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

bias

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Hair loss is prevalent and can affect both males and females of different age groups. Despite the availability of many conventional treatment options, these might cause side effects, leading to a growing interest in natural and herbal remedies (HRs).

This review aimed to investigate the efficacy and safety of various HRs for hair loss and examine the current scientific evidence behind them. A literature search identified relevant studies published up to March 2024. The results suggested potential benefits in promoting hair growth and treating various forms of hair loss (HL). Several remedies were found to be effective in different conditions, including:

  • androgenetic alopecia (AGA),
  • telogen effluvium,
  • alopecia areata (AA).

Various mechanisms of action (MOA) seem to be involved,
including

  • 5α-reductase inhibition,
  • increased microcapillary blood flow,
  • antioxidant effects,
  • modulation of the hair growth signaling pathways.

The authors concluded that natural and herbal remedies show promise in treating hair loss, However, many of these studies have limitations such as lack of long-term follow-up, small sample sizes, and short treatment durations. Due to this variation in the quality of evidence, further well-designed randomized trials with larger sample sizes are required to confirm the efficacy of these HRs.

The herbal remedies included in this review are:

  • rosemary,
  • saw palmetto,
  • onion juice,
  • Korean red ginseng,
  • pumpkin seed oil,
  • azelaic acid,
  • olive oil,
  • coconut oil,
  • henna,
  • honey,
  • rice bran extract,
  • Ashwagandha,
  • Amla.

The authors claim that they “show promise”. Is it ‘splitting hair’ to ask: all of them? Closer inspection finds significant ‘hair in the soup’ and reveals that this statement is ‘pulled by the hair’ and based largely on wishful thinking. The truth is that evidence from rigorous clinical trials is almost totally absent.

I am tempted to say that this review is ‘hair-raising’ – alas there is not much hair left on my head to raise – even for a review as poor and misleading as this one.

In case you are new here and don’t know, the ‘ALTERNATIVE MEDICINE HALL OF FAME’ is an illustrious group of people researching so-called alternative medicine (SCAM). They have been elected [by myself] for one main reason: they have managed to go through their entire carrer publishing nothing but positive results related to their ‘pet SCAM’.

So far, the group consists of:

  1. Josef M Schmid (homeopathy, Germany)
  2. Meinhard Simon (homeopathy, Germany)
  3. Richard C. Niemtzow (acupuncture, US)
  4. Helmut Kiene (anthroposophical medicine, Germany)
  5. Helge Franke (osteopathy, Germany)
  6. Tery Oleson (acupressure , US)
  7. Jorge Vas (acupuncture, Spain)
  8. Wane Jonas (homeopathy, US)
  9. Harald Walach (various SCAMs, Germany)
  10. Andreas Michalsen ( various SCAMs, Germany)
  11. Jennifer Jacobs (homeopath, US)
  12. Jenise Pellow (homeopath, South Africa)
  13. Adrian White (acupuncturist, UK)
  14. Michael Frass (homeopath, Austria)
  15. Jens Behnke (research officer, Germany)
  16. John Weeks (editor of JCAM, US)
  17. Deepak Chopra (entrepreneur, US)
  18. Cheryl Hawk (chiropractor, US)
  19. David Peters (osteopathy, homeopathy, UK)
  20. Nicola Robinson (TCM, UK)
  21. Peter Fisher (homeopathy, UK)
  22. Simon Mills (herbal medicine, UK)
  23. Gustav Dobos (various SCAMs, Germany)
  24. Claudia Witt (homeopathy, Germany/Switzerland)
  25. George Lewith (acupuncture, UK)
  26. John Licciardone (osteopathy, US)

Inspired by my post from yesterday which focussed on a study by NAFKAM, I had a look at the director of this institute, Miek C Jong. Her pet SCAM seems to be homeopathy. She has published, as far as I can see, 4 clinical trials and two reviews of homeopathy (in case I have missed any, please let me know). Here are the links and key sentences from all of these papers:

CLINICAL TRIALS

REVIEWS

I hope you agree that publishing all these homeopathy-papers without even a hint of a negative finding is a remarkable effort (bearing in mind that trials of highly diluted homeopathic remedies are, in fact, testing one placebo against another) In my view, this achievement is so remarkable that, today, I take the pleasure to admit Miek Jong into my ALTERNATIVE MEDICINE HALL OF FAME.

