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

charlatan

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The UK Reiki Federation (UKRF) is an independent organisation of individuals who have been attuned to Reiki, with the objective of providing support and guidance to Reiki professionals and to the public, with particular reference to education and training, and the public practice of Reiki. Some of their members give of their time each week to send Reiki healing to anyone who makes a request from anywhere in the world.

Each week the volunteers receive a list of those people/animals/events that have requested healing and they all collectively send positive Reiki healing to everyone on the list.

The UKRF claim that Reiki distant healing (RDH) has now been scientifically proven by Lynne McTaggart in these articles http://www.shareguide.com/McTaggart.html and https://lynnemctaggart.com/the-intention-experiment/ that healing is magnified when many healers are involved, so we are contributing an amazing vibration of positivity into our world and doing so much good, with so little effort. Imagine how brilliant it would be if even more members decided they too wanted to support other people, with minimum effort. It’s so simple just to place your hands on the list and send Reiki to everyone on it. It can be so quick if time is an issue for you and yet so powerful.

A group of UKRF members send Reiki to each other at specific times of the week. They state that we have a list of members’ names and allocated time slots in the week when we can send and receive Reiki energy to each other. The intention is to send Reiki for all the different time slots and then sit down and receive the energy whenever it is convenient for us to do so. Those members who have given me feedback all say they can feel the energy flowing during these times.

I urge you to look up the two ‘scientific proofs’ by McTaggart – I promise, you will not regret the effort. For those who might like to see real evidence for or against RDH, I ran a quick Medline search. Somewhat to my surprise, I did find a rigorous study RDH. Here is its abstract:

In this randomised, double-blinded study, women who underwent an elective C-section were allocated to either usual care (control, n=40) or three distant reiki sessions in addition to usual care (n=40). Pain was assessed using a visual analogue scale (VAS). The primary endpoint was the Area Under the VAS-Time Curve (AUC) for days 1-3. Secondary measures included: the proportion of women who required opioid medications and dose consumed, rate of healing and vital signs.

AUC for pain was not significantly different in the distant reiki and control groups (mean ± SD; 212.1 ± 104.7 vs 223.1 ± 117.8; p=0.96). There were no significant differences in opioid consumption or rate of healing; however, the distant reiki group had a significantly lower heart rate (74.3 ± 8.1 bpm vs 79.8 ± 7.9 bpm, p=0.003) and blood pressure (106.4 ± 9.7 mmHg vs 111.9 ± 11.0 mmHg, p=0.02) post surgery.

CONCLUSION: Distant reiki had no significant effect on pain following an elective C-section.

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This begs at least three questions, in my view:

  1. Which evidence should I trust, that of McTaggart or that from what seems to be the only RCT on RDH?
  2. The UK Reiki Foundation state on their website: As the largest Reiki-only professional organisation in the UK and Europe we are setting the highest standard for Reiki. Is the promotion of the McTaggart ‘proof’ combined with the omission from the UKRF site of the only trial of RDH truly in accordance with the highest standards?
  3. Is a professional organisation that does such things really professional?

In the bizarre world of chiropractic, the war between vitalistic subluxationists and reformers has reached a new climax. The World Federation of Chiropractic (WFC) has just announced that its president, Laurie Tassell, has resigned. The move follows what the International Chiropractor’s Association (ICA) called a “blatant offensive behaviour on a public stage” that “speaks for itself” and “cannot be excused under any circumstances.” The ICA’s alleged an embarrassing display of unprofessional and disruptive behaviour of presenters and attendees at the WFC Conference in Berlin in March 2019. It involved attacks on subluxationist chiropractors and included the throwing of water bottles onto the stage and clapping and cheering as the management of subluxation was denigrated.

The ICA President, Stephen Welsh, subsequently demanded that:

  1. The current Chair of the WFC Research Council be immediately removed from his current position and denied future participation in any activities on behalf of the WFC.
  2. An additional member of the WFC Research Council be publicly reprimanded and sanctioned and prohibited from the opportunity to serve in any leadership role at the WFC for at least 5 years.
  3. The sponsoring organization that coordinated, reviewed and permitted the alleged questionable presentations be sanctioned for conduct not reflecting the professional, inclusive and collegial respect for the values embedded in the WFC Strategic Plan, Governing Documents and the WFC Official Policy Statements.

According to Welsh, and others who attended, the Chair of the WFC Research Council, Greg Kawchuk DC, Ph.D, compared bringing a child to a vitalistic chiropractor to bringing them to a Catholic priest at a children’s school.

