case report
Manfred Lucha has been Baden-Württemberg’s Minister for Social Affairs, Health and Integration since 12 May 2016. He also is a staunch defender of homeopathy.
Lucha has repeatedly spoken out in favour of maintaining the reimbursement of costs for homeopathy by health insurance companies. He described anthroposophy and homeopathy as the essence of the Green Party. In August 2022, Lucha positioned himself against the Baden-Württemberg Medical Association on the subject of homeopathy. The Association had announced that additional training for doctors in homeopathy would be removed from the medical training catalogue. Health Minister Lucha stated that he still believed in the effectiveness of homeopathy and announced a legal review of the decision, as the Ministry of Health has legal supervision over the Medical Association. Lucha also criticised the plan by Federal Health Minister Karl Lauterbach to no longer allow homeopathic treatments to be paid for by health insurance companies. Finally, it seems safe to assume that Lucha is not amused about the new development about which I reported yesterday.
With so much outspoken engagement in the medical field, one would expect that Lucha has a solid background in evidence-based medicine and science. Yet, one would be mistaken.
After an apprenticeship as a chemical worker, Lucha completed secondary school and trained as a nurse at the Weißenau Psychiatric State Hospital. He went on to gain his university entrance qualification and studied social work. In 2005, he also completed a Master’s degree in ‘Management in Social and Health Care’. He then became the technical director of a community psychiatric centre in Friedrichshafen. Lucha is spokesman for the Bodensee district community psychiatric association and deputy federal chairman of the Federal Working Group of Community Psychiatric Associations.
Any education in evidence-based medicine?
No!
So, why does he feel he knows better than the experts?
I am not sure.
PS
Mr. Lucha, if you read these lines, please tell us.
To show my appreciation, I would then send you a copy of the German translation of my book on homeopathy.
Recently, I heard JD Vance (the would-be Vicepresident of the US) proclaim: THE ENEMY ARE THE PROFESSORS! Unsurprisingly, this remark alarmed me; I had not been previously aware of being an enemy of the people.
Vance stressed that this was a quote by Richard Nixon made some 40/50 years ago. I looked up Nixon’s quote and found that the original is apparently a little different:
Never forget, the press is the enemy. The establishment is the enemy. The professors are the enemy. The professors are the enemy. Write that on a blackboard a hundred times and never forget it.
So, why does Vance quote Nixon (arguably not one of the most honest men in the history of US politics) and insist on THE PROFESSORS ARE THE ENEMY? Why was this puzzling quote followed by plenty of applause from his audience?
The answer must be that it is a populist theme that touches a nerve with right-wing voters. But what does the sentence actually mean?
On Vance’s campaign website, he explains that “hundreds of billions of American tax dollars” get sent to universities that “teach that America is an evil, racist nation.” These universities “then train teachers who bring that indoctrination into our elementary and high schools.” Vance doesn’t want public funds to go to institutions that teach “critical race theory or radical gender ideology.” He rather wants them to deliver “an honest, patriotic account of American history.”
Vance and Nixon are not the first politicians to recently claimed that the enemies are the professors. In 2016, the UK conservative Michael Gove refused to name any economist backing Britain’s exit from the European Union, saying that “people in this country have had enough of experts”.
According to Wikipedia, anti-intellectualism is hostility to and mistrust of intellect, intellectuals, and intellectualism, commonly expressed as deprecation of education and philosophy and the dismissal of art, literature, history, and science as impractical, politically motivated, and even contemptible human pursuits. Anti-intellectuals may present themselves and be perceived as champions of common folk—populists against political and academic elitism—and tend to see educated people as a status class that dominates political discourse and higher education while being detached from the concerns of ordinary people. Totalitarian governments have, in the past, manipulated and applied anti-intellectualism to repress political dissent. During the Spanish Civil War (1936–1939) and the following dictatorship (1939–1975) of General Francisco Franco, the reactionary repression of the White Terror (1936–1945) was notably anti-intellectual, with most of the 200,000 civilians killed being the Spanish intelligentsia, the politically active teachers and academics, artists and writers of the deposed Second Spanish Republic (1931–1939). During the Cambodian Genocide (1975–1979), the totalitarian regime of Cambodia led by Pol Pot nearly destroyed its entire educated population.
Fascist movements are 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 Joseph Goebbels said this: “There was no point in seeking to convert the intellectuals. For intellectuals would never be converted and would anyway always yield to the stronger, and this will always be the man in the street. Arguments must therefore be crude, clear and forcible, and appeal to emotions and instincts, not the intellect. Truth was unimportant and entirely subordinate to tactics and psychology.” 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.
And here we might have a reason why a certain type of politician dislikes intellectuals and feels that the enemy are the professors. Professors do science, science is about truth, and the truth is something that politiciance like Vance must fear like the pest. It would disclose their agenda as being fascist.
In conclusion, the claim, “THE PROFESSORS ARE THE ENEMY”, is an argument of polititians who have good reason to fear the truth, and it appeals to voters who are too dim to understand the danger posed by those they wish to elect.
It has been announced that advertisements for three supplement brands claiming to treat a range of medical conditions, including autism and ADHD, have been banned in the UK.
A paid-for Facebook advert for Aspire Nutrition in April said: “The secret weapon parents of ASD kids swear by”, while text in the form of a review attributed to “Tara K. Verified Buyer”, read: “This has helped my five-year-old with level two autism so much. “Within the first week his meltdowns decreased by 80%. He is communicating so much better… he is starting to show kindness and empathy to his little sister.” Further text read: “As parents of children with autism, we all share the same dream: to see our children thrive in school.”