WELCOME MIEK!

 

Many individuals with depression explore so-called alternative medicine (SCAM), including spiritual healing. This pilot randomized controlled trial (RCT) aimed to assess the feasibility of a study that integrated spiritual healing with standard care versus standard care alone for adults with moderate depression.
28 adult patients with depression were randomized to receive either:
  • spiritual healing alongside usual care (n = 14);
  • or usual care alone (n = 14).

The healing sessions were highly individualized. The healer positioned her hands over various areas of the client’s body (head, chest, knee, hip, and feet) intending to adjust the energy flow within the client. Outcomes were measured by changes in the Beck Depression Inventory for Primary Care (BDI) scores pre-and post-intervention. Participants’ experiences with spiritual healing were explored through a process evaluation.

The BDI scores captured significant changes in depression severity, with the intervention group showing the greatest mean difference from baseline (BDI 23.0) to week 16 (BDI 14.9), compared to the control group which worsened from baseline (BDI 24.2) to week 16 (BDI 26.7). In addition, participants expressed satisfaction with the study components and procedures, and all completed the questionnaires at designated times. Recruiting from clinical practice proved suboptimal due to conflicts with primary care physicians’ schedules leading to fewer participants in the study than planned. Measures to minimize loss to follow-up were effective.
The authors concluded that spiritual healing may be a beneficial option for individuals who suffer from moderate depression. The participants in this study were satisfied with the spiritual healing treatment, and adherence rates were high. Future RCTs should consider recruiting participants through different avenues to enhance research feasibility to alleviate the burden on family care physicians’ offices.
Where to start?
Here are just some of the most obvious concerns that render the conclusion nonsensical and false:
  1. A pilot study is for testing the feasibility and not for calculating outcomes.
  2. In any case, this was not a pilot study but an effectiveness trial that failed because of recruitment difficulties.
  3. As it followed the infamous ‘A+B versus B’ design that produces a positive result even for a placebo treatment, the study (if we disregard the small sample size and take its findings seriously) merely shows that placebo can be effective.
  4. The conclusion is therefore wrong and should read: spiritual healing causes a placebo response in individuals who suffer from moderate depression.
  5. The National Research Center of Complementary and Alternative Medicine (NAFKAM), Faculty of Health Science, Institute of Community Medicine, The Arctic University of Norway which seems to be the main institution responsible for this nonsense should be questioned how they justify spending money and time on such pseudoscience.

This double-blind, randomized, placebo-controlled trial compared the effects of individualized homeopathic medicinal products (IHMPs) and placebo after 4 months of intervention in patients with chronic low-back pain (LBP).

Sixty participants with chronic LBP were treated with either verum (n = 30; IHMPs plus concomitant care) versus control (n = 30; placebos plus concomitant care). The primary outcome measure was the ‘Oswestry LBP Disability Questionnaire’ (ODQ); secondary endpoints were the Roland Morris Pain and Disability Questionnaire (RMPDQ); McGill Pain Questionnaire—Short Form (SF-MPQ); all measured at baseline, and every month, up to 4 months.
The results show that group differences achieved significance or near significance in all the specified outcomes—ODQ score (F1, 58 = 4.331, p = 0.042), RMPDQ score (F1, 58 = 2.939, p = 0.092), and SF-MPQ total score (F1, 58 = 6.666, p = 0.012). Rhus toxicodendron (n = 13), Bryonia alba (n = 8), Hypericum perforatum, and Nux vomica (n = 5 each) were the most frequently prescribed remedies. Different repertories were used as per the need of the cases—Kent, Synthesis, Murphy, Pulford, Boericke, Boger Boenninghausen’s Characteristics and Repertory, and Complete. Minor adverse events were reported from both groups.
The authors concluded that homeopathic medicines worked significantly better than placebos in reducing chronic LBP. Independent replications are warranted to substantiate the findings.
Sadly, I have no access to the full text of this paper – if someone has, please provide the link, and I might then revise my post accordingly. In the absence of the full text, I can only say that I don’t know a single homeopath who would even consider using homeopathy for LBP.
Based on the available information, some areas of suspicion include:
  • the small sample size might have the result unreliable;
  • the marginal level of statistical significance;
  • the fact that 5+5+8+13=31 and not 30;
  • the fact that the study originated from India where hardly any negative studys of homeopathy see the light of day;
  • the fact that allmost all of the many authors of this paper are affiliated with homeopathic institutions;
  • the existance of a strangely similar study that has recently reported largely negative results.