The WFC has now announced the appointment of Vivian Kil DC as Interim President to take over from Tassel. Kil is a graduate of the AECC, full-time clinician and the owner of a multidisciplinary clinic in the Netherlands. Kil is an advocate for chiropractors as practitioners of so called “primary spine care”. She stated her vision as follows:

  1. That we will (the chiropractic profession) set aside our differences within the profession, unite as a profession, and agree that becoming the source of nonsurgical, nonpharmacological, primary, spine care expertise and management should be a primary common goal.
  2. That for us to do the necessary work to fulfill this role and do it with the entire profession, every chiropractor will be involved and not just a small active group of leaders.
  3. And finally, that we will become the source of nonsurgical, nonpharmacological, primary, spine care expertise and management worldwide.

In my view, the problem of the chiropractic profession is unsolvable. Giving up Palmer’s obsolete nonsense of vitalism, innate intelligence, subluxation etc. is an essential precondition for joining the 21st century. Yet, doing so would abandon any identity chiropractors will ever have and render them physiotherapists in all but name. Neither solution bodes well for the future of the profession.

Prince Charles is visiting Germany. According to the British press, he will say (or, by now, probably has said):

“… Our countries and our people have been through so much together… As we look towards the future, I can only hope that we can also pledge to redouble our commitment to each other and to the ties between us… For some of us, of course, these connections are particularly personal…

And right he is!

Charles is Britain’s staunchest supporter of and meddler in SCAM, while the Germans seem to be the most prolific innovators of SCAM.

Just think of

  • von Bingen, Hildegard – inventor of a form of herbal medicine;
  • Hahnemann, Samuel – inventor of homeopathy;
  • Hamer, Ryke Geerd – inventor of New German Medicine;
  • Huneke, Ferdinand – inventor of neural therapy;
  • Kneipp, Sebastian – co-inventor of naturopathy;
  • Mesmer, Anton – inventor of hypnotherapy;
  • Morlell, Franz – inventor of bioresonance;
  • Reckeweg, Hans -inventor of homotoxicology;
  • Schimmel, Helmut – co-inventor of the Vega test;
  • Schulz, Heinrich – inventor of autogenic training;
  • Steiner, Rudlof – inventor of anthroposophical medicine;
  • Voll, Reinhold – inventor of a form of electroacupuncture;
  • Wegman, Ita – co-inventor of anthroposophical medicine.

Why did I compile this list?

Actually, I am not quite sure. But now that it is in front of me, a few thoughts go through my mind:

  1. Germany seems to be the promised land for quacks; in addition to the list above, think of the Heilpraktiker or the German alternative cancer clinics.
  2. On this blog, we have discussed most of these SCAMs, yet the list gave me several ideas for future posts;
  3. With only three exceptions, these SCAMs are fairly recent. They were invented when conventional medicine was already making big strides towards progress. There was no need for them. Why then were they invented?
  4. Almost all of these treatments were the brainchild of a single person. Could this be a hallmark for quackery?
  5. With only two exceptions, the inventors were male. Is the innovation of SCAM a male prerogative?
  6. With just one or two exceptions, these SCAMs are ineffective, useless and superfluous. Not attributes, of course, that would link them to Charles!

 

A series of article in The Times yesterday (to which I had made several minor contributions) focussed on the dangers of homeoprophylaxis/homeopathic vaccinations. Sadly, the paper is behind a paywall. I therefore will try to summarise some of the relevant points.

A courageous Times-reporter went under cover to extract some of the anti-vaccination views from a lay homeopath. This particular homeopath happened to charge £330 from customers who want to protect themselves or their family from infectious diseases (£130 for a homeopathic remedy kit, plus £200 for the compulsory instructions via skype that automatically come with the kit). Here are some of the most obvious porkies uttered by that homeopath:

  • Only 30% of healthcare professionals get vaccinated.
  • Rubella is a very mild disease.
  • Cancer patients don’t get fever.
  • Measles mainly kills children with severe disease.
  • Anything which messes with natural immunity could contribute to autism.
  • Health officials devised a seven-step recipe to scare consumers into vaccinating their kids.
  • Fevers should be celebrated.

This new undercover research by the Times is reminiscent of our own investigation of 2002. At the time, we contacted 168 homoeopaths, of whom 104 (72%) responded, 27 (26%) withdrawing their answers after debriefing. We also contacted 63 chiropractors, of whom 22 (44%) responded, six (27%) withdrawing their responses after debriefing.  Only 3% of professional homoeopaths and 25% of the chiropractors advised in favour of the MMR vaccination. Almost half of the homoeopaths and nearly a fifth of the chiropractors advised against it. (This tiny and seemingly insignificant study almost cost me my job: some homeopaths complained to my peers at Exeter University who then, in their infinite wisdom, conducted a most unpleasant investigation into my allegedly ‘unethical’ research; full details of this amazing story are provided in my memoir.)

