case-control study
Iridology is an assessment technique that involves examining the iris allegedly to identify potential pathological disorders. Despite being practised for centuries, the effectiveness of iris diagnosis as a diagnostic tool remains doubtful, primarily due to limited empirical evidence supporting its claims. Thus, there is a need for scientific studies to test the efficacy of iridology assessment.
This study aimed to determine the sensitivity and specificity of iridology assessment in detecting abnormalities in the female reproductive system.
This cross-sectional observational study included 100 female participants. All participants underwent an iris examination, a clinical assessment, and ultrasonography. The results from these investigations were compared, and sensitivity and specificity rates were calculated using standard formulas.
The study found that iridology assessment demonstrated a sensitivity of 92% and a specificity of 56% in detecting abnormalities within the female reproductive system.
The authors concluded that their findings suggest that iridology assessment may serve as a potentially useful complementary tool for detecting abnormalities in the female reproductive system. However, further research is essential to confirm the effectiveness of this method and to explore its potential benefits and limitations in gynecological diagnosis. Continued scientific investigation is crucial to establish the role of iridology assessment in enhancing gynecological healthcare.
The authors of this study published in “Advances in Integrative Medicine” list the following affiliations:
- Department of Naturopathy, Government Yoga and Naturopathy Medical College, The Tamilnadu Dr. MGR Medical University, Chennai, Tamilnadu, India
- Department of Research, Government Yoga and Naturopathy Medical College, The Tamilnadu Dr. MGR Medical University, Chennai, Tamilnadu, India
- Department of Yoga, Government Yoga and Naturopathy Medical College, The Tamilnadu Dr. MGR Medical University, Chennai, Tamilnadu, India
- Department of Women and Child Care, National Institute of Naturopathy, Pune, Ministry of AYUSH, Government of India, India
I fear that this does not inspire me with confidence. But let’s have a look at the actual study.
The first thing that strikes me is the fact that there are many dozens of abnormalities in the female reproductive system. It seems oddly unscientific that the Indian researchers did not bother to define one single disorder. This gets even weirder when we realize that many of the abnormalities in the female reproductive system are easily recognisable or guessable without any diagnostic procedure upon first encountering the patient.
What I am trying to explain: the iridologists probably used all sorts of clues to guess which group each patient belonged to. In any case, the study is so poorly conceived and described that we really cannot be sure what happened.
But why am I so critical? Perhaps iridology is a useful diagnostic tool after all?
I find this possibility highly unlikely, and here is why:
Iridology was invented by a Hungarian homeopath in the late 19th century who thought to observe changes in the iris of an owl during the recovery of the animal after it had broken a leg. Iridologists believe that the iris is a ‘mirror of our body’. Any relevant abnormality on the right half of the body will reveal itself on the right iris and problems on the left side will show up on the left iris. They assume that the iris is linked via multiple nerve connections to all organs and believe that any bodily malfunction will thus be represented as abnormalities of pigmentation on the iris. These assumptions are not in keeping with basic anatomy or physiology and thus lack plausibility.
Iridologists have produced detailed maps of the iris where each iris is divided in 60 sectors (much like the face of a clock) and each segment is related to an inner organ or bodily function (for instance, heart diseases are thus seen in the left iris somewhere between two and three o’clock). Iridologists either study the iris in situ or they produce high-quality colour photographs of both irides for detailed inspection. Several studies have tested the validity of iridology. My systematic review of these data concluded that “the validity of iridology as a diagnostic tool is not supported by scientific evaluations. Patients and therapists should be discouraged from using this method.”
A final thought: if iridology were a valid diagnostic tool, this would be a scientific sensation, and the study proving it would get published in journals like SCIENCE or NATURE and not in s 3rd class SCAM journal.
I REST MY CASE.