Another paid-for Facebook ad in January, for Drop Supplements, stated: “For people with stress, anxiety, brain fog, ADHD … Happy Mind Drops – your new secret adaptogen against stress! Prepare yourself to unleash your true potential and banish your mental barriers.”
A third paid-for Facebook ad for Spectrum Awakening stated: “My five-year-old son Scout is diagnosed with receptive expressive language disorder and sensory disorder. Until I found Spectrum Awakening he could barely put a sentence together with very limited speech and words and lots of jargon.” It went on: “The first supplement we tried was Power and Focus and within the first three days he started using way more words. Within a week he was speaking sentences. I’m absolutely amazed that I can’t wait to order more.”
The Advertising Standards Authority (ASA) found that the claims that each supplement, or substances in them, could help to prevent, treat or cure autism breached regulations after investigations.
Aspire Nutrition said they had stopped sending adverts to UK residents who visited their website and had withdrawn the ad entirely for all audiences after being informed of the complaint. Drop Supplements said their adverts featuring Happy Mind made no direct or implied statements about curing, treating or preventing ailments or diseases. However, the ASA said the advert’s claims would be understood by most consumers as implied claims that the product could prevent, treat or cure human disease. Spectrum Awakening did not respond to the ASA’s inquiries.
The ASA told each firm to ensure their future advertising did not claim that food – in these cases in the form of a supplement – could prevent, treat or cure human disease.
____________________
Such work by the ASA is most laudable, in my view. Misleading advertising is endangering the health of consumers thousands of times every day. However, the firms affected by the ASA reprimands are probably not all that worried. In fact, I imagine that they are laughing their heads off:
- The chances of getting caught for misleading advertising are truly minimal.
- If they are unlucky and do get caught the punishment is negligible.
- There is little to stop them re-offending.
It is time that the ASA (and the equivalent organisations in other countries) get more power, more support and more money to effectively go after offenders in such a way that others think twice before breaking advertising rules.
For many years, Dale Thompson has been one of our most loyal commentators, often defending the indefensible, or willfully misleading us, or deliberately distracting us from the topic at hand. He has made his comments under several names or pseudomyms, sometimes with and sometines without using the doctor-title, sometimes disclosing that he is a chiropractor and someimes not disclosing either this information or his most obvious conflicts of interest.
Recently, several readers became more interested in Dale and his activities. I therefore thought it would be relevant to find out how he is being presented on the Internet. Here are the mentions I found that include some relevant information about Dale:
- Dr. Dale Thompson. Over 20 years of delivering a conservative approach to muscle and joint issues. Trained in approaches that don’t require the typical adjustment but it is available when needed. Use a whole body approach and consider other factors that may be contributing to problems such as diet, ergonomics, lifestyles, etc.
- Dr. Dale Thompson is a Stratford, Iowa based male chiropractor with 22 years of experience in General Chiropractor. He completed his graduation from Logan College Of Chiropractic in 2002. He accepts the Medicare-approved amount. Patients will not be billed for any more than the Medicare deductible and coinsurance. Active license number of Dr. Dale Thompson as General Chiropractor is 06631 in Iowa. Dr. Dale Thompson is qualified as a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.
- Dr. Thompson graduated from the Logan College of Chiropractic in 2002. He works in Stratford, IA and specializes in Chiropractor.
- DALE THOMPSON, D.C. practices at 813 SHAKESPEARE AVE, STRATFORD, IA 50249. Chiropractors diagnose and treat common spinal misalignments that can occur from lifestyle or injuries causing pain, discomfort and degenerative conditions. DALE THOMPSON, D.C. may be able to treat; back pain, sciatica, neck pain, shoulder pain, headaches, sports injuries, and auto accident injuries.
- Dr. Dale Thompson – Why I Like Being An Evidence-Based Chiropractor. Today we’re going to talk about being an evidence-based chiropractor. What does it mean to be practicing evidence-based chiropractic and we’re going to be talking about with Dr. Dale Thompson from Iowa. USA.
As we see, these texts are not always entirely clear about the fact that Dale has no medical degree. Dale recently posted: “Here in the USA it would be a board violation to ‘conceal’ that one is a doctor of chiropractic.” And in August 2021, he made this comment: “There are several professions that use the title doctor which aren’t earned from a medical college: dentists, optometrists, physical therapists. Within chiropractic, when we advertise, at least in the USA, we are required to identify that we are a doctor of chiropractic. Of course the word doctor originally was used by a religious sect but the medical profession decided they wanted it … “Several authors have recently lamented the continued chiropractic inclination to use outdated and anatomically incorrect language to describe the nature of the manipulable lesion (“subluxation”) and the method of treatment (“adjustment”).2,3,11 J Chiropr Educ. 2020 Oct; 34(2): 172–176.”
Next, I looked on Medline to find out wether Dale has ever published any research on his subject. I failed to find a single article in his name. This is remarkable because, all too often, he presents himself as THE expert in research.
Subsequently, I looked at some of the claims made by Dale. Here are a few of them:
- I can go to a conference and know if the speaker is generally telling the truth or is trying to sell a lie.
- I can read a research paper and know if it’s good or bad and how it may apply to what I do.
- I can take the best evidence and apply it and yet also have the freedom to find novel ways to approach a problem.
- I can take a seemly complex problem and find a simple solution as well as understand the complexity of an apparently simple problem.
- I know my clinical strengths and limitations as well as the strengths and limitations of other healthcare professionals.