But perhaps you think that homeoprophylaxis might be effective after all? In this case, you would be mistaken! As discussed a couple of weeks ago, a recent study demonstrated that such treatments are ineffective. Its authors concluded that homeopathic vaccines do not evoke antibody responses and produce a response that is similar to placebo. In contrast, conventional vaccines provide a robust antibody response in the majority of those vaccinated.

The Times article stated that about half of all new parents have been exposed to anti-vaxx propaganda. Consequently, global measles cases have risen by 300% in the first three months of this year compared to last year. Faced with measles outbreaks across the world, it is hard to deny that homeopaths who promote homeopathic vaccinations are a significant risk to public health.

The Times considered the issue sufficiently important to add an editorial. Its opening sentence sums up the issue well, I think: The evidence supporting claims that homeopathic remedies offer an effective alternative to the measles vaccine can be summarised in one word: zero. And its concluding sentences are even clearer: Tobacco companies are obliged to carry prominent public health warnings on their products. Homeopaths should too.

If one agrees with this sentiment, I suggest, we also consider the same for some:

  1. chiropractors;
  2. doctors of anthroposophical medicine;
  3. naturopaths;
  4. doctors practising integrative medicine.

And furthermore I suggest we disregard the many pro-vaccination statements by the professional organisations of these clinicians – they are nothing but semi-transparent fig-leaves and a politically-correct lip services which they neither enforce nor even truly mean.

 

Biofield tuning?

What on earth is this new SCAM?

Do I really have a ‘biofield’?

How can I tune it?

And what effect does it have?

Here is an article that explains all this in some detail; enjoy:

While western science has yet to describe and measure this energy, other cultures, especially ancient Indian or Vedic cultures describe it extensively. The term “chakra” (wheel) in Sanskirt, refers to spinning energy vortices which are seen as structures in the body’s subtle energy anatomy. Not coincidentally, within the body at each chakra location there is a corresponding large cluster of nerves or plexuses.​

One way of understanding subtle energy is through the analogy “subtle energy is to electromagnetism as water vapor is to water.”  Just as we do not measure water vapor with the same tools we use to measure water, we can’t use the same tools to measure subtle energy we would use to measure electricity.  Subtle energy is higher, finer, more diffuse and follows slightly different laws.

Another word for this energy is “bioplasma.”  Bioplasma is a diffuse magnetic fluid which surrounds all living beings. Like a fluid, it can be of varying viscosities and densities. In Biofield Tuning (also known as “sound balancing”, we see the human biofield as a bioplasmic toroid-shaped (doughnut-shaped) bubble which surrounds the body at a distance of about five feet to the sides and two-three feet at the top and bottom; bounded by a double layer plasma membrane much like the protective boundary which defines the earth’s upper atmosphere.

During a Biofield Tuning session, a client lies fully clothed on a treatment table while the practitioner activates a tuning fork and scans the body slowly beginning from a distance. The practitioner is feeling for resistance and turbulence in the client’s energy field, as well as listening for a change in the overtones and undertones of the tuning fork. When the practitioner encounters a turbulent area he/she continues to activate the tuning fork and hold it in that specific spot. Research suggests the body’s organizational energy uses the steady coherent vibrational frequency of the tuning fork to “tune” itself.  In short order, the dissonance resolves and the sense of resistance gives way. This appears to correspond to the release of tension within the body.

Practitioners work with the “Biofield Anatomy Map“, a compilation of Biofield Tuning’s founder, Eileen Day McKusick’s 20+ years of biofield observations. Areas of dissonance can be pinpointed to a specific age and type of memory. For example, one might find a strong sense of sadness at age 12 or birth trauma at the outer edge of the biofield.

Holding an activated tuning fork in the area of a traumatic memory or another difficult time period produces repeatable, predictable outcomes. The sound input seems to help the body digest and integrate unprocessed experiences.  As the biofield dissonance subsides, clients generally report feeling “lighter” and a diminishment or resolution of their symptoms.

The Sonic Slider is a custom-made weighted tuning fork that harnesses the power of therapeutic sound to help you feel and look younger and healthier.

Users report a wide range of benefits including more energy, greater well-being, weight loss, increased muscle tone, smoother skin, reduced pain, improved circulation and more.

Did I promise too much? Surely, you must agree, this is FANTASTIC!

I am so glad that someone has closely studied my instructions and followed them almost to the dot – my instructions as to HOW TO BECOME A CHARLATAN. In case you have forgotten, I repeat them here:

1. Find an attractive therapy and give it a fantastic name

Most of the really loony ideas turn out to be taken: ear candles, homeopathy, aura massage, energy healing, urine-therapy, chiropractic etc. As a true charlatan, you want your very own quackery. So you will have to think of a new concept.