Aaron Siri, the personal lawyer/adviser of Robert F. Kennedy Jr., recently presented to the US Senate the unpublished (and thus not peer-reviewed) “Henry Ford Health System Analysis“. With a sample size of 18,468, the study is the largest vaccinated versus unvaccinated birth cohort study ever conducted in the US. Children were tracked from birth over a 10-year period, and their data were drawn from medical records. The frequencies of several common illnesses during the observation period were compared between the vaccinated and the unvaccinated goups.
The findings imply that vaccinated children have dramatically higher rates of common, chronic conditions than unvaccinated children. As could be expected, the news spread instantly and the worldwide anti-vaxx community was triumphant. Their long-held belief that vaccinations are detrimental to the health of children had finally been confirmed!
But it took only hours before serious doubts about the reliability of the data emerged. It was soon demonstrated that the study is full of fundamental errors, inconsistencies and findings that do not stand up under even the slightest scrutiny. Crucially, it did not show an association between vaccines and autism, which is, as we all know, the main claim of anti-vaxers.
The most obvious methodological problem with the study is detection bias. This occurs in case control studies when one group gets examined more frequently than the other. This must almost inevitably lead to more diagnoses regardless of actual disease rates. In the study, vaccinated children had substantially more health care visits than unvaccinated kids. In such a situation, conditions requiring clinical evaluation to diagnose — for instance, ADHD, learning disorders, speech delays, ear infections — will inevitably be recorded more often in the group that was investigated regularly than in the group that consulted physicians less frquently.
An example might explain: There was a 6-8-fold increase in ear infections among vaccinated children. This is highly unlikely to be a true result; it can, however, be explained by detection bias. Children who rarely sees a clinician will not have “otitis media” coded in their record, even if they have had ear pain. In other words, the study repeatedly conflates absence of diagnosis with absence of disease.
Another example: there were almost no cases of common conditions like ADHD and learning disabilities among the group of unvaccinated children. Yet, such a finding is an impossibility. Epidemiological data prove that these conditions affect roughly 11% and 9% of children, respectively. This can only mean that these illnesses went undiagnosed and unrecorded in unvaccinated children who rarely consulted a doctor.
As any first year Phd student should spot such fundamental flaws and overt inconcistencies, it is a huge embarrassment that RFKJr, his minions and the entire cult of anti-vaxx failed to spot and discuss them. They thoroughly invalidate the entire study as well as its conclusions.
For the world of anti-vaxx, the study presents a further big probem: if they accept its findings, they must also accept another of its results: there is no link between vaccination and autism. Will they now try to pretend that those findings that suit their ideology are real, while others that contradict their delusions are not?
If this study shows anything of value at all, it is this: peer-review is an indispensible process in science. Without it pseudo-science can far too easily masquarade as science. We all deserve better than a farcical political theater to mislead the public presented by malignant pseudo-scientists and ignorant anti-vaccination clowns. We deserve rigorous science and reliable results that approach the truth as closely as possible. The “Henry Ford Health System Analysis” had remained unpublished for a very good reason: it is misleading trash that makes RFKJr and his minions the laughing stock of the world of science.
The result of all this, I am afraid, is rather concerning: consumers are getting more and more confused, and the discussions about vaccines get less and less rational. As an example for the latter, let me quote a comment on ‘X’ by Dr Aseem Malhotra (yes, the guy who I have repeatedly blogged about and who recently claimed that COVID vaccines cause cancer): “Is it time to arrest all those using the term ‘anti – vaxxer’ because it’s a term of abuse, especially when used to describe someone vaccine injured, or has lost a relative or a child because of it ? It’s absolutely disgusting.”
Influenza poses a major health challenge due to its variability, pandemic potential and absence of an effective cure. These fact render prevention crucial. This cross-sectional study aimed to explore the link between influenza vaccination and so-called alternative medicine (SCAM) practices among Palestinian adults, along with factors influencing vaccination rates. It also evaluated participants’ attitudes towards SCAM and beliefs regarding herbal and vitamin use for influenza management.
The study was carried out between 18/02/2024 and 23/04/2024. A self-administered online questionnaire was shared through social media and personal communication. This questionnaire was aimed at all adults aged 18 and above. Both descriptive and regression analyses were performed.