- I do not have to jump on board the latest health fad but I can, and may, scrutinize it using logic, reasoning and supporting evidence.
- I can respect my colleagues desire to practice different than me but I still demand they do so in an evidence-based chiropractor and ethical manner.
- My patients come first, my profession second and I am last.
So, what should we conclude about Dale Thompson?
I don’t know about you, but I get the impression that Dale lacks the ability to be critical of his own abilities and of the value of chiropractic. He likes to post comments that are aimed at misleading us. He might not be a ‘straight chiropractor‘ in the usual sense of the term, but in my view he also is still far from straight. Personally, I have not taken much notice of his deeply biased, often pompous and smug comments for some time. I suggest you consider doing the same.
But Dale is just one chiro!
He hardly has any wider significance.
So, why even bother and write a whole blog post about him?
I certainly agree that such a man does not deserve the attention we have been giving him. But Dale stand for so many of his colleagues. In fact, he is a prime example of a chiro victim of the ‘Dunning Kruger Effect‘. These people have a thin veneer of respectability which allows them to pretend to be veritable ‘know alls’. They remain entirely oblivious to the fact that they have been brain-washed at chiro school and have become a life-time members of a cult unable to see how deluded they truly are. As such they are dangerous, and I feel that the public needs to be aware of the danger.
And here you have the true reason why I am writing these lines.
Jay Kennedy is an experienced chiropractor of some standing.
In “2018, ‘The American Chiropractor’ wrote this about Jay Kennedy:
Jay Kennedy, DC, is a 1987 graduate of Palmer Chiropractic College and maintains afull time practice in western Pennsylvania. He is the principal developer of the Kennedy Decompression Technique. Dr. Kennedy teaches his non-machine specific technique to practitioners who want to learn clinical expertise required to apply this increasingly mainstream therapy. Kennedy Decompression Technique Seminars are approved for CE through various Chiropractic Colleges.
‘The Dynamic Chiropractor’ published plenty of articles authored by Jay Kennedy.
I am telling you this because Jay Kennedy recently posted a comment which is far too important to be burried in the many other comments on this blog. I think it deserves full recognition and loud applause. I have therefore decided to take the unusual step and re-post it here as an entirely seperate post.
Here we go:
I was a DC for 30+ years and a notable one for the last 20 years. I taught 200+ seminars, wrote innumerable articles and taught at many chiropractic colleges. I had (3) private practices and was a technique “guru”: “Kennedy decompression technique” or KDT. We “certified” nearly 5000 DCs to be “decompression experts”!
Kdt still sells farcical traction-tables I developed and designed (labeled as “decompression systems”) as well as useless lasers, ultrasonic vibrators and other scam modalities to confound the DCs and milk the public. (I have been out of it for several years now).
I am not proud of the fact I made a lot of money both in practice and as a lying cultist-entrepreneur.
I have read your blog for several years and many of your books, especially related to Chiropractic. You are not mistaken and I do NOT believe you are biased, the fact that you define the practice as SCAM and a cult is absolutely the case. As has been said before it is “the world’s largest non-scientific healthcare delivery system”. I was fortunate many years ago to meet Stuart McGill PhD. It changed my practice considerably. I opened a gym and focused dramatically on exercise. I also had other income steams from selling bullshit equipment. The regrettable feature is chiropractors sell “treatments”…. Some of which superficially alter pain signals temporarily like many OTHER less expensive and less mendacious things. This “traps” many patients into an erroneous paradigm….one a DC is ready, willing and able to exploit. “Chiropractic treatments” NEVER get to the root of a problem, alter any disease-process or substantially improve a patient. Regrettably selling exercise simply WILL NOT garner the income that selling (and coercing) subluxation-elimination treatments will (and virtually NO DC has the experience or expertise a PT PhD has in that arena).
Interestingly when you do seminars as a chiropractor, most states make you sign a waiver stating that you will not disparage Chiropractic or discuss information that minimize the value of Chiropractic. Can you imagine medical seminars or a scientific seminar having such a waiver? Chiropractic is and has always been a moneymaking scheme. That doesn’t exclude the fact there are many chiropractors who buy into it as a supreme truth….just like Muslims who murder with the thought of getting directly to Heaven to start porking some virgins.
I have discovered most DCs are on the low IQ scale, have poor critical thinking skills and rarely question their golden-goose (or perhaps more sympathetically; never venture outside the bounds of the profession and its rhetoric and hyperbole. They have been effectively able to compartmentalize Chiropractic from rightful and accurate criticism). Most of the successful ones are of course entrepreneurs with ravenous appetites for money, prestige and approval (and have little or no interest in the “truth”…..oops I described myself I guess).
The majority however struggle to get by and are constantly seeking SOMETHING that might actually work. Thus 70%+ use and advertise “decompression”, Activators (and other ridiculous “adjusting guns”), drop-tables, energy-techniques, orthotics and whatever other nonsense some company advertises in Chiropractic Economics with a testimonial of how much money can be made. It always fascinated me that if “subluxation-reduction or elimination” was the solution for disease and pain WHY did the profession embrace all of these other nonsensical modalities? If your guess is: “chiropractic doesn’t really work”…give yourself a beer.
When you graduate as a DC you CAN ONLY be in private SCAM practice….no other opportunities exist. Is it really any wonder that lying is the only avenue available to support a practice and an income stream? Nope.
______________________
I wish to express my thanks to Jay for his courage and honesty in writing these lines.
