database], and Index to Chiropractic Literature) from January 1, 2018, to September 12, 2023. They included randomized clinical trials (RCTs) from recent systematic reviews and newly identified RCTs published during the review process and employed artificial intelligence to identify potentially relevant articles not retrieved through our electronic database searches. The authors included RCTs of the effects of high-velocity, low-amplitude SMT, compared to other SMT approaches, interventions, or controls, in adults with spine pain. The outcomes were spinal pain intensity and disability measured at short-term (end of treatment) and long-term (closest to 12 months) follow-ups. Risk of bias (RoB) was assessed using version 2 of the Cochrane RoB tool. Results were presented as network plots, evidence rankings, and league tables.

The researchers included 161 RCTs (11 849 participants). Most SMT procedures were equal to clinical guideline interventions and were slightly more effective than other treatments. When comparing inter-SMT procedures, effects were small and not clinically relevant. A general and nonspecific rather than a specific and targeted SMT approach had the highest probability of achieving the largest effects. Results were based on very low- to low-certainty evidence, mainly downgraded owing to large within-study heterogeneity, high RoB, and an absence of direct comparisons.

The authors concluded that there was low-certainty evidence that clinicians could apply SMT according to their preferences and the patients’ preferences and comfort. Differences between SMT approaches appear small and likely not clinically relevant.

What does that mean?

It means that it is largely irrelevant which form of SMT is being used; the outcomes are more or less independet of the technique that is applied. You don’t need to be particularly skeptical to go one step further and conclude that:

  • The percieved effectiveness of SMT compared to other treatments is due to a placebo effect which is likely to be strong with a therapy involving touch, cracking bones, etc.
  • The effects of different types of SMT are all similar because these interventions are little more than theatrical placebos.
  • Since these placebos can cause consideraable harm, their risk/benefit balance is not positive.
  • Because their risk/benefit balance fails to be positive, SMT cannot be recommended as a treatment in routine care.

This study was aimed at investigating how Spanish media reinforce a positive image of dietary supplements in the treatment of  children, potentially leading to harmful health attitudes and behaviors.

The researchers conducted a quantitative content analysis of 912 news articles published between 2015 and 2021 in Spanish media outlets discussing dietary supplements for children. They used a frequency analysis and a proportion comparison to analyze variables such as the reach of news, tone of news, mentions of health professional consultation, association with natural products, media specialization, intertextuality, and headline mentions.

The study found a 60% increase in publications discussing dietary supplements for children during the study period. The content analysis indicates that these articles predominantly present dietary supplements in a positive light, often without robust scientific evidence. Furthermore, many do not emphasize the need for medical consultation, which may contribute to unsupervised consumption of supplements, particularly among minors. This highlights the critical importance of professional guidance when considering dietary supplements for children. Additionally, the frequent emphasis on the “natural” attributes of these products raises concerns regarding consumer perceptions and potential safety risks.

The authors concluded that their study reveals a problem regarding the portrayal of dietary supplements for children in Spanish media. The overly optimistic image, lack of scientific basis, and failure to recommend medical supervision may contribute to unsupervised consumption among minors, risking their health due to misinformed decisions influenced by media portrayal.

I would add that this problem exists not just for children and not just in Spain. It has long been noted to put consumers of all ages and from all countries at risk. The authors kindly cite our own study from 2006 that concluded: “UK national newspapers frequently publish articles on CATs for cancer. Much of this information seems to be uncritical with a potential for misleading patients.”

Even several years before that, my late friend Thomas Weimayr and I published this study in the BMJ:

The media strongly influences the public’s view of medical matters. Thus, we sought to determine the frequency and tone of reporting on medical topics in daily newspapers in the United Kingdom and Germany. The following eight newspapers were scanned for medical articles on eight randomly chosen working days in the summer of 1999: the Times, the Independent, the Daily Telegraph, and the Guardian in the United Kingdom, and Frankfurter Allgemeine Zeitung, Süddeutsche Zeitung, Frankfurter Rundschau, and Die Welt in Germany. All articles relating to medical topics were extracted and categorised according to subject, length, and tone of article (critical, positive, or neutral).

A total of 256 newspaper articles were evaluated. The results of our analysis are summarised in the table. We identified 80 articles in the German newspapers and 176 in the British; thus, British newspapers seem to report on medical topics more than twice as often as German broadsheets. Articles in German papers are on average considerably longer and take a positive attitude more often than British ones. Drug treatment was the medical topic most frequently discussed in both countries (51 articles (64%) in German newspapers and 97 (55%) in British). Surgery was the second most commonly discussed medical topic in the UK newspapers (32 articles; 18%). In Germany professional politics was the second most commonly discussed topic (11 articles; 14%); this category included articles about the standing of the medical profession, health care, and social and economic systems—that is, issues not strictly about treating patients.

Because our particular interest is in complementary medicine, we also calculated the number of articles on this subject. We identified four articles in the German newspapers and 26 in the UK newspapers. In the United Kingdom the tone of these articles was unanimously positive (100%) whereas most (3; 75%) of the German articles on complementary medicine were critical.

This analysis is, of course, limited by its small sample size, the short observation period, and the subjectivity of some of the end points. Yet it does suggest that, compared with German newspapers, British newspapers report more frequently on medical matters and generally have a more critical attitude (table). German newspapers frequently discuss medical professional politics, a subject that is almost totally absent from newspapers in the United Kingdom.

The proportion of articles about complementary medicine seems to be considerably larger in the United Kingdom (15% v 5%), and, in contrast to articles on medical matters in general, reporting on complementary medicine in the United Kingdom is overwhelmingly positive. In view of the fact that both healthcare professionals and the general public gain their knowledge of complementary medicine predominantly from the media, these findings may be important.,

25 years later, the call on journalists to behave more responsibly when reporting about so-called alternative medicine (SCAM) is as loud and clear as it is neglected and ignored.

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