Something truly ‘far out’ would be ideal, like claiming the ear is a map of the human body which allows you to treat all diseases by doing something odd on specific areas of the ear – oops, this territory is already occupied by the ear acupuncture brigade. How about postulating that you have super-natural powers which enable you to send ‘healing energy’ into patients’ bodies so that they can repair themselves? No good either: Reiki-healers might accuse you of plagiarism.

But you get the gist, I am sure, and will be able to invent something. When you do, give it a memorable name, the name can make or break your new venture.

2. Invent a fascinating history

Having identified your treatment and a fantastic name for it, you now need a good story to explain how it all came about. This task is not all that tough and might even turn out to be fun; you could think of something touching like you cured your moribund little sister at the age of 6 with your intervention, or you received the inspiration in your dreams from an old aunt who had just died, or perhaps you want to create some religious connection [have you ever visited Lourdes?]. There are no limits to your imagination; just make sure the story is gripping – one day, they might make a movie of it.

3. Add a dash of pseudo-science

Like it or not, but we live in an age where we cannot entirely exclude science from our considerations. At the very minimum, I recommend a little smattering of sciency terminology. As you don’t want to be found out, select something that only few experts understand; quantum physics, entanglement, chaos-theory and Nano-technology are all excellent options.

It might also look more convincing to hint at the notion that top scientists adore your concepts, or that whole teams from universities in distant places are working on the underlying mechanisms, or that the Nobel committee has recently been alerted etc. If at all possible, add a bit of high tech to your new invention; some shiny new apparatus with flashing lights and digital displays might be just the ticket. The apparatus can be otherwise empty – as long as it looks impressive, all is fine.

4. Do not forget a dose of ancient wisdom

With all this science – sorry, pseudo-science – you must not forget to remain firmly grounded in tradition. Your treatment ought to be based on ancient wisdom which you have rediscovered, modified and perfected. I recommend mentioning that some of the oldest cultures of the planet have already been aware of the main pillars on which your invention today proudly stands. Anything that is that old has stood the test of time which is to say, your treatment is both effective and safe.

5. Claim to have a panacea

To maximise your income, you want to have as many customers as possible. It would therefore be unwise to focus your endeavours on just one or two conditions. Commercially, it is much better to affirm in no uncertain terms that your treatment is a cure for everything, a panacea. Do not worry about the implausibility of such a claim. In the realm of quackery, it is perfectly acceptable, even common behaviour to be outlandish.

6. Deal with the ‘evidence-problem’ and the nasty sceptics

It is depressing, I know, but even the most exceptionally gifted charlatan is bound to attract doubters. Sceptics will sooner or later ask you for evidence; in fact, they are obsessed by it. But do not panic – this is by no means as threatening as it appears. The obvious solution is to provide testimonial after testimonial.

You need a website where satisfied customers report impressive stories how your treatment saved their lives. In case you do not know such customers, invent them; in the realm of quackery, there is a time-honoured tradition of writing your own testimonials. Nobody will be able to tell!

7. Demonstrate that you master the fine art of cheating with statistics

Some of the sceptics might not be impressed, and when they start criticising your ‘evidence’, you might need to go the extra mile. Providing statistics is a very good way of keeping them at bay, at least for a while. The general consensus amongst charlatans is that about 70% of their patients experience remarkable benefit from whatever placebo they throw at them. So, my advice is to do a little better and cite a case series of at least 5000 patients of whom 76.5 % showed significant improvements.

What? You don’t have such case series? Don’t be daft, be inventive!

8. Score points with Big Pharma

You must be aware who your (future) customers are (will be): they are affluent, had a decent education (evidently without much success), and are middle-aged, gullible and deeply alternative. Think of Prince Charles! Once you have empathised with this mind-set, it is obvious that you can profitably plug into the persecution complex which haunts these people.

An easy way of achieving this is to claim that Big Pharma has got wind of your innovation, is positively frightened of losing millions, and is thus doing all they can to supress it. Not only will this give you street cred with the lunatic fringe of society, it also provides a perfect explanation why your ground-breaking discovery has not been published it the top journals of medicine: the editors are all in the pocket of Big Pharma, of course.

9. Ask for money, much money

I have left the most important bit for the end; remember: your aim is to get rich! So, charge high fees, even extravagantly high ones. If your treatment is a product that you can sell (e.g. via the internet, to escape the regulators), sell it dearly; if it is a hands-on therapy, charge heavy consultation fees and claim exclusivity; if it is a teachable technique, start training other therapists at high fees and ask a franchise-cut of their future earnings.

Over-charging is your best chance of getting famous – or have you ever heard of a charlatan famous for being reasonably priced?  It will also get rid of the riff-raff you don’t want to see in your surgery. Poor people might be even ill! No, you don’t want them; you want the ‘worried rich and well’ who can afford to see a real doctor when things should go wrong. But most importantly, high fees will do a lot of good to your bank account.