The objective of this paper was to review the 10 most recent case reports of cervical spine manipulation and cervical artery dissection for convincing evidence of the causation of cervical artery dissection by cervical spine manipulation. The author, Steven P. Brown, a chiropractor (who is quoted as “the authors have declared that no competing interests exist”), lists the following 10 cases:
Case 1: Yeung et al. (2023) [17]
Yeung et al. [17] reported that a “48-year-old female went to a chiropractor for chronic neck pain and developed right-sided weakness, nausea, dizziness, and vomiting immediately after neck manipulation.” Imaging showed occlusion of the V1 segment of the right vertebral artery and cerebellar stroke.
The adverse event immediately following cervical spine manipulation (CSM) was the cerebellar stroke, not the cerebral artery dissection (CAD). Right-sided weakness, nausea, dizziness, and vomiting are symptoms of cerebellar ischemia, not right VAD. The neck pain prior to the CSM is consistent with a CAD being present prior to CSM, not caused by CSM.
Even if CSM had caused the CAD, it is not biologically possible for a thrombus large enough to occlude the vertebral artery to form immediately [6]. Therefore, the CAD was likely pre-existing to CSM. While an existing thrombus may have been aggravated by the CSM, it was not caused by the CSM. In this case, it is plausible that CSM may have suddenly repositioned an already large thrombus in such a way that it blocked the V1 segment of the right vertebral artery, resulting in thrombotic ischemic stroke from vascular occlusion [26]. The practitioner failed to exclude CAD and performed CSM when it was contraindicated [7]. So, while thrombotic stroke may have been causally related to the CSM, the CAD was not.
Cases 2 and 3: Chen et al. (2022) [18]
Chen et al. [18] reported that “a 51-year-old man with a history of mild hypertension noted new-onset right neck pain two days following chiropractic manipulation.” Imaging revealed dissection of the C3 segment of the right ICA and right-sided stroke.
Chen et al. [18] also reported a second case in which “a 55-year-old man with a history of cigarette smoking, no other cerebrovascular risk factors, received chiropractic cervical manipulation 1 day prior to presentation to the emergency department with new onset of left hemiparesis, facial paralysis, right neck pain, and dysarthria lasting for 5 hours.” Imaging revealed dissection of the C3 segment of the right ICA and right-sided cerebral stroke.
In these two case reports, the symptoms that prompted the patients to seek CSM were not documented. In the first case, neck pain started two days after CSM. In the second case, neck pain started 19 hours after CSM.
In these two cases, there was no adverse event immediately following CSM. As there was no neck pain, headache, or ischemic symptoms noted immediately after CSM, it is not likely that CSM caused the ICA dissection or the stroke. Furthermore, the C3 segment of the ICA is intracranial and has not been identified as an area for strain by CSM.
Case 4: Arning et al. (2022) [19]
Arning et al. [19] reported the case of a 47-year-old female with a two-week history of non-traumatic right neck pain who had increased, severe right neck pain immediately after CSM, and paresis of the right deltoid muscle and hypalgesia in the right C3 and right C4 dermatomes. MRI revealed a dissection of the V2 segment of the right vertebral artery.
The adverse event immediately following CSM was a stroke, not a CAD. Paresis and hypalgesia are symptoms of brain ischemia, not right VAD. The right neck pain prior to the CSM is consistent with a right VAD being present prior to CSM, not caused by CSM.
Prior to CSM, cervical spine disc herniation had been ruled out by MRI. Upon review, the pre-CSM MRI also showed dissection of the right V2 segment, which had initially been overlooked by the radiologist. The practitioner performed CSM when it was contraindicated. Therefore, while the CSM may have caused the ischemic stroke by a thromboembolic mechanism, the CSM did not cause the CAD.
Case 5: Abidoye et al. (2022) [20]
Abidoye et al. [20] reported, “This is a 40-year-old male with a medical history of migraine headaches and cervicalgia, evaluated for a sudden onset of headache, associated with nausea, vomiting, blurred vision, and dizziness, two months after a chiropractic manipulation. He also reported rigorous exercise and sexual intercourse prior to the headache onset. Vital sign is significant for a 10/10, non-radiating right-sided headache. Neurological examination revealed right ptosis and miosis. Labs were unremarkable. CTA of neck showed tapering of the right ICA with near occlusion at the skull base.” No imaging evidence or diagnosis of stroke was documented. However, with ischemic symptoms of nausea, vomiting, blurred vision, dizziness, right ptosis, and right miosis, it is likely that this patient suffered a stroke.
In this case, there was no adverse event immediately following CSM, and the most recent CSM was two months prior to the onset of symptoms. As there was no neck pain, headache, or ischemic symptoms noted immediately after CSM, it is not likely that CSM caused the ICA dissection or the stroke.
The patient’s medical history of neck pain and headaches are risk factors for CAD. If there was existing right ICA dissection, it is plausible that rigorous exercise and sexual intercourse could have dislodged a loosely adherent ICA thrombus and caused immediate stroke by a thromboembolic mechanism. However, this is not possible to determine as the temporality from exercise and intercourse to ischemic symptoms of stroke was vaguely documented as “prior to.”
Case 6: Yap et al. (2021) [21]
Yap et al. [21] reported a 35-year-old male who presented with a two-day history of expressive dysphasia and a one-day history of right-sided weakness. The patient reported having CSM for pain relief sometime in the prior two weeks. Imaging showed left ICA dissection and left middle cerebral artery stroke. The dissected segment of the left ICA was not documented.
In this case, there was no adverse event immediately following CSM. As there was no neck pain, headache, or ischemic symptoms noted immediately after CSM, it is not likely that CSM caused the ICA dissection or the stroke.