The use of so-called alternative medicine (SCAM) has been widely recognized as a potential contributor to the emergence of vaccine scepticism and refusal. However, a direct correlation between trust in SCAM and vaccine scepticism is still a matter of discussion.

The objective of this study is to explore the multidimensional factors that explain the association between SCAM usage and vaccine scepticism. Qualitative and quantitative research designs were adopted to examine whether visiting SCAM practitioners directly contributes to vaccine scepticism and to identify whether anti-vaccination attitudes are caused by other social, and cultural factors.

The results support the idea that SCAM users tend to exhibit more vaccine scepticism compared to non-users. However, preferring a holistic health model, individual autonomy, and a negative perception of biomedicine representatives emerged as more influential factors in understanding the connection between the prevalence of SCAM utilization and vaccine scepticism.

The authors concluded that the results of this study indicate that people who regularly visit SCAM practitioners are more likely to be vaccine sceptics and have a higher tendency to vaccine scepticism. This is in line with other findings, suggesting that trust in SCAM is one of the factors affecting vaccine scepticism. This research conducted among people visiting healthcare professionals specializing in SCAM extends our knowledge for a deeper understanding of the other aspects behind this relationship. This implies that SCAM itself is not the direct predictor of vaccine scepticism; rather, an individualized holistic worldview and a lack of trust in medical professionals play a much more significant role in antivaccine attitudes. In addition, this investigation has shown that instead of expressing general dissatisfaction with biomedicine, the respondents displayed frustration with the individuals representing conventional medicine and the quality of the healthcare services provided. Notably, in the interviews, the participants indicated that their use of SCAM did not cause their vaccine scepticism, although they considered alternative healthcare options to be more valuable in dealing with several health issues. Instead of critiquing SCAM and vaccine scepticism, which contribute to the further polarization of society, a key policy priority regarding building trust in vaccines should therefore focus on strategies to improve healthcare services and develop medical doctors’ soft skills. A future follow-up evaluation investigating vaccine scepticism among complementary and alternative medicine users would be very useful to address vaccine scepticism more deeply.

So, individualized ‘holistic’ worldview and a lack of trust in medical professionals seem to have two simultaneous effects: they tend to make people turn towards SCAM and they render them skeptical about vaccinations. This makes sense – I never assumed anything else. I never thought that a SCAM in itself might, by some undefined magic, turn people into antivaxers. It always had to be a common denominator, like a general outlook or attitude that would prompt both the SCAM-use and the dislike of vaccines.

As the authors imply, this might be good news and point to one solution for two different problems: improve conventional healthcare and, as a result, both SCAM-use will diminish and vaccine acceprance will increase. The trouble is that this is easier said than done!

Tuina, or Tui Na is based on the notion that imbalances of the life-force, qi, can cause blockages or imbalances that lead to symptoms and illness. Tuina massage is similar to acupressure in that it targets specific acupoints. Practitioners use fingers to apply pressure to stimulate these points.

Some people suggest that Tuina might benefit diabetic peripheral neuropathy (DPN), but the evidence is inconclusive. This review evaluated its clinical efficacy and safety for DPN treatment.

Ten databases were searched, covering the period from their inception to February 21, 2024. Relevant data were extracted from studies meeting the inclusion criteria, and a meta-analysis was conducted using RevMan
5.3 software.

A total of 24 randomized controlled trials (RCTs) involving 1,989 participants were included. Patients in the experimental group received Tuina in addition to routine treatments and nursing of DPN. Patients in the control group received routine treatments and nursing of DPN, including health education, dietary guidance, blood sugar control, and oral vitamin B or mecobalamin.