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I must say, it is truly satisfying to see one’s advice taken so literally!

Bleach can be a useful product – but not as a medicine taken by mouth or for injection.

A 39-year-old man with a fracture of the right acetabulum underwent open reduction and internal fixation with a plate under general anaesthesia. At closure, the surgeons injected 0.75% ropivacaine into the subcutaneous tissue of the incision wound for postoperative analgesia. Soon after injection, subcutaneous emphysema at the injection site and a sudden decrease in end-tidal CO2 tension with crude oscillatory ripples during the alveolar plateau phase were observed. Shortly thereafter, it was found that the surgeons had mistakenly injected hydrogen peroxide instead of ropivacaine. Fortunately, the patient recovered to normal status after 10 minutes. After the surgery, the patient was carefully observed for suspected pulmonary embolism and discharged without complications.

A team from Morocco reported the case of a massive embolism after hydrogen peroxide use in the cleaning of infected wound with osteosynthesis material left femoral done under spinal anaesthesia in a young girl of 17 years admitted after to the ICU intubated ventilated. She was placed under mechanical ventilation with vasoactive drugs for ten hours and then extubated without neurological sequelae.

Tunisian doctors reported 2 cases of embolic events with neurological signs. The first, during a pleural cleaning with hydrogen peroxide after cystectomy of a pulmonary hydatic cyst at the right upper lobe. The second case, after a pleural washing during the treatment of hepatitic hydatidosis complicated by a ruptured cyst in the thorax.

Canadian anaesthetists reported a case of suspected oxygen venous embolism during lumbar discectomy in the knee-prone position after use of H2O2. Immediately after irrigation of a discectomy wound with H2O2, a dramatic decrease of the PETCO2, blood pressure and oxygen saturation coincident with ST segment elevation occurred suggesting a coronary gas embolism. Symptomatic treatment was initiated immediately and the patient recovered without any sequelae.

Indian nephrologists reported a case of chlorine dioxide poisoning presenting with acute kidney injury.

A 1-year-old boy presented to the emergency department with vomiting and poor complexion after accidentally ingesting a ClO2-based household product. The patient had profound hypoxia that did not respond to oxygen therapy and required endotracheal intubation to maintain a normal oxygen level. Methemoglobinemia was suspected based on the gap between SpO2 and PaO2, and subsequently increased methemoglobin at 8.0% was detected. The patient was admitted to the paediatric intensive care unit for further management. After supportive treatment, he was discharged without any complications. He had no cognitive or motor dysfunction on follow up 3 months later.

The medical literature is littered with such case-reports. They give us a fairly good idea that the internal use of bleach is not a good idea. In fact, it has caused several deaths. Yet, this is precisely what some SCAM practitioners are advocating.

Now one of them is in court for manslaughter. “If I am such a clear and present danger and a murderer, I should be in jail by now,” said doctor Shortt, who despite a criminal investigation, is still treating patients in his office on the outskirts of Columbia, S.C. Shortt got his medical degree 13 years ago on the Caribbean island of Montserrat. Being a “longevity physician” didn’t seem to bother anyone until one of his patients wound up dead. Shortt gave her an infusion of hydrogen peroxide. Katherine Bibeau, a medical technologist and a mother of two, had been battling multiple sclerosis for two years, and was looking for any treatment that might keep her out of a wheelchair. According to her husband, doctor Shortt said hydrogen peroxide was just the thing. “He had said that there was other people who had been in wheelchairs, and had actually gone through treatment and were now walking again.” It didn’t worry the Bibeaus that Shortt wasn’t affiliated with any hospital or university – and that insurance didn’t cover most of his treatments. “He was a licensed medical doctor in Carolina,” says Bibeau. “So I put my faith in those credentials.” According to Shortt’s own records, the patient subsequently complained of “nausea,” “leg pain,” and later “bruises” with no clear cause. “She went Tuesday, she went Thursday. And by 11 o’clock on Sunday, she died,” says Mr Bibeau. Shortt never told him or his wife about any serious risks. “Even if it wasn’t effective, it should not have been harmful.”

Shortt has been putting hydrogen peroxide in several of his patients’ veins, because he believes it can effectively treat illnesses from AIDS to the common cold. “I think it’s an effective treatment for the flu,” says Shortt, who also believes that it’s effective for multiple sclerosis, Lyme disease, and “as adjunctive therapy” for heart disease. “Things that involve the immune system, viruses, bacteria, sometimes parasites.”

He’s not the only physician using this treatment. Intravenous hydrogen peroxide is a SCAM touted as a cure the medical establishment doesn’t want you to know about. There even is an association that claims to have trained hundreds of doctors how to administer it. The theory is that hydrogen peroxide releases extra oxygen inside the body, killing viruses and bacteria.