The study included 363 participants, revealing an influenza vaccination rate of only 9%. A significant correlation was found between vaccination status and the use of:
- manipulative therapies,
- body-based methods,
- mind-body medicine.
No significant relationship was noted with herbal remedies or alternative medical systems.
Higher income and better health status were linked to increased vaccination likelihood (P-value<0.05), indicating a need for targeted public health campaigns. Although 63% of participants were familiar with SCAM, 34% had never used it for influenza, highlighting a knowledge gap. Popular natural remedies like Vitamin C, ginger, and honey reflect a trend toward preventive healthcare despite concerns over costs and skepticism about SCAM’s effectiveness.
The authors concluded that vaccine hesitancy is influenced by multiple factors, including context and types of SCAM use. Cultural beliefs and personal health philosophies significantly shape attitudes toward SCAM use and vaccination.
On this blog, we have discussed dozens of papers showing a link between various forms of SCAM and uptake of various form of vaccinations (please use the search fascility, if you want to know the details). We have seen that consumers from all parts of the world are less likely to vaccinate, if they are enthusiastic about SCAM. The reasons for this association, and the role of SCAM practitioners in it seem fairly clear:
- SCAM practitioners tend to advise against vaccination;
- SCAM practitioners tend to claim that their own treatments protect against infections;
- SCAM practitioners tend to stress the risks of vaccinations;
- SCAM practitioners tend to claim that vaccinations are not effective;
- SCAM practitioners tend learn these fallacies during their training;
- SCAM practitioners tend to get bombarded with such messages in their ‘professional’ literature;
- Many consumers believe the nonsense they hear from SCAM practitioners, particularly if they share their anti-establishment/science mind-set.
The damage caused in this way by SCAM practitioners is untold. Is it not time to educate SCAM practitioners properly in order to prevent the damage they do to public health?
Aim of this study was to investigate associations between use of so-called alternative medicine (SCAM) and uptake of COVID-19 and flu vaccines in a nationally representative US sample.
The results of this secondary analysis of National Health Interview Survey 2022 data indicated that after accounting for potential confounders, the overall use of SCAM did not significantly predict uptake of COVID-19 (p = 0.745) or flu vaccination (p = 0.123).
Vaccination uptake was lower for both COVID-19 and flu vaccines respectively, in individuals who visited:
- chiropractors (AOR = 0.78, 95% CI [0.69, 0.89], p < 0.001; AOR = 0.71, 95% CI [0.63, 0.81], p < 0.001),
- naturopaths (AOR = 0.66, 95% CI [0.51, 0.86], p = 0.002; AOR = 0.72, 95% CI [0.55, 0.94], p = 0.017).
Uptake rates were higher for both COVID-19 and flu vaccines respectively, for those who employed:
- acupuncturists (AOR = 1.46, 95% CI [1.15, 1.86], p = 0.002; AOR = 1.32, 95% CI [1.08, 1.63], p = 0.008),
mind-body medicine [increased likelihood of COVID-19 vaccination uptake (AOR = 1.24, 95% CI [1.08, 1.42], p = 0.002), but not flu vaccine (p = 0.264)].
Visiting a massage therapist was not a significant predictor for COVID-19 and flu vaccines, respectively (p = 0.128, p = 0.232).
Overall, the pattern of associations of SCAM use with COVID-19 vaccination uptake was comparable to that of flu vaccination uptake.
We have discussed many similar studies before, e.g.:
- Attitudes of Vaccination-Hesitant Parents Towards So-Called Alternative Medicine (SCAM)
- Do views about so-called alternative medicine (SCAM), nature and god influence people’s vaccination intentions?
- Use of so-called alternative medicine (SCAM) and its association with SARS-CoV-2 vaccination status
- Reasons for parental hesitancy or refusal of childhood vaccination
- Are people who oppose COVID-19 vaccinations intellectually challenged?