The meta-analysis showed that, compared to various control therapies, Tuina demonstrated a higher overall clinical efficacy rate and improved Toronto Clinical Scoring System (TCSS) scores, indicating that Chinese Tuina may provide benefits beyond conventional treatment. Furthermore, improvements were observed in the motor and sensory nerve conduction velocities (MNCV and SNCV) of certain specific nerves, such as the common peroneal nerve, sural nerve, and ulnar nerve. Although the differences in MNCV and SNCV of the tibial and median nerves were not statistically significant, the overall improvement in clinical outcome supports the notion that Tuina is superior to conventional treatment.

The authors concluded that Chinese Tuina therapy is a safe and effective treatment option for DPN. It can alleviate clinical symptoms and improve the MNCV of the common peroneal nerve as well as the SNCV of the sural and ulnar nerves. Its efficacy in the tibial and median nerves remains unconfirmed, highlighting a need for future large-scale, high-quality RCTs.

There are several reasons why I cannot accept the conclusion that Tuina is effective for DPN, e.g:

  1. All the RCTs were of the notorious A+B vs B design that – as discussed ad nauseam on this blog – does not control for placebo effects and thus never generate negative results.
  2. None of the RCTs were single or double blind which means that expectation and therapist influence would have impacted on the findings.
  3. All of the studes originate from China; we have often discussed why such studies are notoriously unreliable. Funding for the review was supported by the National Key Research and Development Program of China and Jilin Provincial Natural Science Foundation Project.
  4. Most of the studies are published in journals and/or laguages that are not accessible to non-Chinese readers.
  5. None of these serious limitations are discussed by the review authors.

I REST MY CASE

 

 

It does not happen every day that the prestigeous German FRANKFURTER ALLGEMEINE ZEITUNG publishes an in-depth analysis of TCM (Traditional Chinese Medicine) and even discusses several of the themes that we, here on this blog, have often debated. Allow me, therefore, to translate a few passages from the recent FAZ article entitled “Der Fluch der alten Dinge” (The Curse of Old Things):

… TCM has countless followers in many countries. ‘TCM is a wonderful medicine that thinks ‘holistically’, that sees not just one organ but the whole person and that offers very good treatment options,’ says Dominik Irnich. He heads the German Medical Association for Acupuncture. Although there is not evidence for all indications, TCM is ‘a scientifically based option for a number of diseases, the effects of which have been proven many times over’…

Meanwhile, Beijing wants to utilise the positive image of TCM to present itself in a good light and promote exports. The current five-year plan also provides for the creation of around 20 TCM positions for epidemic prevention and control. Critics, on the other hand, see patients at risk due to insufficiently tested therapies – and medicine as a whole: many studies are hardly valid and distort the state of science…

The top leadership of the Chinese Communist Party is using the ‘old things’ to increase its global influence and utilise TCM not only in its own country, but also as an export hit. The global TCM market is estimated to be worth many billions of euros annually, but there are no reliable figures – not least because it often includes illegally traded products such as rhino horn or donkey skin, which has led to mass killings.

Officially, Beijing prosecutes illegal trade and promotes science-based medicine, but the interests are intertwined. Even under Mao, traditional methods were used in China as a favourable alternative to imported medicines, and Beijing is currently increasingly allowing them to be reimbursed. At the same time, China’s leadership is trying to anchor TCM products in healthcare worldwide, for example as part of a ‘health Silk Road’ in Africa. During the Covid-19 pandemic, the state not only used TCM products en masse in its own country, Chinese foreign representatives also distributed them to Chinese people in Europe. This included a product based on gypsum, apricot kernels and plant parts called Lianhua Qingwen. According to a report published by the consulate in Düsseldorf, this was distributed even though the sale of medicines outside of pharmacies is generally punishable by law.

Beijing has also been successful at the level of the World Health Organisation (WHO), which promotes traditional medicine from China. ‘This was part of the interests and election programme of former Chinese Director-General Margaret Chan,’ says WHO consultant Ilona Kickbusch. The WHO drew up standards for acupuncture training, including knowledge of the ‘function and interactive relationship of qi, blood, essence and fluid’, as the document states.