Natural News, for instance, tells us that cancer has a rival that destroys it like an M-60 leveling a field of enemy soldiers. It’s called “hydrogen peroxide,” and the “lame-stream,” mainstream media will tell you how “dangerous” it is at 35%, but they won’t tell you that you can drip a couple drops in a glass of water each day and end cancer. Yes, it’s true.

And hydrogen peroxide is not the only bleach that found its way into the realm of SCAM.

Perhaps even worse (if that is possible), the Genesis II Church of Health and Healing promote MMS as a miracle cure. It consists of chlorine dioxide, a powerful bleach that has been banned in several countries around the world for use as a medical treatment. The ‘Church’ claim that MMS cures 95% of all diseases in the world by making adults and children, including infants, drink industrial bleach. The group is inviting members to attend what they call their “effective alternative healing”.

The organizer of the event, Tom Merry, has publicized it by telling people that learning how to consume the bleach “could save your life, or the life of a loved one sent home to die”. The “church” is asking attendants of the meeting to “donate” $450 each, or $800 per couple, in exchange for receiving membership to the organization as well as packages of the bleach, which they call “sacraments”. The chemical is referred to as MMS, or “miracle mineral solution or supplement”, and participants are promised they will acquire “the knowledge to help heal many people of this world’s terrible diseases”.

Fiona O’Leary, a tireless and courageous campaigner for putting an end to a wide variety of mistreatments of children and adults, whose work helped to get MMS banned in Ireland, said she was horrified that the Genesis II Church, which she called a “bleach cult”, was hosting a public event in Washington.

In Fiona’s words: “ Its experimentation and abuse”. I do agree and might just add this: selling bleach for oral or intravenous application, while pretending it is an effective medicine, seems criminal as well.

Chiropractic spinal manipulative therapy (CSMT) for migraine?

Why?

There is no good evidence that it works!

On the contrary, there is good evidence that it does NOT work!

A recent and rigorous study (conducted by chiropractors!) tested the efficacy of chiropractic CSMT for migraine. It was designed as a three-armed, single-blinded, placebo -controlled RCT of 17 months duration including 104 migraineurs with at least one migraine attack per month. Active treatment consisted of CSMT (group 1) and the placebo was a sham push manoeuvre of the lateral edge of the scapula and/or the gluteal region (group 2). The control group continued their usual pharmacological management (group 3). The results show that migraine days were significantly reduced within all three groups from baseline to post-treatment. The effect continued in the CSMT and placebo groups at all follow-up time points (groups 1 and 2), whereas the control group (group 3) returned to baseline. The reduction in migraine days was not significantly different between the groups. Migraine duration and headache index were reduced significantly more in the CSMT than in group 3 towards the end of follow-up. Adverse events were few, mild and transient. Blinding was sustained throughout the RCT. The authors concluded that the effect of CSMT observed in our study is probably due to a placebo response.

One can understand that, for chiropractors, this finding is upsetting. After all, they earn a good part of their living by treating migraineurs. They don’t want to lose patients and, at the same time, they need to claim to practise evidence-based medicine.

What is the way out of this dilemma?

Simple!

They only need to publish a review in which they dilute the irritatingly negative result of the above trial by including all previous low-quality trials with false-positive results and thus generate a new overall finding that alleges CSMT to be evidence-based.

This new systematic review of randomized clinical trials (RCTs) evaluated the evidence regarding spinal manipulation as an alternative or integrative therapy in reducing migraine pain and disability.

The searches identified 6 RCTs eligible for meta-analysis. Intervention duration ranged from 2 to 6 months; outcomes included measures of migraine days (primary outcome), migraine pain/intensity, and migraine disability. Methodological quality varied across the studies. The results showed that spinal manipulation reduced migraine days with an overall small effect size as well as migraine pain/intensity.

The authors concluded that spinal manipulation may be an effective therapeutic technique to reduce migraine days and pain/intensity. However, given the limitations to studies included in this meta-analysis, we consider these results to be preliminary. Methodologically rigorous, large-scale RCTs are warranted to better inform the evidence base for spinal manipulation as a treatment for migraine.

Bob’s your uncle!

Perhaps not perfect, but at least the chiropractic profession can now continue to claim they practice something akin to evidence-based medicine, while happily cashing in on selling their unproven treatments to migraineurs!

But that’s not very fair; research is not for promotion, research is for finding the truth; this white-wash is not in the best interest of patients! I hear you say.

Who cares about fairness, truth or conflicts of interest?

Christine Goertz, one of the review-authors, has received funding from the NCMIC Foundation and served as the Director of the Inter‐Institutional Network for Chiropractic Research (IINCR). Peter M. Wayne, another author, has received funding from the NCMIC Foundation and served as the co‐Director of the Inter‐Institutional Network for Chiropractic Research (IINCR)

And who the Dickens are the  NCMIC and the IINCR?