- Interest in so-called alternative medicine is linked to vaccination coverage
- Vaccination rates of Canadian healthcare professionals: those of chiropractors and naturopaths are at the lowest
- Preference of so-called alternative medicine predicts negative attitudes to vaccination
- Intelligence, Religiosity, SCAM, Vaccination Hesitancy – are there links?
- A naturopath promoting fake news about COVID vaccinations
- More information on homeopaths’ and anthroposophic doctors’ attitude towards vaccinations
- The UK Society of Homeopaths, a hub of anti-vaccination activists?
- Are anthroposophy-enthusiasts for or against vaccinations?
- Far too many chiropractors believe that vaccinations do not have a positive effect on public health
- Naturopaths’ counselling against vaccinations could be criminally negligent
- HOMEOPATHS AGAINST VACCINATION: “The decision to vaccinate and how you implement that decision is yours and yours alone”
- Use of alternative medicine is associated with low vaccination rates
- Integrative medicine physicians tend to harbour anti-vaccination views
- Vaccination: chiropractors “espouse views which aren’t evidence based”
Generally speking, these studies show that SCAM-users are less likely to approve of vaccinations than non-users. The present study partly confirms this finding and shows that, at least in the US, chiropractors and naturopaths are primarily responsible for the association.
My conclusion:
yet another reason to avoid these types of practitioners!
In this article, two German researchers investigated the persuasions of homeopathy users:
(a) whether and how homeopathy should be used to treat serious conditions like cancer,
(b) the role of science and the relevance of scientific evidence regarding homeopathy.
Using latent profile analysis (N = 225), they identified subgroups of homeopathy users that differ in their normative beliefs about the use of homeopathy in serious conditions:
- supporters of standalone use of homeopathy in serious conditions (~9%),
- people who are open toward standalone use (~43%),
- supporters of supplementary use (~35%),
- supporters of both supplementary use and non-use in serious conditions (~13%).
The findings indicate that subgroups that supported or were open toward the standalone use of homeopathy in serious conditions held the most negative attitudes toward science.
The authors concluded that despite being a minority in our sample, homeopathy users that support the standalone use of homeopathy to treat serious conditions like cancer clearly exist. These individuals are at risk of harming their own (and others’) health. In combination with the large subgroup of undecided users that emerged in our sample, these findings highlight the need for interventions aimed at preventing harmful homeopathy use. Most likely, before factual communication of scientific evidence can have a persuasive effect, negative attitudes toward science among homeopathy users need to be targeted.
The authors pont out that their findings highlight the need for interventions aimed at preventing the use of homeopathy in the treatment of serious conditions. Such interventions could take place at both a structural (e.g. legal restrictions or stricter sanctions for practitioners that conduct or allow such treatments, better financing of evidence-based medicine so that doctors have more time for their patients) and individual level (e.g. educational efforts targeting homeopathy users). Regarding the latter, it needs to be kept in mind that both subgroups most in need of interventions (i.e. the subgroups supporting or being open toward the standalone use of homeopathy in serious conditions) indicated the most negative attitudes toward science: They cared the least about scientific evidence regarding homeopathy and perceived science to be the most corrupt and limited. Given these characteristics, simply informing members of these subgroups about the scientific consensus regarding homeopathy—as is typically recommended in the psychological literature to address beliefs in conflict with scientific evidence —might not be an effective strategy. Instead, interventions might first have to create a shared understanding of the importance and value of scientific evidence and evidence-based treatments. This might entail, for example, a more foundational education about how the scientific method works, and why it is superior to, for example, relying on personal experiences and observations in making causal judgments.
WISE WORDS INDEED!
Traditional Chinese Medicine (TCM) tends to prioritize inherent general immunity instead of vaccination, thereby contributing to widespread vaccine hesitancy or refusal amidst the general public. The objective of this investigation was to furnish evidence regarding the profiles and drivers of seasonal influenza vaccine hesitancy (IVH) among TCM clinicians. Between January and May 2022, the Chinese researchers conducted a nationwide survey in China with embedded an influenza vaccine hesitancy scale to 3085 registered clinicians (1013 TCM and 2072 Western medicine (WM) clinicians).