Case 7: Xia et al. (2021) [22]
Xia et al. [22] reported a case of a 44-year-old male with chronic neck pain who reported sudden-onset left homonymous hemianopia after CSM a few days prior. The patient reported progression from a left homonymous hemianopia to a left homonymous inferior quadrantanopia. Imaging revealed bilateral VAD at the left V2 and right V3 segments, and right medial occipital lobe stroke. The authors noted that a right posterior communicating artery stroke was likely embolic from the right V3 and left V2 dissections. They also noted that the patient likely had a migrating embolus as evidenced by the progression from a homonymous hemianopia to a quadrantanopia.
The adverse event immediately following CSM was the stroke, not the CAD. Left homonymous hemianopia is a symptom of brain ischemia, not VAD. The neck pain prior to the CSM is consistent with VAD being present prior to CSM, not caused by CSM.
Even if CSM had caused the CAD, it is not biologically possible for a thrombus to instantly form and dislodge to cause sudden-onset thromboembolic stroke [6]. Therefore, the CAD was likely pre-existing to CSM. While an existing thrombus may have been aggravated by the CSM, it was not caused by the CSM. In this case, it is possible that CSM dislodged a loosely adherent vertebral artery thrombus to cause thromboembolic stroke [26]. The practitioner failed to exclude CAD and performed CSM when it was contraindicated [7]. So, while thromboembolic stroke may have been causally related to the CSM, the CAD was not.
Case 8: Lindsay et al. (2021) [23]
Lindsay et al. [23] reported a case of a 47-year-old male who presented with left neck pain and headache. His medical history was notable for dyslipidemia and a cerebellar stroke six years prior. Imaging revealed dissections of the left vertebral artery extending from the origin of the artery to the V3 segment. The patient also had a dissection of his right renal artery. There was no evidence of a stroke.
Six years prior, the patient had presented with a one-week history of left neck pain and headache, as well as left facial numbness and dizziness. The pain was not relieved with ibuprofen and previously been evaluated and treated by a chiropractor. Imaging done six years prior showed no evidence of CAD but did show a left cerebellar stroke.
There is no plausible biological mechanism by which CSM six years prior could cause a current VAD. Therefore, it is not likely that there was a causal relationship between CSM and CAD in this case.
Ultimately, the patient was diagnosed with vascular Ehlers-Danlos syndrome, a disorder that causes connective tissue weakness and makes a patient susceptible to arterial dissection. This diagnosis is consistent with the left VAD and right renal artery dissection.
Case 9: Monari et al. (2021) [24]
Monari et al. [24] reported a case of a 39-year-old pregnant female with a history of tension headaches presenting with vertigo, vomiting, nystagmus, dizziness, and hindrance in the execution of fine movements of the right arm. The patient reported having CSM by an osteopathic specialist “in the days preceding the beginning of the symptoms.” Imaging showed a dissection of the V2 segment of the right vertebral artery and a right-sided stroke.
In this case, there was no adverse event immediately following CSM. As there was no neck pain, headache, or ischemic symptoms noted immediately after CSM, it is not likely that CSM caused the right vertebral artery dissection or the stroke. Medical history of headache prior to the CSM is consistent with a VAD being present prior to CSM, not caused by CSM. Pregnancy is also a risk factor for CAD.
Case 10: Ramos et al. (2021) [25]
Ramos et al. [25] reported a case of a 48-year-old female with a history of chronic neck pain who experienced sudden neck pain and generalized weakness during CSM. Imaging showed bilateral VAD and occlusion and bilateral acute cerebellar stroke. There was also tetraplegia noted at the C5 sensory level, C5 and C6 vertebral fracture, spinal cord injury, epidural hematoma, and acute disc herniation.
There is convincing evidence that CSM caused CAD and stroke in this case. This case is exceptional as the CSM was contraindicated by pre-existing cervical spine pathology. Cervical spine bony ankylosis was noted which existed prior to the CSM. The CSM appears to have been a posterior-anterior manipulation of the cervical spine at the level of C5-C6, which was contraindicated due to the presence of the bony ankylosis [27].
The practitioner failed to exclude cervical spine pathology and performed CSM when it was contraindicated. The spinal pathology in this case could have been diagnosed with a cervical spine X-ray examination.
As the Ramos et al. [25] study provided limited case information, a case report from Macêdo et al. [28] provides additional information on this exceptional case.
“A 47-year-old Afro-Brazilian woman with long-standing back pain sought chiropractic care for symptomatic relief. Until then, she had never consulted a doctor to treat her axial pain and was not aware of having any specific spinal pathology. Since childhood, she had a moderate cognitive deficit, which probably compromised her ability to adequately describe the pain and, thus, led the family to seek medical advice. During her last session of spinal manipulation, she mentioned new-onset paresthesia beginning on the upper limbs and progressing to the lower limbs. Her complaint was disregarded, and the session continued, at the end of which she was unable to stand. Urinary retention ensued a little after. The patient was referred to our service only a week after, completely bedridden. Spine MRI revealed a transdiscal fracture at C5-C6, resulting in critical stenosis and compressive myelopathy. CT angiography revealed traumatic thrombosis of the vertebral arteries emerging on this level. Whole spine-imaging evidenced multiple syndesmophytes giving a characteristic bamboo spine appearance, as well as ankylosis in sacroiliac joints, uncovering the diagnosis of ankylosing spondylitis. She underwent laminectomy from C2 to C6 and arthrodesis from C2 to T2 for spine stabilization but did not recover mobility. Even though a systematic review did not find an increased risk of significant adverse events related to spine manipulation therapy, there have been descriptions of vertebral fracture following a session on patients with ankylosing spondylitis and unsuspected multiple myeloma.”