In 2019, the WHO member states decided to add a chapter on ‘traditional medicine’ to the standard classification of diseases. Doctors can now code alleged patterns of ‘qi stagnation’ or yang deficiency of the liver. The umbrella organisation of European science academies EASAC criticised this as a ‘significant problem’: doctors and patients could be misled and pressure could be exerted on healthcare providers to reimburse unscientific approaches. Nature magazine found: ‘The WHO’s association with drugs that have not been properly tested and could even be harmful is unacceptable for the organisation that has the greatest responsibility and power to protect human health.’ …

In general, the study situation on therapies that are categorised as TCM is extremely confusing. The evidence is ‘terrible’, says the physician Edzard Ernst, who has analysed such procedures. ‘There are thousands of studies – that’s part of the problem.’ Many studies come from China, but it is known that a large proportion are invalid or falsified. It is almost impossible to report critically on TCM there: according to media reports, a doctor was imprisoned for three months in 2018 after criticising a TCM remedy. In 2020, Beijing even considered banning criticism of TCM, but refrained from doing so after an outcry.

According to Ernst, the quality of even some of the meta-analyses from the respected Cochrane Collaboration is ‘hair-raising’ due to the inclusion of unreliable studies, and according to some Chinese researchers, acupuncture works for everything. Prof. Unschuld said at an event a year ago that he was asked in China not to address critical issues.

‘In a country without the open and free critical culture that is common in democratic countries, the control mechanisms are missing,’ says Jutta Hübner, Professor of Integrative Oncology at Jena University Hospital. The inclusion of Chinese studies, which almost never report negative results, can create a much too positive image of TCM at a formally very high level of scientific evidence, without the results being reliable…

Instead of allowing the research to be carried out by proponents, it would be desirable ‘if the universities in particular remembered that they have the duty to be critical,’ says physician Edzard Ernst. However, some university clinics prefer to advertise TCM methods in order to attract patients and money.

In 2019, there were 94 million cases of benign prostatic hyperplasia (BPH) worldwide. Our systematic review evaluated the effectiveness of Urtica dioica (Stinging Nettle) as a treatment of benign prostatic hyperplasia (BPH).
MEDLINE, Embase, CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and ClinicalTrials.gov were searched from databases inceptions to February 2024. Randomized clinical trials (RCTs) investigating Urtica dioica (with or without usual care) for treating BPH in human subjects were considered. Urtica dioica preparations used in combination with other herbs or supplements were excluded. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the certainty of evidence.
Six RCTs with a total of 1210 patients met the inclusion criteria. Risk of bias of the included studies was mostly unclear or high. Meta-analyses showed that, compared with controls (who received mostly placebo or usual care), Urtica dioica:
  • slightly improved BPH symptoms measured with the International Prostate Symptom Score (IPSS) at follow-ups of up to 12 months (standardized mean difference [SMD] -2.06, 95% confidence intervals [CI] [-3.22, -0.91] very low certainty evidence, 6 studies),
  • reduced prostate specific antigen (PSA) levels (mean difference [MD] -0.37 ng/ml, 95% CI [-0.50, -0.23] low certainty evidence, 4 studies)
  • had little effect on quality of life (SMD -0.59, 95% CI [-1.57, 0.38] very low certainty evidence, 2 studies).

The main reasons for downgrading the evidence were study limitations (studies judged to be at an unclear or high risk of bias), inconsistency (considerable heterogeneity), and imprecision (small effect sizes and wide confidence intervals around effect estimates). All six studies reported no adverse-effects.

We concluded that there is some promising evidence to support the effectiveness of Urtica in reducing the symptoms of BPH. Larger and more rigorous studies might reduce the existing uncertainties.
I find it lamentable that systematic reviews (SRs) of so-called alternative medicine (SCAM) are so often either:
  1. positive but not truly honest about the limitations of the evidence (we see this regularly on my blog);
  2. or they are sufficiently critical and thus arrive, like our above paper, at unequivocal (and sadly not very helpul) conclusions.

As this is so, we see very few SRs that conclude “there is sound evidence to show that SCAM xy is effective (or ineffective)”. Yet, such verdicts would be what consumers need.

The cause of the first scenario (false-positive conclusion) is that reviewers are biased and want to demonstrate that SCAM works. Such authors behave unethically, in my view, because they mislead the public and might cause untold harm. The cause of the second scenario (unequivocal conclusion) is the poor quality of the primary studies. This phenomenon too is mostly due to over-enthusiastic researchers who want to prove their SCAM instead of testing it. Conducting a clinical trial is far from easy or cheap. It is beyond me, why so many SCAM trialists do not try their best to do it well!