The results suggest that TCM clinicians exhibit lower possibility of influenza vaccine uptake and are less likely to recommend the immunisation to the patients. 58.3 % TCM clinicians and 52.3 % WM clinicians were categorized as being influenza vaccine hesitant. Compared to WM clinicians, TCM clinicians have lower confidence in vaccine (p < 0.001) and are less inclined to accept others’ vaccination recommendation (p < 0.001). Higher educational attainment in TCM (postgraduate: OR = 1.98, 95 %CI,1.30–3.02; doctor: OR = 2.20, 95 %CI, 1.28–3.77) and ignorance of influenza vaccination cost policy (OR = 1.76, 95 %CI, 1.18–2.63) are significantly associated with increased influenza vaccine hesitancy.
The authors concluded that the concerns and doubts towards influenza vaccine is highly prevalent in the Chinese clinicians, especially those practicing TCM. High TCM educational degrees and ignorance of influenza vaccination cost policies are two primary risk factors for developing influenza vaccine hesitancy.
The findings are, I think, far from surprising. There is plenty of evidence about the negative stance towards influenza and other vaccination that practitioners or proponents of so-called alternative medicine (SCAM) display, e.g.:
- Do views about so-called alternative medicine (SCAM), nature and god influence people’s vaccination intentions?
- Use of so-called alternative medicine (SCAM) and its association with SARS-CoV-2 vaccination status
- Chiropractors Aren’t The Solution To The Primary Care Shortage: the thorny issue of vaccination
- An osteopath and anti-vaccination activist received a well-deserved and long-overdue indefinite suspension
- Prison sentence for a German HEILPRAKTIKER who issued false vaccination certificates
- Interest in so-called alternative medicine is linked to vaccination coverage
- Naturopath jailed for selling fraudulent vaccination documents
- Vaccination rates of Canadian healthcare professionals: those of chiropractors and naturopaths are at the lowest
- A Professor for Integrative and Anthroposophical Medicine claims that severe adverse effects of COVID vaccinations are 40 times more frequent than officially recognized
- Preference of so-called alternative medicine predicts negative attitudes to vaccination
- Intelligence, Religiosity, SCAM, Vaccination Hesitancy – are there links?
- A well-known opponent of vaccination has died of COVID after self-treatment with MMS
- The International Chiropractors Association’s Statement on Vaccination
- A naturopath promoting fake news about COVID vaccinations
- More information on homeopaths’ and anthroposophic doctors’ attitude towards vaccinations
- The UK Society of Homeopaths, a hub of anti-vaccination activists?
- HOMEOPATHY = “the complete alternative to vaccination” ?!?!
- Are anthroposophy-enthusiasts for or against vaccinations?
- Far too many chiropractors believe that vaccinations do not have a positive effect on public health
- Naturopaths’ counselling against vaccinations could be criminally negligent
- HOMEOPATHS AGAINST VACCINATION: “The decision to vaccinate and how you implement that decision is yours and yours alone”
- Use of alternative medicine is associated with low vaccination rates
- Integrative medicine physicians tend to harbour anti-vaccination views
- Vaccination: chiropractors “espouse views which aren’t evidence based”
With so much evidence and unquestionable serious harm being caused by these SCAM anti-vaxxers, the obvious question is this:
WHY IS SO LITTLE BEING DONE ABOUT IT?