At NCMIC, they believe that supporting the chiropractic profession, including chiropractic research programs and projects, is an important part of our heritage. They also offer business training and malpractice risk management seminars and resources to D.C.s as a complement to the education provided by the chiropractic colleges.

The IINCR is a collaborative effort between PCCR, Yale Center for Medical Informatics and the Osher Center for Integrative Medicine at Brigham and Women’s Hospital and Harvard Medical School. They aim at creating a chiropractic research portfolio that’s truly translational. Vice Chancellor for Research and Health Policy at Palmer College of Chiropractic Christine Goertz, DC, PhD (PCCR) is the network director. Peter Wayne, PhD (Osher Center for Integrative Medicine at Brigham and Women’s Hospital and Harvard Medical School) will join Anthony J. Lisi, DC (Yale Center for Medical Informatics and VA Connecticut Healthcare System) as a co-director. These investigators will form a robust foundation to advance chiropractic science, practice and policy. “Our collective efforts provide an unprecedented opportunity to conduct clinical and basic research that advances chiropractic research and evidence-based clinical practice, ultimately benefiting the patients we serve,” said Christine Goertz.

Really: benefiting the patients? 

You could have fooled me!

Exactly 20 years ago, I published a review concluding that the generally high and possibly growing prevalence of complementary/alternative medicine use by children renders this topic an important candidate for rigorous investigation. Since then, many papers have emerged, and most of them are worrying in one way or another. Here is the latest one.

This Canadian survey assessed chiropractic (DC) and naturopathic doctors’ (ND) natural health product (NHP) recommendations for paediatric care. It was developed in collaboration with DC and ND educators, and delivered as an on-line national survey. NHP dose, form of delivery, and indications across paediatric age ranges (from newborn to 16 years) for each practitioner’s top five NHPs were assessed. Data were analysed using descriptive statistics, t-tests, and non-parametric tests.

Of the 421 respondents seeing one or more paediatric patients per week, 172 (41%, 107 DCs, 65 NDs) provided 440 NHP recommendations, categorized as:

  • vitamins and minerals (89 practitioners, 127 recommendations),
  • probiotics (110 practitioners, 110 recommendations),
  • essential fatty acids (EFAs: 72 practitioners, 72 recommendations),
  • homeopathics (56 practitioners, 66 recommendations),
  • botanicals (29 practitioners, 31 recommendations),
  • other NHPs (33 practitioners, 34 recommendations).

Indications for the NHP recommendations were tabulated for NHPs with 10 or more recommendations in any age category:

  • 596 total indications for probiotics,
  • 318 indications for essential fatty acids,
  • 138 indications for vitamin D,
  • 71 indications for multi-vitamins.

Good evidence regarding the efficacy, safety, and dosing for NHP use in children is scarce or even absent. Therefore, the finding that so many DCs and NDs recommend unproven NHPs for use in children is worrying, to say the least. It seems to indicate that, at least in Canada, DCs and NDs are peddling unproven, mostly useless  and potentially harmful children.

In an earlier, similar survey the same group of researchers had disclosed that the majority of Canadian DCs and NDs seem to see infants, children, and youth for a variety of health conditions and issues, while, according to their own admission, not having adequate paediatric training.

Is this a Canadian phenomenon? If you think so, read this abstract:

AIM:

This systematic review is aimed at estimating the prevalence of complementary and alternative medicine (CAM)-use by paediatric populations in the United Kingdom (UK).

METHOD:

AMED, CINAHL, COCHRANE, EMBASE and MEDLINE were searched for English language peer-reviewed surveys published between 01 January 2000 and September 2011. Additionally, relevant book chapters and our own departmental files were searched manually.

RESULTS:

Eleven surveys were included with a total of 17,631 paediatric patients. The majority were of poor methodological quality. Due to significant heterogeneity of the data, a formal meta-analysis was deemed inappropriate. Ten surveys related to CAM in general, while one was specifically on homeopathy. Across all surveys on CAM in general, the average one-year prevalence rate was 34% and the average lifetime prevalence was 42%. In surveys with a sample size of more than 500, the prevalence rates were considerably lower than in surveys with the sample size of lower than 500. Herbal medicine was the most popular CAM modality, followed by homeopathy and aromatherapy.

CONCLUSIONS:

Many paediatric patients in the UK seem to use CAM. Paediatricians should therefore have sufficient knowledge about CAM to issue responsible advice.

This means, I fear, that children are regularly treated by SCAM practitioners who are devoid of the medical competence to do so, and  who prescribe or recommend treatments of unknown value, usually without the children needing them.

Why are regulators not more concerned about this obvious abuse?

The purpose of this recently published survey was to obtain the demographic profile and educational background of chiropractors with paediatric patients on a multinational scale.