If you think of it, the most likely reason is that they are not really interested in finding the truth but mainly want to promote their agenda. If you don’t believe me, have a look at my ALTERNATIVE MEDICINE HALL OF FAME and the amazing men and women in it.

It is time, I think, that SCAM researcher learn the most basic principle of their profession: science is not a game where you set out to confirm what you believe. Science works by

  1. formulating a hypothesis,
  2. doing your very best to prove your hypothesis wrong,
  3. only if it cannot be proven wrong, assuming that it probably is correct.

To put it bluntly: investigators who use science to prove their point are not scientists but pseudo-scientists, and sadly SCAM has more than its fair share of such charlatans (drunken men using a lamp-post for support rather than enlightenment!). To put it even more bluntly: to prevent serious harm – because that sort of thing does a lot of real harm! – researchers who repeatedly show themselves to be incapable of doing unbiased science (again, see my ALTERNATIVE MEDICINE HALL OF FAME), should be banned from doing research.

CNN reported that a measles outbreak is growing in a rural area of West Texas where vaccination rates are well below the recommended level. In late January, two children in Gaines County were hospitalized for measles. On Wednesday, the state health department issued a health alert:

The Texas Department of State Health Services (DSHS) is reporting an outbreak of measles in Gaines County. At this time, six cases have been identified with symptom onset within the last two weeks, all among unvaccinated school-aged children who are residents of Gaines County.

Due to the highly contagious nature of this disease, additional cases are likely to occur in Gaines County and the surrounding communities. DSHS advises clinicians to follow the below measles immunization recommendations for the communities affected by the outbreak and immediately report any suspected cases to your local health department, preferably while the patient is in your presence.

To immediately increase the measles immunity and prevent disease occurrence in the affected communities, DSHS advises the following immunization recommendations for residents of Gaines County:

  • Infants ages 6 to 11 months:
    • Administer an early dose of measles, mumps, and rubella (MMR) vaccine.
    • Follow the CDC’s recommended schedule and get:
      • Another dose at 12 through 15 months.
      • A final dose at 4 through 6 years.
  • Children over 12 months old:
    • If the child has not been vaccinated, administer one dose immediately and follow with a second dose at least 28 days after the first.
    • If the child has received one dose, administer the second dose as soon as possible, at least 28 days after the first.
  • Teen and adults with no evidence of immunity:

Administer one dose immediately and follow with a second dose at least 28 days after the first.

As of last Friday afternoon, the outbreak has jumped to 14 confirmed cases and six probable cases among people who are symptomatic and had close contact with infected individuals.

Investigations are ongoing, as cases have been identified also in parts of the region that are outside the Gaines County lines where the first cases were reported.

All the cases are believed to be among people who are not vaccinated against measles, and most of them are children.

record share of US kindergartners had an exemption for required vaccinations last school year, leaving more than 125,000 new schoolchildren without coverage for at least one state-mandated vaccine, according to data published by the US Centers for Disease Control and Prevention in October.

The US Department of Health and Human Services has set a goal that at least 95% of children in kindergarten will have gotten two doses of the measles-mumps-rubella (MMR) vaccine, a threshold necessary to help prevent outbreaks of the highly contagious disease. The US has now fallen short of that threshold for four years in a row. MMR coverage is particularly low in Gaines County, where nearly 1 in 5 incoming kindergartners in the 2023-24 school year did not get the vaccine.

In the health alert Wednesday, the Texas health department warned that additional cases are “likely to occur in Gaines County and the surrounding communities” due to the highly contagious nature of the disease.

Officials recommend that residents of Gaines County immediately improve their immunity and help prevent disease spread by ensuring that they are up to date on vaccinations. Children and adults who have not been vaccinated should get one dose immediately, followed by a second dose after 28 days. Infants between 6 and 11 months should get an early dose of the vaccine, and children who have had their first shot should get their second as soon as possible.