This investigation seems highly relevant to my blog and some of the comments it receives:
The spread of misinformation has emerged as a global concern. Academic attention has recently shifted to emphasize the role of political elites as drivers of misinformation. Yet, little is known of the relationship between party politics and the spread of misinformation—in part due to a dearth of cross-national empirical data needed for comparative study. This article examines which parties are more likely to spread misinformation, by drawing on a comprehensive database of 32M tweets from parliamentarians in 26 countries, spanning 6 years and several election periods. The dataset is combined with external databases such as Parlgov and V-Dem, linking the spread of misinformation to detailed information about political parties and cabinets, thus enabling a comparative politics approach to misinformation. Using multilevel analysis with random country intercepts, we find that radical-right populism is the strongest determinant for the propensity to spread misinformation. Populism, left-wing populism, and right-wing politics are not linked to the spread of misinformation. These results suggest that political misinformation should be understood as part and parcel of the current wave of radical right populism, and its opposition to liberal democratic institution.
Whether related to health or politics, misinformation affects us all. Contrary to a widespread belief, not all sides of the political spectrum are equally guilty of bending the truth or spreading falsehoods.
According to this study, radical-right populists are far more likely to spread falsehoods than their counterparts. The study also points to the creation of an “alternative media ecosystem” by far-right groups that try to recreate reality and create an echo chamber that reinforces their worldview.
The study suggests that radical-right supporters often believe they are better informed than others, even when they are being misinformed. This makes them much more susceptible to misinformation that aligns with their worldview, creating a feedback loop where misinformation fuels distrust, which in turn amplifies the effectiveness of false narratives.
Far-right populists have incorporated misinformation into a strategy that serves multiple purposes:
- Undermining trust in mainstream media.
- Strengthening their base by reinforcing fears and grievances.
- Distracting from policy scrutiny by dominating the media agenda with provocative content.
Radical-right populists bypass gatekeepers, create and disseminate their own narratives. The authors go one step further: they see far-right populism and misinformation as two sides of the same coin. “Misinformation and radical-right populism must hence be understood as inextricable and synergistic—two expressions of the same political moment.”
Unlike other groups, far-right populists rely heavily on falsehoods to exploit our fears and galvanize their base. Understanding this phenomenon seems crucial for addressing the causes of the problem and dealing with it effectively.
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.
Cauda equina syndrome (CES) is a lumbosacral surgical emergency that has been associated with chiropractic spinal manipulation (CSM) in numerous case reports. However, identifying if there is a potential causal effect is complicated by the heightened incidence of CES among those with low back pain (LBP). This study‘s hypothesis was that there would be no increase in the risk of CES in adults with LBP following CSM compared to a propensity-matched cohort following physical therapy (PT) evaluation without spinal manipulation over a three-month follow-up period.
A query of a United States network (TriNetX, Inc.) was conducted, searching health records of more than 107 million patients attending academic health centers, yielding data ranging from 20 years prior to the search date (July 30, 2023). Patients aged 18 or older with LBP were included, excluding those with pre-existing CES, incontinence, or serious pathology that may cause CES. Patients were divided into two cohorts:
- (1) LBP patients receiving CSM,
- (2) LBP patients receiving PT evaluation without spinal manipulation.
Propensity score matching controlled for confounding variables associated with CES.
67,220 patients per cohort (mean age 51 years) remained after propensity matching. CES incidence was 0.07% (95% confidence intervals [CI]: 0.05–0.09%) in the CSM cohort compared to 0.11% (95% CI: 0.09–0.14%) in the PT evaluation cohort, yielding a risk ratio and 95% CI of 0.60 (0.42–0.86; p = .0052). Both cohorts showed a higher rate of CES during the first two weeks of follow-up.
The authors concluded that the present study involving over 130,000 propensity-matched patients found that CSM is not a risk factor for CES. The incidence of CES in both CSM and PT evaluation cohorts aligns with previous estimates of CES incidence among patients with LBP, indicating a heightened risk of CES compared to asymptomatic individuals regardless of intervention. Moreover, these findings underscore the increased CES incidence within the first two weeks after either CSM or PT evaluation, emphasizing the need for clinicians’ vigilance in identifying and emergently referring patients with CES for surgical evaluation. Further real-world evidence is needed to corroborate these findings using alternative case-control and case-crossover designs, and different clinician comparators.