A multinational online cross-sectional demographic survey was conducted over a 15-day period in July 2010. The survey was electronically administered via chiropractic associations in 17 countries, using SurveyMonkey for data acquisition, transfer, and descriptive analysis.

The response rate was 10.1%, and 1498 responses were received from 17 countries on 6 continents. Of these, 90.4% accepted paediatric cases. The average practitioner was male (61.1%) and 41.4 years old, had 13.6 years in practice, and saw 107 patient visits per week. Regarding educational background, 63.4% had a bachelor’s degree or higher in addition to their chiropractic qualification, and 18.4% had a postgraduate certificate or higher in paediatric chiropractic.

The authors from the Anglo-European College of Chiropractic (AECC), Bournemouth University, United Kingdom, drew the following conclusion: this is the first study about chiropractors who treat children from the United Arab Emirates, Peru, Japan, South Africa, and Spain. Although the response rate was low, the results of this multinational survey suggest that pediatric chiropractic care may be a common component of usual chiropractic practice on a multinational level for these respondents.

A survey with a response rate of 10%?

An investigation published 9 years after it has been conducted?

Who at the AECC is responsible for controlling the quality of the research output?

Or is this paper perhaps an attempt to get the AECC into the ‘Guinness Book of Records’ for outstanding research incompetence?

But let’s just for a minute pretend that this paper is of acceptable quality. If the finding that ~90% of chiropractors tread kids is approximately correct, one has to be very concerned indeed.

I am not aware of any good evidence that chiropractic care is effective for paediatric conditions. On the contrary, it can do quite a bit of direct harm! To this, we sadly also have to add the indirect harm many chiropractors cause, for instance, by advising parents against vaccinating their kids.

This clearly begs the question: is it not time to stop these charlatans?

What do you think?

This paper reports a survey amongst European chiropractors during early 2017. Dissemination was through an on-line platform with links to the survey being sent to all European chiropractic associations regardless of European Chiropractors’ Union (ECU) membership and additionally through the European Academy of Chiropractic (EAC). Social media via Facebook groups was also used to disseminate links to the survey.

One thousand three hundred twenty and two responses from chiropractors across Europe representing approximately 17.2% of the profession were collected. Five initial self-determined chiropractic identities were collapsed into 2 groups categorised as orthodox (79.9%) and unorthodox (20.1%); by the latter term, the investigators mean the subluxationists/vitalists.

When comparing the percentage of new patients chiropractors x-rayed, 23% of the unorthodox group x-rayed > 50% of their new patients compared to 5% in the orthodox group. Furthermore, the proportion of respondents reporting > 150 patient encounters per week in the unorthodox group were double compared to the orthodox (22 v 11%). Lastly the proportion of those respondents disagreeing or strongly disagreeing with the statement “In general, vaccinations have had a positive effect on global public health” was 57 and 4% in unorthodox and orthodox categories respectively. Logistic regression models identified male gender, seeing more than 150 patients per week, no routine differential diagnosis, and not strongly agreeing that vaccines have generally had a positive impact on health as highly predictive of unorthodox categorisation.

The authors concluded that despite limitations with generalisability in this survey, the proportion of respondents adhering to the different belief categories are remarkably similar to other studies exploring this phenomenon. In addition, and in parallel with other research, this survey suggests that key practice characteristics in contravention of national radiation guidelines or opposition to evidence based public health policy are significantly more associated with non-orthodox chiropractic paradigms.

Country

N (%) Orthodox

N (%) Unorthodox

Belgium

51 (92.7)

4 (7.3)

Germany

43 (66.2)

22 (33.8)

Ireland

31 (79.5)

8 (20.5)

Italy

23 (59.0)

16 (41.0)

Norway

132 (93.0)

10 (7.0)

Spain

34 (43.6)

44 (56.4)

Sweden

101 (82.8)

21 (17.2)

Switzerland

102 (90.3)

11 (9.7)

The Netherlands

81 (82.7)

17 (17.3)

UK

236 (80.0)

59 (20.0)

The authors do laudably question that their findings are generalisable. However, this does not mean that this limitation is not significant. With such a dismal response rate, the value of any such survey approaches zero. I think, one has to be a chiropractor to publish such valueless paper nevertheless.

If, for a minute, I disregarded the non-generalisability of these data, what I would find most remarkable here is the high proportion of subluxationists/vitalists/anti-vaccinationists amongst today’s chiropractors. Chiropractic subluxation is an obsolete theory which should have been banned to the history books a long time ago. Yet, in some European countries around half of the chiropractors would adhere to it (I speculate that the figures would be significantly higher, if the response rate had been 100%).

I would find this unacceptable.

The reason I said ‘would find it acceptable’ is that I do not accept the validity of the survey results in the first place.

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