The author concluded that nine out of the 10 case reports of CSM and CAD did not provide convincing evidence of the causal relationship between CSM and CAD. Only one case report provided convincing evidence of a causal relationship between CAD and CSM. This case was exceptional as the CSM was contraindicated by pre-existing cervical spine pathology. Therefore, we conclude that practitioners of CSM should exclude cervical spine pathology before performing CSM.
I must say that I find it difficult or even impossible to follow most of the arguments of Mr Brown. Do they teach them a different kind of physiology and pathophysiology in chiro-school? Foremost, he seems to think that case-reports can/should establish cause and effect. Do they teach research methodology at all in chiro-school?
Here is what Wiki tells us, for instance:
In medicine, a case report is a detailed report of the symptoms, signs, diagnosis, treatment, and follow-up of an individual patient. Case reports may contain a demographic profile of the patient, but usually describe an unusual or novel occurrence. Some case reports also contain a literature review of other reported cases. Case reports are professional narratives that provide feedback on clinical practice guidelines and offer a framework for early signals of effectiveness, adverse events, and cost.
So, case reports “offer a framework for early signals of adverse events”. To expect that they demonstrate a causal link is ill-informed. Their significance in relation to risks lies mostly in providing a signal, particularly if the signal becomes loud and clear due to numerous repetitions, as is the case in chiropractic manipulations. Once the signal is noted, it needs further investigation to determine its nature. In the absence of conclusive further studies, a signal that has emerged hundreds of times, as in chiropractic, it has to be taken seriously. In fact, the precautionary principle demands that we then assume causality until proven otherwise.
As to the research effort of Mr Brown in assembling 10 case reports, I must say it is frightfully daft for the following reasons:
- Most cases do probably not get connected to a CSM at all.
- Many lead to litigation and are not published.
- In the end, very few get published in the medical literature.
- Being retrospective, they all lack important detail and are thus incomplete.
- None prove causation and only some render it likely.
- A sample size of 10 is laughable.
- Brown’s desire to white-wash chiropractic is plapable.
- So is his naivety.
An article in ‘METRO’ caught my eye – not least because it quotes me. Here are a few edited excerpts:
Peter Stott lost his first wife to cancer in 1998. Her death, he believes, was due to geopathic stress (GS) – harmful energies that originate from the Earth. ‘I found out that the house where we had lived had a serious GS problem,’ he says. The discovery prompted him to become a professional ‘dowser’, devoting his life to finding and managing geopathic stress.
But what exactly is this mysterious force erupting from the surface of the Earth – and can it really harm people?Geopathic stress is said to cause discomfort and health issues for certain individuals. These energies, also called ‘harmful Earth rays’ by believers, can be detrimental, beneficial or neutral according to those who think they are ‘in the know’.
The word ‘geopathic’ is derived from the Greek words ‘Geo’ meaning the Earth and ‘pathos’, meaning disease or suffering – hence the term pathogens, the medical terms for bugs that make us ill.
Dowsing, practitioners say, is a method used to detect the presence of various subtle Earth energies and assess their nature and quality. They argue that some of these energies can be linked to geomagnetic anomalies caused by flowing underground water, dry faults and fissures, subterranean cavities, or mineral and crystal deposits.
Dowsing is carried out by a dowser, practitioners who try to find the source of these energies using special tools, such as pendulums, rods, and bobbers – essentially sexed-up tree branches. The person holds the tool, waiting for it to move or react, which they take as a sign that they’ve found what they’re looking for. The odd practice can allegedly also be used to identify leaks, stress fractures, environmental pollutants, electromagnetic fields, nutritional deficiencies, black spots, and, rather oddly, sexing pigeons.
Peter claims that a skilled dowser effectively advises on the optimal placement of buildings and structures to mitigate the impact of geopathic stress, and often possesses the ability to reduce or eliminate it through the use of various methods. He emphasises the fact that GS ‘does not affect everybody in the same way. Cancer has been described as “a disease of location”,’ he says. ‘And if there is a family history of cancer – as there was in my late wife’s case – a person can be more susceptible to GS being a contributing factor in succumbing to the disease.’ Peter believes that GS impacts our immune system, depleting its resources and hindering its ability to function optimally. By eliminating GS from our surroundings, we allow our immune system to operate more efficiently, he contends. Our susceptibility to GS varies, he says, with some experiencing mild symptoms like sleep disturbances and fatigue, while others may face more severe health issues such as arthritis, multiple sclerosis and cancer.
In 2017, rather incredibly, a report revealed that 10 out of 12 water companies in the UK were employing the practice of water dowsing to identify and locate leaks. Even more incredibly, last year, it emerged that Thames Water and Severn Trent Water were still using this form of ‘witchcraft’ for leak detection, despite scientific research indicating its lack of efficacy.
But water companies aren’t the only ones turning to dowsers for help. Peter believes that ‘it is also possible to carry a token or amulet on your person that has been imbued with the powers of protection by someone who is proficient in [dowsing]’. ‘This can protect you from GS and other detrimental energies wherever you go anywhere throughout the world,’ he claims. ‘Other protection techniques can also offer a degree of protection.’