This is an interesting and well-reported investigation. Its particular strength is the huge sample size. Its weakness, on the other hand, is the fact that, despite the researchers best efforts, the two groups might not have been entirely comparable and that there could be a host of relevant factors that the propensity matching was unable to control for.
It is, I think, to the credit of the authors that they abstain from overrating their results and correctly emphasize in their conclusions that: Further real-world evidence is needed to corroborate these findings using alternative case-control and case-crossover designs, and different clinician comparators.
Acute encephalitis syndrome is a health burden to a populous country like India. It is characterized by a sudden onset of fever, altered sensorium with or without seizures, irritability, abnormal behaviour, or unconsciousness. This study aims to augment further evidence on the effects of add-on homeopathic treatment in reducing mortality and morbidity in children.
This comparative retrospective study included children hospitalized with acute encephalitis syndrome between July 2016 to December 2016. The researchers compared the parameters of children for whom decisions on Glasgow Outcome scale and Liverpool outcome score aided by add-on homeopathy against those of children from the same year when the add-on homeopathy was not used. All the children were on conventional supportive care and treatment tailored to each child. We also counted the days until the resumption of oral feeding and the length of hospital stay.
Ordinal regression analysis on analyses on 622 children (IH +CSC=329; IMP only=293) was done. Odds of a shift towards increased recovery were superior in the homeopathy-added group than in the IMP group without adjustment (crude OR 2·30, 95% CI 1·66 to 3·20; p=0·0001) and with adjustment (adjusted OR 3.38, 95% CI 2·38 to 4.81; p=0·0001). There was 14.8% less mortality and 17.4% more recovery in the add-on homeopathy group compared to CSC alone. Individualized homeopathic remedies commonly used were: Belladonna (n =238), Stramonium (n =17), Opium (n = 14), Sulphur (n=11) and Hyoscyamus niger (n = 7).
The authors concluded that this retrospective cohort study advocates for add-on homoeopathy in children suffering acute encephalitis which can produce notable improvements in terms of mortality and morbidity. Further studies in different settings are warranted.
If responsible physicians come across such an unexpected and implausible finding, instead of publishing it unchecked, they must properly test the hypothesis in a rigorous trial. As it stands, the results are meaningless and might even do untold harm, if some doctors drew the conclusion that homeopathy saves lives in acute encephalitis.
The most likely explanation for the reported outcomes is that there was considerable selection bias in recruiting patients to this study. The less severely ill patients might thus have ended up in the homeopathy group. The plausibility for the outcomes being due to the homeopathic treatment is virtually zero.
So, why did the authors of this paper publish such utterly unreliable findings and did not even include a hint of critical thinking? I think their affiliations might go some way in answering this question:
- Ramesh Prasad, Clinical Trial Unit Homoeopathy,BRD Medical College and Hospital, GorakhpurAlok Upadhyay, Clinical Trial Unit Homoeopathy (Viral encephalitis) BRD Medical College and Hospital, Gorakhpur
- Vinod Kumar Maurya, Clinical Trial Unit Homoeopathy (Viral encephalitis) BRD Medical College and Hospital, Gorakhpur
- Preeti Verma, Clinical Trial Unit Homoeopathy (Viral encephalitis) Medical College and Hospital, Gorakhpur
- Shashi Arya, Clinical Trial Unit Homoeopathy (Viral encephalitis) Medical College and Hospital, Gorakhpur
- Supriya Singh, Central Council for Research in Homoeopathy
- Purnima Shukla, Clinical Trial Unit Homoeopathy (Viral encephalitis) BRD Medical College and Hospital, Gorakhpur
- AK Gupta, Clinical Trial Unit Homoeopathy (Viral encephalitis) BRD Medical College and Hospital, Gorakhpur
- Arvind Kumar, Central Council for Research in Homoeopathy
- Praveen Oberai, Central Council for Research in Homoeopathy
- Raj K Manchanda, Central Council for Research in Homoeopathy, New Delhi
And why did they take all of 8 years to publish this nonsense?
Search me!