‘US News’ adds the following: As Robert F. Kennedy Jr., one of the most influential purveyors of dangerous vaccine misinformation, prepares to take the helm of the Department of Health and Human Services, researchers say such bills have a higher chance of passing and that more parents will refuse vaccines because of false information spread at the highest levels of government.

“Mr. Kennedy has been an opponent of many health-protecting and life-saving vaccines, such as those that prevent measles and polio,” scores of Nobel Prize laureates wrote in a letter to the Senate. Having him head HHS, they wrote, “would put the public’s health in jeopardy.”…

On this blog, we have discussed Kennedy’s imbecilic attitudes to measles and other health issues several times, e.g.:

In the forseeable future, we will most certainly encounter endemics and epidemics. I fear that, with Kennedy in charge of the US Department of Health and Human Services, the danger for them to grow into pandemics is hugely increased.

It has been reported that a woman who suffered a severe headache after injuring her neck during a workout died following a visit to a chiropractor. Joanna Kowalczyk, aged 29, declined a procedure at hospital for her injury and chose instead to try chiropractic. Her medical history showed she regularly suffered migraines and joint hypermobility issues. She also had an undiagnosed connective tissue disorder which made her susceptible to arterial dissections.

Ms Kowalczyk told the chiropractor that she had discharged herself from hospital. The chiropractor was unaware of her medical history but nevertheless manipulated her neck. It is thought Ms Kowalczyk suffered an arterial dissection when she injured her neck in the gym and that she suffered acute dissections to the same location when a chiropractor cracked her neck. She died on October 19, 2021, at Gateshead’s Queen Elizabeth Hospital several days after her chiropractic treatment.

Now her coroner has raised concerns that chiropractors aren’t required to check patient medical records after Ms Kowalczyk’s death. Specifically, the coroner’s report raised two matters of concern:

1.  The evidence from the attending paramedic was that she was not aware that symptoms of a stroke can stop after a short time as clearly set out on NHS website and guidance, and that this was not part of her training. This was directly contrary to the Head of Operations’ evidence that this was part of both paramedic training and annual continuing professional development. This was a concerning feature given the accepted evidence of the time critical period to treat patients with symptoms potentially indicative of stroke.

2.  The evidence on behalf of the treating chiropractor was that he did not consider it necessary to request GP records or hospital records, before assessment or treatment despite being informed about the Deceased’s recent hospital attendance, investigation which was recommended, and her discharge against medical advice. Even in the updated consent form I have been  provided  with,  which  was  designed  by  the  British  Chiropractic Association, there is no prompt or question designed for the chiropractor to  ask  to  consider  obtaining  medical  records  before  assessment  or treatment, and when this may be appropriate, and the only reference to medical records is a consent to communicate as deemed necessary for the treatment, and for a report to be sent to the GP after treatment. I am concerned that consideration to obtaining medical records should always be given before assessment, particularly where recent medical treatment or investigations has been undertaken.

Receiving a Regulation 28 (Prevent Future Deaths) report from the coroner, the GCC stated that the case may raise some concerns for chiropractors and their patients and published the following additional comment:

The chiropractor involved is subject to a GCC investigation, which was paused to allow for the coronial process. This is standard procedure.

It is not appropriate for us to comment further as it could prejudice proceedings. It is inappropriate and unprofessional for chiropractors to speculate publicly on the details of the case, or the identity of the individual involved.

All matters brought to the attention of the GCC are risk assessed and are considered by an Investigating Committee. More about the investigation process.

In her report, the Coroner has asked the GCC to consider the following concern.

(I am) “concerned that consideration to obtaining medical records should always be given before assessment, particularly where recent medical treatment or investigations has been undertaken.”

We will give full and careful consideration to her concern. Given the clinical matters involved, we are seeking expertise (from across the profession, and beyond) to consider the impact of such a step – including on the care and safety of all patients. The Registrar will be writing to the coroner in the next week to set out how her concerns will be considered, and the expected timing of that work.

We have been in contact with leaders from across the profession and are grateful to them all for their support of our proposed approach.

____________________________

The GCC’s main task is the protection of consumers. I have repeatedly pointed out that they seem  to have forgotten this and seem to think it is to promote chiropractic in every way they can, e.g.:

Let’s hope the GCC takes the occasion of yet another tragic and unnecessary death as a wake-up call for finally getting its act together!

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