However, Dr Edzard Ernst, a man who has dedicated years of his life to examining questionable, science-based claims, won’t be enlisting the services of a GS specialist or house healer anytime soon. ‘Geopathic stress cannot cause health problems for the simple reason that it does not exist,’ says the retired physician. ‘It is a sly invention of quacks who exploit gullible consumers. The methods to diagnose GS are as bogus as the ones that allegedly treat it. But the quacks don’t mind – as long as the consumer pays.’
Peter fully acknowledges ‘that dowsing and this work in general is not a catch-all solution for every ailment or every person’s situation’. ‘However, often we are approached by people who are “at the end of their tether” due to their exasperation of experiencing events or circumstances in their lives that are not well catered for in the mainstream wellbeing sector,’ he says. ‘I can only speak personally, I cannot speak for the possibly tens of thousands of dowsers around the world. If our work can help ease a person’s experience of life then that is a good enough reason to continue to help where I can’. He adds that ‘we are never going to change the minds of people like Dr Edzard Ernst’, someone ‘who seems to focus exclusively on debunking anything for which there is not a scientific explanation’. Moreover, science, he notes, ‘is moving on with research done into quantum physics and the theory that everything in the universe is connected and is also accessible to everyone’.
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Oh, dear Peter!
Perhaps you should learn the difference between critical evaluation and debunking (this ‘debunker’ has shown more forms of so-called alternative medicine (SCAM) to be worthy of integrating into the NHS than anyone else).
Perhaps you should read up about the difference between evidence and belief?
And perhaps the chapter on dowsing in my book could help you in this endeavour:
Dowsing is a common but unproven method for divining water and other materials. In alternative medicine, it is sometimes used as a technique for diagnosing diseases or the causes of health problems.
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- Dowsers employ a motor automatism, amplified through a pendulum, divining rod or similar device. The effect is that the device seemingly provides an independent, visible reaction, while the dowser is, in fact, its true cause.
- Dowsing is used by some homeopaths as an aid to prescribe the optimal remedy and as a tool for identify a miasm or toxin load.
- The assumptions upon which dowsing is based lack plausibility.
- Dowsing has not often been submitted to clinical trials.
- All rigorous attempts to test water dowsing have failed, and it is no longer considered a viable method for this purpose.
- The only randomized double-blind trial that has tested whether homeopaths are able to distinguish between a homeopathic remedy and placebo by dowsing failed to show that it is a valid method. Its authors (well-known homeopaths) drew the following conclusion: “These results, wholly negative, add to doubts whether dowsing in this context can yield objective information.”[1]
- If dowsing is employed for differentiating between truly effective treatments (rather than homeopathic remedies), the risk of false choices would be intolerably high, and serious harm would inevitably be the result.
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As I am currently not in the UK, I (almost) missed the news about my ex-friend Michael Dixon (can you forgive me please, Michael?). I am going to report it here as published in the Independent without any comments of my own (which would inevitably have an after-taste of sour grapes):
The King has personally honoured his top medical team amid his treatment for cancer. Dr Michael Dixon, head of the Royal Medical Household, and Charles’s GP Dr Fiona Butler – otherwise known as the Apothecary to the King – have been recognised by Charles for their personal service to the monarch and the royal family…
Dr Dixon has been made a Commander of the Royal Victorian Order (CVO) and Dr Butler is now a Lieutenant of the Royal Victorian Order (LVO), with the accolades announced on the King’s official birthday. Awards of the Royal Victorian Order are in the King’s gift and are bestowed independently of Downing Street to people who have served the monarch or the royal family in a personal way. Dr Dixon and the King have known one another for decades, and he is responsible for overseeing the eminent members of the medical profession entrusted to care for the royal family.
His appointment as head of the Royal Medical Household following Charles’s accession drew criticism due to his outspoken support for alternative therapies, such as faith healing and herbalism. In 2023, Buckingham Palace set out the doctor’s beliefs to The Sunday Times, saying: “Dr Dixon does not believe homeopathy can cure cancer. His position is that complementary therapies can sit alongside conventional treatments, provided they are safe, appropriate and evidence-based.”
As the Prince of Wales, Charles was a passionate campaigner for integrated health, raising the profile of combining evidence-based, conventional medicine with an holistic approach to healthcare. Dr Dixon’s previous roles include a practising GP, a fellow of the Royal College of GPs, a fellow of the Royal College of Physicians, former chairman of NHS Alliance and the chairman of the College of Medicine…
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In case you are not familiar with the relevant history and wonder about the “ex-friendship”, there are numerous posts on this blog about Dixon that might explain. Alternatively, you could read my memoir, A Scientist in Wonderland.
Whenever I report a case of arterial dissection after spinal manipulation, a defender of the indefensible comments that the case does not prove anything.
Let’s try again, shall we?
It has been reported that Nerissa E. Weeks has filed a negligence complaint against Dr. Jack J. Cacic and his business, Lake Worth Chiropractic & Wellness (LWCW). Weeks, a resident of Lake Worth, alleges that she suffered permanent neurological injuries due to the negligence of Dr. Cacic during chiropractic treatments at LWCW. Weeks initially sought treatment from Cacic on January 12, 2023, for low back pain related to a herniated disc in her lumbar spine. Following this initial visit, she returned to Cacic’s office several months later on June 26, 2023, complaining of neck pain and headaches.
During subsequent visits on June 26 and June 28, Cacic performed cervical manipulations and other treatments without obtaining appropriate informed consent from Weeks regarding the risks involved. On June 30, following another session of cervical manipulations by Cacic, Weeks experienced severe dizziness and vertigo shortly after the procedure. She was subsequently hospitalized and diagnosed with an acute right vertebral artery dissection and an ischemic stroke.
Weeks contends that Cacic failed to recognize symptoms indicative of a vertebral artery dissection and did not provide adequate care consistent with professional standards. The complaint states: “As a direct and proximate result of the negligence of the Defendants, WEEKS suffered permanent neurologic injuries due to an acute thromboembolic cerebrovascular accident.”
The plaintiff is seeking damages exceeding $50,000 for medical expenses, loss of earnings, pain and suffering, mental anguish, disability, impairment, and other related costs incurred due to the alleged negligence. Represented by attorney Hector Buigas from Morgan & Morgan P.A., Weeks demands compensatory damages along with interest, taxable costs, attorneys’ fees, prejudgment interest on medical bills as well as any other relief deemed proper by the court.
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How many more such cases do we need before chiropractors admit that cervical manipulations do more harm than good?
How long until all chiropractors explain to their patients that cervical manipulations do more harm than good?
How long until cervical manipulations become obsolete?
It has been reported that HomeoCare Laboratories Inc. is recalling two batches of Homeopathic StellaLife Oral Care Products citing microbial contamination. The recall involves Homeopathic Stella Life Vega Oral Care Spray Unflavored and Advanced Formula Peppermint Oral Care Rinse manufactured in 2024, which are marketed to promote oral health, hydrate oral cavities and support healthy gums. The recall is to be performed at the consumer level.
StellaLife VEGA Oral Care, Spray Unflavored comes with NDC 69685-121-01, lot no. 2552 and expiration date of 02-2026. StellaLife Advanced Formula Peppermint VEGA Oral Care Rinse comes with NDC 69685-143-16, lot no. 2550, and expiration date of 02- 2026.
The affected products were manufactured at HomeoCare Laboratories, shipped nationwide, and distributed through various dental practices. As per the FDA, higher than acceptable levels of TAMC was found in the Advanced Formula Peppermint Vega Oral Care Rinse, while Bacillus sp was found in the StellaLife Vega Oral Spray, Unflavored. Bacillus is a common species found in the environment and are generally non-pathogenic, while patients with oral disease, undergoing dental surgical procedures or with compromised immune systems hold potential risks. In the immunocompromised population, the impacted product may cause severe or life-threatening adverse events due to the introduction of bacteria to the disrupted oral mucosa, possibly leading to bacteremia and sepsis. However, the manufacturer of homeopathic products has not received any reports of adverse events related to these two recalled products so far.
Dental practices and consumers, who have the recalled products, are urged to return the impacted products to HomeoCare Laboratories or to the place of purchase or discard them. The company said it is implementing enhanced quality control measures to prevent recurrence.
On the manufacturer’s website, we find the following:
Homeopathy is a safe, gentle, and natural system of healing that works with your body to relieve symptoms, restore itself, and improve your overall health. It is safe to use and has none of the side effects of many traditional medications, because it is made from the natural substances and is FDA regulated. Homeopathic medicines – known as “remedies” – are made from natural sources (e.g., plants, minerals), and are environmentally friendly and cruelty free.
Homeopathic remedies when used as directed, are completely safe for everyone. They are given in such small doses that they don’t cause side effects.* Homeopathy is not a general or “umbrella” term that describes a variety of different natural therapies. Although homeopathic remedies are derived from natural substances, homeopathy should not be confused with herbal medicine, Chinese medicine, or other types of natural medicines. It is its own, unique therapeutic system.
The FDA’s present policy does not require homeopathic medicines to go through the FDA approval process. The homeopathic ingredients monographed in the Homeopathic Pharmacopoeia of the United States have been reviewed for homeopathic efficacy, toxicology, adverse effects and clinical use. The historical safety record with the use of homeopathic drugs, some for close to 200 years. The FDA drug monitoring process does not reveal any significant instances of problems with homeopathic drug products, thus establishing a positive safety profile.
Homeopathy’s Basic Principle: The Law of Similars It is accepted knowledge that every plant, mineral, and chemical can cause in overdose its own unique set of physical, emotional, and mental symptoms. It also is readily acknowledged that individuals, when ill, have their own idiosyncratic physical, emotional, and mental symptom patterns, even when people have the same disease. Homeopathic medicine is a natural pharmaceutical science in which a practitioner seeks to find a substance which would cause in overdose similar symptoms to those a sick person is experiencing. When the match is made, that substance then is given in very small, safe doses, often with dramatic effects.
Homeopaths define the underlying principle for this matching process as the “law of similars.” The “law” is not unknown to conventional medicine. Immunizations are based on the principle of similars. No less a person as Dr. Emil Adolph Von Behring, the “father of immunology,” directly pointed to the origins of immunizations when he asserted, “By what technical term could we more appropriately speak of this influence than by Hahnemann’s word “homeopathy.”
Homeopathy is a natural form of medicine used by over 200 million people worldwide. The holistic nature of homeopathy means each person is treated as a unique individual and their body, mind, spirit and emotions are all considered in the management and prevention of disease. Taking all these factors into account a homeopath will select the most appropriate medicine based on the individual’s specific symptoms and personal level of health to stimulate their own healing ability.
Homeopathic medicines are safe to use as they rarely cause side-effects. This means when used appropriately under the guidance of a qualified homeopath they can be taken by people of all ages*.
* Claims based on traditional homeopathic practice, not accepted medical evidence. Not FDA evaluated. Individual results may vary.
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I feel like congratulating the manufacturer: not only have they managed to produce normally harmless products in such a way that they are dangerous, but also they are promoting a plethora of untruth and misleading statements about homeopathy. A most remarkable effort!
